• 16-week duration of relief with a single 1.0 mCi/kg injection1

Patient Counseling

Radiation safety

  • Patients who receive QUADRAMET® should be advised that for several hours following administration, radioactivity will be present in excreted urine
  • To help protect themselves and others in the environment, precautions need to be taken for 12 hours following administration
flush

Whenever possible, a toilet should be used, rather than a urinal, and the toilet should be flushed several times after each use

Spilled urine

Spilled urine should be cleaned up completely and patients should wash their hands thoroughly

clothing

If blood or urine gets onto clothing, the clothing should be washed separately, or stored for 1-2 weeks to allow for decay of the Sm-153

urniary bladder

Patients drink a minimum of 500 mL (8 oz) and void as often as possible during the first few hours after the injection to minimize radiation exposure in the urinary bladder

flare reaction

Flare: some patients (7% in controlled trials) have reported a transient increase in bone pain shortly after injection (flare reaction)
-- This is usually mild and self-limiting and occurs within 72 hours of injection
-- Such reactions are usually responsive to analgesics

Pain Management

  • Patients who respond to QUADRAMET may begin to notice the onset of pain relief one week after administration
  • Maximal pain relief generally occurs 3 to 4 weeks after injection of QUADRAMET
  • Patients who experience a reduction in pain may be encouraged to decrease their use of opioid analgesics
  • Patients should be counseled against precipitous discontinuation of opioid analgesics

Follow-up

  • Beginning 2 weeks after QUADRAMET administration, blood counts should be monitored weekly for at least 8 weeks or until recovery of adequate bone marrow function
  • Periodic assessment of bone pain over the following months will alert the patient and healthcare team if there is a need to consider repeat administration of QUADRAMET

REFERENCES:

  1. Serafini AN, Houston SJ, Resche I, et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol. 1998;16:1574-1581.

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