If you have bone problems caused by certain cancers, your doctor might suggest Xgeva (denosumab) as a treatment option for you.

Xgeva is a prescription medication that’s used in certain situations to:

  • help prevent fractures (broken bones) and other bone problems in adults with multiple myeloma or with bone cancer caused by solid tumors
  • treat giant cell tumors (a mass or lump of cancer tissue that contains a large number of cancer cells) in adults and some children
  • treat a high calcium level in the blood in adults with certain cancers that have not responded to other treatments

Xgeva comes as an injection that’s given under your skin. The drug is typically used as a long-term treatment. For more information about Xgeva, including details about its uses, see this in-depth article on the drug.

Like other drugs, Xgeva can cause mild or serious side effects. Keep reading to learn more.

Some people may experience mild or serious side effects during their Xgeva treatment. Below are a few of the more common side effects reported by people who took Xgeva in studies. These side effects can vary, depending on the condition the drug is being used to treat.

Examples of Xgeva’s commonly reported side effects may include:

* To learn more about this side effect, see “Side effects explained” below.

Xgeva can cause mild side effects. These can vary, depending on the condition the drug is being used to treat.

Examples of mild side effects that have been reported with Xgeva include:

* To learn more about this side effect, see “Side effects explained” below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have any symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And don’t stop using Xgeva unless your doctor recommends it.

Xgeva may cause mild side effects other than the ones listed above. See the Xgeva patient counseling information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Xgeva, visit MedWatch.

In rare cases, serious side effects can occur with Xgeva. These side effects are expected to be the same, regardless of the condition being treated.

Serious side effects that have been reported with Xgeva include:

If you develop serious side effects while using Xgeva, call your doctor right away. If the side effects seem life threatening or if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see “Side effects explained” below.
† An allergic reaction is possible after using Xgeva. But it’s not clear whether this side effect occurred in studies.

Xgeva is approved to treat giant cell tumors (a lump of cancer tissue that contains a large number of cancer cells) in adults and some children.

Most side effects of Xgeva in children are expected to be the same as those in adults. However, certain side effects of Xgeva may be more common in children whose bones have not stopped growing. Examples include a high level of calcium in the blood and slowed bone growth.

Because of these risks, Xgeva is only approved for use in children whose bones have stopped growing. This typically happens around 12 years of age.

Get answers to some frequently asked questions about Xgeva’s side effects.

Does Xgeva cause dental side effects?

Yes, Xgeva can cause certain dental side effects. These side effects were common in studies of the drug.

Specifically, Xgeva may cause osteonecrosis (death of bone cells) in the jaw. And dental problems are often early warning signs of this side effect.

For example, loose, infected, or aching teeth are possible symptoms of osteonecrosis. To learn more, see the “Side effects explained” section below.

How long do Xgeva’s side effects last?

The duration (length of time) that Xgeva’s side effects last varies from person to person.

Most of Xgeva’s side effects are short term. They usually go away either shortly after your body gets used to Xgeva or shortly after you stop using the drug.

But it’s possible that some of Xgeva’s side effects might last longer. For details, see “What are some of the long-term side effects of Xgeva?” below.

If you have questions about how long Xgeva’s side effects may last, talk with your doctor or pharmacist.

What are some of the long-term side effects of Xgeva?

Xgeva may cause certain long-term side effects. For example, using Xgeva can lead to broken bones and osteonecrosis (death of bone cells) in the jaw. These conditions can cause complications that are long term. (To learn more about osteonecrosis, see the “Side effects explained” section below.)

If you’re concerned about long-term side effects of Xgeva, talk with your doctor.

Learn more about some of the side effects that Xgeva may cause.

Osteonecrosis of the jaw

Osteonecrosis (death of bone cells) in the jaw is a common side effect of Xgeva.

Your risk of this side effect may be higher if you use Xgeva for a long period. Your risk may also be higher if you have poor oral hygiene, such as not flossing, brushing, or visiting your dentist regularly during your Xgeva treatment.

Symptoms of osteonecrosis can include:

  • having bone that’s visible in your mouth
  • numbness in your jaw
  • pain, redness, or swelling in your gums
  • slow healing after dental work
  • teeth that are loose, infected, or that ache

What might help

Your doctor will likely suggest that you visit a dentist before you start using Xgeva and periodically during your treatment. Both your doctor and dentist will monitor your risk of developing osteonecrosis.

Be sure to tell your doctor or dentist right away if you have any symptoms of osteonecrosis while using Xgeva. They’ll check your mouth and suggest ways to treat your condition.

Bone pain

Bone pain is one of the most common side effects of Xgeva.

But bone pain can also be a symptom of a more serious side effect of Xgeva. Examples of these side effects include:

What might help

Tell your doctor right away if you have bone pain during your Xgeva treatment. They’ll check to make sure your bone pain isn’t a symptom of a more serious side effect.

If your bone pain is mild, your doctor can suggest ways to ease it. For example, they may suggest that you take medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). But be sure to check with your doctor or pharmacist before starting any new medications during your Xgeva treatment.

Back pain

Back pain is a common side effect of Xgeva. But back pain can also be a symptom of a more serious side effect of Xgeva, such as broken back bones.

What might help

Let your doctor know right away if you’re having back pain during your Xgeva treatment. They may perform tests to make sure your back pain isn’t a symptom of a serious side effect.

If your back pain is mild, your doctor may suggest that you take drugs such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) to ease your pain. But you shouldn’t start any new drugs during your Xgeva treatment unless your doctor or pharmacist says it’s safe to do so.

Respiratory side effects

Respiratory side effects, which affect breathing, are common with Xgeva. Examples include:

What might help

If you have bothersome respiratory side effects while using Xgeva, talk with your doctor. They can suggest ways to ease your symptoms.

Changes in the level of calcium in your blood

Xgeva may cause the calcium level in your blood to be lower or higher than usual.

During your Xgeva treatment, it’s common to have a low level of calcium in your blood. You may not notice any symptoms of this side effect. But possible that symptoms of low calcium can include:

In rare cases, low calcium levels can be fatal.

On the other hand, it’s common to have a high level of calcium in your blood after you stop using Xgeva. In rare cases, high calcium levels can lead to kidney problems, such as acute kidney failure.

After you’ve stopped your Xgeva treatment, watch for the following symptoms of high calcium and kidney problems:

What might help

Your doctor will check your calcium levels before you start using Xgeva, periodically during treatment, and after your treatment ends.

To help prevent low calcium levels, your doctor may have you take calcium and vitamin D supplements during your Xgeva treatment. Talk with your doctor about your calcium needs while using Xgeva. And after you’ve stopped using Xgeva, ask your doctor if you should continue taking these supplements.

If you have symptoms of low or high calcium during your Xgeva treatment, tell your doctor right away. They’ll likely check your calcium levels and can suggest ways to ease your symptoms.

Allergic reaction

Like most drugs, Xgeva can cause an allergic reaction in some people. But it’s not clear whether this side effect occurred in studies.

Symptoms can be mild or serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an over-the-counter oral antihistamine, such as Benadryl (diphenhydramine), or a topical product, such as hydrocortisone cream, to manage your symptoms.

If your doctor confirms that you had a mild allergic reaction to Xgeva, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms that you had a serious allergic reaction to Xgeva, they may have you switch to a different treatment.

Keeping track of side effects

During your Xgeva treatment, consider keeping notes about any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dosage of the drug you were using when you had the side effect
  • how soon after starting that dosage you experienced it
  • the symptoms of the side effect
  • how it affected your daily activities
  • any other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how Xgeva affects you. Your doctor can use this information to adjust your treatment plan if needed.

Xgeva may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you start using Xgeva. The list below includes factors to consider.

Low level of calcium in your blood. Your doctor will check your calcium levels before you start using Xgeva, periodically during treatment, and after your treatment ends. If you have a low calcium level before starting your treatment, your doctor will need to treat this before you use Xgeva. They may prescribe calcium and vitamin D supplements to help increase your calcium level.

Osteoporosis. Before using Xgeva, tell your doctor if you have osteoporosis. Xgeva can cause certain fractures during treatment and after you stop using it. You may have a higher risk of this side effect if you have osteoporosis. If you have this condition, talk with your doctor about whether it’s safe for you to use Xgeva.

Allergic reaction. If you’ve had an allergic reaction to Xgeva or any of its ingredients, you shouldn’t use this drug. Ask your doctor what other medications are better options for you.

Alcohol use and Xgeva

It should be safe to drink alcohol while using Xgeva.

If you drink alcohol, talk with your doctor about the amount that’s safe for you during your Xgeva treatment.

Pregnancy and breastfeeding while using Xgeva

Below is information about using Xgeva during pregnancy or while breastfeeding.

Pregnancy

It may not be safe to use Xgeva while pregnant. If you can become pregnant, you should use birth control during your Xgeva treatment and for at least 5 months after your last dose. You will also be given a pregnancy test before starting the treatment.

If you have questions about using Xgeva during pregnancy, talk with your doctor.

Breastfeeding

It’s not known whether Xgeva is safe to use while breastfeeding. Human studies haven’t looked at whether the drug passes into breast milk or what effects it could have on a breastfed child.

In animal studies, Xgeva was shown to pass into breast milk. But animal studies don’t always predict what will happen in humans.

If you’re currently breastfeeding or planning to breastfeed, talk with your doctor before using Xgeva.

Xgeva is a drug used to treat bone problems caused by certain cancers. Most of its side effects are mild, but it’s possible to have serious side effects.

If you have questions about Xgeva’s side effects, talk with your doctor or pharmacist. Here are a few questions you may want to ask:

  • Will other drugs I’m taking increase my risk of side effects from Xgeva?
  • What can I do to help manage side effects from Xgeva?
  • Am I at a higher risk of dental or jaw problems from Xgeva?

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.