Xofigo (radium Ra 223 dichloride) is a prescription drug used to treat prostate cancer that has spread to the bones. Xofigo can cause side effects that range from mild to serious. Examples include nausea, vomiting, diarrhea, and edema.

Specifically, Xofigo is prescribed for adults to treat prostate cancer that:

  • has spread to the bones but not any other parts of the body
  • is causing bone pain
  • is not responding to other treatments, such as surgery or testosterone blockers

Xofigo belongs to a group of drugs called radiopharmaceuticals. It contains the active ingredient radium Ra 223 dichloride. (An active ingredient is what makes a drug work.) The drug comes as an intravenous (IV) injection (an injection into a vein) by a medical clinic’s radiation oncologist or nuclear medicine specialist.

Keep reading to learn about the common, mild, and serious side effects that Xofigo can cause. See this article for a general overview of the drug, including details about its uses.

Some people, but not all, may develop mild to serious side effects during their Xofigo treatment.

Xofigo is a radioactive medication that targets areas of rapid bone growth where tumors are in your bones. The radioactive effects of this drug usually don’t harm most body cells. However, bone marrow and the digestive system can be sensitive to radiation. This can cause common side effects that include:

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

Mild side effects have been reported occasionally with Xofigo. These include:

Generally, side effects such as nausea, vomiting, or diarrhea don’t last long and can usually be easily treated. Other side effects, such as edema, may last longer.

Still, if you have any side effects that persist or cause discomfort, be sure to discuss them with your doctor or pharmacist. And do not stop Xofigo treatment unless your doctor advises you to do so.

Xofigo may cause mild side effects other than those listed above. See the drug’s prescribing information for details.

* To learn more about this side effect, see the “Side effects explained” section below.
† An allergic reaction is possible after receiving Xofigo, but this side effect wasn’t reported in studies.

Serious side effects are uncommon but have been reported with Xofigo. These include:

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

* To learn more about this side effect, see the “Side effects explained” section below.
† An allergic reaction is possible after receiving Xofigo, but this side effect wasn’t reported in studies.

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

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

How likely am I to become dehydrated from Xofigo?

Any radiopharmaceutical (radioactive drug) can cause vomiting and diarrhea. In some people, this may be severe and can lead to dehydration (low fluid level). Being prepared for dehydration can help you prevent it. It’s recommended that you:

  • ask your doctor for nausea and diarrhea prevention medications
  • keep popsicles, ice chips, low sodium broth, and low sugar juices on hand
  • make a routine fluid drinking schedule by setting reminder alarms
  • keep track of how much you’re drinking and urinating
  • try to avoid getting overheated or sweating

Watch for symptoms of dehydration. These may include dry mouth, dizziness, fatigue (low energy), low blood pressure, and confusion. If your urine is a dark cola color or you have pain or difficulty urinating, contact your doctor or get an urgent medical evaluation. Left untreated, these symptoms could lead to kidney damage or failure.

Can Xofigo cause long-term side effects?

It’s possible. Long-term side effects include those that may start at any time during treatment, even if you’ve been receiving the drug for a long time. It also includes side effects that may not go away even after you stop treatment.

Examples of possible long-term side effects mentioned in Xofigo’s studies include:

If you’re concerned about long-term side effects from Xofigo, talk with your doctor or pharmacist.

Learn more about some of the side effects Xofigo may cause.


Edema (fluid buildup in the body) was an occasional side effect reported in studies of Xofigo. Edema may cause symptoms such as:

  • swelling of arms, hands, legs, or feet
  • bruised or discolored areas of skin
  • skin tightness
  • skin weeping
  • skin that is sore, warm, or painful to the touch

Factors that can increase the risk of edema during treatment with this drug include:

  • decreased kidney or heart function
  • too much sodium in the diet

What might help

If you have edema during Xofigo treatment, consider the following options to help relieve your symptoms:

  • elevate your arms or legs when sitting or lying down
  • limit sodium in your food
  • use compression sleeves or stockings

If the swollen areas become painful, tight, warm to the touch, or start weeping, talk with your doctor right away. These could be signs of decreased kidney function, blood clots, or infection. Your doctor will likely recommend that you seek urgent medical evaluation.

Low blood cell counts

Low blood cell counts were a common side effect reported in studies of Xofigo. Your body makes blood cells inside your bone marrow. The radiation from Xofigo can damage bone marrow and cause it to stop producing red and white blood cells and platelets. This condition is known as bone marrow suppression.

Low blood cell counts may cause symptoms such as:

Factors that can increase the risk of low blood cell counts during Xofigo treatment include:

  • a history of problems with bone marrow
  • anemia (low level of red blood cells)
  • a weakened immune system

It’s important to contact your doctor right away if you develop symptoms of low blood cell counts. This is especially important if you develop a fever, as this may be a sign of infection.

What might help

If you have low blood cell counts during Xofigo treatment, your doctor will probably recommend either:

  • interrupting your treatment schedule
  • using blood transfusions to help your body recover between treatments

Allergic reaction

Like most drugs, Xofigo can cause an allergic reaction in some people. However, this side effect wasn’t reported in studies. Symptoms can be mild to serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin (usually 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 a treatment to manage your symptoms. Examples include:

  • an oral antihistamine, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to Xofigo, they’ll decide whether you should continue treatment.

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 you’ve had a serious allergic reaction to Xofigo, they may have you switch to a different treatment.

Keeping track of side effects

During your Xofigo treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking a new drug or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how your symptoms affected your daily activities
  • what 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 Xofigo affects you. They can then use this information to adjust your treatment plan if needed.

Below is important information you should consider before starting Xofigo.


Xofigo can sometimes cause harmful effects in people with certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Xofigo is a good treatment option for you.

Talk with your doctor about your health history before starting Xofigo. Be sure to tell them if any of the following factors apply to you:

Also, Xofigo is not recommended with Zytiga (abiraterone) plus prednisone or prednisolone. People who took this combination in studies had a higher risk of broken bones and death.

Alcohol and Xofigo

There are no known interactions between alcohol and Xofigo. However, Xofigo can cause nausea and vomiting, and alcohol may worsen those side effects.

If you have questions about consuming alcohol during Xofigo treatment, talk with your doctor or pharmacist.

Pregnancy and breastfeeding with Xofigo

It’s unclear whether Xofigo is safe for use in females*† because studies haven’t been done in females. But because of how the drug works, Xofigo can harm a fetus.

It’s recommended that males* use condoms during sex and that their female partners who can become pregnant also use birth control. This should be done the entire time the male receives treatment with Xofigo and for 6 months after treatment ends.


Because Xofigo contains radioactive elements, it is not safe to receive or be exposed to during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor about your treatment options.


Xofigo is not safe to receive or be exposed to while breastfeeding. If you’re breastfeeding or planning to do so, talk with your doctor about your options.

* In this article, we use the terms “female” and “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
† Although Xofigo isn’t approved for use in females, it’s sometimes used off-label to treat bone metastases in people with breast cancer. (Off-label use is when a drug is prescribed to treat a condition other than those it’s been approved for.)

Like most drugs, Xofigo can cause several side effects that range from mild to serious. However, most are temporary and go away after a few days to weeks. If you have questions about side effects Xofigo can cause, talk with your doctor.

Examples of questions to help get you started include:

  • What are the most common side effects of Xofigo?
  • Will Xofigo make me tired?
  • What do I do if I get a fever while taking Xofigo?
  • Can I use over-the-counter medications to treat diarrhea caused by Xofigo?
  • How should I treat the swelling in my arms, hands, legs, and feet?
  • What is my risk of developing kidney failure with Xofigo?

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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.