Xgeva interactions: Alcohol, medications, and other factors

Before you start treatment with Xgeva, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Xgeva interacts with supplements, herbs, or vitamins, see the “Xgeva and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Xgeva. Keep in mind that this table doesn’t include all drugs that may interact with Xgeva. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about Xgeva’s side effects, see this article.
† For details about this interaction, see the “Drug interactions in depth” section below.

In some cases, factors or conditions could prevent your doctor from prescribing Xgeva due to the risk of harm. These are known as contraindications. The contraindications of Xgeva include:

Having a low blood calcium level

If you have a low blood calcium level, your doctor likely will not prescribe Xgeva. This is because Xgeva may cause low calcium levels as a side effect. Receiving Xgeva could lower your calcium levels even further.

Before starting your Xgeva treatment, your doctor will likely check your calcium level with a blood test. If your calcium level is low, they may prescribe calcium and vitamin D supplements to help raise your calcium level. They’ll tell you how long to take these supplements and when it may be safe to start Xgeva treatment.

Having had an allergic reaction to Xgeva or any of its ingredients

If you have had an allergic reaction to Xgeva or any of its ingredients, your doctor will likely not prescribe Xgeva. Receiving the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Xgeva, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Xgeva.

There are no known interactions between Xgeva and alcohol.

If you have questions about drinking alcohol during Xgeva treatment, talk with your doctor.

Here’s a closer look at certain drug interactions of Xgeva.

Calcimimetic drugs

Calcimimetic drugs are prescribed for overactive parathyroid glands.

Interaction result: Taking calcimimetic drugs during Xgeva treatment can increase the risk of low mineral levels in your blood. These minerals include calcium, magnesium, and phosphorus.

Interaction explained: Xgeva and calcimimetics may cause low levels of calcium, magnesium, and phosphorus in your blood. Taking these drugs together increases this risk even more.

Examples of calcimimetic drugs: Calcimimetic drugs that may interact with Xgeva include cinacalcet (Sensipar) and etelcalcetide (Parsabiv).

Steps you or your doctor may take: Before starting Xgeva treatment, tell your doctor if you take a calcimimetic. They can recommend whether to take these medications together.

If your doctor prescribes Xgeva with a calcimimetic, they’ll monitor your blood levels of calcium, magnesium, and phosphorus. Your doctor will recommend what to do if these levels are below the usual range.

To learn more about Xgeva and calcimimetic drugs, talk with your doctor or pharmacist.

Certain targeted cancer therapies

Targeted cancer therapies are prescribed to treat a variety of cancers, including multiple myeloma.

Interaction result: Treatment with Xgeva in combination with certain targeted cancer therapies may increase the risk of osteonecrosis of the jaw (death of jawbone tissue).

Interaction explained: Xgeva may cause osteonecrosis of the jaw, especially when combined with factors that slow healing. Certain targeted cancer therapies may slow the healing process and increase this risk if they’re taken with Xgeva.

Examples of targeted cancer therapy drugs: Here are some targeted cancer therapies that may interact with Xgeva:

• bevacizumab (Avastin)
• cabozantinib (Cabometyx, Cometriq)
• pazopanib (Votrient)
• sunitinib (Sutent)

Steps you or your doctor may take: Before starting Xgeva treatment, tell your doctor if you take a targeted cancer therapy. They can advise on whether it’s safe to take these drugs together.

If your doctor prescribes Xgeva with certain targeted cancer therapies, watch for symptoms of osteonecrosis of the jaw. Examples include mouth or jaw pain, loose teeth, and swollen gums. Tell your doctor right away if you have these symptoms. They may advise you to have regular dental visits while you’re taking these drugs together.

To learn more about Xgeva and targeted cancer therapies, talk with your doctor or pharmacist.

Calcitonin

Calcitonin (Miacalcin) is prescribed to treat bone-related conditions. Examples include high blood calcium levels and osteoporosis after menopause.

Interaction result: Taking calcitonin during Xgeva treatment can increase the risk of low mineral levels in your blood. These minerals include calcium, magnesium, and phosphorus.

Interaction explained: Xgeva and calcitonin may cause low levels of calcium, magnesium, and phosphorus in your blood when taken individually. This risk may be increased when these treatments are combined.

Steps you or your doctor may take: Before starting Xgeva treatment, tell your doctor if you take calcitonin. They can tell you whether to take these drugs together.

If your doctor prescribes Xgeva with calcitonin, they’ll check your blood levels of calcium, magnesium, and phosphorus. If these levels are below the usual range, your doctor will recommend what to do.

To learn more about Xgeva and calcitonin, talk with your doctor or pharmacist.

Xgeva may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Xgeva.

Xgeva interactions with supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Xgeva interactions with herbs

There are no reports of herbs interacting with Xgeva. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Xgeva treatment.

Xgeva interactions with vitamins

There are no reports of vitamins interacting with Xgeva. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Xgeva.

Xgeva interactions with food

There were no reports of food interactions with Xgeva. If you’d like to learn more about eating certain foods during treatment with Xgeva, talk with your doctor.

Xgeva interactions with vaccines

It is possible for Xgeva to interact with vaccines for COVID-19 (Comirnaty, Spikevax) and cholera (Vaxchora).

Vaccines work by preparing your immune system to fight off a specific bacterium or virus. However, Xgeva may weaken the activity of your immune system. So, if you receive these vaccines during Xgeva treatment, the vaccines may not work as well.

Before starting Xgeva, talk with your doctor or pharmacist about any vaccines you may need.

Xgeva interactions with lab tests

Xgeva may interfere with the results of a tuberculosis (TB) skin test. This drug could cause the test to show that you do not have the TB bacteria in your body, even if you do.

Because of this, it’s important to tell the person giving you the test that you’re taking Xgeva. They may give you a different type of test for TB.

For additional information, talk with your doctor or pharmacist.

XGEVA AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Xgeva. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Xgeva. The impact of cannabis may affect how well you stick to your Xgeva treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xgeva. Before you receive this injection, be sure to talk with your doctor about your health history. Xgeva may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xgeva include:

• Low blood calcium level: If you have a low blood calcium level, your doctor likely will not prescribe Xgeva. For details about this, see the “When to avoid Xgeva” section above.
• Kidney problems: Taking Xgeva may cause the calcium level in your blood to fall below the usual range. Having a kidney problem, such as kidney failure, may increase the likelihood of this side effect. Your doctor may prescribe calcium and vitamin D supplements to reduce this risk. To learn more, talk with your doctor.
• Diabetes: Xgeva may cause osteonecrosis of the jaw (death of jawbone tissue). Having diabetes may increase the likelihood of this side effect. If you have diabetes, your doctor can recommend whether Xgeva is a safe treatment option.
• Dental problems or procedures: Certain dental problems may increase the risk of osteonecrosis of the jaw with Xgeva. Examples include gum infections and a lack of proper care for your teeth and gums. Having a serious dental procedure, such as a tooth extraction, also increases this risk. Your doctor may advise you to have regular dental visits during Xgeva treatment.
• Osteoporosis: Bone fractures in your spine may occur after stopping Xgeva treatment. This risk may be higher in people with osteoporosis. If you have osteoporosis, talk with your doctor before stopping Xgeva treatment. They’ll help you safely stop the drug.
• Allergic reaction: If you’ve had an allergic reaction to Xgeva or any of its ingredients, your doctor will likely not prescribe Xgeva. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether it’s safe to use Xgeva while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Xgeva may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before using Xgeva. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: There haven’t been enough clinical trials to determine whether Xgeva is safe to use while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects) or pregnancy loss. However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Xgeva. They can advise you on the right treatment plan for you.

You can take certain steps to help prevent interactions with Xgeva. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Xgeva label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Xgeva doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Xgeva by using it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Xgeva. These resources might help:

• Overview of Xgeva: For a general overview of Xgeva, you can see this article.
• Side effects: If you’re interested in the side effects of Xgeva, see this article. Another option is to refer to the Xgeva prescribing information.
• Dosage specifics: To learn about the dosage of Xgeva, see this article.
• Drug comparison: For information about how Xgeva compares with Prolia, read this article.
• Facts about cancer: To learn more about cancer, see our cancer hub.

Disclaimer: Medical News Today 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.