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Patient Information for Self-Administration of Denosumab 

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The information on this page will help you to safely give yourself the denosumab treatment by subcutaneous injection (an injection under the skin). 

Self-administration of the medication will allow you to have greater freedom and take control of your treatment. This type of injection is very safe but you may have some bruising, redness or a small lump to the injection site. 

Information about X-geva denosumab is available on the Cancer Research UK website.

 

How is my Treatment Administered?  

This medicine (Xgeva denosumab 120 mg) is an injection that is administered once every four weeks (or every three months dependent on prescription) under the skin (subcutaneous) of your abdomen or thigh.  

The treatment that you administer yourself is in a pre-filled syringe.  

If you have previously been given this treatment at clinic, you would have received it from a vial. 

The pre-filled syringe can be administered by a patient or caregiver who has been trained in injection techniques by a healthcare professional. 

Your first self-administration with the XGEVA® pre-filled syringe will be supervised by a healthcare professional. 

A member of the team will contact you by phone or video call, to support you with your first self-administered treatment at home.  

Thereafter, we will contact you after each dose to confirm that the treatment has been administered. It is important that we record this information on our clinical systems. 

Important: If you have any dental issues or new onset of bone pain do not administer the treatment and call the treatment helpline for advice on 02920 615888. 

 

Pre-Administration Checklist 

Please ask yourself these questions before preparing to give your own injection:

  • Have you received invasive dental treatment in the last 6 weeks (such as extraction, root canal or dental implants) or planning any in the next 8 weeks? 
    • If Response is “Yes”: Withhold denosumab. Contact the oncology team for advice.
  • Any new oral problems – jaw pain, new dental issues.
    • If Response is “Yes”: Withhold denosumab. See your dentist and report to the oncology team following your dental review.  
  • Have you been receiving denosumab for over 2 years? If so, have you experienced any new or unusual pain in your thigh, hip, or groin?
    • If Response is “Yes”: Contact the oncology team for advice if there are new pains. 

 

Preparing to give your own injections 

You will be shown by a nurse the following skills: 

  • Preparation - denosumab comes in a pre-filled syringe with the needle attached. 

  • How to give the injection. 

  • Storing and disposal of the medication and equipment. The denosumab injections must be stored in the packaging box in a fridge until needed. 

Each stage of the process will be shown to you. You (or your carer) will be observed by a nurse administering Denosumab during your clinic appointment.   A nurse will assess that you are competent and safe to do so in your home.  

 

Equipment 

The following items will be given to you by the hospital. It is important that you have them available before giving yourself the injection. 

  • Prescription for you to collect pre-filled syringe from your local pharmacy.  

  • Sharps bin 

  • Disposable gloves will be provided if someone else is giving you the injection 

You will also need a clean surface, such as a table or worktop and some gauze/cotton wool. 

If you are unable to obtain syringes from your community pharmacy, please contact the Outpatient Department (OPD). The staff will ask for the pharmacy’s name and the reason for the issue, in order to help resolve it.  

 

Preparing to give the injection 

  1. Remove one denosumab pre-filled syringe from the fridge and allow it to reach room temperature before injecting. This usually takes 15 to 30 minutes and reduces any discomfort from having the injection. 

  1. Check the details on the label of your medicine. Make sure that the label has your name on it.

  1. Check that the contents of the denosumab syringe is clear and not discoloured, and that it is in-date 

  1. Wash your hands thoroughly with soap and water and dry them. 

 

Giving yourself the injection

1. Sit comfortably.

2. Have gauze/cotton wool ready just in case you bleed a little after the injection.

3. The injection must be given in the thigh or abdomen. Do not inject denosumab into skin, which is bruised, broken, red, swollen or hard. Avoid scars, stretch marks and skin which is tender. Take it in turns to inject into the left and right sides of your tummy or left and right thigh. It may help to record the area (site) that you use for each injection in a table.

4. Do not inject the medication if you are feeling unwell. Call the treatment helpline for advice.

5. Pick up the syringe and pull the needle cap straight off while holding the bottom of the barrel, as if you are writing your name with a pen. Only remove the needle cap when you can inject right away (within 5 minutes) as this can dry out the medicine. Do not twist or bend the needle cap. Never put the needle cap back on, it may damage the needle. Do not let anything touch the needle once the needle cap is removed. Do not try to push air bubbles out of the pre-filled syringe. It is okay to see air bubbles. A drop of medicine at the end of the needle is normal.

6. With your free hand pinch the skin at the site you are going to inject and insert the needle at a 90-degree right angle.

7. When the needle is in place, press the plunger down until the syringe is empty and the plunger head is level with the needle guard clips. You may feel or hear a ‘snap’. Do not pull back on the plunger at any time. Do not remove the needle until all the medicine is delivered.

8. With your thumb still on the plunger lift the syringe away from your skin. Once away from the skin, the needle will move into the needle guard when you remove your thumb from the plunger. Do not rub the injection site.

9. Apply gauze/cotton wool to the injection site and cover with plaster – if needed.

10. Dispose of the syringe in the sharps bin. When your sharps bin is full, return it to Velindre outpatient department for a replacement. Alternatively, the sharps bin can be disposed of at your local hospital.

 

Frequently Asked Questions

How will I get my next prescription?

When you have been seen in clinic, you will be prescribed 3 months of denosumab, 3 injections, one for each month (if you are on a monthly frequency). These prescriptions should be collected from your local pharmacy. They are not available to be collected from the on-site pharmacy within Velindre Cancer Services.

What if I forget to take my injection on the allotted date?

A few days either side of your intended injection date is not a problem. If the delay is more than one week, please call the outpatient treatment room via the switchboard Mon to Fri between 8.30 and 5.30 for advice.

Can I take my denosumab doses on holiday with me?

Yes, you can. If you are flying check with the airline. Typically, passengers are permitted to carry syringes in the aircraft cabin, if they are needed for medical reasons. However, passengers should carry a doctor's letter confirming their requirement.

Note that once the pre-filled syringe has been left to reach room temperature (up to 25°C), do not put it back in the refrigerator and it must be used within 30 days.

What if I encounter difficulties with administering the treatment e.g. a malfunction with the device?

We are always on hand to provide advice and guidance. In the unlikely event of a syringe malfunction, call the outpatient treatment room via the Switchboard Mon to Fri between 8.30 and 5.30 for advice.

What if I am unable to take calcichew tablets?

If you have difficulties with either obtaining or ingesting the calcichew tablets, contact your oncology team for advice.

Can I use the 60 mg dose of Denosumab (Prolia) twice instead of the X-geva 120 mg dose?

No, you must only administer the X-geva 120mg dose of treatment.

What if I take the denosumab from the fridge but don’t use it?

Write the date it was removed from the fridge on the denosumab box and store in a cool, dark place. Use within 30 days.

 

A member of the team will call you after 4pm on ............... to talk through your administration at home. Please remove the injection from the fridge at 3:30pm so it is ready when we call. For subsequent injections a member of the team will call you within a couple of days of your injection date to confirm you have administered it and that there weren't any problems.  

 

Denosumab Self Administration Record Card

 

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We value your feedback! Please complete a short questionnaire about your experience with Denosumab self-administration. Your input will help us improve the service.

Please note that the form should not be used for clinical queries.