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Quadramet Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 3/21/2016

Quadramet (samarium SM 153 lexidronam) Injection contains a radioactive medication and is used to treat pain caused by cancer that has spread to the bone. Common side effects of Quadramet include:

  • diarrhea
  • nausea
  • vomiting
  • abdominal pain
  • dizziness
  • a temporary increase in bone pain (pain flare)
  • infection
  • fever 
  • chills
  • weakness
  • cough
  • rash or
  • chest pain.

The recommended dose of Quadramet is 1.0 mCi/kg administered intravenously over a period of one minute through a secure in-dwelling catheter and followed with a saline flush. Quadramet may interact with cancer chemotherapy drugs or radiation. Tell your doctor all medications and supplements you use. Quadramet is not recommended for use during pregnancy. It may harm a fetus. Women should have a negative pregnancy test before treatment. Men and women receiving this medication should use at least 2 forms of birth control (e.g. condoms birth control pills) to prevent pregnancy. If you become pregnant or think you may be pregnant tell your doctor. It is unknown if Quadramet passes into breast milk. Because of possible risk to the infant breastfeeding while using this medication is not recommended.

Our Quadramet (samarium SM 153 lexidronam) Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information Overview?

A concise overview of the drug for the patient or caregiver from First DataBank.

Quadramet Overview - Patient Information: Side Effects

SIDE EFFECTS: Diarrhea, dizziness, or a temporary increase in bone pain (pain flare) may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Many people using this medication have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.

This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection (e.g., fever, chills, persistent sore throat/cough, pain when you urinate).

Tell your doctor immediately if any of these unlikely but serious side effects occur: easy or unusual bleeding/bruising (e.g., bloody nose, bloody/black/tarry stools, bloody/pink urine), unusual weakness/tiredness, pounding/persistent headache, fast/slow/irregular heartbeat.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice any other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the entire patient information overview for Quadramet (Samarium SM 153 Lexidronam)

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Quadramet FDA Prescribing Information: Side Effects
(Adverse Reactions)


Adverse events were evaluated in a total of 580 patients who received QUADRAMET® (samarium sm 153 lexidronam) in clinical trials. Of the 580 patients, there were 472 men and 108 women with a mean age of 66 (range 20 to 87).

Of these patients, 472 (83%) had at least one adverse event. In a subgroup of 399 patients who received QUADRAMET® (samarium sm 153 lexidronam) 1.0 mCi/kg, there were 23 deaths and 46 serious adverse events. The deaths occurred an average of 67 days (9 to 130) after QUADRAMET® (samarium sm 153 lexidronam) . Seriou events occurred an average of 46 days (1 - 118) after QUADRAMET® (samarium sm 153 lexidronam) . Although most of the patient deaths and serious adverse events appear to be related to the underlying disease, the relationship of end stage disease, marrow invasion by cancer cells, previous myelotoxic treatmen and QUADRAMET® (samarium sm 153 lexidronam) toxicity can not be easily distinguished. In clinical studies, two patients with rapidly progressive prostate cancer developed thrombocytopenia and died 4 weeks after receiving QUADRAMET® (samarium sm 153 lexidronam) . One of the patients showed evidence of disseminated intravascular coagulation (DIC); the other patient experienced a fatal cerebrovascular accident, with a suspicion of DIC. The relationship of the DIC to the bone marrow suppressive effect of Samarium is not known. Marrow toxicity occurred in 277 (47%) patients (See WARNINGS section).

In controlled studies, 7% of patients receiving 1.0 mCi/kg QUADRAMET® (samarium sm 153 lexidronam) (as compared to 6% of patients receiving placebo) reported a transient increase in bone pain shortly after injection (flare reaction). This was usually mild, self-limiting, and responded to analgesics.

The most common adverse events observed in controlled clinical studies of QUADRAMET® (samarium sm 153 lexidronam) , are given in Table 6.


N = 90 N = 199
# Patients with Any Adverse Event 72 (80%) 169 (85%)
Body As A Whole 56 (62%) 100 (50%)
Pain Flare Reaction 5 (5.6%) 14 (7.0%)
Cardiovascular 19 (21%) 32 (16%)
Arrhythmias 2 (2.2%) 10 (5.0%)
Chest Pain 4 (4.4%) 8 (4.0%)
Hypertension 0 6 (3.0%)
Hypotension 2 (2.2%) 4 (2.0%)
Digestive 44 (49%) 82 (41%)
Abdominal Pain 7 (7.8%) 12 (6.0%)
Diarrhea 3 (3.3%) 12 (6.0%)
Nausea &/or Vomiting 37 (41.1%) 65 (32.7%)
Hematologic & Lymphatic 12 (13%) 54 (27%)
Coagulation Disorder 0 3 (1.5%)
Hemoglobin Decreased 21 (23.3%) 81 (40.7%)
Leukopenia 6 (6.7%) 118(59.3%)
Lymphadenopathy 0 4 (2.0%)
Thrombocytopenia 8 (8.9%) 138(69.3%)
Any Bleeding Manifestations* 8 (8.9%) 32 (16.1%)
Ecchymosis 1 (1.1%) 3 (3.0%)
Epistaxis 1 (1.1%) 4 (2.0%)
Hematuria 3 (3.3%) 10 (5%)
Infection 10 (11.1%) 34 (17.1%)
Fever and/or Chills 10 (11.1%) 17 (8.5%)
Infection, Not Specified 4 (4.4%) 14 (7.0%)
Oral Moniliasis 1 (1.1%) 4 (2.0%)
Pneumonia 1 (1.1%) 3 (1.5%)
Musculoskeletal 28 (31%) 55 (27%)
Myasthenia 8 (8.9%) 13 (6.5%)
Pathologic Fracture 2 (2.2%) 5 (2.5%)
Nervous 39 (43%) 59 (30%)
Dizziness 1 (1.1%) 8 (4.0%)
Paresthesia 7 (7.8%) 4 (2.0%)
Spinal Cord Compression 5 (5.5%) 13 (6.5%)
Cerebrovascular Accident/Stroke 0 2 (1.0%)
Respiratory 24 (27%) 35 (18%)
Bronchitis/Cough Increased 2 (2.2%) 8 (4.0%)
Special Senses 11 (12%) 11 (6%)
Skin & Appendages 17 (19%) 13 (7%)
Purpura 0 2 (1%)
Rash 2 (2.2%) 2 (1%)
*Includes hemorrhage (gastrointestinal, ocular) reported in <1%.

In an additional 200 patients who received QUADRAMET® (samarium sm 153 lexidronam) in uncontrolled clinical trials, adverse events that were reported at a rate of greater than or equal to 1.0% were similar except for 9 (4.5%) patients who had agranulocytosis. Other selected adverse events that were reported in <1% of the patients who received QUADRAMET® (samarium sm 153 lexidronam) 1.0 mCi/kg in any clinical trial include: alopecia, angina, congestive heart failure, sinus bradycardia, and vasodilation.

Read the entire FDA prescribing information for Quadramet (Samarium SM 153 Lexidronam)

Report Problems to the Food and Drug Administration


You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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