STRONTIUM CHLORIDE SR-89

Clinical safety rating: caution

Comprehensive clinical and safety monograph for STRONTIUM CHLORIDE SR-89 (STRONTIUM CHLORIDE SR-89).

How it works

Strontium-89 is a calcium mimetic that localizes to bone, particularly areas of increased osteoblastic activity, emitting beta radiation that causes DNA damage and cell death in metastatic tumor cells.

What the body does with it

Metabolism	Strontium-89 is not metabolized; it is excreted unchanged primarily via renal filtration and partially through feces.
Excretion	Primarily renal (urinary) excretion; approximately 50-80% of absorbed dose eliminated via urine over 7 days. Fecal elimination is negligible (<5%).
Half-life	Terminal elimination half-life: 50.5 days (range 33–65 days). Reflects slow clearance from bone; clinical effect persists due to long skeletal retention.
Protein binding	No significant plasma protein binding (<10%); strontium-89 behaves as a calcium analog and is rapidly taken up by bone.
Volume of Distribution	Apparent volume of distribution: approximately 1-2 L/kg; reflects extensive distribution into bone mineral (hydroxyapatite matrix) with minimal soft tissue distribution.
Bioavailability	Bioavailability: 100% after intravenous administration (only route); not administered orally. No clinically relevant bioavailability for other routes.
Onset of Action	Onset of pain relief: 7–21 days after intravenous administration; maximal effect may require up to 6 weeks.
Duration of Action	Pain relief duration: 3–6 months; may vary based on individual bone turnover and disease progression. Repeated doses may be given after ≥90 days.

Classification & Brands

Dosing & administration

148 MBq (4 mCi) intravenously over 1-2 minutes, single dose. Repeat after 3-6 months if needed.

Dosage form	INJECTABLE
Renal impairment	No specific dose adjustment required for renal impairment as strontium-89 is minimally renally excreted; use caution in severe renal impairment.
Liver impairment	No specific dose adjustment required for hepatic impairment.
Pediatric use	Safety and efficacy not established; not recommended for use in pediatric patients.
Geriatric use	No specific dose adjustment required; use standard adult dose with consideration of overall health status.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for STRONTIUM CHLORIDE SR-89 (STRONTIUM CHLORIDE SR-89).

Breastfeeding	Radioactive strontium-89 is excreted into human milk. M/P ratio not established. Exposure to nursing infant via breast milk poses risk of radiation toxicity. Breastfeeding must be discontinued permanently after administration.
Teratogenic Risk	Strontium-89 is a radioactive calcium analog emitting beta particles. First trimester: high risk of fetal malformations and growth restriction due to radiation exposure. Second and third trimesters: risk of fetal hypothyroidism, growth restriction, and carcinogenesis. Contraindicated in pregnancy.

Warnings & precautions

■ FDA Black Box Warning

Bone marrow suppression, including severe thrombocytopenia and neutropenia, may occur; monitor blood counts regularly. Not recommended for patients with evidence of severely compromised bone marrow.

Side Effect Profile

Serious Effects

Absolute Contraindications

Pregnancy, breastfeeding, established bone marrow suppression (e.g., platelet count <60,000/mm³ or white blood cell count <3,000/mm³), hypersensitivity to strontium-89 or any component.

Clinical Precautions

Precautions

Bone marrow suppression, increased risk of infections and bleeding; use caution in patients with renal impairment; monitor renal function; evaluate bone marrow reserve before administration; avoid concomitant use with myelosuppressive drugs.

Clinical Tips & Counseling

Drug interactions

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STRONTIUM CHLORIDE SR-89

Clinical safety rating: caution

Comprehensive clinical and safety monograph for STRONTIUM CHLORIDE SR-89 (STRONTIUM CHLORIDE SR-89).

How it works

What the body does with it

Metabolism	Strontium-89 is not metabolized; it is excreted unchanged primarily via renal filtration and partially through feces.
Excretion	Primarily renal (urinary) excretion; approximately 50-80% of absorbed dose eliminated via urine over 7 days. Fecal elimination is negligible (<5%).
Half-life	Terminal elimination half-life: 50.5 days (range 33–65 days). Reflects slow clearance from bone; clinical effect persists due to long skeletal retention.
Protein binding	No significant plasma protein binding (<10%); strontium-89 behaves as a calcium analog and is rapidly taken up by bone.
Volume of Distribution	Apparent volume of distribution: approximately 1-2 L/kg; reflects extensive distribution into bone mineral (hydroxyapatite matrix) with minimal soft tissue distribution.
Bioavailability	Bioavailability: 100% after intravenous administration (only route); not administered orally. No clinically relevant bioavailability for other routes.
Onset of Action	Onset of pain relief: 7–21 days after intravenous administration; maximal effect may require up to 6 weeks.
Duration of Action	Pain relief duration: 3–6 months; may vary based on individual bone turnover and disease progression. Repeated doses may be given after ≥90 days.

Classification & Brands

Dosing & administration

148 MBq (4 mCi) intravenously over 1-2 minutes, single dose. Repeat after 3-6 months if needed.

Dosage form	INJECTABLE
Renal impairment	No specific dose adjustment required for renal impairment as strontium-89 is minimally renally excreted; use caution in severe renal impairment.
Liver impairment	No specific dose adjustment required for hepatic impairment.
Pediatric use	Safety and efficacy not established; not recommended for use in pediatric patients.
Geriatric use	No specific dose adjustment required; use standard adult dose with consideration of overall health status.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for STRONTIUM CHLORIDE SR-89 (STRONTIUM CHLORIDE SR-89).

Breastfeeding	Radioactive strontium-89 is excreted into human milk. M/P ratio not established. Exposure to nursing infant via breast milk poses risk of radiation toxicity. Breastfeeding must be discontinued permanently after administration.
Teratogenic Risk	Strontium-89 is a radioactive calcium analog emitting beta particles. First trimester: high risk of fetal malformations and growth restriction due to radiation exposure. Second and third trimesters: risk of fetal hypothyroidism, growth restriction, and carcinogenesis. Contraindicated in pregnancy.

Warnings & precautions

■ FDA Black Box Warning

Bone marrow suppression, including severe thrombocytopenia and neutropenia, may occur; monitor blood counts regularly. Not recommended for patients with evidence of severely compromised bone marrow.

Side Effect Profile

Serious Effects

Absolute Contraindications

Pregnancy, breastfeeding, established bone marrow suppression (e.g., platelet count <60,000/mm³ or white blood cell count <3,000/mm³), hypersensitivity to strontium-89 or any component.