Timing of Side Effects After Pluvicto Infusion
Most side effects from Pluvicto (lutetium Lu 177 vipivotide tetraxetan) begin within hours to days after infusion, with the most common symptoms appearing immediately to within the first week, though some delayed effects like laboratory abnormalities may emerge 5-10 days post-infusion.
Immediate to Early Side Effects (Hours to Days 1-3)
Acute symptoms typically manifest within the first several hours after infusion, including fatigue, dry mouth, nausea, and altered taste (dysgeusia), which was reported in 11.9% of patients 1, 2.
Neurologic symptoms such as dizziness can occur early, with 6% of patients experiencing dizziness with no other clear etiology in the immediate post-treatment period 2.
Headaches may develop acutely, affecting 2.7% of patients, with some requiring emergency department admission due to severity of symptoms 2.
Delayed Side Effects (Days 5-10)
Laboratory abnormalities emerge in a delayed fashion, typically 5-10 days post-infusion, including decreased lymphocytes, hemoglobin, leukocytes, platelets, calcium, and sodium 1.
Transaminitis (elevated liver enzymes) typically has onset 5-10 days after infusion, with full resolution usually occurring 15-21 days following treatment 3.
Anemia develops as a delayed effect, occurring in more than 20% of patients as one of the most common adverse reactions, though the exact timing aligns with the general hematologic toxicity window 1.
Ongoing Symptoms Throughout Treatment Cycle
Fatigue, decreased appetite, and constipation persist as ongoing symptoms affecting more than 20% of patients throughout the 6-week treatment cycle 1.
Dry mouth remains a persistent symptom rather than an acute reaction, affecting a significant proportion of patients continuously 1, 4.
Critical Monitoring Periods
The first 24 hours post-infusion represent the highest risk period for acute reactions, though severe neurologic problems requiring treatment discontinuation are rare in patients without pre-existing central nervous system involvement 2.
The 5-10 day window requires vigilance for laboratory abnormalities and hepatotoxicity, with monitoring recommended during this period to detect worsening cytopenias or transaminitis 3, 1.
Paresthesia symptoms may develop at variable times, reported in 3.2% of patients without a specific temporal pattern clearly defined 2.
Important Clinical Considerations
Severe adverse reactions are uncommon, and in a cohort of 185 patients, only 3.78% required emergency department admission for neurologic symptoms, with none discontinuing therapy due to these effects 2.
The 6-week interval between doses allows for recovery from most toxicities, particularly hematologic and hepatic abnormalities which typically resolve within 15-21 days 3.
Rare but serious events like ischemic stroke occurred in 1.08% of patients, though the temporal relationship to infusion timing was not precisely defined in available data 2.