Latest vblog post by Dr. Myers.
A couple of interesting points to me:
a) the concept of drug clearance & dose adjustments. Myers is speaking in the context of clearance mechanisms becoming less efficient with age. Levels of a drug in the circulation can be much higher than intended. Side effects in some may not be due to being over-sensitive, & lowering a dose may not reduce efficacy, if clearance is sluggish.
I had my first & last colonoscopy about 5 years ago. I was warned that, owing to my drinking habits, one of the three drugs in the sedative might not work. A few minutes into the procedure, I was becoming very uncomfortable. I saw the technician nod to the nurse, & she gave me more of the sedative. It made no difference at all & the procedure was quickly halted.
My wife - the designated driver - was expecting to drive me home to bed, but I suggested a nearby Thai restaurant. Ignoring her frowns, I had a couple glasses of red wine with the meal. Was alert for the remainder of the day.
It seems that my liver is a bit hyper & quickly metabolizes some drugs, including alcohol. This is the opposite problem to the one that Myers mentions. Presumably, some drugs are ineffective for me at the standard dose?
Perhaps there will be a test one day, to determine a dose adjustment factor. Is weight & height ever taken into account?
b) Myers speak of using 'Castration-Lite" on some patients - of wanting to preserve testosterone levels. I wonder how many other oncologists give that a try?
Myers' Castration-Lite is Avodart + Casodex. i.e. no Lupron, etc. I was surprised that some do very well on it long-term. I remember reading that Casodex was approved as monotherapy in Germany, & thinking that was odd. In 1995, it was approved as an add-on to Lupron (or similar drug) in the U.S..
The antiandrogen Casodex is outclassed by Xtandi these days, I suppose.