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Advanced Prostate Cancer
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Abiraterone & Milk Thistle not a good combo

I am on the new protocol for PCa: Lupron w Zytiga. A friend suggested that I add milk thistle to enhance liver protection as these drugs can effect liver function. After two days adding this to my regimen I thought to call the pharmacist where my oncologist practices (Seattle Cancer Care Alliance). Word back: milk thistle might inhibit the metabolism of abiraterone, meaning it could lead to an increased concentration of the drug in my system, putting me at risk for more or increased side effects. Suffice it to say, I have stopped the milk thistle. Latest PSA: Lowest since I was diagnosed in 2005 @0.0- I can only hope this continues into the future.

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I like that PSA number!

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Great news about your PSA! For me they added Zytiga last June to the Lupron that I been on for a while. My main concern with Zytiga is how easy it is to get an overdose. Just drinking one glass of milk with it could put up to 17 times the recommend does into your body. For me that means getting up at 5:15 AM to take Zytiga, eat breakfast at 7AM and then taking Prednisone and all of my other pills.

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Dr. Who, We are pretty much the same schedule. I take mine from bed@5am. Our mini-dachsunds get me out of bed soon after. I have nothing to eat until about 7 or 7:15 when I take the Pred and other meds.

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Great minds are the same! Our two Airedales get us up at 6:30.

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I think what you said about the ability to overdose is not related by all Drs as well as it should be. We only discovered that through my reading everything I could get my hands on. Never, did our Dr mention it. Thanks.

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Hi Charlean,

It's absurd that the med onc didn't tell you that. It is stressed in the product info, & the oncology pharmacists at my hospital put it on the label instructions. See my comment to Dr. WHO below about my doc's reaction to my interest in experimenting.

I hope you're doing well!

Neal

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Hi WHO,

I took it at bedtime. Even that cramped my style, as I needed either to adjust from late dinner & later fruit + nuts & seeds, or stay up too late. But if you're not inclined to finish your eating within 2 hours of bedtime, this approach would save you some sleep in the morning.

When I'd been on Zytiga for 2 1/2 years, I started experimenting with having it closer to when I stopped eating, as I noticed there were clinical trials experimenting with this. I wanted to see if I could boost the effectiveness without damage. I went from 2 hours to 1.5 (no change in liver function), to 1 hour (no change) to 1/2 hour (no change). I was going to go to eating with Zytiga next, but unfortunately that's when my PSA began to rise & I had to move on. My med onc had tried to terrify me about the dangers, or I would have gone directly to having food & Zytiga together. So there's not necessarily much to worry about with a glass of milk.

Other than dairy being contraindicated for PCa patients, that is. I'm drinking oat beverage now, & eating my oatmeal with it. It's really delicious! If you can't find it, there's almond milk, soy milk, etc.

Neal

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Thank you guys for this info. I don't drink milk but I do eat plain Greek yoghurt. As of today I have stopped and will see if I can get below 0.030 where I have been stuck for more than a year. Staying alive with numbers can get boring! Best the beast!

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Great numbers! I believe Prednisone helps protect the liver. Definitely fast at least an hour on solids.

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Yes, that's the reason for the prednisone. I had really easy bruising from the prednisone, so we tried cutting from 10 mg to 5, & the bruses were less thick & likely to break open if bumped.

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They started me off with 5mg of prednisone for that reason.

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Dr. Who, My oncologist's pharmacist felt that prednisone alone would not be enough to protect the liver when taking both Lupron, Zytiga and adding milk thistle. I was trying to make that distinction. The milk thistle did, indeed, enhance side effects for me--not in a good way. Much more intensified hot flashes, some nausea.

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Good Morning ronton2,

Interesting note on milk thistle. Dr. Charles "Snuffy" Myers had me taking European Milk Thistle daily for quite a while, but never with either Zytiga or Xtandi. I took it after both of those drugs were no longer effective, but I was taking Lynparza.

I never actually knew what it was supposed to do, but if Snuffy said take it, I did! Have a supply left if anyone wants it?

Best wishes. Never Give In.

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Hi Vandy,

I already took Zytiga. I'm on Xtandi, but I may not be for much longer. I was just about to order milk thistle, so it's good to hear about your experience with Snuffy.

If someone contacts you & they're ready to start it now, that's fine. Otherwise, please email me, neal@yvonnegarcia.net. I'd be glad to have a supply ready for when I'm done with Xtandi. Thank you very much for offering it.

Neal

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Thank you very much for sending it! Quite a large supply! I really appreciate it. You don't have a clue of what the expiration date is, do you? I can't find a date on the bottles.. If not, approximately when did you get it? Then I can figure it out. It's probably no problem as it probably lasts a long time.

Thanks again!

Neal

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I haven't heard that milk thistle is a CYP inhibitor.

"Cytochrome P450 Isozymes

"Studies of milk thistle coadministered with various drugs in humans suggest it is unlikely to affect the most common cytochrome, the P450 (CYP450) isozyme. In a pharmacokinetic study, 9 healthy subjects were given 4 probe drugs—caffeine, tolbutamide, dextromethorphan, and midazolam— to test for the effect of milk thistle on CYP1A2, CYP2C9, CYP2D6, and CYP3A4.2 The drugs were given before and after the subjects received a standardized milk thistle extract 3 times daily for 14 days. Milk thistle had no effect on any of the drugs."

pharmacytimes.com/publicati...

On the other hand, the Mayo is cautious:

"Milk thistle may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system."

mayoclinic.org/drugs-supple...

-Patrick

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pjoshea, my oncologist and pharmacist are following the Mayo caution. I will not take milk thistle in combination with Zytiga and Lupron.

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I have not heard either, or read anything anywhere. And if trying to keep your liver enzymes in check, the best combo is Milk Thistle with Dandelion. But on the other hand there could be room for caution. Doctors do not know all, either to Pharmacists, and either do I.

I just know the above combo works--have my wife on it because of Tylenol, and Aleve, for back pain cranked her enzymes---after 30 days perfect numbers.

So with enough flak, an this, caution is the word of the day, we do not wish to elevate your doses, by external substances.

Nakakrats

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My Research Oncologist told me that often when zytiga stops working it is not being absorbed in the system, and that they had patients getting an extra 8 months by eating a high fat breakfast with it, I did this for 6 months , ate high fat breakfast at same time as zytiga, it worked for a while, and my liver numbers never went above the low end of normal, the liver numbers must be watched when doing this< I did it at the advice of my Oncologist.

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In relation to abiraterone absorption and bioavailability, here are 2 articles targeting cost but also backing it up with data that points to meals and abiraterone increase activity:

ptcommunity.com/news/201702...

sciencelife.uchospitals.edu...

I have in theory failed trial with abiraterone/prednisone within 6 months but it was still keeping my PSA in the 2 digit numbers. I then went on to cabazitaxel which failed also and now on radium, but in addition, my doc put me on the above regimen, so not to "overdose" and to potentially gain added benefit at lowering cell burden and PSA. While on Radium-223, PSA is not really observed but with abiraterone on board, it'll be interesting to see if any benefits...

Stephan

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Stephan, Perhaps abiraterone (Zytiga) is the missing link in treatments of different kinds. I fervently hope so for you, me and everyone else afflicted with this torturous disease. I can only imagine how isolated you feel at times. This is a good place to relieve that feeling. We are a caring bunch, as your thoughtful post proves. As a gay man who was diagnosed at 53, I understand the shock of having one's youthful outlook shattered. But, please, don't give up on your treatments. So many new therapies coming all the time--as combining Lupron with Zytiga. I will pursue the articles. Keep in touch here. Do it day by day!

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