I have a concern with Prednisone after talking to my pharmacist about affects of combining some medications. My concern is the need for Prednisone. My pharmacist tells me that Prednisone is hard on the kidneys so my concern is ending up on dialysis in the future. But, I have two trains of thought and would like information on both.
1) Everything I've read states that Prednisone itself doesn't deal with the cancer, it deals with the side effects from Zytiga. Now, my question is; why would I take Prednisone in the first place until I find out exactly what side affects I experience from Zytiga? If I'm one of those rare individuals that experience no side affects, or minimal, then why take Prednisone? I'm not saying I'm one of those rare individuals, but it just makes sense to me to find out what side affects I experience before I treat them. Maybe I can live with the side affects, maybe not, but shouldn't we find out first?
2) Another contention I have is this; Approximately 45 minutes after I take the Prednisone (one in morning and one late afternoon), I get the hot flashes. It happens twice a day. I'll explain why this isn't a contradiction to 1); it "seems" that the Prednisone is causing the hot flashes. I don't get them at other times during the day. Usually 45-60 minutes after taking the Prednisone. Along with this and 1), if the Prednisone is supposed to deal with the symptoms of the Zytiga, and hot flashes are a result of Zytiga, and I take the Prednisone and still get hot flashes.....then again, why take the Prednisone?
Mind you, these hot flashes don't hit me as "trivial" things. I can be sitting in a controlled temperature room, and when the hot flashes hit I break out in a sweat....a serious sweat. All over my body, it drips off my face and my hair and clothes get wet from it. I still work fulltime with overtime. I'm currently working 12 hours a day. Much of my work is outside involving large steel structures, which requires me to be on them. And while the temperatures have been decent, my concern is; whats going to happen with the side affects when I'm on a building in 100+F degree temperature?
My Oncologist never mentioned that Prednisone is hard on the stomach. When I emailed him about the hot flashes he prescribed Oxybutynin. Again, if Oxybutynin takes care of the hot flashes (which it doesn't) then why wouldn't I take that instead of Prednisone? It's really frustrating. I hate taking pills, any pills. I went from somebody who didn't take ANY pills 8 months ago, to now taking 8-10 pills a day. And to top that off, as I stated above, now I take a pill to counter the side affects of a pill that I'm taking to counter the side affects of another pill. It sounds like a downward spiral..........
......if the cancer doesn't kill me the treatment will.......
You misunderstand why Prednisone is given with Zytiga. Zytiga impairs the adrenal glands' ability to manufacture cortisol. So you have to REPLACE what was lost. The dose of prednisone is very low - it only replaces what is lost. If you don't use it, you will suffer certain symptoms, due to ACTH excess, including hypertension, hypokalemia, and fluid retention. You are not taking enough prednisone to cause symptoms related to cortisol excess.
You are taking prednisone to replace the amount manufactured during natural circadian rhythms. Hot flashes also occur during the natural circadian rhythms of body temperature. So the effect you observe is not causal.
Oxybutynin is given for bladder spasms. I'm not sure why it works for hot flashes, but it seems to. If you want to avoid taking another pill, acupuncture has reduced hot flashes in randomized clinical trials. Effexor has also shown some efficacy. Estrogen patches are very effective taken with tamoxifen to prevent gynecomastia.
Well it sounds like my oncologist hasn't exactly been forthcoming about Prednisone. And without having this knowledge beforehand, it makes it difficult to ask him the questions when I don't know what questions to ask. When I prompted him about how long I will be on Zytiga and Prednisone, his response was......"indefinitely".
"Indefinitely" is true. No one can predict for the individual how long Zytiga will be effective before resistance sets in.
A lot of Doctors would seem to benefit from a course in communicating. "Until it stops working for you. It varies from person to person." IMO that would have been a better response than indefinitely which for some people means forever.
If only drugs worked as precisely as the label says.