Good day to you all, wherever you may be! Let's get into the weeds straightaway. In the next logical step in my treatment, I've been placed on Zytiga. For those in the know, it is recommended/required that the pills be taken on "an empty stomach" - which, after my questioning of the specialty pharmacist, roughly means two hours prior to ingestion, and one hour post-ingestion. Like many here, I have never been one to accept generalities without question, and my research on this topic has led to some contradictory answers and 2 big questions.
Some background: Zytiga itself is abiraterone acetate, the salt form of abiraterone that is more readily absorbed than pure abiraterone and resistant to premature metabolism. While this salt-pairing (or other molecular pairing) isn't uncommon for many drugs, it indicates for me that Zytiga may be a bit more finicky when taken orally (but I haven't heard of abiraterone injections...was this ever a "thing"....?). For me (and as far as I can tell, everyone), Zytiga is a once-a-day drug.
A review of Zytiga's information on my go-to drug website from Canada ( drugbank.ca/drugs/DB05812 ) revealed:
1. Terminal half life is between 5-14 hours, with an average half life of ~9 hours (contrast this, dear readers, with a Bicalutamide half life of 5.9 days)... this would seem to indicate 2x per day rather than the 1x per day dosing approach...
2. "Food and high fat meals increases absorption 4.4-fold." The implications are obvious - less pills with same effective dose if you eat. BUT...since this drug does seem to be a bit finicky in the metabolism department, does mixing the drug with food expose it to degradation in the GI tract prior to "intended" metabolism and transport to cancer cells?
So...I would love to know that my drug of...well, no choice, really.... is getting to the places it needs to go in my body in the quantities it needs to be effective. This oral route seems a bit arbitrary, and while I can accept that in my favorite painkiller, I am frankly not comfortable. Thoughts and comments? Thanks in advance. - Joe M.
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I took abiraterone-acetate for 3 months (part of a clinical trial). I was informed my daily dose (4 pills) had to be taken w/o food. As you said above, no food 2 hours before, and 1 hour after taking pills. I asked my oncologist why w/o food, he said food will throw off (increase) absorption rate. My daily absorption of this medicine would be a function of food intake. He said it was important my daily absorption be predictably 'constant', and this is why I should take it w/o ingesting food. Perhaps others have more information. Best of health!
I may be wrong, but believe recommended dosage strength and frequency of a medicine is determined (typically) from its' clinical trial information... prior to its' approval for standard care. If anyone knows different, please let me know.
Half life only seems loosely related to dosing schedule. For example, the half life of ibuprofen is about 2 hours but is taken every 6-8 hours.
In the specific case of Zytiga, the mechanism of action is described as "irreversibly blocks CYP17A1 enzymes". My non-expert understanding is that "irreversibly" means "destroys the enzyme". As long as you have enough Zytiga in your system to destroy enzymes faster than they are being created by the cells, you're good.
Picking numbers out of thin air, if a drug is effective at 1/8th of the peak plasma concentration, then the effects will last for about 3 half lives.
I take it once a day--1,000 mg--generally allow an hour and a half and then eat, taking my prednisone 5 mg--hot flashes have been my biggest side effect....had issues with liver functions, straightened out when I stopped taking a sleep supplement--valerian root with low dose phenobarbital... just got switched to generic--guess I'll find out tomorrow if it's working ok...
Great news....undetectable....I guess the generic must be doing fine....all my LFT's were normal....no liver issues so far except when taking the valerian root/phenobarbital sleep potion....I slept so well on that stuff....
No....slept 3 hours that night....gut ache....and then had to sit in the appointment and wait for the PSanxiety results to come in...at the end of the visit no less...slept about 8 hrs last night...cold as heck here, but the sun is shining on this old WV boy.... LIfe is good... Take care, warrior... Keep fighting !!!
You too....I like the photo that is on your profile...you must have done some skiing...the area from Ohio to lower WV is like 1 degree and below zero tonight....50's by weekend....go figure...shalom, amigo...Have a great day...
Fish have you looked into taking melatonin -- I (and my wife) take 10 mg right at bedtime -- helps a lot --- I think I read from Patrick's postings that you can safely take 20mg or more nightly --- it has shown benefit for slowing cancer too.
I have increased my dose to 10 mg....thank you...I am sleeping better, and except for the occasional hot flash...getting up no more than twice a night--usually only once to the bathroom... I feel like I am settled in with this mentally/ emotionally... as much as you can be...Thanks again for the article you posted on the multimodal approach results yesterday...more and more it makes me believe my approach of getting on zytiga, prednisone, Lupron and getting PSA to undetectable--then having my stereotactic radiation to my one met lesion was the best approach... only time will tell, of course... I feel more hopeful every day...hope you do too..
Indeed...still a bit early to pull out the poles yet and put on new line...2 fishing expeditions with forum members and one with my brother planned already....hope the wife will tolerate it...don't want to end up like the Brad Paisley video...
The FDA approved treatment is 1,000mg daily fasting (no food 2 hours before and 1 hour after taking Zytiga). There is a small clinical trial by Chicago Med. (72 patients) using 250mg daily with a low fat meal. The trial showed that the low dose with a meal was as effective as the larger dose fasting. I started Zytiga generic on Jan. 3rd and the SE were terrible. My first lab work at two weeks showed that it was irritating my liver and my BP had shot up. So, I dropped dosage to the 250mg with meal. Two weeks later my lab work showed the liver is fine again, my BP has dropped to normal. And, this afternoon when I met with my MedOnc he was okay with my decision. Since I am not castrate resistant or even metastatic, prescribing Zytiga was off label anyway.
June 3, 2017. For details see: vi3c.org/ The slide deck at their site has the specifics and how they plan to conduct a long term trial as soon as funding is secured.
How do you get a doctor to prescribe zytiga if you are not metastatic?
Any recommendations for hospital?
My MO wont put me on Zytiga even though its obvious that I have metastasis. He says the recent studies like Stampede etc. don't proved that the simultaneous use (zytiga, Lupron, pred) is more effective than subsequent useage of Lupron, then zytiga. Plus, he's worried about my coronary artery disease and zytiga.
Would it still be called castrate resistant if the Lupron stopped working alone but the zytiga/Lupron/pred combo does work effectively?
I’ll obviously let Indy weigh in, GG, but there are definitely more and more advocates for earlier use of Zytiga in treatment. And, yah, the concern of “undetectable” micrometastases is a real one.
After biopsy, the CT scan & bone scans showed that I had one met on my left femur, so plan was to use IMRT and Lupron/Zytiga/Predesone as ADT. After starting, I asked for an MRI of the femur and WOWZER! the radiologist and an ortho surgeon both said the lesion is not consistent with PCa but 'likely' a benign encondroma. While my situation was far better than originally thought, my MedOnc and I agree to continue the ADT for 18 months to treat any micromets that might be floating around in my system. Without doing the more specific PMSA or PET scans for tiny mets it's reasonable to me to consider the possibility that this could still be systemic.
I am participating in a pre RP surgery Study, for Gleason 9/10. It’s a 6 month Study which has me taking an LHRH (shots), Abiraterone (1000mg/d), 5mg Prednisone, and Apalutamide. I started Dec. 12th. To date I have no significant SE, other than occasional minor hot flashes..knocking on wood. My first labs showed elevated numbers on Liver, not dangerous, have since dropped slightly. My PSA went from 6.7 to .14, as of 1/24 lab. My scans showed no metastatic tumors.
Yes, I had RP Aug 30th 2018. My surgeon was Louis Pisters. He was taken back by how effective the Drugs were when he did the surgery, however my Pathology showed 2 Lymph nodes involved out of 24.
After two months Post op my PSA came back from zero, to .2 then .6 then 1.7, then 4.3 monthly tests...
My Axumin scan showed radiotracer uptake in the Prostate Bed region and my Ramus pelvic bone.
I’m back on the Lupron and start Zytiga again with 6.5 weeks of radiation in April. Ugg.
If you would like to discuss you are welcome to call 720-273-2335
I have no cost for the Zytiga because I’m in the Study. The Study is to see if using the combination of the three drugs prior to surgery, might reduce post surgery reoccurrence of the Prostate Cancer.
Three months ago, my PSA was showing a slight increase after only 4 months on Zytiga. When I visited my MO, the Professor was not available so I saw his Registrar. Given the disappointing result I asked him if it would be worth trying Zytiga WITH food as that seemed to increase its effectiveness. As all my other bloods were good he went along with that. I started on that regime for a couple of weeks, but as it happened I developed a UTI and was feeling pretty bad, so being uncertain as whether it was the UTI or the new regime that was affecting me, I reverted to Zytiga without food.
Anyway last test happily showed PSA stable, and on my MO visit a couple of weeks ago, I saw my regular guy (the professor of Oncology) and he explained an interesting fact.
When new drugs are developed, the testing includes determining the Optimal Dosage Level. For Zytiga that has been set at 1000mg per day, usually prescribed as 2x500mg on an empty stomach. Now while it has been shown that taking lower levels of Zytiga WITH food can achieve the same result, that does NOT mean that taking more than the normal dosage will be more effective. Consequently taking the normal dosage WITH food is also unlikely to improve effectiveness and while some tests have shown that toxicity is also NOT increased, it is generally considered better not to overdose.
I have also had a full range of blood tests (including liver tests) and they all came back completely normal so my brief period of overdosing had no effect.
I am just happy that Zytiga does seem to be holding me steady. Would prefer it to be zero, but I’ll take .8. Next test in a bit over a month, and I can continue enjoying a glass of good Aussie Shiraz.
I began Zytiga at age 70 in August 2017 at Psa 6.0. Psa fell to 2.1 nadir at Dec 2017, then increased to 6.0 by June 2018 so Zytiga gave me about 8 months Psa suppression and this was equal to the mean time of efficacy and the nadir was what doc said I would get. He said he had patients who had got 2 years suppression. During the months before and months after I had a constant diet, mainly vegetarian / Mediterranean and no red meat or chicken. I cycled an average of 200km a week. But about 3 months after beginning Zytiga, I had slight heart rate irregularities, uneven HR, but generally it remained low at 50bpm because I was keeping fit. But in October 2017 I began to get pains up spine like sciatica that pulsed at the same rate as HR, but these strange pains lasted only 20 seconds after cycling hard up a long hill then stopping at the top for traffic lights, or for companions to catch up to me. Then I found these pulsing pains happened more in hot weather so I quit cycling with my group because they started out on hot days at 8am, and the last 2 hours of ride were often in 30C+. So I rode alone and began at 6am, to avoid summer heat.
These strange pain symptoms puzzled my docs who gave no explanations, but low potassium was blamed so I ate a lot more vegies high in K and symptoms lessened, but I kept up the exercise because nobody told me exercise was bad for me on this drug.
Anyway, after Zytiga failed, just like everything else had, ie, ADT, Cosadex, I moved to get Docetaxel in July 2018 and this prevented me cycling such large distances but I got used to it, and for doses 3, 4 and 5, I was able to cycle the 19km to hospital to get the chemo infusion and cycle home, without any problems.
Only the first 8 days after each chemo was bad, but during last 3 chemo cycles I got on the bike every day, and by 5th cycle was doing at least 15km a day .
But during the first 3 chemo cycles the pulsing pain effect of Zytiga continued unpredictably but not for very long each time and these side effects vanished after 3 chemo cycles and since then my HR has become very regular and is now 55bpm while typing to all you nice people and after I have cycled 22km in 35C and after swimming 1/2 a km to get cool, because I have no air con.
So Zytiga did what doctors said it would, I was never hospitalised for complications or side effects and needed no extra medications except button mushrooms and English spinach, both high in potassium, K.
I have read about so many ppl having terrible side effects from whatever the doctors foist upon them. But usually, doctors are right, and there is nothing else that can offer. My age now at 71 is relatively younger than someone of say 81 or 91 where side effects might be far more severe, and especially if I was basically very unfit, and with other health conditions like diabetes, poor vascular function, bad lungs, and 10 other darn things.
Docs told me I was The Most healthy stage 4 Pca patient they'd ever seen.
Such a nice body, shame about all the mets.
Anyway, 5 x chemo shots just made Psa rise from 12 to 45, more mets were seen, so I begged for Lu177, and My Dear Oncologist referred me to the doc who administers Lu177. I am maybe due for my 3rd Lu177 infusion in 3 weeks after blood tests tomorrow and my 5th PsMa scans on 5th Feb.
Side effects of slight discomfort in 5 bone joints may be due to Pca, but these have now got less than they were. Lu177 has caused very mild side effects compared to chemo. In hind sight, I might have done myself a favour by NOT trying out chemo which my onco said would not work forever. But mine did not seem to work at all. The only worry now ( apart from later probable death due to Pca ) is that my right hip is a little painy, but only on / off for during first 3km of a cycle ride. Rest of time I feel something is not quite right, but I can walk OK, and pain is only when I cycle and I know Pca is in right femur so I don't yet know if I have beginning of hip joint cartilage failure, due to old age and spillover RT from EBRT to PG in 2010 and 2016, or whether Pca in femur is causing inflammation of joint. Many possible factors exist. Last week I worked hard helping my contractor replace a 40M long fence here, maybe I stretched a ligament, but just what is wrong is a Miss Terrey, and Lord Noze what is causing the problem with my hip.
I must just Suk It Up Bro as they say, but I enjoyed the cheerful waitress at the café at lunch, and have had quite a nice day of life today, far, far better than maybe 4 billion other people, at least.
You are the “amazing man” from down under.. I applaud your attitude and strength.. We suk it up. APC is humbleling ...tip well that cheerful waitress .and keep riding . .. Take care
I'm doing house fixing work while I still can. Most ppl stop spending time and money on their house once they know they have bad cancer, eg, Pca.
I cycle past houses with cars that have been parked for 20 years, tyres all flat, and some have grass up to waist all around, and its a sure sign someone oldishy is having a long struggle, and they just won't say yes to selling up, they still dream of getting better and going back home.
I still am able to fix plumbing, drains, electrical, fencing, brickwork, paving
and trying to get rid of ant's nests in the roof. I'm dreaming of nice big fat solar power system with maybe 20 panels and a battery. No more aud $2,000 bills per year for my electricity, just for me, living as a frugal suburban hermit.
Scans next week, and I might know if Aunty Lutetia has helped me streak ahead of the Pca in my race to the finish line.
This has been the same question we've been asking. We researched it during chemo as well and ended up having the MO lower the dose of taxotere - it still worked so we were happy.
I have been taking zytiga for 5 months and taking it once a day in morning before food at 1,000 mg. Just got back last week from my oncologist at M.D. Anderson and they changed me to taking it with food. They said they have studied results that shows it is more effective with food. The clinical trials all took it on empty stomach, but now new studies show differently. I'm not a doctor but that's what I just found out. my psa has dropped from 64 to 6 in 5 mo.
1) if the half-life is 9 hours, then at 18 hrs there's still 25% of Abi left in your system, and at 24 hrs, about 15% is left, that's when the next dosage should be taken. So taking it once a day seems reasonable.
2) there's been more than one study about taking low dose Abi with food, but all have been small studies, here's a second one: meetinglibrary.asco.org/rec.... There's no incentive for drug companies to develop a protocol for taking lower dosages with food (and lose about 75% of revenues)
I've bee taking Abi for about three months now. Every third day, instead of 4 pills on empty stomach, i take one pill with low fat breakfast. Makes a difference for me, reduces upset stomach.
Great post. CB. I agree that there is a huge economic disincentive for big pharma to reduce dosing and therefore not move product. This is where the medical community needs to step up and really understand the drugs they prescribe to see if there are multiple effective dosing regimens and not simply one. However, liability being what it is......
One interesting aside on the financial aspect. In the us most men with psa would be over 65ish and on Medicare. Most of those have a Medicare Drug D plan that has a maximum patient copay about $2500-$3000. That means patient ends up paying the same, whether taking hi dose or low dose...or even the new Yonsa 'generic'. BUT if your treatment laps over 2 yrs, then you get screwed!
I’ve been taking the generic for a month now. I sleep and fast for at least 8 hours then wake at 6:30, take 4x 250mg with water. Ten minutes later (I heard this was a good way to prevent side effects) I drink 12 oz of water. Somewhere between 7:30 and 8:00 I manage to force myself to eat so I can take 5mg of prednisone (a 10mg split in half) on weekdays I do salvage IMRT at 10:45 (RP 5/2018. G9, I am 59 yo) then at lunchtime I eat the other half of the prednisone. I had a 3mo Lupron beginning of dec.
So far so good. Psa is 0.01 as of last week, bloods ok, esp neutrophils and liver panel. Occasional fatigue, but usually just on Sunday evening. 1 - 4 hot flashes s night, I start to wake from sweat and stop instantly. Stress gives me a noticeable cortisol rush so I stay as chill as possible. Still work my job but librarian is a chill gig, at least in my village. Happily married but we care for a severely autistic adult son who lives with us. Great guy though he suffers from a seizure disorder.
Only proactive stuff I think is working for me is I upped my usual exercise by 20 - 25% don’t want to overdo it, but I want to do as much as I can just shy of overdoing it. Also eat lots of blueberries, and whole grains, veg, and good protein. Plus I use CBD hemp flower, a type of industrial hemp which is legal and non-psychoactive (no THC = no high or paranoia) and a worst swear word of a lot cheaper than buying trendy expensive CBD products that advertise a lifestyle not my own. Plus I know what really goes into my cannabutter or brownies or whatever and can control the dosage.
To be both clear and honest, I have no idea if it is actually doing anything. It feels nice and I do get the general sense it is boosting my immune system and possibly helping to stabilize my mood, and apparently successfully as so far I've enjoyed equanimity city. I also do not appear to be suffering any s/e. Seems to help a bit with the appetite that usually eludes me (when the window opens I cram in as much high calorie food as I can before the window shuts again but I have been gaining weight during radiation, mostly muscle mass) and the very occasional pretty rare nausea I get.
And to be crystal clear, in the Nixonian sense, my main interest is in helping the radiation be even more effective. As a IVa I am at least theoretically still curable and feel obligated, to my family if not to anything else, to try for the cure and give it my best shot, though I know the odds are well against, which may be why I am willing to go with the CBD as long as there are no s/e. I don't think I have ever had any false hopes, I don't think a G9 ever does, does he? But we're all doing our best, and I try to be like the tough sobs who have blazed these trails and who have helped me along the way so much, so I would be less intimidated by the unknown. They selflessly give us what they learned and what they learned the hard way, sometimes, so we suffer less. That's caritas, isn't it? A form of love. Love is all around and gratitude is ever the appropriate response. And if we can, we try to do the same for others, to honour those who helped us. Also, a lot of people need a lot of information that they really aren't getting. I have had very scared men, some in tears, ask me questions in hospital waiting rooms and clinics, they were so terrified. I wish I had answers for them but I know terribly little myself. I just looked a little more than them like I knew what I was doing, but I was really making it up as I was going along. Not bluffing, just constantly learning and incorporating what I learned into what I did, in an almost frenzied manner, pretty much since diagnosis a year ago to about 2 or 3 minutes ago. Man, I wish I could help those guys. They were in pain and terrified and quite lost.
Understood, Point-naught-two! And good on ya for actually building up muscle when on radiation! I do not have fond memories.
I completely agree, and I think you've hit it on the head with internet communities like this - it is our duty to minimize fear for those that fight with us and those that come after us, in part by honoring those tough ones who came before. While we cannot minimize what a man may feel about his own mortality, we can minimize the fear caused by simply not knowing. My first introduction to PC treatment was through a very positive urologist who repeatedly said that there are multiple tools in this fight - no guarantees, mind, but at least Plans A, B, and C and more coming down the way.
The emotional companion of Knowledge is Hope...I always look for them striding into my life arm in arm, often referred to my door by just a friendly stranger... Claritas, indeed!
During the trial I was on I was first told to take zytiga and prednisone on an empty stomach. When my PSA began to rise I was told switch and take the medication "with" food. My PSA began to go down again. The efficacy of drugs lasted a total of 3 1/2 years
Take you pick, start on an empty stomach and then switch or start taking it with your meal.
Thanks, Magnus...I was a medic for 2 decades and I hate being spoken down to about medicines and treatments. It certainly seems that Zytiga dosing is routinely in this category! Again, knowing that there are options with any specific medication or treatment is critical for patients to give them a broader understanding of what they are going through. - Joe M.
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