Side Effect of Zytiga. Any non-medication approach?

[bellyhappy]

Just got back from the doctor, after one month on Zytiga, PSA has come down from double-digit to single-digit. The side effects of hot flashes and waking up two to three times a night continue. Any suggestion without taking more medication will be very much appreciated

[Tall_Allen]

(1) acupuncture

(2) estrogen patch

(3) venlafaxine

(4) Megace patch

[NPfisherman in reply to Tall_Allen]

Megace patch ?? Really-doesn't show up in PDR..... oral suspension and tablet...

pdr.net/drug-summary/Megace...

Megace has a lot of serious SE--weight gain--especially for someone on Zytiga--takes prednisone... new onset DM--see below

Side effects:

Adrenal insufficiency, Cushing's syndrome, diabetes mellitus, hyperglycemia, hypotension, hypothalamic-pituitary-adrenal (HPA) suppression, infection, surgery, vomiting

The glucocorticoid activity of megestrol has not been fully evaluated, clinical cases of new onset diabetes mellitus, exacerbation of pre-existing diabetes mellitus, hyperglycemia, and overt Cushing's syndrome have been reported in association with the chronic use of megestrol. In addition, clinical cases of adrenal insufficiency have been observed in patients receiving or being withdrawn from chronic megestrol therapy in the stressed and non-stressed state.

As for the megace patch, I believe it was withdrawn--see below:

clinicaltrials.gov/ct2/show...

Status says: Withdrawn

As for venlafaxine--SE profile leads me to believe that I would avoid that too--see below:

Effexor (venlafaxine) is an antidepressant used for treatment of major depression. A generic version of Effexor is available. Side effects of Effexor include

•dizziness,

•nervousness,

•nausea,

•constipation,

•headaches,

•anxiety,

•insomnia,

•strange dreams,

•drowsiness,

•increased sweating,

•blurred vision,

•dry mouth,

•changes in appetite or weight,

•decreased sex drive,

•impotence,

It actually can be quite energizing in the elderly--can raise blood pressure also...

I believe the poster asked for a NON-MEDICATION treatment --- acupuncture on a regular basis will be quite pricey...

All the best,

Fish

[bellyhappy in reply to NPfisherman]

Thanks, NPfisherman and Tall Allen. Acupuncture is definitely something I could look at. Thanks again

[Tall_Allen in reply to NPfisherman]

I listed Megace last because of potential side effects (weight gain, gynecomastia), but I know several guys who have used it and like it, and several doctors who prescribe it for this purpose. As a patch, one avoids many of the side effects. Both estrogen and Megace can be made up by compounding pharmacies fairly inexpensively. With estrogen or Megace, you will want to take tamoxifen with it to prevent breast enlargement.

Here's data on all of these:

Megace:

nejm.org/doi/pdf/10.1056/NE...

thelancet.com/journals/lano...

Transdermal estrogen:

goldjournal.net/article/S00...

Venlafaxine:

jurology.com/doi/10.1097/00...

One can be taught to self-administer the acupuncture:

ncbi.nlm.nih.gov/pubmed/164...

Discuss with your oncologist.

[NPfisherman in reply to Tall_Allen]

Please list the pharmacies where you get your Megace patches compounded --with name, address, phone number, and prices of course....... Estrogen patches are available at the pharmacy but megace....NOPE !!!! First, you would have to have an approved transdermal delivery system and then get the megace into it... The cost would be astronomical to begin with, and I listed above that the clinical trial for megace patch--withdrawn.

As for the journal articles, what?? Going back to the 90's?? Soon, you'll be in the 80's... Venlafaxine is not a great drug for people who are not sleeping....I guess you can't address that either...as for what formulations I am aware of.. you might be surprised.....GOOD LUCK WITH THAT MEGACE PATCH IN THE US....

[NPfisherman]

I take Zytiga.....the hot flashes probably can't be relieved without using a med....It has become more tolerable over the 3 months I have been on it...some women use black cohash tea but I never tried it and not at night for sure...

I use sleepytime tea and melatonin 5 mg--some people take a melatonin 1 mg sublingual when they get up to pee as a booster to help sleep....try going to bed at the same time at night--10-11 pm, relax before going to bed---read a book-don't watch the news--nothing good there, take your sleepytime tea, light meditation...I still wake up around 3 am but this helps...

All the best,

Fish

[bellyhappy in reply to NPfisherman]

Thanks for the suggestion....

[NPfisherman in reply to bellyhappy]

Welcome fellow sufferer on this hell ship...I have been here only a short while and advise reading pjoshea13 and Nalakrats (I follow them) for information--they are knowledgeable posters on recent medical advances in prostate cancer, supplements, alternative treatments...quite up to date... Many others provide useful info--

You are not alone... it is a shock...it takes time to adjust.,, feel free to come here and vent.....realize that and enjoy each day...like the coffee cup reads-- Live, Laugh, and Love....

All the best,

Fish

[Tall_Allen in reply to NPfisherman]

No alternative treatments (soy, black cohosh, flaxseed) have been proven effective in clinical trials. Black cohosh has been associated with liver damage. Flaxseed oil may cause allergic reactions and may contribute to prostate cancer.

[NPfisherman in reply to Tall_Allen]

I said some WOMEN utilize it but I did not endorse it... here's some info from a reliable source on it:

nccih.nih.gov/health/blackc...

Only with the COMMERCIAL formulations has there been issues of liver toxicity and that is in RARE cases. Read the above.

They do say that people have utilized it safely for a year without issues.

[Tall_Allen in reply to NPfisherman]

Why advocate dangerous substances that have been proven ineffective?

SAFETY

"Acute liver failure associated with the use of herbal preparations containing black cohosh."

ncbi.nlm.nih.gov/pubmed/145...

Did you actually read the citation you provided? It says:

"Cases of liver damage—some of them very serious—have been reported in people taking commercial black cohosh products. These problems are rare, and it is uncertain whether black cohosh was responsible for them. Nevertheless, people with liver disorders should consult a health care provider before taking black cohosh products, and anyone who develops symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking black cohosh should stop using it and consult a health care provider."

"It’s not clear if black cohosh is safe for women who have had hormone-sensitive conditions such as breast cancer or for pregnant women or nursing mothers."

EFFICACY

"Overall, black cohosh was not associated with changes in the number of hot flashes Only 1 study assessed the association of black cohosh with the number of night sweats within 24 hours; this study reported no difference."

jamanetwork.com/journals/ja...

"Black cohosh used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms."

ncbi.nlm.nih.gov/pubmed/171...

"There was no significant difference between black cohosh and placebo in the frequency of hot flushes...Compared to black cohosh, hormone therapy significantly reduced daily hot flush frequency."

cochranelibrary.com/cdsr/do...

"Reductions in number of vasomotor symptoms after a 12-month intervention were as follows: black cohosh (34%), red clover (57%), placebo (63%), and CEE/MPA [estrogen and progesterone] (94%), with only CEE/MPA differing significantly from placebo. Black cohosh and red clover did not significantly reduce the frequency of vasomotor symptoms as compared with placebo."

ncbi.nlm.nih.gov/pmc/articl...

"The primary efficacy analysis showed no superiority of the tested black cohosh extract compared to placebo."

maturitas.org/article/S0378...

"The evidence from these RCTs does not consistently demonstrate an effect of black cohosh on menopausal symptoms"

sciencedirect.com/science/a...

[NPfisherman in reply to bellyhappy]

See Nalakrats post to you below: he has provided some possible non-pharmaceutical solutions to your issues. Good luck...You are not alone....

All the best,

Fish

[Crabcrushe in reply to NPfisherman]

I don't get up to piss; just roll half way to the left and piss in a cran/pom bottle.

Probably don't come very far up outta REM. Barely remember it.

Military situations I've been, you don't get to "get up and take a leak". lol

Charlie

[TNCanuck]

Gee, Fish. You forgot to list unexpected vaginal bleeding as a Megace SE. 🙄 Belly, my DH has used both Megace and Effexor to combat hot flashes and found Effexor to be most effective. No side effects from either. I understand the reluctance to avoid more meds, but if something can reduce hot flashes and improve your sleep quality and duration, it could be worth it.

Whatever you decide, hang in there.

[NPfisherman in reply to TNCanuck]

And do they use the megace patch in the US?? LOL...no, the megesterol suspension or tablet could make someone pack on the weight for sure...usually in higher doses though...used in the elderly for cachexia...

[TNCanuck in reply to NPfisherman]

I have to assume they do, since my husband's doc mentioned a megace patch as an option.

[NPfisherman in reply to TNCanuck]

Are you in Canada??

[TNCanuck in reply to NPfisherman]

Nope. Tennessee

[NPfisherman in reply to TNCanuck]

The estradiol patches I am familiar with, but megace...I have a call to a compounding pharmacy but I am unaware of transdermal compounding of megace Megace comes in a liquid suspension and tablet form--the suspensions have a problem with settling, thus different dosing if not shaken every time before use (uniformity of delivery) Thus, more challenging to compound and get same dose every time....besides that, the suspension is flavored and that too, may provide a problem with transdermal absorption due to the extra substance ( I am not a PharmD)...The trial for megace patches was ended several years ago....and we haven't even discussed costs IF it is available...I'll post an answer IF it is available and cost as soon as I have it. But if, indeed, it is available....I do not believe it will be easy on the pocket book. Also, not every pharmacy compounds, so getting it would be a challenge IF it were available to begin with. He can post about the estradiol patch--I know it is available and inexpensive---

Where are the phase 3 clinical trials on the megace patch ?? They can't be found....

[Tall_Allen in reply to NPfisherman]

I provided links for two of them above.

[NPfisherman in reply to Tall_Allen]

Megace Patch was withdrawn during phase 2 trials

[Tall_Allen in reply to NPfisherman]

There have been several RCTs already (links above) that proved it effective. Here are 3:

ascopubs.org/doi/full/10.12...

nejm.org/doi/pdf/10.1056/NE...

thelancet.com/journals/lano...

I have no idea why you keep bringing up a trial that was withdrawn.

[NPfisherman in reply to Tall_Allen]

None of these citations involve the Megesterol acetate (Megace) Patch...The patch that was listed in the beginning...The patch you advised a forum member to get...This patch was withdrawn from phase 2 trials... see one of my posts above--it is not compounded--we discussed this in earlier posts--your pharmacy that you said compounded it---Does not make a megace patch--The only evidence you provided was an anecdotal story regarding a member in one of your groups having one--I suspect he does not---as previously, the transdermal patch delivery system requires a solution that readily passes through the patch for absorption into the skin. The megace suspension does not lend itself to this type of delivery due to several issues which I also listed above to you.

In essence--you advised the forum member to get a megace patch--it was withdrawn from phase 2 trials--you could provide no pharmacy that compounds a transdermal megace patch... Your websites listed above deal with oral meds--

Hopefully, this recitation of the facts have made the arguments regarding the non-existent megace patch that you recommended more clear...

Regards,

Fish

[Tall_Allen in reply to NPfisherman]

You are wrong. I know a man who had the Megace patch, and you see above the post from TNCanuck whose husband was offered a Megace patch. A compounding pharmacy can make it up - if you are interested, call around. I just called the supplier of the Encino Family Pharmacy. They can indeed make a megestrol cream or patch. They said that any steroid (estrogens, progesterones, testosterone, cortisones) can be made as a transdermal cream, and any transdermal cream can be incorporated into a patch. Transdermal application of estrogen and progesterone is preferable because of a lower side effect profile.

[NPfisherman in reply to Tall_Allen]

Talked to your pharmacy--no patch--it does not exist and wishing will not make it so...I spoke with Amir-- at some point, you need to acknowledge that you have no proof and wishing will not make it so... As stated previously, Megace Patch died in phase 2 clinical trials--the suspension does not lend itself well to transdermal uniformity and absorption... Once again, even if, and that is a big IF, it were to be compounded as a transdermal patch, the cost would be high financially...

Telling me that I am wrong with no proof based on 2 anecdotal stories--TN Canuck who says we " have to assume they do, since my husband's doc mentioned a megace patch as an option. " when--months ago...maybe he said estradiol--who knows and your claim that some unknown follower has one...

I asked for a pharmacy--address--price--you stated it was available and low cost--if you had the information you would post it by now.... so....you don't.... The fact that you can not provide this information readily should tell you that the average forum member can not get it, if you can't...

[Tall_Allen in reply to NPfisherman]

I just did post it - you may have missed it. I spoke to their supplier. Ask your oncologist - it's by prescription. I will stop feeding the trolls now.

[TNCanuck in reply to NPfisherman]

I didn't misunderstand. Not sure what your goal is here, but I will not respond again.

[NPfisherman]

THERE IS NO MEGACE PATCH....A PHARMACIST CAN NOT FORMULATE A MEGACE PATCH....THE TRIAL WAS WITHDRAWN.. Even if a PharmD could make a megace patch, the problem would be where to get a transdermal system that is appropriate...secondly, the cost....it would be huge...

[Tall_Allen in reply to NPfisherman]

Call my local compounding pharmacy to get a less expensive transdermal preparation:

encinopharmacy.com/hormone-...

[NPfisherman in reply to Tall_Allen]

Just spoke with my compounding pharmacist--they do not do it--only one in 50 miles--do not do transdermal compounding--creams, lotions--yes....it is not done by everyday pharmacies, and if it is done by some large specialty compounding companies, then it is not easily available---So why offer it?? ...Ever heard of availability...I'll check your link--- In compounding for transdermal--the problem is uniformity of delivery--ie: dosing. The suspension would not lend itself well to that venture.

[Tall_Allen in reply to NPfisherman]

Compounding pharmacies ship by mail these days.

[NPfisherman in reply to Tall_Allen]

No....your pharmacy did not list megace--megesterol acetate....Try again... I just spoke with Amir at Encino Family Pharmacy--they do not do transdermal compounding--this would have to be done in a sterile facility, I believe...he said they do creams

[NPfisherman in reply to NPfisherman]

Correction--transdermal compounding of megace...

[Tall_Allen in reply to NPfisherman]

Creams are transdermals. Megace -megestrol is one of many progesterones used for this purpose. It is also an anti-androgen.

[NPfisherman in reply to Tall_Allen]

You stated MEGACE PATCH--do you know what a PATCH is?? Answer--it is a non-existent pharmaceutical

[Tall_Allen in reply to NPfisherman]

Tell that to the man in my support group who uses one.

[NPfisherman in reply to Tall_Allen]

You can find no pharmacy--listed your pharmacy as doing a megace patch--they say no....I asked a compounding pharmacist and she said, "It would have to be done in a sterile environment" and also questioned the dose delivery stability of using megace suspension.

[NPfisherman in reply to Tall_Allen]

Don't change horses in the middle of the race--you said megace patch--provide a list of pharmacies with prices in US,

[NPfisherman]

Thanks Nalakrats...it is good that you are available to provide non-pharmaceutical solutions as the poster requested. This is why I advised him to follow you and Patrick...

All the best,

Fish

[Hidden]

Hi Nala,

What, THC will alleviate most side effect? Is it perception from the effects to our minds, mood, and side effect will not come back after withdrawal:

healthline.com/health/marij...

Side effects are biological responses, overlaying it with THC is palliative, is this what you meant?

[dadeb]

We were offered a Megace patch for appetite- but blood clot risk. What’s your deal?

[bellyhappy]

Thanks a lot. As I am new in this group, kindly advise what is THC. Medical Marijuana is not available where I lived.

[Sherpa111]

I am utilizing Accupuncture and it seems to work. I go twice a month. I am not a fan of taking pills to counter side effects of other pills. Just my humble opinion. Good luck! Peace.

[bellyhappy in reply to Sherpa111]

I am also not a fan of taking another medicine to counter side effects. Thank for your suggestion.

[j-o-h-n]

Welcome to the HealthUnlocked open. Tennis anyone?

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 02/01/2019 8:32 PM EST

[Raylin]

I had the same issue. I could not get to sleep or stay asleep. I take a THC oil before bedtime and it works great with no side effects. But its availability depends on what state you live in.

[bellyhappy in reply to Raylin]

Thanks a lot. The area that I live does not permit THC

[Lettuce231]

Hi, I too have all those side effects, but consider it worth while for the result. My previous treatment had all of those, plus acid indigestion, very bad stomach, etc, etc, I was so weak and tired all the time, I felt lousy.

Hope it works out well for you, I am looking at the possibility of reducing the dose for a while, say 3 months, then bringing it back up again. Not sure yet.

Stay in there