I have had to stop taking zytiga due to elevated liver enzymes. I started taking zytiga 5 months ago and after bloodwork showed my liver enzymes to be elevated I was advised to stop which I did (was on zytiga 4 months) After one month of no zytiga my liver enzymes were back to normal so my dr started me back on 750 mg instead of the previous 1000 mg and after just two weeks on zytiga my liver enzymes are elevated again so I have to stop again. Has anyone else had this problem? I’m currently having radiation to my prostate and one bone met. along with 6 month lupron shot.
Elevated liver enzymes: I have had to... - Advanced Prostate...
Elevated liver enzymes
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Oct18
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Can you switch to Xtandi?
the plan is if my liver enzymes are back to normal in 2 weeks, try 500 mg of zytiga. If that doesn't work, then I was told "there are other options". Is Xtandi an oral medication?
Yes - Xtandi = enzalutamide. It's an oral anti-androgen that blocks the androgen receptor and prevents its translocation into the nucleus (which would make it invulnerable).
Thank you so much for the info! It is so nice to have this forum with so many knowledgeable people
Your post motivated me to go read the "Possible Side Effects" blurb that come with my $$$ Zytiga. It says, "Very bad and sometimes deadly liver problems have happened with this drug". But so many potential side effects are listed that it's hard to tell which are likely or serious. Did your Dr infer that your situation was common? Did you have any symptoms prior to disappointing bloodwork results? Good luck. And please keep us posted.
I did not have any prior symptoms. My doctor did say about 6% do have problems with elevated liver enzymes. When I asked him if it was OK to stop the Zytiga he said we don’t have a choice. A toxic liver can be deadly. I am responding well with radiation and Lupron shots, but just a little bummed that the Zytiga may not be an option for me. But I know there are other options .
Some people have tried taking 250 mg with a limited meal and not lost efficacy, although it is not clear if the lower dose resulted in decrease in AST/ALT. Talk with your MO and see if he has further information on this study and LFT's. I believe someone on this board did that and it worked fine...
cancer.gov/news-events/canc...
sciencedaily.com/releases/2...
The other question is whether you take any of the CYP3A drugs which may effect the LFT':
Best of luck with this issue...
Fish
Thank you fish! In a few weeks if my liver enzymes are back to normal I will take 500 mg and discuss things with my doctor a few weeks after that.
Check the CYP3A4 list link I sent--I was taking a Russian OTC med for sleep with a very low dose of phenobarbital--my LFT's were elevated--stopped it and have been fine ever since...under the inhibitors I believe... Good luck...
Fish
Will do, thank you!
Russian OTC? COLLUSION!!!
youtube.com/watch?v=1G9mNBU...
Good luck, Good Health and Good Humor.
j-o-h-n Saturday 05/112019 1:33 PM DST
Heard that and started grabbing my pre-packed escape bag.....thank you for the warning, comrade...Na Zdrovia...
Fish
Great hiding place for you:
Pizda.....
Happy Mother's Day.
Good luck, Good Health and Good Humor.
j-o-h-n Sunday 05/12/2019 1:29 PM DST
I liked the Russian Tea Room, but Pizda....Really? Should I bring a throwaway to NY to see you and the wack air bag? Dang homey !!!! It's a twofer....
Fish
in reply to Oct18
Does anyone know if 500 mg does the job that it needs to. I’m assuming that 1000 is the therapeutic dose. What does Jansen say?
NPfisherman in reply to
1000 mg on an empty stomach is the starting dose advised by Jansen...some are doing 250 mg with a meal--you can google details--in an effort to save money and medicine--seems to work--...anyway...good luck...
Fish
in reply to NPfisherman
Doubt I will reduce it but the muscle loss I’m seeing is beginning to worry me. No I’m not doing the exercising I should be. Starting now. Been on it a year including lupron with a year to go. At least.
GoBucks in reply to
If everyone was taking 500mg, Janssen profits would be cut in half. (sound cynical?) I took 500mg for a month and 750 after that. Still at <0.01. When they do clinical trials they try to find the maximum effective dosage that can be tolerated. Once 1000mg is effective no one is testing to see if 500 or 750 works too.
This happened to my father—his MO took him off Zytiga completely for a few weeks then started him again on 250 mg and slowly worked his way up back to full dose. Liver enzymes went back to normal and stayed normal even after he got back to full dose.
The Zytiga data sheet mentions discontinuing if ALT/AST are > 5 X ULN or bilirubin increases > 1.5 X ULN. (Upper Limit of Normal).
I've been on 750mg/d for one month, after two weeks, ALT jumped to about 1.5x ULN. After one month, it dropped back. But my bilirubin is near the 1.5xs ULN limit.
ALT: 62 > 47 ULN: 46
AST: 43 > 40 ULN: 35
Bil: 1.5 > 1.7 ULN: 1.2
Also, I've read some foods/supplements may help recondition the liver, including Milk Thistle, organic beef liver, and artichoke.
ALT was 106, AST was 211 on March 27th. After stopping for 3 1/2 weeks they were both back to the normal range. So I started back on 750 mg. I don’t know what they are today I just know that they are rising and was told to stop again for two weeks to bring the liver enzymes back to normal
Hi, my liver enzymes, mainly ALT, went up too the first few weeks. My MD then reduced my prednisone from 10 to 5 mg, but we stayed the course on the Zytiga.
Things normalized and fortunately have stayed at the high end of the normal range since. Now at 6 months. Not sure if this helps, but lots of good input on this forum. Good luck!
Good morning -
The exact same thing happened to my Dad. His alkaline Phosphates also went through the roof & his Bilirubin went to 1.9. He was lowered to 750mg at the beginning of April & his numbers seem to be trending down. An interesting article was posted on here about this exact thing.
ncbi.nlm.nih.gov/pubmed/269...
In my Dad’s instance, his numbers mirrored the graph. Elevation at first & lowering now. (At about 12 weeks ). Praying for you & for positive encouraging results !
It was the same with me. I was switched to 750 and been that way for going on 16 months now. There are many options for us so hang in there. Never give up never surrender. Leo
Watch out for herbal vitamins or green shakes that can conflict with zytiga. UROSODIOL can protect your liver. Had same problem with Ketoconozale in 2008. Went to Dr Charles e Myers and he put me on UROSODIOL and lowered my Keto dose. Give a month for herbal supplements to flush out and UROSODIOL to work before starting up liver toxic meds again.
Good to know. What type of green shakes are you referring too? Every morning I have a spinach, almond, banana, and frozen berry with water smoothie/shake. It tastes like a blueberry shake.
No wonder your ALT is going thru the roof. Stop all green immediately if you are on Zytiga or Keto. Give a month to flush out the herbal greens. Suggest same URSODIOL med I took which was prescribed by Dr Charles E Myers for liver protection. It is a prescription and a supplemental remedy for liver problems that started in China thousand years ago. Drunks ate bear meat. Bear meat had UROSODIOL.
I got jaundice because of green shakes in 2008 + Keto and it was a terrible experience. Thank GOD for Dr Charles E Myers (retired) who saved my life and rescued me from Jaundice.
But I thought dark leafy greens were something good. My liver enzymes went back to normal while still having shakes and salads when I stopped Zytiga. Is it the combination of the two that is bad? Leafy greens with zytiga?
I will say a 3rd time. Dont take or drink green or herbal vitamins with zytiga or keto. You will destroy your liver. When you are off liver those toxic drugs like zytiga or keto, you can start drinking all the green you want. I now drink green because I am not on any liver toxic drugs. This advice worked for me in 2008. I paid over $2000 to go see Dr Myers to get this advice after I got Jaundice. He also saved my life with his cancer advice and prescriptions.
Got it, thank you!
Dont forget the UROSODIOL. Your liver is now compromised with the damage you already did and you probably need this extra protection before restarting a liver toxic drug like Zytiga. It was good advice to work slowly into it starting with a lower dose.
If you cant get UROSODIOL, BBQ the meat of a Black Bear if there is such a meat available. It has lots of urosodiol. I am sure there is a renegade dr somewhere who can write you some urosodiol, or go to Canada to get it.
To clarify, I restarted Ketoconozale after severe Jaundice. My Jaundice was so bad I thought I was going to die. Went to see Dr Myers. Rested a month from all drugs, started Urosodiol, slowly worked back into Ketoconazale starting a quarter of the dose and slowly working up to the full dose month by month. Did WEEKLY ALT tests to make sure I was OK. I was fine. ALT did not go up at all. Added in other drugs prescribed by Myers for prostate cancer. Had the longest remission ever in my 17 year cancer experience.
If nothing works to protect your liver, you may have to switch to XTANDI as suggested by TALL Allen. That drug is not toxic to the liver.
All good advice. Thank you for taking the time. So other than my college years 25 years ago, I don't drink nor have I taken any pills except when I was sick my whole life. Before dx I drank a lot of sweet tea, that was my drug. It seems hard to believe that as I am very careful to eat/drink anything that is not healthy that the spinach in my diet (with zytiga) could have caused this. But that is why I ask questions and appreciate all who take the time to give advice. It can be maddening trying to figure out what to do/eat/take etc... dealing with apc.
I too had high liver numbers. Stopped Zytiga for 7 weeks and started again at 500. After a month went to 750 and have stayed there( with 5 mg Prednisone). Liver numbers started rising again but went down and have stayed down. Bilirubin was up though last month. I'm in month 18 of Zytiga.
Thank you, I do drink my share of water, about 6 or more bottles a day.
And I had that backwards. AST 106 and ALT 211
No but I'm responding to let you know we are listening and for those who are most likely to get on Zytiga, we share the concern about the potential liver issues. We are watching and wishing you the best.
Hoping you De Liver.....
Good luck, Good Health and Good Humor.
j-o-h-n Saturday 05/112019 1:38 PM DST
My husband was on a clinical trial with zytiga and either a placebo or the trial drug - his liver enzymes also went to high so they cut him back from 4 pills a day to 3 and said he could not resume the 4 pills. After a year he was taken off the zytiga as it stopped working - not sure if this was an effect of the lower dose.
I was in the same boat. Started on 1000, reduced to 750 and it took a while to normalize. Now on 500mg. Have your blood work done every 2 weeks. I'm Oligo also and had SBRT to the bone. IMRT to the prostate. Good luck.
Thank you, I am having radiation now to my prostate, followed by some radiation to the bone metastases . It sounds like more people have had issues with elevated liver enzyme’s
Sounds like you are on the same plan as I. My PSA rose slightly 2 consecutive times after IMRTand has come down slightly after SBRT. Its at 2.2 What was your prior to IMRT?
Last check March 27th was .02, also the same time I stopped zytiga due to high liver enzymes.
That is excellent. My best was .7 Good luck with your radiation. Mine was w/o issues.
Thank you, so far so good
I had high numbers and my MO took me completely off Zytiga. It took 2 months to come down to a comfortable range. I am now on Xtandi and my numbers are excellent. Actually, once they came down, they stayed down, even through 6 cycles of chemo. I guess all I am really pointing out is Xtandi has not impacted the liver numbers at all which is a relief.
Oct18 in reply to
That is good to hear I hope they stay good for you. Xtandi Has been suggested by Tall Allen. I’m sure my doctor will consider that if I can’t take Zytiga .
I am having the same issue with elevated AST and ALT except my numbers are not going back to normal. I have been off Zytiga for a month, is it normal for the levels to take so long to go back to normal range?
I'm not sure. Mine took a month to get back to a normal range, but as soon as I started back on a lower dose of Zytiga, they went right back up. My doctor finally threw in the towel on Zytiga and I started Xtanti yesterday. Best of luck to you!
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