Zytega hurting my liver

[Billy_Boe]

Hello. I am new to this group. I had my prostate removed in early December. Positive margins and 1 of 9 lymph nodes was positive. 6 of 8 weeks of RT completed. First dose of Lupron in late January. 4 weeks in on Zytega and my liver enzymes are 6 - 10 times max normal range. Stopped Zytega immediately. Will now have weekly blood tests. Has anybody had liver issues with Zytega?

[LearnAll]

Elevated liver enzymes (AST, ALT) is a side effect of Zytiga and many other medicines.

Your doctor has to make a decision if the increase in liver enzyme is significant or not and the decision to stop or continue Zytiga will depend on that assessment.

[Magnus1964]

Have your doctor prescribe Casodex. It's a good replacement drug with fewer side effects.

[Billy_Boe in reply to Magnus1964]

Thank you! I have another appt next Monday to discuss new blood tests and I will ask about this drug.

[CalBear74 in reply to Billy_Boe]

Please remember Big Pharma influences the docs and many have Stopped prescribing Bicalutamide (Casodex) in favor of more advanced “lutamides” which are vastly more profitable. Expect pushback.

[timotur]

Hepatotoxicity

For patients who develop hepatotoxicity during treatment with Zytiga (ALT and/or AST greater than 5× ULN or total bilirubin greater than 3× ULN), interrupt treatment with Zytiga [see Warnings and Precautions (5.3)]. Treatment may be restarted at a reduced dose of 750 mg once daily following return of liver function tests to the patient's baseline or to AST and ALT less than or equal to 2.5× ULN and total bilirubin less than or equal to 1.5× ULN. For patients who resume treatment, monitor serum transaminases and bilirubin at a minimum of every two weeks for three months and monthly thereafter.

If hepatotoxicity recurs at the dose of 750 mg once daily, re-treatment may be restarted at a reduced dose of 500 mg once daily following return of liver function tests to the patient's baseline or to AST and ALT less than or equal to 2.5× ULN and total bilirubin less than or equal to 1.5× ULN.

If hepatotoxicity recurs at the reduced dose of 500 mg once daily, discontinue treatment with Zytiga.

Permanently discontinue Zytiga for patients who develop a concurrent elevation of ALT greater than 3 × ULN and total bilirubin greater than 2 × ULN in the absence of biliary obstruction or other causes responsible for the concurrent elevation [see Warnings and Precautions (5.3)].

[Canoehead]

I had elevated liver enzymes and my MO reduced my dose to 750mg. That didn’t work, so he reduced dose to 500mg. Problem solved. I also took milk thistle, and believe it helped.

[Tall_Allen]

My question is - do you really need the Zytiga? Given that your liver doesn't like it anyway, and there no evidence (yet) that it improves results in the salvage RT situation, maybe you can do without it entirely? Perhaps 2-3 years of Lupron alone is enough?

If you want to "throw everything at it," you can try reducing the dose of Zytiga, but why not combine the Lupron with an advanced anti-androgen instead? They may be less toxic to your liver and accomplish the same thing. There are many clinical trials on this subject. Some combine Lupron with Xtandi or Erleada. Because you've had positive lymph nodes, you should be able to get one of those other advanced hormonal agents instead of Zytiga.

You can discuss all 3 options with your oncologist:

(1) Lupron-only

(2) Lupron with reduced Zytiga dose

(3) Lupron with Erleada or Xtandi

(Don't forget to wean yourself off of the prednisone slowly if you decide on options 1 or 3)

[Hidden in reply to Tall_Allen]

Go Lupron!

[Billy_Boe in reply to Tall_Allen]

Thanks for the tip. I stopped taking the prednisone instantly as well. I was not told to wean off of the prednisone. Do you know what that will cause?

[Tall_Allen in reply to Billy_Boe]

It will cause high blood pressure, low potassium, and edema. Effects may not be immediate. Call your oncologist.

[Hidden in reply to Tall_Allen]

Good answers. Very helpful . Thanks

[Billy_Boe in reply to Tall_Allen]

I have been getting some great replies. Since I am new to this, does everybody see my replies or do I reply to everybody individually (thanking them)?

[Oct18 in reply to Billy_Boe]

We all see the replies. Zytiga elevated my liver enzymes, even taken at lower doses. My Dr. switched me to Xtanti and I have been on that for 8 months with good liver results as well as continued undetectable PSA. As far as weening off of prednisone, I only took 5 mg a day so I was advised to take every other day, then every 3rd day for about a month until I just stopped. If you weren't on prednisone very long it may not matter if you didn't ween off of it but take TA's advise, ask your Dr.

[Tall_Allen in reply to Billy_Boe]

I do not see your replies unless you reply to me directly.

[Victorq1 in reply to Tall_Allen]

Hi Tall_Allen

and Billy_Boe

And All.

Interesting question Tall_Allen.

Do we really need Zytiga?

I had been diagnosed with PC 13 years ago and I am still alive! I live in Canada and occasionally, in Europe and Mexico.

If you travel ,you often meet Practitioners , who are not really much interested. I had described on Health Unlocked

a situation, where my Oncologist substituted Casodex (Bicalutamide) for Anandron (Nilutamide).

That caused a condition ,not much known than. At least out of eight doctors, who were treating me ,did not know, that Nilutamide can cause a type of Chemical Pheumonia ,that can kill you.

Well,its a longer story, I can send details to people ,who are interested.

And that leads me to your case, Billy_Boe.

where Tall_Allan is recommending a mono-therapy with Lupron, among others ,

with Lupron alone.

Caution!

That is what I did ,for almost two years.

My PSA which was than around 5,15,32, suddenly

rose to 160.

I was in Mexico and in pain.

After a metastasis positive, detected by the bone scan, out the few treatments available there, was only chemotherapy

with Docetaxel.

See

The MX Oncologist , who did part of his studies in Canada

suggested , I return there, for Zytiga (Abiraterone ) and Prednisone treatment.

Zytiga is not available in MX , too expensive !

So I am joining the club and will start the drugs next week.

Will watch the liver enzymes and stop red wine !

Good to know what to expect.

Where I live in Canada, they offer Zytiga only ,

not Enzalutamide, so far.

I think with advanced prostate cancers and mine is metastasized into the pelvic bones,the name of the game is ,

to gain some time with whatever.

Like Zytiga ,which was not available , still a while ago, there will be other treatments, so lets hang in there,

describing your experiences

BTW joining these forums, you are newer alone and the collective knowledge here is remarkable.

Your input is appreciated and

Good luck to us all !

Cheers ! victorq1

[Tall_Allen in reply to Victorq1]

You are in a very different situation. BillyBoe is using Lupron+Zytiga as an adjuvant therapy to radiation, not as a permanent therapy. There is no data that it useful as an adjuvant therapy. It may be, there is just no data that supports that use.

[RayF in reply to Tall_Allen]

Haven't there been a few thread comments that Zytiga is more effective with certain foods? I recall one guy here taking 250 mg with food in the morning, and that being effective.

It seems that many of us could be on 250-500 mg with food. I realize the studies were done with 1000 mg on an empty stomach.

[Tall_Allen in reply to RayF]

It isn't more effective with food. Food just increases its absorption, so the same amount of abiraterone gets into the bloodstream with a lower oral dose. That doesn't help the OP who has a toxic reaction from the amount of abiraterone that is in his bloodstream.

[RayF in reply to Tall_Allen]

Thanks for the clarification TA.

[TNCanuck]

Yes. My husband's labs were bad enough soon after he started Zytiga in late 2017 that his doctor discontinued it. The doctors don't seem concerned now that he can't tolerate it, since enzalutamide is available.

[Victorq1 in reply to TNCanuck]

I wish well.

Good ,that Enzalutamide is available where you live.

[abmicro]

Had Jaundice with a similar med because I drank herbal shakes without realizing the shakes conflicted with the med. Stopped everything until all traces of Jaundice resolved, then Dr put me on URODIOL to help protect liver. Worked into med that caused Jaundice starting with a quarter of the dose and working up to full dose within a month. Weekly blood tests. UROSODIOL continued. No more herbal shakes. Jaundice was a horrible experience.

[ctflatlander]

You could try 750 dose after your liver recovers. If that fails you could try 500mg. Be sure to wean off pred when stopping Zytiga. I'm on 500 dose for 1 1/2 yrs.Best Bob

[Newyork6264]

I did. Stopped for a week, had another blood test that showed liver numbers them lower so Doc restarted me at 3/4 dose. So far so good after that. Also be careful with alcohol consumption.

[bcobbjr44709]

Are you on medication for high blood pressure I had to change my BP meds and now BP is great and still on zytiga and prednisone

[Cmdrdata]

Have been on Z for 24 months, liver and other test results have been within limit. T is still at castrate level and PSA 0.01. Glucose slightly elevated at 120-130. BP around 140/80

[Wilbur77]

Billy, take care of your liver. My Med Onc was quite concerned when my AST/ALT numbers rose to more than 5X Upper Limit of Normal after taking Zytiga & prednisone for nearly 4 months. Labs were fine up to then. It took several months for numbers to recover (also had an abdominal ultrasound to check liver). I tried Zytiga again at only 500 vs 1000 mg, but numbers shot right up after only 4 days. Luckily my Med Onc was right on top of it and immediately stopped meds. Took another 3 months to return to normal with limited meds, no alcohol. Next up will be Enzalutimide or Keytruda if necessary, but currently my PSA is <.06 with just Lupron, so just coasting for now and very happy with the results of my treatment. I do think the early treatment with Zytiga was helpful, but really hard to say for sure. Good Luck!

[KJMinPhx]

When my MO first started me on Zytiga he prescribed a dose of 1000 mg, and my liver numbers were terrible. So he lowered the dose to 750 mg and that has been working quite well ever since. Been on it (plus Lupron) for one year three months and my PSA remains undetectable, with my liver doing just fine.

[Victorq1 in reply to KJMinPhx]

Good luck and long life !

I am starting Zytiga with Prednisone next week.

Good to know what to expect

[Billy_Boe]

Thanks to everybody for the wonderful input. I have my next round of blood work this Friday and discussion with MO on Monday. I am hoping liver numbers go down quickly.

[Hidden]

My husbands liver enzymes went way up also. He also had horrible symptoms being on it. His doctor cut his dose in half. He also started on milk thistle. He tolerated the half dose very well. PSA is down to 0.08 and Testosterone is less then 7. All liver enzymes are now normal. He is doing well right now. It was a rough start, but his doctor is wonderful.

[Doggedness]

My husband is on Zytiga and I think my his liver numbers rose too, but he did something to get them down... I can’t remember what though. We’re you on electrolytes? My husband is on potassium in particular. I’ll find out what he did to fix the liver issue.

[j-o-h-n]

I see your replies...... There is a way to send a private message (reply) that only the recipient can view. Go to your home page and you'll see how to send one....

Good LucK, Good Health and Good Humor.

j-o-h-n Wednesday 04/15/2020 6:24 PM DST (formerly Uncle Sam's birthday)

[NOCanceros]

Hi Billy

Try SilyMarin you find this product in your country.First read the information,i'm using it up to now my liver is okay.

George

[CalBear74]

The life extension foundation offers a product that is called European milk Thistle. You can find tests of this product. This is called Silymarin.

[GoBucks]

After 7 months on Zytiga my liver numbers skyrocketed. My MO took me off Zytiga for about 7 weeks until my liver numbers were normal. I restarted at 1/2 dose with weekly blood tests. Once numbers were stable I went up to 3/4 dose. Liver numbers have remained normal.

[Billy_Boe in reply to GoBucks]

My MO called today. My AST and ALT sot up and are 2800 and 1400. Been off Zytega for a week. No alcohol. Doctor is surprised I only feel a bit nauseous. Wants me to see GI doctor for sure on Monday. These numbers are a bit worrisome. Has anybody been through this? I would see doctor tomorrow if I could.

[GoBucks]

Wow, never heard of that. Even if they were 280 & 240 that'd be high. When my numbers were going up my MO was going to order a liver scan if it went up more. Luckily my numbers came down. Perhaps you will have that. Good luck.