Prednisone 5mg twice daily ready to toss the bottle on my road

[depotdoug]

Abiraterone only 250mg daily, Lupron 90 Inj's, and Prednisone 5mg/2X/day since Sept 2019. PSA 0.54 Sept 0.80 Dec 2020.

Read this please: Why was I so energized from a steroid on my Adv PCa treatment?

Had an annual Eye Exam yesterday, complete and comprehensive. My energized, hyper anxious, anxiety riddled body with Prednisone was running rampant.

Mask , yes, face mask req'd during Eye Exam, caused massive glasses and eye fogging. Yes, I was a confused irritated impatient eye patient for 30+ minutes. Could not read eye exam chart letters or words clearly or that was what my eye-fog was telling me. My optometrist assistant lady felt my extreme energized attitude and tried to console to continue trying to read with and without glasses. Atone point Doug(me) was almost out of chair and saying I've had enough.

I know Abiraterone (Zytiga) meds are combined with Prednisone 10mg daily to decrease the risk of Mineralocorticoid excess in my blood chemistry.

But this much energized anxiety steroid flowing from my 68.9 year old body?

Thoughts?

Depotdoug

[tango65]

You could request to change prednisone for eplerenone, an aldosterone receptor blocker which could control the mineralocorticoid excess caused by abiraterone. It is not the SOC,. There are preliminary data indicating that it may work.

ascopubs.org/doi/abs/10.120...

[GP24]

You could reduce the prednisone to once daily or stop taking it for a while. Or try to use a different corticosteroid like 0.5 mg of Dexamethasone or 40 mg Hydrocortisone.

[depotdoug in reply to GP24]

I’ve heard about Dexamethosone but Eplerenone no. Time to check them out tonight this weekend. Less cardiovascular issues with Dexameth or Epe? I have no idea.

[tango65 in reply to depotdoug]

Dexamethasone is much more potent than prednisone. Dexamethasone could cause the same symptoms you are having now.

accessdata.fda.gov/drugsatf...

Eplerenone is a specific aldosterone receptor blocker. Aldosterone is the hormone which is elevated when one takes abiraterone and it is the cause of hypernatremia, hypertension, edema and hypokalemia. . When taking eplerenone the excess of aldosterone caused by zytiga may be under control because the aldosterone receptors are blocked by the eplerenone.

Eplerenone does lower the blood pressure in hypertensive patients, and it can cause an increase in potassium and it can reduce blood sodium levels. You need to discuss this drug with your MO and with an internal medicine doctor and have electrolytes checked periodically.

[depotdoug in reply to tango65]

You got it. I will compile a draft and final document this weekend to send to my MO and super Cardio doc.It should or should not surprise them if if they know their professions well.

Thxs

Doug

[GP24 in reply to depotdoug]

Abiraterone causes mineralocorticoid-related adverse events which are hypokalemia, hypertension, and fluid retention. Adding prednisone will avoid these side effects. I think you can safely reduce the dose to 5 mg or stop at all for four to six weeks to see if this helps you.

Dexamethasone is a different corticosteroid which you can try, it may make a difference. Eplerenone, which Tango mentioned, is no corticosteroid and will avoid the mineralocorticoid toxicity in a different way. As the study shows, this is experimental but could be worth a try.

The cardiovascular issues are caused by the Lupron you get in combination with Abiraterone.

[depotdoug in reply to GP24]

You've got a lot of excellent info to digest. Good time tonight and Sunday to do some extensive reading on these 'mineralocorticoid-corticosteroid' complicated interconnected meds. Thanks again GP24.

[Hidden]

I had the same problem and had 10mg reduced to 5mg daily. That was 6 months ago. I feel much better and my blood work shows no negative effects from a reduced dose. Of course, it's just my personal experience, obviously I'm not a doctor.

[depotdoug in reply to Hidden]

Was that you and your med onc doctors decision to reduce Pred from 10mg to 5mg per day??

[Hidden in reply to depotdoug]

I just reduced from 10mg to 5mg after discussing it with my MO last week. For nmHSPCA the guidance from Jansen is 5mg.

You may experience some fatigue while the body adjusts to the reduced daily dosage. My fatigue lasted about 7 days. Been feeling better as of today.

[depotdoug in reply to Hidden]

Thxs. I think my med onc mentioned dropping to 5mg daily, especially since I’m taking 250mg Abiraterone so far.

Main concern is excessive energy but

another negative impact may be my Cardiac issues.

1. BP increase or decrease? My cardio super doctor just added Furosemide 10mg and i’m on HCTZ 12.5mg plus Potassium CL ER(huge tab)

2. Want to stay in NSR, since my RF cath ablation May 2020 i’ve been in NSR for 268 days and love that feeling. NO AFIB.

Lots of things to consider.

My MO may even up increase my Abiraterone Mar 12th on my next visit?

All assuming my PSA stays at 0.805 (12/15/2020) or jumps up up.

I’m repeating my own PSA & T-level labs this Monday at Lab Corp... through Request A Test web.

[Hidden in reply to depotdoug]

Yes it was, she monitored me closely for a month, (blood work every week) and told me it was ok to only take 5mg. (My blood work has shown acceptable numbers since)Note: I am metastatic castrate resident.

[depotdoug in reply to Hidden]

Great to hear. I will look forward to getting my PSA /T-level labs this coming Monday AM, depending on the amount of snow job we get hit with Sat eve to Sun eve.A PSA increase jump will probably change my path. Which way I don't know. My Med Onc does not know about this interim PSA lab yet. It will be 6 weeks since my last Dec 18th 2020.

[j-o-h-n]

My first suggestion is ask the doc if he makes house calls.

Second suggestion is if doc has a sign in his office which reads "eye exam while you wait" get the hell out of the office asap.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/30/2021 12:03 AM EST

[depotdoug in reply to j-o-h-n]

I shall do exactly that. When i pick up my new 2021 hi-tech lenses and frames 2018 model, will ask” can i get an exam again while i wait”. I’m excellent at wait game. Shocking response i bet.

[j-o-h-n in reply to depotdoug]

Take picture........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/30/2021 7:47 PM EST

[depotdoug in reply to j-o-h-n]

A picture is worth a thousand words I’ve heard. I’ll wait???

[Roscoaus2000]

Hi, I had my eye test yesterday also. The nurse put sticky tape along top of mask to stop glasses and test equipment fogging up. It worked. I have been on Abireterone for 32 months. It has taken that long to go from 0.001 to 0.04. My first 3 weeks really upset my digestion but I persevered and I came good. My blood pressure went up 20 points and my MD has me on Perindopril 5mg to keep it under control. After 12 months my Oncologist said that new information he had that I need only 5mg of Prednisolone and that is what I have used since. My blood tests are all within limits.Prior to this I was on Bitaculamide for 12 months before psa went back up to 2, then Enzalutamide for 4 months , psa down to 0.001, I was full of energy but it broke the blood brain barrier and I had a mild seizure thus onto Zytiga!

My energy is good for an 80 plus yo. Perhaps your Onnc. Could agree to reduced Prednisolone?

[depotdoug in reply to Roscoaus2000]

80+ year old wow, You are doing good quite well on you ADT Abi, Preindopril meds. I had no ideas that Abiraterone(zytiga) can or could cause brain seizure with blood vessel breaking?Yes, I will message this weekend my Med Onc, his RN about reducing my Prednisone from 2 5mg per day to 1 per day. Also send the same to my super Cardiologist's thru his RN Kim.

I will am enlisting both my Med Onc, Cardiologist and my PCP family doctor in all of this mess.

One option still on the table is to throw my Prednisone out on our road.

Doug

[Roscoaus2000 in reply to depotdoug]

Depotdoug. You misunderstood me. It was the enzalutamide that went through the brain. Abiretarone is Zytiga.

[depotdoug in reply to Roscoaus2000]

So enzalutimide you were taking caused your brain seizure. Hope you are doing well or better since. Thxs for the update. I have no qualms about taking increased incremental dosages of Abiraterone meds if thats what it takes. Appreciate your details, friend. We are all in this life situation together helping as we learn. Maybe sometimes more than our skilled doctors, especially about our SOC and or QOL.

[NRoundy1 in reply to depotdoug]

Darolutamide may have less side effects and does not cross the blood brain barrier. ncbi.nlm.nih.gov/pmc/articl...

Firmagon/degarelix and the new oral LHRH Antagonist Relugolix, are shown to have dramatically less heart toxicity compared to Lupron.

[depotdoug in reply to NRoundy1]

Sounds great. If i could only get my MO and insurance Co. to agree on processing Relugolix. With resanable co pay. I’d switch to Relugolix.

[Haskell]

I'm 73. PSA 17. Just getting ready to start the Lupron, Aberaterone, Prednizone regimen. Any helps or warnings I need to consider?

[Hidden in reply to Haskell]

Start exercising now and incorporate a plant based diet.

[depotdoug in reply to Haskell]

Same here, exercising is a must at least for me. I was before I started Lupron, Abiraterone, Pred Sept 2019 so it was easier, yeh right. It's a mind thing do it every day if possible, enlist a well known cancer focused Physical Trainer if you can.

[Hidden]

Getting ready to visit PF to work out and a hydromassage session.

[depotdoug in reply to Hidden]

Just returned home from PF SW FT Wayne. GOt most of my Cardio in.Snow starts tonight @ 8PM on with 5-9".... Probably won't go back to PF tonight or Sunday. Oh well.

THere's always Monday.

[Hidden in reply to depotdoug]

Yeah..us too..but I gotta get my workout 🦾hydromassage session in.

Life's necessities

[Hidden]

I had the same problem. Dropped to half dose and not only saw the changes noted by others but a drop in glucose levels from 150 to 95! So could also stop Jardiance with its lousy side effects as well. Been over 6 months and all is well. PSA at 0.0

[depotdoug in reply to Hidden]

Will see what my Monday PSA lab is lowest so far is 0.475. Dec’s 0.800.

[PhilipSZacarias]

Hello DepotDoug, I have been taking 1000 mg abiraterone 2 hours after meals per day with only 5 mg prednisone with meals. Blood work confirms that my potassium levels are normal. I also check blood pressure once every other day and that has been normal as well, although I have found that adding salt to my food now raises my blood pressure more (which it didn't before). I am also eating more and greater variety of fruits which are good sources of potassium.

250 mg of abiraterone per day is 1/4 the recomemended dosage. Your PSA is rising so you may want to increase the dosage of abiraterone. If you reduce your dosage of prednisone it is better to taper off slowly by cutting one pill in half then in quarters and then none until you only have 5 mg. Cheers, Phil

[depotdoug in reply to PhilipSZacarias]

Understandably so PhilipSZacarais.

My MO(1st one) now on 2nd one same facility, understood my complicated cardio issues along with my Cardiologist(s) and EP docs. Late 2019 when i started ADT again with my cardio/EP convurrence i was in persistent AFIB. Then Feb 12-14 2020 was inpatient w/AFIB had a 4th cardioversion. That led to my RF cath ablation May 6th successful yeh, so far 268 days in normal sinus rhytm. Yes!

Was hospitalized Aug 12-13,2020 with elevated Troponin cardiac blood levels.

Am i concerned with Abitaterone/Lupron inj’s/Pred meds absolutely.

This next Mondays PSA and T-lvl labs should be relevant, lets see it PSA jumps above 0.800 or stays or ?

Yes I am receptive totally to increasing my Abiraterone to 500 or 750mg with my MO’s concurrence and Cardiologists knowledge.

My next MO office visit in Indianapolis, IN, and total CMP, CBC, and PSA Blood labs are March 8th before MO vist on March 12th.

Monday next will be interesting PSA lab results 2-3 days after. Plus throw in my 69th B-day March 10th.

Question: 500 or 750 or stay on 250 Abiratetone meds for my birthday present? Answer: i can always go up.

Off to exercising next.

Depotdoug

[Doseydoe]

I've had dexamethesome and it's like speed. I'd stop taking the steroids and see what happens, DD.

[GP24 in reply to Doseydoe]

I currently take Dexamethasone and do not notice any side effects.

[Doseydoe in reply to GP24]

Wow, I was taking 8mg of dexamethesome twice a day before my chemo shot, on the day of chemo and the day after. How much were you taking?

[GP24 in reply to Doseydoe]

This is the dose you take before chemo. Which is a very high dose. When you combine Dexamethasone with Abiraterone you will take 0.5 mg a day.

I currently take 1 mg per day and will reduce that to 0.5 mg and following that to 0.25 mg. I hope to mitigate scarring after my recent TURP this way.

[Doseydoe in reply to GP24]

How would dexamethesome reduce scaring?

[GP24 in reply to Doseydoe]

This study used deflazocort but I replace this with Dexamethasone, another corticosteroid. As I said, I just hope it works.

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

[docbulldog in reply to GP24]

I was taking .5 mg of Dexamethasone with my 1000mg Zytiga but upped it to 1mg hoping it would help knee pain. I have noticed a lot more abdominal bloating since on the correct dose of the steroid.By the way, my pharmacy made a mistake and had me on 4mg of Dexamethasone for about a month. I came down off that but noticed the bloating and sore knee joints so I bumped up to 1mg.

Oh well, at least my PSA finally started coming down the last 3 months after being on Zytiga for 6 months.

[GP24 in reply to docbulldog]

Dexamethasone is the most potent Corticosteroid there is, you have to be careful when using it. When you had 4 mg per month, you should have tapered the dose to a lower level. The major side effect of high doses of Dexamethasone is the Cushing's syndrome: en.wikipedia.org/wiki/Cushi...

The dose of 0.5 Dexamethason is about equivalent to 5 mg Predinsone. I would not take a higher dose to mitigate the side effects of Zytiga. At 1 mg some patients already begin to develop Cushing's syndrome.

[depotdoug in reply to GP24]

I can now say i am not going to be taking Dexamethason. My Med Onc thru my Abirateone/pred pharmacist called me yesterday and requested i stay on 10mg total of Pred. Side effects side effects.

[GP24 in reply to depotdoug]

I can only make recommendations what you could try to do to mitigate side effects. Your MO says the patient has to live with these and nothing shall be done to mitigate these? I would try to discuss this with the MO and not let the pharamcist do that for me.

[depotdoug in reply to GP24]

Yes, but my Med Onc via his RN evidently does not want to convey my Prednisone use, stay on with me!

He Dr A. seems to funnel my med’s thru IU Health pharmacists.

Wonder what Dr A. would say if i trashed my prednisone bluntly??

[docbulldog in reply to GP24]

Thank you for the advice. I've wondered if switching to dexameth. helped jump start the Zytiga, since psa continued to climb the first 3 months, then started downward after. I'll probably never know, but hoping for a great lab tomorrow.

By the way I was started on 10mg of Prednisone.

[TEBozo]

I was on 750 mg of Zytiga and only 5 mg of predisone. and did fine

[depotdoug in reply to TEBozo]

Maybe it is time to up my Abiraterone to 500 or 750mg. Like for March 10th b-day.Lets see what Mr PSA labs say tomorrow, guess results will be 2-3 later from LabCorp.

Depotdoug

[TEBozo in reply to depotdoug]

Was told "standard dose" is 1000 mg per day. when I upped to such amount, it blew up my blood pressure so I went back down to 750 mg. Jut FYI

[depotdoug in reply to TEBozo]

Not planning on going there. In fact i have a rushed hurried Cardio NP visit Tues hot cold flashes aches pain. Hope its not the C word

[tallguy2]

The prednisone can cause micro-cataracts. You will know when it is time to have the lenses changed.