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
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depotdoug
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
Getting ready to visit PF to work out and a hydromassage session.
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.
Yeah..us too..but I gotta get my workout 🦾hydromassage session in.
Life's necessities
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
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
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.
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.
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.
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.
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.
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.
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.
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