Water weight gain with Zytiga and dexamethasone.

[Cynthgob]

Anyone being taken off Zytiga due to heart issues? Husband has gained a lot of water weight due to an issue with his heart perhaps caused by the Zytiga. Thoughts?

[LearnAll]

Zytiga (Abiraterone) is the most cardiotoxic of all prostate cancer drugs. It not only can cause high blood pressure, high blood sugar but can also hurt heart health in other ways.Prednisone which is required along with it causes water retention and a whole lot of side effects due to messing up with adrenal gland hormones.

If possible, one should choose a lutamide such as Bicalutamide, Enzalutamide, Apalutamide etc. Lutamides are much less cardiotoxic compared to Zytiga. Discuss with your Doctor.

[Cynthgob in reply to LearnAll]

Thank you.

[Tall_Allen]

The problem may not be the Zytiga- it may be that he is not taking enough prednisone with it. Insufficient prednisone will cause edema, high blood pressure, and low potassium. Talk to his oncologist about increasing his prednisone.

[Cynthgob in reply to Tall_Allen]

He’s on 1.0 mg dexamethasone

[Tall_Allen in reply to Cynthgob]

The usual dose of dexamethasone is 0.5 mg - why was it raised?

Here's an article about corticosteroid dosing with Zytiga:

prostatecancer.news/2019/06...

[Cynthgob in reply to Tall_Allen]

We tried to go down to .5 and the Psa went up. Both oncologist said their normal dose is 1.0. Now we are pulled off Zytiga .

[Tall_Allen in reply to Cynthgob]

Corticosteroids have a short-term benefit against PC on their own. But 1.0 mg is twice the recommended dose for supplementing with Zytiga, in spite of what your oncologists told you. 1.0 mg is the dose they would use to prevent inflammation with chemo, not as the replacement dose with Zytiga. High doses like that cause fluid retention and heart problems (and bone loss). I think you should discuss reducing to 0.5 mg. I think you might try this before stopping Zytiga, which is still working.

[Cynthgob in reply to Tall_Allen]

They took him off the Zytiga and replaced the 1.0 with .5. Weaning him off the dex I guess

[Tall_Allen in reply to Cynthgob]

Discuss keeping him on with less Dex.

[Cynthgob in reply to Tall_Allen]

But I can’t get the water off!! He’s gained five more pounds since Thursday.

[Tall_Allen in reply to Cynthgob]

Less Dex should take the water off

[SeosamhM in reply to Cynthgob]

Cancer docs are not cardio docs. Our treatments already raise our cardiopulmonary risks significantly. So much variation over a short period is concerning: Get a cardiopulmonologist on board.

[Cynthgob in reply to SeosamhM]

Yes we are but it all seems to take time

[SeosamhM in reply to Cynthgob]

I know, but you are doing a great job just following up on your concerns for now and getting the ball rolling. Here's 20 years' EMT advice (learned it in the first week): Follow your instincts - if you think your husband is sick, he's sick and needs to be evaluated...but by the right doc at the right time.

You can do some things to assure yourself that this isn't going off the rails (i.e., moving towards an emergency) and you can wait for that appointment. If you are not doing so now: Learn how to monitor his vitals: blood pressure, respirations, and O2 saturation.

Get a decent blood pressure cuff/device (or learn how manually - it's pretty easy, and often a more accurate result) and a pulse oximeter. These two items are the foundation of pulmonology and just tell you one thing, i.e., how well the body is moving oxygenated blood around to where it needs to go.

Certainly learn what are "normal" readings but, more importantly, learn what is normal for your husband and try to identify trends for BP, respirations, and O2 sat: Time (morning, afternoon, night), position (lying down, sitting, standing), and effort level.

Since you are concerned about fluid retention: Although embarrassing, monitor his urine effort, volume, coloration, and odor (you will need him to pee in a clear container for this so that you don't get toilet dilution).

If you are truly concerned, this is not "busy" work - it is data that empowers. It can be the basis of some great discussion and questions for you with the doc that doesn't make you feel helpless or leave you feeling uncertain.

Finally, don't hesitate to go to the ER or call the ambulance if you are concerned about his immediate welfare. I can't tell you how many times on the ambulance that the patient interview has revealed that they've been feeling this way "for a few days" when their EKG has been concerning (btw, they also make portable EKGs - I have one because I have a pre-existing condition).

Good luck, get data, and have faith in yourself. - Joe M.

[j-o-h-n]

Beer?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/09/2021 11:18 PM DST