How to taper steroids and enaleutamide after abiraterone

[Nirman]

Hello my dad was on abiraterone plus prednisone 5 mg last 3 and half years then 4 months on abiraterone and 0.5 mg dexamethesone now psa rising so we are switching to enzaleutamide as chemo can’t be done as current unfortunate situation in India so I need your opinions on how to taper steroids as he’s taking last 4 years and doctor prescribed him 80 mg enzaleutamide morning and 80mg evening everyday is anything else which prolongs enzaleutamide life or works seynerzisticly?

[GP24]

Maybe you can find a doctor who will give him an injection with testosterone cypionate 400mg IM:

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

healthline.com/health/testo...

[LearnAll]

Steroids such as Prednisone or Dexamethasone cause disturbance in mood, increased anxiety and restlessness..if they are stopped suddenly. Therefore, steroids need to be slowly tapered to minimize such withdrawal symptoms. Slow taper also gives Andrenal Gland sufficient time to rebalance its own production of steroids. The simple rule of Tapering steroid is to take 1/2 dose for 1 week, 1/4 dose for next 1 week and then, 1/8 dose for next 1 week and Stop. This slow 3 week tapering schedule reduces the discomfort of withdrawal significantly. This is for information. Let your doctor make final decision.

[Nirman in reply to LearnAll]

Yeah sure I always consult with doctor before doing anything Thank you for your suggestion

[Tall_Allen]

Just taper the dexamethasone slowly - 0.25 every day for a week, then 0.25 every other day for the next week, then 0.25 twice a week for the next week.

Good luck with the enzalutamide. Hopefully, it will last until the crisis is over and he can have chemo.

[Nirman in reply to Tall_Allen]

Thank you very very much Allen by the way what’s your views on BAT therapy is there any risk involved? They claims it resensitize the cells and make enzaleutamide more effective?

[Tall_Allen in reply to Nirman]

It can. In the recent Transformer trial, when used after abiraterone and before enzalutamide, BAT increased the time to PSA progression, delayed radiographic progression, and reduced PSA. Although overall survival did not increase significantly, there was an improvement in quality of life.

ascopubs.org/doi/10.1200/JC...

There was also a finding that checkpoint inhibitor inhibition (e.g., Keytruda, Opdivo, Tecentriq), which is normally not effective for prostate cancer, may work after BAT.

[Nirman in reply to Tall_Allen]

Okay thank you Allen

[TeleGuy]

With respect to the steroid taper, my advice is to taper at a rate that's right for you.

When I've tapered off the steroids at the "normal" rate of dividing the dose in half every week, the taper got ahead of my adrenals kicking back in, and "normal" activities such as skiing would leave me exhausted for days afterwords. At that point my doc had me increase a bit and taper off more slowly. Realize that once you get to 1/4 tablet of whatever drug, you can then do 1/4 every other day, etc.

[Nirman in reply to TeleGuy]

Okay thank you