Zytiga with hydrocortison

Dear all, My dad just took a test of cortisol level at 7am and the result’s 1.5nmol/L (the lab’s threshold’s 133-537nmol/L.). His doctor asked him take Hydrocortisone 30mg/day (20mg in the morning and 10mg in the afternoon,) instead of Prednisone 10mg prescribed before. However, there is no info when this switch stops.

A bit of background, my dad previously took Zytiga with Prednisone 10mg in 3 months. Because his PSA was increased to above 10, we decided to switch from Prednisone 10mg to Dexamethasone 0.5mg (without indication of the doctor). It’s 20 day since this switch he still has not taken PSA test (will be done after 1 month)He often takes Zytiga 1000mg at 6am (empty stomat) and Dexamethasone after breakfast, around 7.30am – 8am. My father feel he has no symptom of cortisol insufficience

-Have any of you taken Hydrocortisone instead of Prednisone / Dexamethasone? Can you share your experience?

- Does the combo of zytiga+ hydrocortison have equal effect as zytiga+ prednisone /dexamethasone?

Thank you for your sharing in advance

[Tall_Allen]

I don't understand. Why is he switching to hydrocortisone if dexamethasone is working well, as far as you know? Is it a cost issue?

[Hidden in reply to Tall_Allen]

It's not cost issue. His doctor did not say the reason of the switch. Low cortisol level is a symptom of Addison's disease so maybe he thought my dad's cortisol level needed recovering to normal level.

[Tall_Allen in reply to Hidden]

Zytiga prevents the adrenals from producing cortisol. That's why corticosteroids are given with it. They are not identical with cortisol, but act very much like it; in fact, they are stronger. When one is taking Zytiga, lab tests that identify only serum cortisol levels will be low, but as long as it is adequately replaced by other corticosteroids, it doesn't matter. The replacement is adequate if there is normal blood pressure, normal serum potassium, and no edema.

[Hidden in reply to Tall_Allen]

If one is taking Zytiga and their blood pressure increases could it be due to too much prednisone?

[Tall_Allen in reply to Hidden]

It may be due to too little prednisone.

[MMK-XFuture in reply to Tall_Allen]

Interesting. Taking 1,000 mg of Zytiga and 10 mg prednisone. BP is elevated, MO said must be from prednisone but did not change dosage. I was hoping to reduce pred due to rounded face, weight gain, high bood sugar, enlarged heart. PSA remains undetectable though.

[Canoehead in reply to MMK-XFuture]

A lot of oncologists are now prescribing only 5 mg of prednisone with Zytiga. You may want to do a search on this site to see if there is a supporting study which you can show your doc.

[Tall_Allen in reply to Canoehead]

I think you misunderstood. 5 mg is the replacement dose for mHSPC; 10 mg for mCRPC.

[Hidden in reply to Tall_Allen]

My BP increased from the Zytiga (my MO said that was a possibility and I did some testing that pointed to Zytiga).

I'm HS. But my MO prescribed 10 mg and we agreed on 250 mg of Zytiga with a high fat meal. Thoughts?

[Tall_Allen in reply to Hidden]

The ONLY reason to reduce the Zytiga dose by taking it with a high-fat meal is to save money. Now that lower cost generics are available, why? The amount absorbed is (hopefully) the same. And the side effects are correlated with amount absorbed. I've seen several patients make this same logical error on this forum.

[Hidden in reply to Tall_Allen]

Neither my MO nor I believe that we all react the same way. I have not discussed this with her but I would think that there would be some metabolites from Zytiga - known or unknown. How do they affect each of us? If you know how some of the known metabolites might affect us I am all ears.

We went through extensive testing. 1000 mg empty stomach, no Zytiga at all, 250 mg with a fatty meal. Repeat testing. Tested each scenario for over a month. The results "might" have been a coincidence, yet I strongly doubt this. So, until my MO and I decide otherwise, the conclusion is 250 mg of Zytiga with a full-fat meal reduces my BP and this is the way forward, regardless of cost (not a consideration by the way). My BP has gone from 140-160/80-100 to 125-135/70-85. Not nearly as low as pre-Zytiga values but at least it's low enough that I no longer take Losartan.

I am interested in the interplay with prednisone and plan to discuss a new test scenario with her. Hopefully, I can get my BP closer to my pre-Zytiga levels. Appears that it is only Zytiga that affects them since without Zytiga my BP slowly dropped to my pre-Zytiga levels of 115-120/65-70.

How does the interaction of Zytiga and prednisone affect me? If I read correctly, you think prednisone might need to be increased. If my MO agrees I'll try that as the first leg of a second experiment.

This is important to figure out since cardiac issues are a large source of death for people regardless of cancer status.

[Tall_Allen in reply to Hidden]

Zytiga does have an active metabolite, but that is irrelevant. All that matters is the amount of abiraterone that gets into your bloodstream. (Yonsa, a micronized form of abiraterone only requires 500 mg to get the same bioavailability as 1000 mg Zytiga, independent of meals.)The rest is excreted and is useless to you. The problem with a lower dose with meals is that the amount of abiraterone absorbed is variable for 2 reasons (1) inter-individual differences in absorption and (2) the amount of absorbable fat in the meal. The reason you are seeing lower BP is because less abiraterone is being absorbed and is less effective at fighting your cancer. The lower amount is also less effective at turning off adrenal cortisol production, which is why your BP is lower.

[MMK-XFuture in reply to Canoehead]

Thanks. Will try that.

[Tall_Allen in reply to MMK-XFuture]

That's the right dose of prednisone for mCRPC. But some guys require a little more; some a little less.

[MMK-XFuture in reply to Tall_Allen]

That's what I've been reading. May just stick to 10 mg until MO says otherwise. Thanks for the quick reply.

[GP24]

30 mg hydrocortisone is almost equivalent to 10 mg prednisone. However, the half-life of hydrocortisone is much shorter than prednisone so it will not work during the entire day as prednisone does. Zytiga plus hydrocortisone is not a good recommendation. Keep using dexamethasone!

[CAMPSOUPS]

we decided to switch from Prednisone 10mg to Dexamethasone 0.5mg (without indication of the doctor).

His doctor is now aware that you switched to Dexamethasone—Correct?

He often takes Zytiga 1000mg at 6am (empty stomach) and Dexamethasone after breakfast, around 7.30am – 8am.

It might be the manner of your typing but to be clear:

Your father was taking his Zytiga and Dex every day correct… not skipping days correct ?

[Hidden in reply to CAMPSOUPS]

No, The doctor still is not aware about that switch.

Definitely, He daily takes dexamethasone about 1.30h later after zytiga (right after breakfast)