Half Dose Abiraterone

[Hillwalker87]

Hi everyone. Does anybody on here half dose abiraterone and if so, is it as successful as full dose? Thanks!

[Tall_Allen]

Of course it's not as successful to take half the effective dose, but if cost is the issue, taking a half dose with meals may be equally effective. Generic abiraterone costs much less.

[Mascouche in reply to Tall_Allen]

I think someone on this site once mentioned that he was taking 250mg with a fatty meal and was getting results as efficient with that quarter dose than a full 1000mg dose on an empty stomach would deliver.

[Tall_Allen in reply to Mascouche]

It's variable with meals because the amount absorbed is dependent upon the amount of fat and individual absorption through the gut.

[Watertower in reply to Tall_Allen]

Tall_Allen, perhaps you can shed light on something that's been puzzling me ever since I started abiraterone 14 months ago. Early every morning, I take my 1 gram, which then sits in my empty stomach (and farther down?) for more than a hour. This limits effective absorption to a smallish fraction -- but a more predictable fraction -- of that gram.

Where did the rest of it go??

I can only think that as it sits there, it's slowly transformed into something ineffective that IS absorbed, and ultimately passed out in the urine;

OR that it moves into the duodenum, and the whole intestine is mysteriously resistant to its absorption.

Do you have any info on the absorption question?

Thanks!

[Tall_Allen in reply to Watertower]

It's not mysterious. Abiraterone is fat soluble and in the absence of fat, it is excreted.

[Watertower in reply to Tall_Allen]

Wouldn't that imply zero absorption when taken on an empty stomach?

[Tall_Allen in reply to Watertower]

No - some gets through - just a lot less.

[Watertower in reply to Tall_Allen]

So that "some" is absorbed not just in the stomach, but (variably) along the entire trip through the intestines -- and the amount stays small as long as fat doesn't catch up with it?

[Tall_Allen in reply to Watertower]

Food is absorbed through the intestines, not the stomach. The amount absorbed without fat is well known and not variable. More is absorbed with fat, but the amount absorbed is variable.

[Hillwalker87 in reply to Mascouche]

Thanks for your feedback 👍

[Concerned-wife in reply to Hillwalker87]

I believe the QUARTER dose with LOW-FAT breakfast is now mentioned in the NCCN guidelines. uchicagomedicine.org/forefr...

[Muffin2019 in reply to Concerned-wife]

I bounced that off my oncologist and he said no, the full dose then eating 1 hour or an hour and half later has worked for me since December of last year. My blood work has been good so far on full dose.

[treedown in reply to Concerned-wife]

It has been for a year with a reference to cost toxicity.

[Hillwalker87 in reply to Tall_Allen]

Where would you ascertain generic TA? We're UK based and this has never really been mentioned to us

[Tall_Allen in reply to Hillwalker87]

Try India. In the UK, Jansen still holds a patent.

[Bryanbhai in reply to Hillwalker87]

In india its much cheaper ...I am myself using it

[sarkozy in reply to Hillwalker87]

WhatsApp: [phone]Medixo Centre

Approx. $200/month

[Bryanbhai in reply to sarkozy]

mine is for $180/month...can try to help anyone if required

[sarkozy in reply to Bryanbhai]

Doest that include FedEx to the UK? Mine does.

[Bryanbhai in reply to sarkozy]

yes you are right ...including fedex it might be same as yours ...any by the way just for my information there are much cheaper versions also available is it worth trying them as the salt composition is same but manufacturer are different ....your advise is appreciated

[Hillwalker87 in reply to sarkozy]

Are there any EU import tariffs to the UK now?

[sarkozy in reply to Hillwalker87]

No

[tango65]

If you tolerate the full dose, keep it. The clinical data refer only to the full dose.

You may try to reduce the dose and see what happens to the PSA month to month for 2 or 3 months, if there is an increase in the PSA you could go back to the full dose, but there is not guarantee your PSA will go back to the previous nadir achieved when on full dose.

If you do not tolerate the full dose you could try to change to other anti androgen and see what happens.

[Stoneartist in reply to tango65]

They must have tested dosage on the way through clinical trials. It seems logical to me that if it will require a full dose to reduce the cancer to minimal, then it may require a lesser dose to maintain the status quo. I guess we could test that on ourselves - if we have a stable PSA and everything else is kept unchanged. I was thinking the same about Zoladex - until I reached Castrate resistant and entered a new ball game.

[dhccpa]

Quite a number of docs are prescribing lower dose of 1 pill with a low fat meal. Find the Universiry of Chicago did with low dose Zytiga.

[KingNeptune]

I’ve been on 500 mgs with breakfast for two years, so far, no change in PSA and I’m considering quarter dosing.

[Hillwalker87 in reply to KingNeptune]

Hi, do you cut down on the prednisone as well?

[KingNeptune in reply to Hillwalker87]

No, I’m on 5mg of prednisone daily, the same dosage I started with.

[Hillwalker87 in reply to KingNeptune]

OK. Thanks for your response, the best of luck going forward 🙏

[ctflatlander]

I'm on 1/2 dose for 4 yrs

[Dlanghorne]

I started with 1000 mg in July 2019.In Nov 2019 my AST and ALT went out of range and MO reduced to 500 mg.

I have been on 500 mg and PSA is still undetectable.

I get blood work every month to be ready asap when it rises.

I have 2 MO's (1 in OH and 1 in FL) and they both agree that

I should have Provenge when it does.

Lupron was switched to Eligard in Sept 2021.

More history in my profile......

[youngigor]

Year 1: 1000 mg at 0500, w/ some leg swelling, some severe leg cramps, significant tummy cramps.Year 2: 250 mg w/ healthy lunch - all the SE's went away, T remained at castrate levels.

Year 3 - on holiday!

The amount that enters the body is highly dependent on fat, a McD Big Breakfast gave over 10X increase in AA in the blood.

Altho the amount of AA taken at lunch was reduced by 3/4 the amount in my blood was about the same or slightly higher and probably varied wildly depending on how much olive oil was in my salad - I just at what was I felt like at lunch. UO at first reduced prednisone by 3/4 and w/in a week or so significant pain in joints. went to 1/2 normal dose of prednisone and joint pain went away. As AA levels in blood were about the same the dose of prednisone should be about the same, but i was able to tolerate the 1/2 normal dose of prednisone.

If (more likely when) I go back on AA will use the lunch approach again.

[EchoII]

Two years ago I started on 1000 mg Aberaterone daily prescribed by my doc at Georgetown in DC. Went to Dana Farber for second opinion from Dr. Mary Ellen Taplin. She recommended 500 mg daily. My Georgetown doc readily agreed and i have been on that dose now for 2 years. PSA undetectable

[Pheart2]

I’m on 250 mg Abiraterone with 5mg Prednisone with low fat breakfast and Lupron injection every three months for last two years. PSA and Scans undetectable so far. PSA <0.03 last month and Scans due tomorrow. My question to y’all is how do you measure (by which test) Abiraterone efficacy in blood at 250mg?

[NRH_Beach]

Thanks for the great question and dialog. I did notice that one of the clinical trials for parp inhibitors paired with abiraterone - used a lower abiraterone dose.

I think this crowd is sophisticated enough to know that the current dose is largely based on the METACURE and other large studies. Individual anecdotes on "success" with lower dose are just that - anecdotal.

I plan to raise this question in my next appointment in 2 weeks.

[VCinTx]

I had to stop my half dose because the side effects were so overwhelming. My daughter described me as a zombie.

[lokibear0803]

Just a sidebar about cost, if that’s the issue: I’m a (US military) veteran, and get my AA (and prednisone) for free thru the VA. In fact VA covers the cost of any and all prescriptions drugs I’m taking, and this should include any cancer drugs that are FDA-approved, not just the AA.

For that matter my MO at the VA has suggested there is an appeal process thru which the VA *might* cover the cost of experimental drugs and even possibly experimental treatments, including a (remote) possibility of covering Lu-177 treatment in Germany (or Australia, etc … these are, of course, considered experimental in the US). I do think this last one is a long shot. Perhaps if enough of us lobby for this, we can get some traction for reimbursement or at least some level of subsidy. Again, a long shot, I’d think, but a low-cost gamble.

But if there is an FDA-approved treatment that the VA itself cannot provide (for, of course, zero or minimal cost), I believe one can file an exception to have costs covered at a different clinic. I have no details on this since I haven’t tried it yet.

Finally, since I’m a Vietnam-Era vet, I receive a generous monthly pension for the prostate cancer “disability” since they’ve now established cause-effect from Agent Orange. For anyone who is a Vietnam Vet with PC and didn’t know about this, I encourage you to check it out. Reach out to your Department of Veterans Affairs in your particular state.

[bean1008 in reply to lokibear0803]

Thanks for your service, Lokibear!

[MateoBeach in reply to lokibear0803]

Semper Fi.

[pineman]

I am using the Costco Pharmacy for my generic Aberaterone for the past 15 months. Currently I am paying $125 for 120 pills.

[Hillwalker87 in reply to pineman]

Do they ship to the UK do you know?

[sarkozy in reply to Hillwalker87]

No

[Bdale]

Hi Hillwalker87 ,

I have taken 250 mg Abiraterone and 5mg Prednisone every morning with a LOW FAT meal for the last 2 years. I also get Lipton shot every 3 months. Side effects are not real bad, every now and then hot flashes, and I really have to fight to keepy activity up.

I was diagnosed in November of 2018, Gleason 4+5, metastatic. Radical laproscopic operation May 2019, 38 sessions of IMRT.

My oncologist is Dr. Szmulewitz at the University of Chicago he researched the lower dose.

I have seen my PSA go from 11 (after radical prostatectomy) to 0.18. I am a very active 67 year Peloton 3x a week, regatta sailing at least twice a week in summer, walking 3 miles at least 3 days a week.

Check out the research mentioned above. Itay work for you as well as is has for me. Good luck

[j-o-h-n]

To stop a bad cough.

Take two large doses of laxatives...

then you'll be too scared to cough....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/13/2021 7:38 PM DST

[treedown]

I have been on 750 mg since my lymphocytes crashed during radiation Feb 2020. Saturday will be my last dose as I determine if my curative treatment cured me. Overall my treatment as a whole has been effective and since I did not use Zytiga by itself I have no idea if the 750 was less effective than if I had taken a full dose. As of my last CBC my lymphocytes have fully recovered.

[MateoBeach]

In the clinical trials to get a new drug approved, they use what is determined (estimated) to be the “maximum tolerated dose”, determined in Phase 1. That is not the same as “ minimum fully effective dose”. So it leaves a large grey area of uncertainty. Post approval this gets refined in clinical practice as has been the case here. All indications are that the lower dose when added to a low far meal increases absorption making it fully effective for many. T_A actually explains the mechanism for this above. The higher dose without the fat has poor absorption so may as well be less effective. So in my opinion it is reasonable to try and follow your scans and PSA trends to verify.

[npaulson1]

Got started in 2017 with ADT, Zytiga and predisone only to find quickly that the full dose was too hard on my liver. MO cut me sown to 500 mgs right away and I remain there to this day. Undetectable is my middle name, so far.

[Grumpyswife in reply to npaulson1]

Undetectable is great! Hope it continues for you.

Wish we were there, too, but my husband is taking abiraterone at half dose without food or prednisone. He is also taking full dose of darolutamide and the results have been amazing to us. His PSA dropped from 168 on 9/14/21 to 53 on 10/11/21.

His bloodwork and blood pressure are a bit iffy but he seems to be tolerating it. Even his newest local MO was impressed. This drug combination was suggested by a highly respected specialist and I couldn't believe our insurance covered both.

I am hesitant to disclose this as I don't want to jinx it but it may help others. It doesn't hurt to ask.

We have never experienced anything like this drop in our 20+ years of dealing with this crap and are back on the emotional roller coaster--just staying alive!