Abiraterone, prednisone, eplerenone, and blood pressure

[Gearhead]

I’ve been on Lupron and abiraterone + prednisone for three years, which has maintained my PSA < 0.1.

But my BP has been increasing even though I’ve been taking benazepril 20 mg/day plus amlodipine besylate 2.5 mg/day for many years. Average BP over Jan 2022 has been 167/80, which obviously isn’t good.

About a week ago, I convinced my oncologist to increase prednisone to 2X5mg/day per posts by Tall Allen and others. So far, after a week, no change in my BP. Now my PCP suggests reducing prednisone back to 5 mg/day and adding eplerenone (Inspra). One relevant study I could find (below) doesn’t indicate much BP benefit but suggests that abiraterone is more effective with prednisone than eplerenone for progression-free survival.

Opinions and suggestions welcome.

ncbi.nlm.nih.gov/pmc/articl...

[Hidden]

I'm also on Zytiga. When I had my last appointment a week ago, I discussed the PEACE 1 trial results with my doctor. He expressed a lot of concern about putting so many patients on it because of the cardiovascular issues with Zytiga. He told me it's a very significant issue.

Have you thought about using a different anti-androgen such as Xtandi? I know there are others issues with Xtandi, but it might be better for your situation.

[Wings-of-Eagles in reply to Hidden]

I feel if it's not broke, dont change it, stay on Zytiga, and maybe get a better BP medicine or some other treatment for that. Dont think a switch to Xtanti would help, but I am certainly no doctor. (Listen to those folks). I have a very similar situation, on zytiga/abiriatone for 7 + years . My cardiologist noticed my rising B.P. and started me on Losartan 50 mg day, seems like slight improvement so far. I need a better exercise regime, also.

[tango65]

Your doctor is right. The reason to give prednisone with abiraterone is to reduce the increase in aldosterone caused by zytiga inhibition of cortisol which leads to an increase in ACTH and in Aldosterone a hormone which is not blocked by abiraterone. Aldosterone causes sodium retention, edema, hypertension and hypokalemia.

Eplerenone is a specific aldosterone receptor blocker. Aldosterone effects are blocked by this drug and hypertension, edema, increase blood volume and hypokalemia could be controlled. It is so effective that some patients can take zytiga without prednisone if they are taking eplerenone.

[Tall_Allen]

BP can be very idiosyncratic and have unknown etiology. Why not try things to see what works for your particular body?

[Gearhead]

gregg57, Wings-of-Eagles, tango65, and Tall_Allen: Thank you very much for your helpful suggestions and comments.

[tango65 in reply to Gearhead]

Best of luck!! There are many other medicines to control the blood pressure if eplerenone does not correct the problem.

[Tonyd789]

I am not a regular on this website - although look at it from time to time. I am 88 yo, do have prostate cancer and have had it probably for 16 years. I concluded I did not want medical treatment - because it seemed pretty devastating - so I tried Chinese herbs, Western alternatives, etc. I found that blood pressure can be reduced considerably by Chinese green tea and hibiscus (tea). I also take Jiaogulan tea - every morning I make a mixed tea: CGreen tea, hibiscus, jiaogulan, and mint. It is refreshing and pleasant - and my blood pressure dropped. I take 3 common heart meds, but I am hoping I can come off them.

I still take CF-IP6 - which certainly has helped keep the prostate cancer to some degree under control. My PSA is now through the roof. I have

for years taken Chinese herbs, but for the last 18 mos have stopped. I do take some small Chinese herbs (called Shen Shi) - when I had pain in

the prostate, the pain stopped thanks to the ShenShi. In Canada a bottle of 100 costs about C$16 - daily dose is 6 pills.

Hope this is all helpful.