Have any of you had to go on High Blood Pressure medication due to side effects from ADT or other PCa treatments? I was already on Amlodpine before my diagnosis and now my PCP wants to increase the dosage.
I’ve also read that Beta Blockers have a positive effect at suppressing Prostate Cancer and I wonder if I should switch to one of those medications for Hypertension control.
Update: thanks for the responses! I’m currently on 1000mg Zytiga and 5 mg of prednisone and 7.5 mg of Amlodpine.
Based on the feedback here, I talked with my MO and I am going to increase to 10 mg of prednisone to address the increased HBP and edema issues.
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You are in one calcium channel blocker. Beta blockers are not usually used to treat hypertension. If the calcium channel blocker is not enough to control the BP, the doctors may want to try a diuretic or ACE inhibitors or ARBs before considering beta blockers. Carvedilol is a beta blocker that also has alpha blocker actions and it may be used in combination with other antihypertension drugs.
Thanks, that makes sense. I’m talking to my MO today and will ask about a diuretic or other meds. My PCP didn’t seem to make the connection to the ADT increasing BP levels and my increased edema.
I also found this response/thread that has some additional feedback and tips from other PCa survivors in active treatment with HBP : healthunlocked.com/advanced...
Are you in abiraterone (Zytiga).? If you are, the treatment of the BP and edema is done by increasing prednisone if taking less than 10 mg or by adding eplerenone. It is a different situation than in essential hypertension.
Yes, I have been on Zytiga since July 2021! I was not aware of this side effect, so Thank you for this advice I will ask my MO today. I also just found your post with similar advice from last year. thank you for responding to me!
You should also request electrolytes since the potassium may be low. Zytiga without enough prednisone may cause an increase in aldosterone with sodium retention, water retention (edema) and low potassium which could cause arrhythmias.
I was on a diuretic for BP but the combination of that and Zytega lowered my potassium levels to a dangerous low. I had to change meds and stop the diuretic. Schwah
When I was taking abiraterone I developed high blood pressure and took amlodipine-olmesartan. Off both now.Best wishes!
For about six months after starting 1000 mg Zytiga with 10 mg prednisone my BP went high (150/90 to 200/120). I increased the prednisone and decreased the Zytiga and it got better but still wasn't normal (my normal was 115/65). I started Losartan and my BP dropped to about 120/75. Losartan gave me some pretty bad fatigue though so I cut the dose in half and added 25 mg of HCTZ (a water pill).
Then I went completely off of Losartan but kept taking the HCTZ. Not much fatigue anymore and my BP is still around 120/75. What confuses the issue is that around the same time I started pulsing the Zytiga as part of a hormonal program.
In my case the cardiologist that I saw recommended the Losartan, my MO recommended more prednisone and changing the Zytiga dose to 250 mg with a meal. What ultimately "seemed" to work best for me was a recommendation from my naturopathic doctor.
would you care to share the recommendations from your naturopathic doc? when you initially increased pre from I suspect 5mg 2x/day to what? what do you mean by pulsing zytiga?
Sorry, I wasn't very clear. 25 mg a day of HCTZ works for me. NMD and me discussed and decided to try it. I split the pill in two and take about 12.5 mg AM/PM.
By pulsing, I mean that I am on bipolar androgen therapy and during the high testosterone part of it I don't take Zytiga. I only take during the low T phase. (4-8 weeks per phase - so around 6 weeks off and then 6 weeks on)
P was 5 mg 2x/day and I increased it to 5 mg 3x/day.
Edit: Today I do:
approx 12-13 mg of HCTZ 2x/day.
250 mg Zytiga with a meal. I only do Zytiga when I am doing an ADT-like therapy - approx 6 weeks long, And then I stop during a non-ADT therapy - approx 6 weeks.
thank you, because of my sleep issues my MO said it is ok for me to do 2 5mg Preg at breakfast instead of the 5 breakfast and dinner, will see what happens
I assume you meant prednisone. It has a short half-life (a couple of hours). I wonder if your MO would think it would be beneficial to have half at breakfast and the other half an hour or so later with a snack (or without - occasionally I take one of my doses without food and it doesn't seem to upset my stomach).
Either prednisone or Zytiga can cause insomnia. Would your MO allow you to try prednisolone? It's similar to prednisone (it's the active metabolite) and might also cause insomnia. However, I tried various statins and 2 caused me terrible insomnia, one wasn't very bad if I took it in the morning (short half-life) and one with a longer half-life wasn't bad at all and I am able to take it before bed. At first, my doctors thought that something else was causing my insomnia because it's rare with the statins I was taking. My point is that we each react differently and sometimes not as expected clinically.
I agree with you. The 1/2 life is about 17 hours as I am told. Doing 7.5 mg preg in the am and 2.5 w dinner, will monitor outcomes. He would not switch out the steroid at this time. Thanks for writing and sharing....Totally agree we are not a one size fits everyone
About 2 months ago, I posted this about my BP increase that I associated with abiraterone (Zytiga): healthunlocked.com/advanced...
In a nutshell, it looks like eplerenone plus 5 mg prednisone has been successful in bringing my blood pressure down while taking 1000 mg abiraterone. In the next day or so, I'll post an update with more specific numbers.
HCTZ worked for me. 150/90ish to 126/71 (average over about a dozen days).Eplerenone also reduces aldosteronism (a Zytiga effect). Perhaps the 5 mg of prednisone isn't potent enough but adding eplerenone pumps up the effect.
No. My blood pressure actually declined from 140-150 to 90 (top number) after starting whole food plant based diet, dropping meat, dairy, alcohol, processed products, and losing 30-35 lbs. I also was on Amlodipine, but dropped it when BP went below 100.
Interesting. I have just started to cut out most meat from my diet, as I have ADT associated weight gain. Your experience lends me to believe I should go for a full Whole 30 type plant based diet. I presume your diet wasn’t based on the similarly named Supermarket.
I take Metoprolol ER for HBP (also has anti arrhythmic for my pvc's) which is a beta blocker and from the studies, neutral to slightly positive for PC. ATr blockers came out best in PC review. So if I was to add to metoprolol, it certainly would be an ATr.
I only meant that Ive always enjoyed caffeinated coffee but years ago I started occasionally trying pre workout drinks, when they weren’t as popular as today. I noticed most contained taurine and I liked the effect.
I still do, but I don’t take any of that stuff anymore, not even as much coffee though I still enjoy it. Lord knows I avoid the more potent stimulants I enjoyed as a idiot youth, which need no mention 😀
I’m a musician and I tried beta blockers when I had stage fright for a period of time long ago. For me they produced a curious state of pleasant indifference not just to the anxiety but my performance skills as well. In other words, not good! Fortunately I either to learned to deal with the issue or it simply passed, probably some of both. Relegating classical music to a hobby couldn’t have hurt.
No wonder you brag about your lifting-you deserve to! I’m committed but I can’t push heavy like that. But I do enjoy being fit more than ever. During the lockdown period of the pandemic I was about 7 months into Lupron and like so many I had no weights, none available for purchase, all gyms closed.
I knew just enough of what was waiting for me on ADT if I didn’t lift. So I took to calisthenics and by summer I had among other things worked up to 1000 push-ups in 25 minutes.
A few of my friends were impressed by this but I said no, most anyone can do it (true).
Although looking back, for being in the midst of my first experience with testosterone suppression maybe not too bad.
Of course I was only 64. You present a nice role model should I make it anywhere near 78.
Double wow, when I was a bodybuilder in my 20's. I weighed 235 ripped and had 20" arms and 35" legs (with the itty bitty 30" waist). I could shrug 700+ lbs but I could DBC 75s for only about 8 reps.
Fast forward to 58. I weigh 215 with 2-3x as much fat as I carried in my 20's. I graduated from the 8 pack to the kegger. I can only shrug 425. I will not divulge how wimpy my DBCs are.
OK, now you all have me wondering if I'm taking the best approach. I never had elevated BP until I started Zytiga. My regular doc (not my MO) put me on "regular" BP med--first lisinopril, now losartan (I switched due to dry cough). I don't have other SEs that some of you have listed, such as edema. Tango65's comment about increasing prednisone makes me wonder if I should be treating the elevated BP a different way. I only take 2.5mg pred, so there is plenty of room to increase. Your thoughts?
If you are on 1000 mg Zytiga and 2.5 mg prednisone, then increasing prednisone to 5 mg, or perhaps 10 mg, while monitoring BP for a month or two seems like the obvious first step. As I suspect you know, Zytiga guidelines for prednisone are 5 mg if castration-sensitive and 10 mg if castration-resistant. Did your MO explain the low 2.5 mg prescription?
When I was a young whippersnapper I used to perform a minimum of 1,000 pushups in 20 minutes when I was on top of a sweetie.....(my nickname in those days was "seedy and speedy")........
My husband went thru this last year! Between the zytiga , dexamethasone and amlodipien he was a mess. The amlodipien seems to cause water weight storage. Along with the other 2 drugs. He had 25 lbs of water weight that took forever to come off after he was taken off the zytiga . These are hard drugs on the heart. I guess my suggestion is to have a cardiologist monitor the drug treatment. These are serious drugs affecting the heart.
Thanks for that information. I’m still in the first of year of what is going to be a long journey (I’m 48 years old), so I need to watch the cardiovascular effects. I have a cardiologist on my team, but not sure if my MO has looped her in. I’ll reach out her directly.
My thoughts are why aren’t they having cardiologists that work along side the mo? The heart damage is inevitable with these drugs. They know this. They know it all.
Excellent point. I’ve gained 13 kg since starting ADT, and will be starting calorie counting, consistent exercising, and intermittent fasting to reduce my weight.
Following ADT, Chemo and Radio, my BP became consistently high at around 165/110. Prior to APCa my BP was usually around 127/85 so my GP started me on 4 mg of Perindopril a day. That did not show any immediate improvement so the dose was increased to 8 mg. This brought it down to around 150/90. So, he added 25 mg of Dithiazide a day which did the trick. My BP has now stabilized at around 120/80 which for a 60yr old is pretty good. I should add that My last Eligard shot was in Aug 2021. 😎 DD.
I had the same problem when I was put on Zytiga which per drugs.com stated has a "moderate"conflict with what I was on as a blood pressure medicine, Metropoli which resulted in me going to ER 2 nights in a row, due to reaching close to 200/115. I switched to lisinopril which solved the problem; when switched (trying to find the solution) to amlodipine, I ended up with swollen feet legs...and could hardly walk. Lisinopril works for me and blood pressure if anything, may be a little too low, now. Still on Zytiga. Everybody, was down playing the potential or actual conflict issue...not pleased with my cardiologist that was not very pro-active, only reactive after going to the hospital.
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