Abiraterone-related hypokalemia is presumably rare. However, it's probably a good idea to keep an eye on potassium levels.
"Hypokalemia is a low level of potassium (K+) in the blood serum. Mild low potassium does not typically cause symptoms. Symptoms may include feeling tired, leg cramps, weakness, and constipation. Low potassium also increases the risk of an abnormal heart rhythm, which is often too slow and can cause cardiac arrest." [2]
"A Case of Abiraterone-Related Hypokalemia Leading to Torsades de Pointes and Cardiac Arrest" [1]
"By inhibiting CYP17, abiraterone can induce a state of mineralocorticoid excess, which is associated with profound hypokalemia. We present a case of abiraterone-related hypokalemia which led to torsades de pointes (TdP) and ventricular fibrillation (VF)."
"Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormones. Mineralocorticoids are produced in the adrenal cortex and influence salt and water balances (electrolyte balance and fluid balance). The primary mineralocorticoid is aldosterone." [3]
Abiraterone acetate is an androgen-depriving therapy (ADT) that is highly effective for treating castration-resistant prostate cancer (CRPC). By inhibiting CYP17, abiraterone can induce a state of mineralocorticoid excess, which is associated with profound hypokalemia. We present a case of abiraterone-related hypokalemia which led to torsades de pointes (TdP) and ventricular fibrillation (VF). We reviewed the literature and showed the need for close monitoring of the potassium level and electrocardiogram (ECG) to prevent fatal arrhythmias.
Keywords: abiraterone; cardio-oncology; cardiotoxicity; hypokalemia; torsades de pointes.
From another thread:"I read some case studies and prednisone causing BG to skyrocket to over 900 has happened to others.
One thing that was advised is to monitor your BG when on prednisone. Makes sense to me to start at a small dose and see how you react. I think something like this:
Full dose Zytiga is usually 1000 mg and Prednisone either 5 mg or 10 mg
Week 1 1/4 dose of each
Week 2 1/2 dose of each
Week 3 3/4
Week 4 full dose
It also would be good to get a CMG. I used to have one (I'm not diabetic but like to test things).
I'd go over this with my MO first and show them studies showing prednisone can cause BG to shoot up (diabetics but there are also cases that happen with people who are not diabetic).
Most, but not all, cases of prednisone-induced diabetes resolve themselves after discontinuation of prednisone.
I've been taking it for 4 years and haven't seen any major BG increase (fasting BG is 75-90)."
Thanks for the post pjoshea13,I have been on Zytiga/Prednisone for nearly 8years, so my CTCA Cancer center insists on checking all the various blood levels regularly(every 3 to 4 months) Additionally, I go to a Cardiologist ,who monitors my heart and cholesterol levels regularly. He had noticed a very infrequent arterial fibulation back in 2013.
In any case my Potassium has usually been between 4.0 and 4.1 ( normal) and the Glucose is usually between 95 and 105. They keep an eye on my RBC as it is always 3.6 to 3.9, slightly anemic. Aslo, the ALK phosphatase, still in the lower range and the ASL and ALT Levels still low. So my liver, bone density, blood sugars and heart all good, just need to keep my PC and PSA in check, which is happening,,almost 8 years undetectable.
Yep! My dad has been on Zytiga and Prednisone since 2018. Had a UTI, a bad one and was septic. Luckily is ok now - and before he went home they gave him potassium to restore normal levels. One doctor told him to eat a banana a day a long time ago. Could be why. Will get him on a chelated potassium.... but yes I think this is super common for Zytiga users and should be monitored.
I've been on zytiga with prednisone for three years. Last month when I contracted Covid, and took a course of Paxlovid, I was advised to stop all my cancer meds to avoid bad interactions... plus I wasn't keeping anything down anyway. What I did not know was to NOT stop prednisone, the body needs that and the Zytiga by design shuts down normal adrenal production. I wound up in hospital for three days with electrolyte deficiency, along with extreme cortisol deficiency, the symptom was increasing difficulty standing due to hip and leg weakness, and it wasn't getting any better. Consequently I've had to add an endocrinologist to my bulging portfolio of specialist doctors, and I've learned a lot about cortisol replacement. So the paper that started this thread is very helpful and indicates to me there is more lurking here. Covid seems to ignite any simmering medical issue and bring it to the surface. And even if you were to stop Zytiga temporarily, don't stop the prednisone.
I've had two iv infusions on Potassium in the last week. I'm really struggling to get my level to stay up. I am traveling out of country so I don't have my usual coverage.
Will aggressive mineral supplements help enough to get my up and away back home?
Or do I need something else?
Should I temporarily stop Zytiga or stop Prednisone, or what?
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