Don't take Tylenol (acetaminophen or paracetamol) if you are using any kind of immunotherapy

[Tall_Allen]

It may increase regulatory T cells and PD-1 expression, which stop immunotherapies from working. It also changes the enzymes responsible for drug metabolism, and may cause drug-drug interactions (also a reason to avoid supplements when taking other medicines).

ascopubs.org/doi/abs/10.120...

[DeanNelson]

So the hydrocodone I take for pain, maybe stopping Nubeqa from working!?!?

[Tall_Allen in reply to DeanNelson]

Nubeqa is a second-line hormonal medicine, not an immunotherapy.

[Fiddler2004]

Thanks for posting.... holy ____

[KAgolf]

Thanks T_AI also found in small print on Zytiga insert that you shouldn't take aspirin with Zytiga, so hubby had to stop his baby aspirin. Lots of places people can and should check for drug-drug and drug-supplement interactions.

thanks again for your informative posts

[Tall_Allen in reply to KAgolf]

I never heard about an interaction of Zytiga with aspirin and just checked the prescribing info and epocrates and didn't see it listed - where did you see that?

[KAgolf in reply to Tall_Allen]

I “know” I saw it online in the patient insert on Zytiga website; it was in left column, near bottom of page, and very small print—I only saw it the 2nd or 3rd time I read it. I see that insert was revised in 8/2021 and can’t find it in this new one. So, not sure if I was looking at old insert info. and the reference to aspirin has been removed or what?

Revised: 8/2021: Tell your healthcare provider about all the medicines you take or treatments you receive, including prescription and over-the-counter medicines, vitamins, and herbal supplements. ZYTIGA can interact with many other medicines.

However, I did find this reference online: chemocare.com/chemotherapy/...

Abiraterone Acetate Precautions:

• Before starting abiraterone acetate treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.

I'll keep looking

[Tall_Allen in reply to KAgolf]

My guess is that they worried early on that Zytiga hampered the enzymes responsible for metabolizing aspirin, thus requiring a lower dose of aspirin. But it seems to not be the case.

[Proflac in reply to Tall_Allen]

Hi. Would be interested in any further info on the aspirin- zytiga interaction if you find any. I guess quite a few men are on low dose aspirin and abi. I too found a reference to avoid aspirin in the Chemocare abi precautions online. It's never been mentioned by our oncologist. Is it suspected to reduce effectivity or cause adverse effects? Thanks

[Tall_Allen in reply to Proflac]

I think it's ok per most current info. They might have worried that Zytiga affected the enzymes responsible for metabolizing aspirin.

[Hidden in reply to KAgolf]

I read the same thing in 2019 when I first started in Zytiga. I quit taking my daily 81 mg, low dose aspirin

[Tall_Allen in reply to Hidden]

It seems to be OK per most current info.

[KAgolf in reply to Hidden]

I read it in late summer 2021 just as hubby started taking Zytiga and I was checking for any drug or supplement interactionsThanks----now I know I'm not "crazy", as least not totally

😅

[Tall_Allen in reply to KAgolf]

I checked with Janssen Pharmaceuticals: There are no interactions between Zytiga and aspirin (nor any NSAIDs). I checked labeling changes cleared by the FDA- there never have been any issues with aspirin on the official labels. As far as I can tell, that chemocare.com site is just some Internet misinformation. I recommend you do not look things up there.

[KAgolf in reply to Tall_Allen]

as always, THANKS

[tallguy2]

Nuts. Only acetaminophen was permitted when I got a 103 degree fever on my last (failed) BiTE immunotherapy trial. I will see why my oncologist has to say. Thanks for posting this.

[dico]

Darn. When I first read this I wasn't worried because my husband takes Advil, not acetaminophen. Then I realized that his pain pills contain hydrocodone AND acetaminophen. I will have to ask the doctor for something else. Thanks for posting this.

[Tall_Allen in reply to dico]

As far as I know, NSAIDs and pure opiates including Tramadol are OK

[gloriahale in reply to dico]

straight oxycodone ask for.

[CWT53]

Thanks for this 'heads up'. Drug and supplement interactions are certainly problematic. I also wonder if I am or was eating foods that interfere with the Lupron, Xgeva, nubeqa, and Keytruda that I am now taking. I developed a sensitivity to bananas and salmon after I started Keytruda. (Bananas are not that critical, but I would really like to find a way to eat wild salmon again since I am a former commercial fisherman and have a ready supply of top-quality product.) A Naturopathic Doctor suggested I take CoQ10 top help me feel better. I quit after six days due to diarrhea that wouldn't respond to Metamucil and even more severe and debilitating fatigue than I already experience. Quick question: Is Ibuprofen okay for minor pain?

[Tall_Allen in reply to CWT53]

I think all NSAIDs, including ibuprofen are OK.

[Docker53]

My husband had been taking Tylenol with codeine because he tore his rotator cuff and was in pain. He is on Xtandi daily, Xgeva injections monthly and Eligard every 6 months. His PSA jumped to 22 over the past few months. It was 14.6 just before he started taken Tylenol. Oncologist now wants him to start Chemo and prednisone starting this Tuesday. He had a bone and CT scan on Friday and the results weren't back yet, however due to the jump in PSA Oncologist wanted to schedule the Chemo treatment sooner then later.

[JazzMan42]

I'm trying to grasp if there is any medical consensus in the aspirin-abi conflict. Like so many medical controversies there are opinions all over the lot. I've been doing the baby aspirin/Zytiga combo for more than 3 years and hope I am not diluting the effectiveness of either medication.

[Tall_Allen in reply to JazzMan42]

It's not in the current prescribing info for Zytiga and not listed as an interaction for pharmacists, so I wouldn't worry about it.

[anonymoose2]

Thanks TA! Good to know if me or my family need to take PAXLOVID if Covid comes knocking on our door.

[dentaltwin]

Interesting--I thought that higher PD-1/PD-L1 expression improved the chances of response to ICB.

[Tall_Allen]

PD-1 is what your T cells use to avoid killing "self" cells. Artificially raising PD-1 expression will help the cancer evade the immune system. You wouldn't want to give PD-1 inhibitors more work to do.

[Hidden]

I have pretty severe arthritis and neuropathy which cause foot, leg and pelvic pain. I take Celebrex a special vitamin supplement called Metanx, and Lyrica for the arthritis and neuropathy, and a baby aspirin because I had colon cancer and a heart stent. Also, I often take Tylenol Arthritis and it works amazingly well to relieve foot pain. Am I understanding you correctly that all of these meds are really bad for my Zytiga and Lupron???

[Tall_Allen in reply to Hidden]

None of those are immunotherapies.

[Janhpr]

What are immunology therapies

[Tall_Allen in reply to Janhpr]

Therapies that recruit the immune system to fight cancer.

[tallguy2]

Response to this paper from my oncologist FYI:“He mentions that there were several key flaws in the study and tylenol was not solely isolated as a cause of poor outcome. Also, the immune hypothesis was tested in blood only and not tumor. Mouse regulatory T cells differ from human T cells. It would be more convincing to have seen this study in regulatory T cells in human tumor samples.”

[Tall_Allen in reply to tallguy2]

Like all mouse studies, it rules OUT but doesn't rule IN. After this, why would anyone use Tylenol while undergoing immunotherapy? It just wouldn't be prudent. There are dozens of NSAIDs/tramadol that can substitute for pain or antipyresis.

[tallguy2 in reply to Tall_Allen]

My answer would be that 1. Tylenol is the ONLy anti-fever med permitted by Amgen (in my BiTE protocol), and 2. 50% of the men (not me) are seeing a durable response and even coming off of ADT. Clearly much more to learn!

[Tall_Allen in reply to tallguy2]

Probably a good idea to measure Tregs before and after taking Tylenol.

[gloriahale]

wow wish knew that b4- hos gives to spouse. great.