High AST and ALT on Zytiga. Advice to help lower?

[StephH72]

my husbands AST and ALT have continued to climb on Zytiga and Orgovyx. His MO said he would start testing every 2 weeks but wasn’t concerned until they were 5x the upper limit. We are approaching that after yesterdays test unfortunately. He doesn’t want to stop the meds since he’s newly diagnosed Gleason 10 and stage 4b with lymph node involvement (no bone Mets) and meds have lowered his PSA (from 146 to 3.6 in two months). He doesn’t drink any alcohol, has good cholesterol numbers and follows a low fat plant based diet. Is very fit and exercises every day for an hour or more and maintains a low average weight/good Bmi. Does anyone have advice on how to help the liver on our own? Any supplements etc?

[ChicagoJ]

I had the same thing happen when I started Zytiga in Dec 2021. We tried lowering the dose and watching diet and no alcohol but nothing helped. I then stopped the Zytiga and prednisone, waited until the liver numbers came back to normal-which took only a couple of weeks-and then switched to Xtandi (Enzalutamide). It has worked really well for me so far with no liver issues. PSA is now undetectable.

[Tall_Allen]

Sometimes the liver acclimates to Zytiga after a while. Discuss cutting off for a few weeks (stay on prednisone!) and slowly ramping back up. If that doesn't resolve the problem, he can always switch to Xtandi or Erleada.

[tango65]

If he is newly diagnosed with mCSPC the treatment should be a triple therapy of ADT, docetaxel and abiraterone or darolutamide.

Abiraterone is affecting his liver and it may be the time to stop. Darolutamide may also affect the liver increasing the AST.

Discuss continuing on ADT, stop abiraterone and wait until the liver enzymes normalize and then try darolutamide and if it is well tolerated then plan the chemo with docetaxel.

[GoBucks]

That happened to me in 2018 after 6 months on Zytiga. I went off Zytiga for about 7 weeks until my AST & ALT returned to normal. I then started taking 1/2 dose (500mg) Zytiga and watched as AST & ALT stayed low. Then I went up to 750mg and stayed there. All the time my PSA remained at <0.01. For sure try a reduced dose when your number come back down. Best of luck.

[Si52]

When I was first prescribed Zytiga in 2019, my AST and ALT numbers also went up. I was prescribed Heptral. I stopped taking it after about 3 months. The AST and ALT numbers have remained normal since then. If cost is a factor, there is a generic, called Hepaxin available.

[Phil1097]

I just started ADT with generic Zytiga, prednisone and. Orgovyx. I’m a little over a month in and my first lab results show some higher numbers than normal. Not sure what MCHC is but it’s high and off the normal scale. Bilirubin is at the top of the scale and ALT is at the top of the normal range. I go for lab work again in a few days. Hopefully these numbers don’t ride too much higher.

[Phil1097]

thanks for that. Yes my bp is typically slightly elevated (with meds for hypertension). I have a telemedicine visit in two weeks with MO and will go over these.

[katartizo61]

I have experienced rises in liver enzymes as well. I use several supportive approaches with positive results. While there are many liver support supplements out there I like Optimal Health Liver/Kidney 2 tid or Pure Encapsulations Liver detox. Both with drinking lots of good water. I added footbath detox, sauna infra red. Worked

[leo2634]

It happened to me my Doctor cut me back to three pills a day been normal since then. That was three years ago. Leo2634

[Waterdog]

try milk thistle, it is a good detox for the liver