Substitute Eplerenone for Prednisone with Zytiga?

[garyjp9]

I am taking Eligard + Zytiga + Prednisone (5mg). I would like to stop the prednisone and substitute eplerenone (Inspra), if that is viable. I found this exchange from earlier this year from Gearhead, with comments from Tango65 and T_A, among others. Has anyone stopped prednisone altogether in lieu of eplerenone? Is it true that the referenced study "suggests that abiraterone is more effective with prednisone than eplerenone for PFS," and if so, why would that be? What would favor prednisone in that regard? Thank you for any input.

Gearhead• 11 months ago

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 (2017) 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...

tango65 --- 11 months ago

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 --- 11 months ago

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

[Tall_Allen]

Why do you want to stop prednisone? Perhaps you just need a dose adjustment.

prostatecancer.news/2019/06...

There are cortisol receptors on every cell of your body, which is to say that there are many effects of not replacing your natural cortisol with prednisone. The worst of the effects is the high blood pressure, which eplerenone may be able to control. But there are many other effects that will increase over time. I think you may feel terrible.

[garyjp9 in reply to Tall_Allen]

Thank you, T_A. I've been on this regimen for 2 years now, still HSPC, but my fasting glucose is rising, my muscle mass is falling, my weight is rising, and my bone density is falling. I have also developed gastritis, which I never had before. BP is stable. That's why I was looking for a good substitute. I've heard dexamethasone causes many of the same problems.

[Tall_Allen in reply to garyjp9]

May be ADT. Estrogen patch may help.

[garyjp9 in reply to Tall_Allen]

Thank you, T_A

[exeinoo in reply to garyjp9]

0.1-0.2 mg/day Climara (not Climara Pro). Or possibly a gel or cream (bioidentical).

Sounds like ADT side effects. Prednisone shouldn't do those things.

[garyjp9 in reply to exeinoo]

Thanks Exeinoo, are you on this Climara protocol?

[exeinoo in reply to garyjp9]

Yes. I use 0.1

[garyjp9 in reply to exeinoo]

Thanks. Sent you a DM

[Jbooml]

I’ve only had reason to increase my prednisone as I feel I was being depleted of sterols.. from 5 to 10 mg...it seems to be working 2 years in keeping my tendons more supple. If you’re free of CV side effects you’re well ahead of the crowd. BTW..I take 500mg Zytiga together with preds in the morning with creamed turmeric coffee and a banana…my guilty pleasure. Who knows if it all helps but I’m 4 years clear of Mets.

[garyjp9 in reply to Jbooml]

thank you, Jboomi