Zytiga stopped working for me and I am castrate-resistant. After a failed clinical trial (immunotherapy) I started Docetaxel 2 weeks ago and was prescribed Prednisone (5mg twice per day). I seem to be very sensitive to the Prednisone....having trouble sleeping, feeling anxious, etc. even when taking it at dinner at 6:00pm. My question is, has anyone taken a reduced-dose of Prednisone while on Docetaxel, such as 2.5mg twice daily (or eliminated it completely)? Would the reduced Prednisone dose increase the side effects from Docetaxel? I don't have any side effects now (only minor nose bleeding) and no fatigue (yet). I plan to ask my MO these questions, but wanted to hear any opinions on the subject first.
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carguy
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I didn't want to take prednisolone with my early chemotherapy according to the information from Fred Saad it is optional when you are hspc. My cancer centre wanted me on prednisolone but I took it only for 11 days. During this 11 days all my prostate symptoms dissolved but returned when I stopped prednisolone.
For crpc prednisolone is I believe compolsory with docetaxel chemotherapy. I didn't have chemotherapy while crpc as I am still only at hspc stage, therefore I don't have personal experience yet.
Please read it for yourself in the document from Fred Saad:
It prevents most of the worst side effects of chemo, so don't take less. It may also have an independent survival benefit.
All of the prednisone should be taken by noon, with food. Maybe try 7.5 mg with breakfast and 2.5 mg with lunch. That's similar to the natural cortisol pattern. It will keep you awake if you take it in the evening.
I was on the the same regiment , with Docetaxel and prednisone. The second prednisone was causing the problems, anxiety , sleeplessness etc. I ask MO if I could reduce prednisone to one a day. He agreed and the issues were resolved. I take one prednisone after breakfast . So far I feel great and my numbers are better.
It did. Day of chemoI get IV Benadryl and left tired. Later was ok and next day. Day after that kind of crashed. That was only issue for me. Not a big deal.
Jumping in here since I’ve just had me 3rd round of docetaxel…
My dose of dexamethasone is 8mg orally twice per day the day of and day after infusion AND 10mg by injection during the infusion.
I definitely had an amped up feeling and trouble getting a full night’s sleep for a couple of days after the dexamethasone.
The dose can be tailored if you discuss it with your doctor, for example my doctor told me on the third round that if the sleeplessness was too much to handle I could take the day after doses much earlier in the day or even skip the final dose.
I considered skipping or taking half of the last dose but decided against it. I’d rather have a little insomnia than terrible nausea.
My doctor said some folks report that they schedule major housekeeping for dexamethasone days because of the energy boost.
I totally get that because the two to three days after each chemo infusion I’ve had enough extra energy to do double gym sessions. 😉
For docetaxel + carboplatin, I took 16mg dexamethasone the day before and the day of chemo (8 in am, 8 in pm), then three days of 4mg. I was told that the high doses help prevent the big side effects and fluid retention, while the lower doses help with nausea.
For those of you taking prednisone, are you taking it just around the infusion, or for the entire time you are doing chemo (weeks)?
DH had steroids reduced because of sleeplessness, irritability. He went to 1 1/2 pills 12 hours before chemo, one hour before and 12 hours after. It helped a great deal. (He also received a steroid infusion before the docytaxal because of an allergic reaction with his first infusion. )Yes, it meant setting alarm and taking it in the middle of the night. But it was worth it.
Yes. Before, during and after. Enough to wire you up, then fatigue when they wear off. We did experience moodiness and “some irritability “ with them. I wasn’t prepared for that
My spouse has similar story re castration resistant after Zytiga. He was prescribed 5 mg twice a day with his Zytiga. But the MO reduced to 5 mg once a day in the morning because my spouse is very sensitive to steroids. Went to docetaxel next. Still taking 5 mg prednisone every morning. He was so wired after the extra steroids (decadron) day/before/day of/ day after the docetaxel infusion that his MO reduced the infusion-specific steroid regimen to a reduced amount (I think 8 mg instead of 12) only given right before the infusion.
My spouse had 4 rounds of docetaxel. Numbness in feet got quite bad after 4 infusions. Fatigue and general yuck seemed to get worse by 4th infusion. Taste disruption was very troubling but would do away after about a week. Generally felt OK after about 7-10 days. But very depressing to know that the assault would be coming around the corner. PSA rose throughout the time frame of the 4 infusions, now trying cabazitacxel. Just had first infusion a few days ago. We'll see...
I assume with your prior Zytiga you were already taking 5mg pred, no? That's what I was prescribed, and always took it in the am with just a few SEs (increased appetite, a bit wired/hyper, minor insomnia, etc). I also had a bit of problem with the taper when I stopped Zytiga.
On Friday I was just prescribed a two-week course of high-dose dex 3x daily by my new MO, and a few days in it is working wonders for my fatigue, loss of appetite, pain perception, etc. (And hopefully slowing PC, too.) But already I have real insomnia and am "upbeat" bordering on mania... plan to have a similar talk with the MO about pushing most of the dose to the am and early pm to avoid trouble.
I agree with TA and even think you could do 5mg in the early am and 5mg in the early pm, but only the MO could confirm that. Good luck!
I was taking 10 mg of Prednisone daily when I was on Zytiga a few years ago. I was reduced to 5 mg a day because I started having an allergic reaction (rash) to the full 10 mg. That was the dosage that worked but I did not stay on Zytiga for long because I was doing so well with the Lupron, my MO figured we could have Zytiga as a back up strategy for treatment later on. Currently, I am still on Lupron with "consistent perfect PSA results" from the Lupron alone. I think you'll benefit from the lower dosage as prednisone is a steriod, you get amped up - no wonder you couldn't sleep.😀
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