I've been on Lupron/Abi/Pred for about 13 months. Never had high blood pressure prior to this ADT treatment. Was warned that high BP was one of the primary side effects of my treatment plan. Pretty quickly, I developed elevated BP and I am on 50mg of Losartan daily. 25mg wasn't enough. I am also on a second 5mg dose of Prednisone daily, for a total of 10mg. If I don't take the second dose, my blood pressure is not well controlled. (I've tried to reduce without luck)
I thought Prednisone raised BP, but in my case I need it for control. Doc also said that it might help with energy level a bit, though I don't really have an energy problem anyway.
My problem is that I hate the skin sensitivity, skin thinning, body hair loss and increased appetite. I have only gained about 6-8 pounds since I started, and I am not obese. But I don't need the extra weight.
Anyone have similar experience? Suggestions to get off the second dose?
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jmarsh
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I have exactly the same SEs, ( plus a truck load more ) ….diagnosed adt induced high BP, ( I’m well controlled with amlodipine, HTZ , lisinopril ) ….smooth thinning skin, weight gain , etc. ….but my meds are Lupron- Xtandi. I don’t take prednisone. While prednisone might have some involvement, I’d suspect the Lupron - Abi as more of the culprit. Just my own anecdotal IMHO.
In an effort to reduce my hypertension with abiraterone + prednisone, I switched to abiraterone + dexamethasone about 1.5 months ago. My reasoning is explained in this post:
So far, my BP seems to be lower with dexamethasone. But it's probably premature to draw general conclusions. When I have more experience and BP data, I'll post a thread here describing my results.
Abiraterone elevates the amount of aldosterone, a hormone which retains sodium and eliminates potassium causing edema, hypertension and hypokalemia.
The way to avoid this situation is to give prednisone reducing the increase in ACTH caused when abiraterone is given. ACTH stimulates the adrenals causing the increase in aldosterone.
One way to reduce the dose of prednisone is to use aldosterone receptor blockers. There are 2: spironolactone and eplerenone. Eplerenone is more specific and has less side effects.
You could discuss adding 50 mg of eplerenone twice a day and see if it is possible to reduce the amount of prednisone and losartan. Eplerenone alone may control the hypertension even when patients do not take prednisone.
There are a few studies published. This is one of them:
Tango65 is correct. His clearly written posts have been helpful to me in trying things to reduce my BP while taking abiraterone. I've gone from prednisone 5 mg/d (high BP), to prednisone 10 mg/d (somewhat lower BP, but didn't want this dose long term with CSMPC), to prednisone 5 mg/d + eplerenone 50 mg/d (initially lower BP, but increased over ~8 months), and now dexamethasone 0.5 mg/d + eplerenone 50 mg/d (lowest BP, almost normal, but only been on this 1.5 months). As I said in prior post, I'll post a thread with quantitative data after I've been on dexamethasone a few more months.
FWIW, I started ADT about eight years ago with just Lupron . Within five months I was in ER with high BP-induced CV event. There was no question that Lupron was the culprit in my case.
Changed Oncs after that fun. New one put me on Abi+pred, then augmented with Firmagon. Later, I got a honeymoon with Abi by switching pred to Dex, but dex struck me as much more powerful.
Everyone reacts differently, but I’d be suspicious of Lupron based upon my experience. Onc said around 10% have significant CV SE. Good luck. High BP sucks.
I never had hypertension before till ZYTIGA. Now I take 100mg losartan, 2.5 mg zebeta ( for tachycardia and HTN), and Norvasc 5mg for SBP > 140. I read study where 5mg prednisone 2x a day caused less HTN than once a day, but it didn't reach clinical significance. Apparently, it made a difference for you. Only way to get off 2nd dose would be to talk more HTN meds.
For those of you reporting HBP could you post how much exercise - walking, biking, hiking, etc and resistance training you are doing daily/weekly. Thanks.
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