Abiraterone and food

[NLondon43]

My husband has been on Abiraterone for 2 months, during which time his PSA has doubled. I’ve recently read posts about the advantages of taking Abiraterone with food instead of taking it an hour before eating as recommended. The posts are quite old (5 years) - is taking Abi with food still a consideration or has it been disproven?

[Tall_Allen]

Since a low-cost generic has become available, there is no reason to reduce the dose by taking with food.

[Lettuce231]

Hello, I see that you have one reply.

I've been on Zytiga since 2018 and have always taken it with my breakfast. Not before or after. I've had very good results and my PSA is undetectable. I've worked on the theory of absorption, taken with food, there are many of us doing the same.

It might be that the treatment your husband is on is not the correct one for him, or it may take a little longer to work.

Don't delay for too long, speak to the oncologist.

I hope that things improve for him.

[dhccpa in reply to Lettuce231]

One pill only with a meal?

[Lettuce231 in reply to dhccpa]

Hello, I have 1 x 500mg Zytiga every morning with breakfast, the breakfast is fried egg on toast and a good yoghurt. The prednisone I take one hour before breakfast.

I have the Lupron jab every three months, it helped lessen the fatigue.

I reduced the Zytiga to 500mg not due to cost, as has been suggested many times before on the forum. I was concerned about the long term side effects, I figured if I can take less and it works for me, then I have the option of increasing the dose back up if I needed too.

If you take something and wash it down with water, where does it go ? With food it should stay in your system longer and increase the efficiency. Just my thoughts.

Its often stated that there is no scientific studies to back the food and Zytiga experiment up. But those of us who do it this way are the scientific study.

I hope this answers your question and I wish you all the best.

[dhccpa in reply to Lettuce231]

There was the U of Chicago study that kicked off taking lower dose with food. However, I believe most doing low dose Zytiga with food take 1 250 mg. pill, not a 500 mg. pill.

Any great side effects? You may be getting a heavy dose with food. How much Prednisone do you take? Are you in good cardio and pulmo shape? Thanks. I haven't taken Zytiga yet, but it may be next.

[Lettuce231 in reply to dhccpa]

Hi, I believe there was also another study in Europe, but I can't locate it right now.

I live in France and the 250 mg Zytiga pill was withdrawn. I'm not into cutting them.

I have very few side effects, the usual osteoarthritis and osteoporosis, some loss of muscle. I was diagnosed in 2013 and have no heart problems.

I cut the prednisone to 5mg when I reduced the Zytiga.

I wish you well.

[dhccpa in reply to Lettuce231]

Thanks for the information.

[Lettuce231 in reply to dhccpa]

My pleasure

[Ron53 in reply to dhccpa]

My Oncologist gave me a copy of that study when I went on the lower dosage. I was instructed to take 250 mg Zyriga with low fat breakfast ( 5 grams of fat or less). Been doing so for the past year.

[dhccpa in reply to Ron53]

Thanks

[Hidden in reply to Lettuce231]

You're fooling yourself.

More is absorbed in the body by 5 fold with food than on an empty stomach.

So your 500mg with food is more like 2500 mg on an empty stomach

[Lettuce231 in reply to Hidden]

Thanks, so if you swallow 1000mg with water, how much efficiency did you lose ? 😒

[Hidden in reply to Lettuce231]

None, that the basis!

250 with food was used when it wasn't generic, and people needed to save cost.

[Lettuce231 in reply to Hidden]

Thanks, so on that basis, if I take 1000mg with water, I'm taking too much.

If your synopsis is true, then I'm correct. 5 fold with food 😒

[Hidden in reply to Lettuce231]

I’m done playing your game.

[Lettuce231 in reply to Hidden]

Not too worry, eat drink and be happy.

I'm okay with what I'm doing, thanks for the conversation.

[TMcgee in reply to Hidden]

Terminal: Based on my research, there is a possibility that Lettuce is getting the equivalent of 2500mg, which could increase the drug’s side effects. However, if Lettuce can tolerate the additional side effects, what is the harm or additional risks?

Looking at the challenge another way, Prednisone should only be taken with food. If you are consuming 2 5mg tabs, you have to take the first 5mg tab with your food, an hour after taking Abi on an empty stomach. How does the delay affect the efficacy of Prednisone? I couldn’t find any research that answered my questions about the combination of Abi/Pred

I found that my gastrointestinal issues stopped when I changed to Abi + food. It is likely that the issue was caused by taking Pred with the Abi on an empty stomach, but I can’t (won’t) live my life based on an alarm clock telling me to go eat and take your pills.

[Hidden in reply to TMcgee]

Prednisone is independent of Abiraterone.

It is taken to make up the loss of corticosteroids due to Abiraterone shutting dow your adrenals.

[TMcgee in reply to Hidden]

You are correct; but I didn’t comment on the reason it is prescribed. You have commented on a potential change in bioavailability when taking a lower dosage of Abi with food. Theoretically, you are right; but, you haven’t articulated the risks or consequences.

I consume 250mg Abi and 10mg Pred with yogurt each morning. I tried to follow the recommended dosage, but encountered gastric problems and scheduling challenges. I have researched every paper that I can find to understand the risk of not following the recommended procedures and have found nothing. My MO and VA Pharmacy agree with my usage.

If you have information counter to my findings I would very much appreciate reading it.

[Grandpa4 in reply to Lettuce231]

No one thinks it is better with food. Just cheaper. The drug is absorbed better with food so you don’t have to take as much. This dffect is somewhat variable so unless you need to save money 1000mg on an empty stomach is preferable.

[Lettuce231 in reply to Grandpa4]

" the drug is absorbed better with food so you don't have to take so much "

interesting, which is precisely my point.

" no one thinks its better with food "

Have you read the replies on this post ?

[Grandpa4 in reply to Lettuce231]

What I meant was there is no data to suggest it is better. All the data documenting that it works was fine with the 1000 mg dose.

[Lettuce231 in reply to Grandpa4]

Yes, that's true at the moment, maybe in the future though.🤔

[Stephen399b]

I have been on Abiraterone for 2 1/2 years and PSA has been unmeasurable for most of that. I routinely take 2 hours after food and then leave an hour afterwards before eating again. Works for me.

Best wishes

[Peealot]

I’ve been instructed to take Zytiga only on an empty stomach.

[Proflac]

Take on empty stomach as advised if he is on the full dose or you risk problems. The taking with food option is/was used in the main by those who were/are taking a reduced dose due to the cost of the meds. It's now available cheaply (off patent) so no need for this in most parts of the world. Taking with food increases absorption. But it was/is always difficult to get the dose right with the particular food consumed. Assuming you are prescribed full dose on the NHS then I would suggest you do as doctor and pharmacist direct.

[TMcgee in reply to Proflac]

You mention that you “risk problems”. What problems have been identified, beyond the typical side effects? Below I posted 4 links, one of which breaks down the side effects associated with different doses; but I have found no studies that suggest a risk of additional problems. I’m very interested in learning what problems you have discovered. Thanks

[Haa2020]

Started with 500mg with corn cereal (called Akamu in Nigeria) as first meal/breakfast. This was my urologist's advise. Later due to cost and lack of funds, I changed to 250mg with same Akamu in the morning. My last PSA reading was 0.16. Am on Zytiga and 3 monthly Zoladex including some supplements and exercises.

[Magnus1964]

I was on a drug trial with aboraterone. The trial had me start taking the drug on an empty stomach. Then later switch to taking it with food. My PSA dropped with the switch. That was 11 years ago.

[dhccpa in reply to Magnus1964]

A lot of variations in answers/results here. I guess we all react differently.

[HikerWife]

My husband has been on 250mg of abiraterone (with prednisone), taken with food, since February. With it he eats a breakfast of roughly 300 cal and 9 g of fat. This protocol was approved by both the chief of oncology at our local hospital (Angela Taber), and Dr. Sylvan Baca at Dana Farber's PCa department (Boston). He has responded very well, PSA continues to fall (down to .36 from over 270). No side effects whatsoever. This was not a financial decision, this was a wish to take less of the drug (toxicity concerns), not have to take it on an empty stomach (nausea), and make timing and convenience easier. Food enhances absorption of the drug (as it does with many drugs). Both of our MO's pointed out that the "1000 mg on an empty stomach" protocol is prescribed primarily b/c that was what was done in clinical trials of abiraterone.

[MarkBC]

When new drugs are put through clinical trials, the scientists check things like:

1. What is the best dosage?

2. Is it better to take it once or twice per day?

3. Is the drug more effective with or without food?

Personally, I would follow the instructions given and, if I want to alter those instructions, I would talk with my oncologist about it and not just do it of my own volition. The scientists and doctors know much more about the drugs and the cancer than you and I do.

[j-o-h-n in reply to MarkBC]

SOMETIMES.....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 08/18/2023 1:25 PM DST

[16starsky]

My Husband has been on Abi for 32 months, and for the last 8 his PSA has been creeping up, now stands at 16.2. I too was wandering if we should try taking the Abi with food, to see if it would lower his PSA, a little scared of potential side effects. But we know come Oct our NHS OC will take him off it if PSA hasn't fallen, then it will be chemo!!!

[Lettuce231 in reply to 16starsky]

Hello, I've had no side effects, I feel better than I did before I changed the way I took the medication.

[16starsky in reply to Lettuce231]

Ohh Thanks, think we will try it, what have we got to lose ?

Did it lower your PSA ?

[Lettuce231 in reply to 16starsky]

That's a difficult question 😕, my PSA was on a downward projectory.

I've just had a conversation with Terminal, he says I'm kidding myself. But I think he defeated his own argument. Look back on this blog.

I'm so sorry that your husband's PSA is creeping up. It's very concerning.

All you can do is try.

I really wish you all the best.

BBQ with the family, spelling has gone stupid, nice whiskey though. 🥃

[TMcgee]

here are the papers discussing Abi with food:

pubmed.ncbi.nlm.nih.gov/295...

Here is a trial

clinicaltrials.gov/study/NC...

I’ve researched the topic to determine how widespread the usage of 250mg is globally. It appears that Europe and India are more likely to prescribe 250mg.

As I see the issue, bioavailability is the point of contention. None of us want to consume a dosage that falls short of what is recommended. It appears the consensus is 1000mg on an empty stomach provides consistent absorption. At issue is the question of how much fat must be added to achieve the same absorption as you reduce dosage. And, if you add too much fat what are the consequences of absorbing more than the recommended dosage?

The studies below answers those questions

link.springer.com/article/1...

future-science.com/doi/10.4...

After reviewing, I decided to take 250mg Abi/10mg Prednisone with low fat yogurt with blueberries. I use Splenda (sugar substitute) to sweeten.

I hope this info helps.