BP with abiraterone + prednisone, eplerenone, dexamethasone

[Gearhead]

I have been on Lupron and abiraterone with (initially) prednisone for 4.5 years, which has maintained my PSA at <0.1 since 111 at diagnosis. I have all the usual side effects. One that doesn't bother me day-to-day, but definitely concerns me, is hypertension. Before PCa, I had moderately high BP, which was controlled OK with benazepril + amlodipine. After starting Lupron, abiraterone, and 5 mg/day prednisone, my BP increased substantially.

Posts by Tall_Allan, tango65, and others explain the mechanisms by which abiraterone may increase BP, and how this can often be mitigated by increasing the prednisone dose (Zytiga literature instructs 5 mg/day if CSCPa and 10 mg/day if CRPCa). HU posts and medical literature describe how eplerenone and dexamethasone are alternatives for use with abiraterone, and how these alternatives may have less hypertension effects.

The purpose of this post is to share my experience trying prednisone, eplerenone, and dexamethasone to manage my high BP. Important disclaimer besides the obvious fact that we all react differently to medications: The BP numbers are very approximate because I've been inconsistent wrt measurement methods, frequency, Dr. office vs my home device, etc.

Prednisone 5 mg/day -- BP averaged approximately 162/79. This is Zytiga instructed dose for my mCSPCa. Besides the high BP, I developed edema in my calves.

Prednisone 2x5 mg/day -- BP averaged approximately 150/71. This was an improvement, but my understanding is that continuing this prednisone dose for many years is potentially problematic.

Prednisone 5 mg/day + eplerenone 50 mg/day -- BP averaged approximately143/68. This was more improvement, but BP was still higher than I would like.

Dexamethasone 0.5 mg/day + eplerenone 50 mg/day -- BP is averaging approximately 129/61 since starting this combo 4 months ago. I intend to continue this if BP stays at this level and no problems arise.

Comments, advice, and your experiences are welcome.

[mrscruffy]

For what it's worth I lost 20lbs and cut all my BP meds in half except for the 2 my GP took me off

[Gearhead in reply to mrscruffy]

Off of what?

[mrscruffy in reply to Gearhead]

BP meds, was on four

[dhccpa in reply to mrscruffy]

Excellent. I radically changed my diet in 2019 and got off my sole BP medicine in 2021. It does not happen overnight, but it happens.

[chickgreen]

We changed around my BP med - I'm now on 50 mg losartan a day, and 5 mg amlodipine - my average BP is now 119/70 down from the recent high of 145/90. I did have to take a short vacation from Abiraterone because I was maxed out on the losartan and my BP was rising fast. The heart doc and the oncologist didn't seem to want to talk with each other much

[Scout4answers]

Great post , I have been experiencing erratic BP on Zytiga + prednisone 5mg.

Will run this by my MO at our upcoming meeting.

Not familiar with - eplerenone, what is it's purpose, have you tried just Dexamethasone

[Gearhead in reply to Scout4answers]

He re is the most pertinent article re eplerenone and abiraterone that is not behind a paywall: ncbi.nlm.nih.gov/pmc/articl...

Eplerenone, which was sold as Inspra before a generic was available), is mainly a heart and BP medication. As I wrote in my long-winded post, I was never on eplerenone alone. After prednisone at 5 and 10 mg/day, I tried prednisone at 5 mg/day + eplerenone, and I'm now on dexamethasone + eplerenone.

[Scout4answers]

thanks great info

[jmarsh]

I was on Lupron, Abi + Pred 5mg. BP was high, so I went on 50mg Losartan. Incidentally, I never had hypertension until I started ADT. BP was still high on the Losartan. MO put me on a second 5 mg of Pred. That corrected my BP issue. However, like you, I don't think long term Pred is good for us. I am in the process of reducing the second dose, under my doctor's supervision. I'm down to 2.5mg on the second dose. So far, so good. We plan to get it to zero if possible. If BP rises, I am to increase the Losartan. My regular doc and MO agree that more Losartan is better than extra Pred. Good luck.

[Calhoun113]

Zytiga/5MG pred daily Eligard once every three months. BP was high. Endema. I started doing the tread mill every day. Fast walk 25 min break into a 5 min run. No more Endima and BP back to normal. Also taking .5MG Tamsulosin to stop peeing so often. Side effect is low blood pressure. Maybe that had something to do with it.