Prednisone weaning period after stopping Zytiga

[Gatodd]

I stopped taking Zytiga after 2 years. I am on 5mg once per day of prednisone. What is the weaning period for prednisone?

[JohnInTheMiddle]

Why didn't your MO our physician explain this to you immediately? Why would you even want to stop Abiraterone/Zytiga? Going to replace it with something else? Or maybe you're doing a sophisticated management of evolutionary pressure and you will stop now and then go back on it later or something? Or are you just doing it because apparently your cured or something like that or you'll want a holiday for the holidays?

As for how long you should wait, my understanding is that the half-life of Zytiga in the body is very short and that on this basis logically one would stop the prednisone almost immediately, or you will have too much of prednisone derivatives in the corticosteroid category or something. But this is not medical advice and I am not a doctor. It would seem you should get medically advice as soon as possible.

[Gatodd in reply to JohnInTheMiddle]

I am stopping zytiga after 2 years, in accordance with the stampede trial and at the direction of my MO. However, the MO was not specific about the prednisone weaning period, only saying that my dosage was so small, he thinks I could stop in a few days. I recall reading on this forum others had poor experience weaning over extremely short periods - and wanted to benefit from that experience.

Hope that helps.

[Mascouche in reply to Gatodd]

Weaning of it was difficult for me when I was following my oncologist advice which was to cut it by half every week. I was taking 10mg for over two years. What worked better for me was to use a half dose one day out of two and the regular dose the other day. So if I was you I would take 5mg one day, 2.25 the next day then 5mg then 5,... A week later take 2.5mg one day and none the next day and then 2.5mg,... Best of luck to you.

[dhccpa in reply to Gatodd]

I understand why you asked. I've wondered the same thing.

[Mbnm in reply to Gatodd]

gatodd..in Canada I have been on abiraterone for 4 months for prostate cancer in lymph nodes…why did u stop and how do i read about stampede trial u are in ?

[Gatodd in reply to Mbnm]

Here is one link about stampede

ncbi.nlm.nih.gov/pmc/articl...

There are many references to stampede on this forum that might be better. You may want to do a search on “stampede” for other articles.

We stopped due to the findings. I think the reasoning is that, for me in my particular situation, after 2 years - there is more risk in the long term effects of Abi than the potential benefit from continuing. I’m sure every person is different.

[JohnInTheMiddle in reply to Gatodd]

Dang. I'm coming up to 2 years on Abi (and like @Mbnm I'm in Canada too). Very successful so far! But nobody's suggested or mentioned going off Abi, yet. Do we know the reason why someone would want to go off Abi?

Because (1) we want to reduce evolutionary pressure and the development of resistance? (2) or because of cumulative damage to the system and we don't want to destroy our kidneys or liver or something? (3) or because it's too expensive and we didn't expect you to live this long anyway and you've had your run, have a nice day?

[Gatodd]

thanks. Makes sense to me

[Tall_Allen]

Slower is better. Maybe alternate days with 1 pill and half a pill for 2 weeks, then half a pill every day for 2 weeks, then alternate days of half a pill and no pills for 2 weeks, then half a pill every 3 days for 2 weeks. If your BP goes up, take more.

[Gatodd in reply to Tall_Allen]

I am weaning slowly, but after 2 days, blood pressure is high. Wouldn’t taking more prednisone increase BP further?

[Tall_Allen in reply to Gatodd]

The opposite. The biggest danger of taking too little corticosteroid to replace what is lost is a condition called a "syndrome of secondary mineralocorticoid excess." This occurs because the pituitary gland reacts to the lack of cortisol by producing a hormone called ACTH (this is called "negative feedback"). ACTH increases the production of mineralocorticoids (like aldosterone), hormones that increase blood pressure, lower potassium and cause edema in the limbs.

[Gatodd]

thank you. That’s consistent with what I recall reading on this forum. I will follow this approach.

[Leps]

The last time I was weened--after nine courses of docetaxel-- my MO scheduled it over a two month period.

[Gatodd]

thanks. My mo said short, but I am going to stretch it out some.

[Todd1963]

I took a treatment holiday a few years back. My Adrenal system never restarted and it is possible it may never do so even though we may never know as my treatment holidays typically last only a year. Atay enough to take another holiday from treatment. I will continue with the prednisone as not doing so causes everything to hurt.

[garyjp9 in reply to Todd1963]

Like Gatodd, I stopped Abi + 5mg prednisone after 2 years, because of the results in the STAMPEDE trial. Like Todd1963, however, my adrenal glands have thus far not recovered their own ability to produce cortisol. I am left with a secondary adrenal insufficiency and am now taking hydrocortisone daily, until the time if and when my body can pick up the slack.

[lhall2]

I will also be stopping Abiraterone/Zytiga after two years in May 2024 based on the results of my treatment. My MO told me to stop taking Prednisone at the same time without any weaning. So the question is to wean or not to wean. Only your MO would knows for sure. Ask him/her specifically for your case.

[dhccpa in reply to lhall2]

No weaning at all? Haven't heard that before.

[lhall2 in reply to dhccpa]

That is what my MO told me to do.

[dhccpa in reply to lhall2]

If it worked well for you, that's great. Many have trouble when dropping a steroid abruptly.

[Carnivore45]

Hi Gatodd,

The length of time that you have been on the Prednisone is a factor. I am on Nubeqa which doesn’t require Prednisone. I was on 10mg Prednisone for the chemo and now weaning. My MO gave me a simple schedule. Reduce to 5mg for a week. Then every other day for a week, then skip two days for a week, then 3 days, then stop.

I think given the long term use you should consider TA’s suggestion. Seems appropriate.

Best wishes!