Enzalutimide and high blood pressure

[Knittingque]

Husband has been on Enzalutimide 8 weeks 160mg alongside Zoladex for CRPC he had a week of bad headaches, with flu season around we just thought he had caught something before realizing it could be his blood pressure so when we took it it was off the wall for him. His Oncologist is on vacation so the on call Oncologist gave me a script for 5mg Amladopine (what has anyone else been prescribed) blood pressure is now eractic, if he sits and does nothing it goes down, if l get up and move around eg go to the bathroom 2 min walk blood pressure shoots up again, he has increased dose to 8.5 but still the same should he go to the maximum of 10mg . Onc not back until next Thursday. anyone else had this problem, l know everyone reacts differently to these drugs but just trying to get a general input. Thanks guys

[Benkaymel]

Personally, I would increase the Amlodipine dose to bring his blood pressure down to within a reasonable range but I'm no doctor. I've been on Amlodipine for around 6 years but when I started ADT, Xtandi and Tamsulosin, I found my BP plummeted so I took it upon myself to stop taking the Amlodipine. Sometimes you need to be your own advocate.

[Knittingque in reply to Benkaymel]

What is your dosage of Enza and what was your disage for Amlodipine initially

[Benkaymel in reply to Knittingque]

I took the full 160mg of Enza but stopped now as I’m CRPC. Amlodipine is 5mg.

[Kaliber]

yes, I’m on Xtandi ( Enza ) and it caused major changes in my bp as well. Like your husband , my bp skyrockets , even with minor - modest exercise …. Physical exertion. I’m taking amlodipne , lisinopril / hydrochlorothiazide , and rosuvastatin. The rosuvastatin for preventing heart attacks and strokes , says my PCP.

I’ve been like this for over 5 years and it hasn’t been much of a problem. Most of us, after starting powerful ADT will experience many changes in our lives. Necessary to help keep us alive a little longer. Your pcp will help work this out with you.

❤️❤️❤️

[Knittingque in reply to Kaliber]

Thanks for replying. What is your dosage of Enza and Amlodipine please, did you get head pain as well

[Kaliber in reply to Knittingque]

Xtandi - enzalutamide dosage is usually 4ea 80mg a day for everyone. Some people take less under certain circumstances. And amlopipine is usually decided by body mass and / or your doctor’s expertise. The head pain might be from high bp and disappear when bp is under control. I don’t think I experienced head pain with either.

❤️❤️❤️

[tango65]

The blood pressure should be taken at rest. An increase of the BP with movement and exercise is a normal physiological response and it should not be treated.

If he has a high blood pressure after 15 minutes at rest, you should consult with an internal medicine doctor or a nephrologist, to medicate correctly the high blood pressure.

There are plenty of drugs to treat high blood pressure such as ACE inhibitors, Angiotensin Receptor Blockers, diuretics, calcium channel blockers, beta blockers etc. etc.

[vincent57]

Does your husband happen to eat grapefruit(juice)? If yes, than he should stop this. Grapefruit contains a CYP3A4 inhibitor, causing a too slow metabolizing of enzalutamide, with an overdose of enzalutamide as a result. This again forces his BP to go through the roof.

[Knittingque in reply to vincent57]

Thanks for your reply and good comment, he is taking no grapefruit as specified when l looked up the drug so it has to be the 160mg dosage of Enza so ( there are so many men on this site who have been in the same boat so we are doing one less 40mg pill tonight to see if that helps with the BP and monitor everything. MO back on Thurs from vac and we have put a call into his office. Thanks again from Canada

[Justfor_ in reply to Knittingque]

Maximum Tolerated Dose (MTD) is the epitome of medical silliness. Every person reacts differently to a fixed quantity of a drug. When you go to buy a pair of pants there are all sort of waist and length size combinations. Imagine a shop carrying a single (fits all) size. Whould it be doing business next month? Certainly NOT! Yet, the medical profession is based on such a silly principal, as individualized dose titration is too much of a job for docs. My Bicalutamide Minimum Effective Dose (MED) is 1/10 the recommended one and yes, I like drinking grapefruit juice with breakfast.

[vincent57 in reply to Knittingque]

When experimenting with the enzalutamide dose, you may consider that the half-life of enzalutamide in the body is mentioned to be around six days. In other words, you should be patient when observing the results of your dosage experiments.

[Ian99]

I am CRPC. Am 2 years on Zoladex (3 monthly) and Zytiga (2x500mg/day), never had headaches or bp issues. Everyone is different but it may be worth checking if Zytiga is viable alternative to Xtandi.

[Hawk56]

Since I started ADT in January 2017 (see my clinical history), my BP has increased, I developed Afib (treated with medications, when those didn't work, cardioversion, finally, cardio ablation). My cardiologist has me on 10 mg Amlodipine, started at 2.5, doubled it when that didn't work, doubled it again...

I have BP monitor at home I take readings throughout the day. It's tied to my smart phone, allowing me to send a report to my cardiologist (just like my Apple watch did with AFib). I meet with him next week.

In discussions with my cardiologist and primary care doctor, we know it's not my weight, diet or lifestyle since I exercise every day, generally follow a heart healthy diet (well, those Manhattans...). Interestingly, they point to "old age.." I say, well, the onslaught of my CV issues did not begin until I went on ADT. I can see by the look in their eyes they are not necessarily in agreement with me.

While I have joked with my cancer team that their job is to have me die of something other than PCa, my cardiologist's job is if I am to die of CV disease, to make that at some point in the distant future. So, if your husband does not have a cardiologist on his team, consider doing so. My oncologist is great but he is not an expert in cardiology!

Kevin

Clinical History

[milehigh]

I have similar issues. I take 4 bp drugs. I don’t get treated for BP by my oncologist, My Primary Care Doc and cardiologist handle my BP, even while on ADT.

[EdBar]

I have a family history of high BP so I’ve been on meds for a good part of my life but after being on Enzi for a few years it started increasing my BP despite the meds I was using. I had to get my meds adjusted, now I take Valsartan, Amlodipine-5mg 3 times daily and Hydralazine twice a day. My cardiologist and GP had to tinker a bit. Amlodipine has a very short half life that’s why I take it throughout the day.

I wouldn’t ask my Onc to prescribe meds for my BP, it’s not their specialty, cardiologist is a better bet and stay away from ACE inhibitors, according to Snuffy Myers, who had a background in pharmacology, he said they they can inhibit the activity of ADT drugs. Vasodilators, Calcium Channel Blockers and ARBs are ok. I tried a beta blocker and my heart rate which is already low due to exercise bottomed out plus I felt terrible. You’ll get it straightened out, may just take a little trial and error until you get it dialed in.

Ed

[RCOG2000]

i found in my case a daily dose of enz was effective. In combination with lupron resulted in “complete redponse” after one year.

I heard from another patient that he had s similar response once per week dosing

In psychiatry the rule is to start low and go slow. May not be a bad approach here

[RCOG2000]

daily dose os 40 mg

[Knittingque in reply to RCOG2000]

Are you saying your daily dose is 40mg, if so how is your psa. My husband became CR after his second time round with Adt his psa was 69 so 160 enza was added, the psa fell to 39 after 4 weeks now on enza 9 weeks and BP off the wall, Amlodopine 10mg added, erractic BP so reduced enza to 120 mg with still 10mg of BP pill put taking 5mg in pm and 5mg am. BP has gone down ( not optimal but manageable) A psa on the 5th will indicate if the enza is still doing it's job on 120mg. He has a cardiologist due to Adt causing fib Catch 22 and his cholesterol is like a 16 yr old per cardio. We have been going at this now for 10 years and generally very positive but there can be some moments of doubts and distress. Thanks for replying appreciate it.

[RCOG2000]

my daily dose was 40 mg. Psa less than 0.01

[Lenders]

It’s a very common side effect with Enzalutamide. It took about 3 months trying different combinations of amalodapine and candesartan before it was stabilised. Hope all works out for you

[j-o-h-n]

ABOUT XTANDI

Common side effects include fatigue, diarrhea, anorexia, weight loss, constipation, joint and muscle pain, hot flushes, headaches, dizziness, hypertension, hypokalemia, fluid retention, and edema. Rare, but potentially serious side effects include seizures and posterior reversible encephalopathy. Mar 15, 2023.

No alcohol except for rubbing him with it..... Happy New Year.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 12/31/2023 7:58 PM

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

🤣😂😚