After around 7 months on Abiraterone, I developed high blood pressure and quite bad irregular heartbeats. My Oncologist took me off Abiraterone immediately, and I was subsequently diagnosed with Atrial Fibrillation. After seeing a Cardiology Consultant, I was prescribed Bisoporol and started back on 500mg daily of Abiraterone.
Almost immediately, I became very short of breath on a regular basis and was again taken off Abiraterone. My Cardiologist then changed my A/F medication to Diltiazem, and I started back on 500g Abiraterone. In the meantime, I got hold of a spreadsheet from Liverpool University that showed how Abiraterone reacts with all other listed drugs. There is potential interaction with both Bisoporol and Diltiazem, but little has been done to examine this.
I tolerated the half dose of Abiraterone and Diltiazem quite well and, after a time, I was put back on a full dose of Abiraterone. Straight away, I experienced a lot of breathlessness and, once again, I was back on a half dose of Abiraterone. In the meantime, I saw a Respiratory Consultant and was told that, apart from a very light touch of Emphysema, my lungs were in good condition.
So, has anybody else experienced breathing problems when taking Abiraterone? My Oncologist tells me the NHS will no longer approve changing to Xtandi, and he clearly thinks that Abiraterone is the villain of the piece. Meanwhile, my PSA continues to be <0.1. I should point out that going back on half a dose of Abiraterone has shown little improvement in the breathlessness, and it is certainly a lot higher than the level when I first tried Diltiazem with 500mg of Abi.
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Sotalol does not interact with abiraterone and it is quite effective to control AF.
The blood pressure issue could be controlled by increasing the amount of steroids (double what your taking) and if it is not enough they could add eplerenone which block aldosterone the only hormone produced by the suprarenal glands when taking abiraterone.
Consult with a cardiologist about having a heart echo and see if there is a problem during diastole which could require decrease sodium intake and the use diuretics.
Thanks tango65, I had an echocardiogram a short while ago and the only point of note was a dilated left atrial. The Cardiologist didn't think this was a problem. I am not familiar with Sotalol, so I will check it out. Can't say I am keen on increasing steroids though.
It's well documented that abiraterone lengthens the Q-T interval, in effect prolonging the time before the heart resets for the next pulse. During ADT, I experienced this and it felt like the heartbeat was slower, albeit, much stronger and pronounced, possibly trying to make up for less blood flow from a longer Q-T interval. There's lots of studies on it, just Google "abiraterone QT-elongation" and form your own opinion on what to do. [I stopped Zytiga after five months and continued on Lupron only for the duration of 18mos ADT].
Here's some case studies of people experiencing elongated Q-T interval for reference>
Case Reports
Rodieux et al (2015)6 described a 74-year-old patient with hypertension, diabetes, anxiety disorder, and mCRPC who had life-threatening Torsade de Pointes associated with a prolonged QTc interval. The patient presented with cardiac arrest. Lab results includedsevere hypokalemia (2.5 milliequivalent [mEq]/L) and mild hypocalcemia (4.1 mEq/L). The patient was taking ZYTIGA, in addition to other medications, and was found to have pooradherence to prednisone. ZYTIGA was discontinued during the admission. The patient’s serum potassium returned to normal by day 2 and the QTc interval gradually decreased by day 6. The patient was discharged 2 weeks later.
Khan et al (2016)7 described a 77-year-old patient with ischemic heart disease, previous coronary artery bypass grafting, atrial fibrillation, and mCRPC who had recurrent Torsades de Pointes due to hypokalemia (2.7 mmol/L) with a prolonged QTc interval. The patient was taking ZYTIGA plus prednisone, in addition to other medications. ZYTIGA was discontinued during admission, and the patient was discharged after remaining stable. The patient’s electrolytes remained normal at clinic follow-up 1 month later.
Morales et al (2021)8 described a 70-year-old patient with hyperlipidemia, hypertension, and mCRPC who presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of Torsade de Pointes, severe hypomagnesemia (0.8 mg/dL), and hypokalemia (2.4 mEq/L). Additional testing revealed mild coronary artery disease and moderately depressed LVEF. After electrolyte disturbanceswere corrected, the QT interval normalized. The patient was taking ZYTIGA, in addition to other medications. ZYTIGA was discontinued during the admission, and the patient returned to baseline and was discharged. Of note, the patient was not receiving prednisone at the time of admission.
Riad et al (2021)9 described a 78-year-old man with hypertension and mCRPC who presented with progressive generalized weakness and shortness of breath. Laboratory results revealed a potassium level of 2.2 mmol/L, magnesium level of 2.4 mg/dL, and normal kidney and hepatic functions. The initial ECG showed atrial fibrillation with a rapid ventricular rate, frequent premature ventricular contractions, and a prolonged QTc (634 ms). Overnight, the patient developed multiple episodes of Torsade de Pointes, became pulseless, and underwent advanced cardiac life support, including defibrillation.
The patient was taking ZYTIGA in addition to other medications. The patient was started on IV lidocaine and dopamine infusion to augment the heart rate and assist in shortening the QTc.
A slight improvement in potassium level (2.8 mmol/L) was observed despite a total of 220 mEq of IV potassium chloride. The patient received spironolactone and amiloride for urinary potassium reabsorption, in addition to hydrocortisone, to reduce the effect of ZYTIGA on increasing mineralocorticoid synthesis. After this, his potassium level normalized.
Upon discharge, the patient was advised to discontinue ZYTIGA indefinitely and follow-up with his oncologist for further evaluation and management of cancer. At 3 months follow-up after discharge, the patient was symptomatically well and had normal electrolyte levels off of ZYTIGA.
So it looks like there were several articles in 2012, perhaps based on that Jansenn-funded study, saying that Zytiga did not affect QT interval. It must have of concern to Jansenn.
Then beginning in 2017 other studies said it did cause low potassium and affect the QT, including the 2021 case you linked where a patient almost died. I wonder how common that is among that thousands that have taken abiraterone since it came out in 2012.
Good question as to how common it is. I found a couple of websites dedicated to listing drugs that affect QT-interval and abiraterone is listed in both. In the first one, it is listed as "conditional"-- meaning conditions have to be present for AA to affect the QT interval, such as being on another drug concomitantly that affects QT-i, such as Lupron, (also on the list at an even higher risk level, referred to as "possible risk of TdP).
Looks like abiraterone has risk of messing up how each heartbeat works internally, or causing rapid beats, or starving the heart muscle of potassium. But it's been the gold standard second generation androgen drug, often used concomitantly with first generation Lupron. And by tens of thousands of people for the past decade.
Could be. There is always a price to pay when you send strong drugs rampaging through your body. I just wish Oncologists were a little more forthcoming about the effects of the treatments they are giving us. I appreciate that some of us don't like to hear the details, but its my life we are talking about here, and I need to know what is going on.
I wasn't aware that Abiraterone lengthens the Q-T interval, and so looked it up. To be honest, I read that Abi does not affect the Q-T interval. All suggestions are welcome though.
I have been on Flecainide for my AF for years. I just concluded two years of Zytiga (Abiraterone) and have experienced muscle fatigue and shortness of breath only if I exert myself.
Thanks for your suggestion of using Flecainide, good to see that you have had success with it. It appears that AF is one of those conditions that presents lots of treatment choices, along with some striking side effects. The unknown, of course, is how any new drug will react with those you are already taking. If I can get to see my Cardiologist (lots of people with heart problems), I will certainly mention Flecainide.
I have not had any breathing problems on Zytiga/Abiraterone, but I sure got elevated blood pressure from it.
MO took me down to 3 tabs daily instead of 4, (750 mg ipo 1000mg). Along with 5 mg of the Prednisone. I seemed to help some, but still have periods of 170/70. Cardiologist has me on 4 different meds. The MO has been reluctant to increase the Prednisone.
I cannot provide any first hand advice on the breathing, but will mention that exercise does help all of the side effects in some fashion. There are a lot of posts discussing it. Please check them out.
My Diltiazem is doing a good job of controlling my BP at the moment, but the main problems are breathlessness, positional vertigo and poor balance. As a result of chemo, I have CIPN in both feet, resulting in some 35% of the nerves causing numbness. As a result, I can't always 'feel' the ground I am walking on. I usually manage a 1-2 mile walk each day, as long if it isn't raining hard, but I think I would fail a risk assessment if I applied to join a gym.
Sorry you are having problems with your BP and obtaining alternatives to the abiraterone. I’m confident you will get that part sorted. How much do you exercise and what kind?
I'm gonna copy and paste some of my reply to an earlier answer.
As a result of chemo, I have CIPN in both feet, resulting in some 35% of the nerves causing numbness. As a result, I can't always 'feel' the ground I am walking on. I usually manage a 1-2 mile walk each day, as long if it isn't raining hard, but I think I would fail a risk assessment if I applied to join a gym.
I can also manage gardening in small bursts. Apart from that, me and my PS4 see a lot of action. With 78 years on the clock, I now do what pleases me, and ignore the things that don't.
Doing what pleases you at 78? Sign me up. A lost cause? Perish the thought!
Sorry about the chemo toxicity though. One fine day we’ll have drugs that attack the enemy exclusively, not like the napalm we have now, yes? Stay strong!
I have not experienced this, but then I have had little side effects from Abiraterone/Lupron + Prednisone. I have a Mitral Regurgitation as well as a natural slow heart rate (my resting rate is 47-49 bpm) so my cardiologist spent a bit of time discussing possible SEs I might have. I have well controlled high blood pressure, taking only a small dose of medication. A surprise to my doctors is that it has done little regarding breathing, oxygen levels, heart rate and no impact on my blood pressure. So as always impacts can vary from person to person, I do know of a couple of men who did develop AF while taking it, and several who saw issues with their blood pressure increasing. So I believe it could be the issue reading your results. Hope your doctors can come up with an answer.
Good to hear that you are tolerating Abiraterone so well. Before I developed AF, my average heart rate was 55-65, which I was very happy with. Now, it is somewhere in the region of 70-85, going up to 95 every now and again. This is still within the operating guidelines, of course, but I was much happier when it was lower. However, as a Mr Michael Jagger once remarked, "You can't always get what you want". Trouble is, I don't always get what I need either.
However, onwards and upwards. Coming up to 5 years with this 'gift', so can't complain.
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