Orgovyx /Degarelix, Time Risk - & Jail

[JohnInTheMiddle]

"Compliance" with meds taking and timing is a big issue, as we all know. And research shows that especially with the elderly, compliance to meds regimes and timings by day and by week is difficult to follow. And the consequences are not good.

When one is on doublet therapy (whether or not one had also chemo and then triplet for a while) there's typically a schedule to follow every day. Some drugs like Abiraterone need to be taken every day on an empty stomach.

And then there are meds such as prednisone (which in this case goes along with the Abiraterone) that need to be taken on the other hand every day with food.

Many of us also take some supplements, e.g. especially vitamin D and calcium for the threat of osteoporosis from ADT. (And the ADT itself is in my case a monthly injection.)

The pharmacokinetics of the drugs above are slightly tolerant of imprecise dose timing. For the pills, by hours, and for the injections, by days.

But then we come to the new oral ADT Orgovyx / Relugolix. And because of the pharmacokinetics of this excellent GnRH antagonist ADT drug, it's recommended that you take it every day at exactly the same time.

And if you miss a dose apparently it's not a good thing. Testosterone production can resume quickly, thus triggering androgen receptors on your prostate cancer cells.

The big picture here is people with any kind of cancer often have to take drugs everyday according to a strict schedule. And one's risk is apparently significant if one doesn't stick to the schedule or even worse misses a day or two or more.

So I started thinking about this because of Orgovyx ADT. And I've been thinking that it would be great to be on Orgovyx because its profile for side effects, especially for cardiovascular disease, is very good. And then you don't have to have an ADT injection every month or every 3 months etc.

But what about interruptions in access to your meds? I originally was thinking about interruptions in terms of travel. Or worse, what if your house burned down?

Then I started to wonder about arrest. I have never been arrested in my life, thank goodness. And I don't believe I'm at risk of being arrested. But lots of people are arrested. And no doubt there's an overlap between populations of people who are arrested and people who are taking pill-based cancer meds.

If you are arrested, you might miss the following day's meds taking. And if this is Orgovyx this is not good. Even assuming you get bail right away. Probably not a big risk but for me I'm thinking maybe that would be a reason not to switch to Orgovyx.

And then I broadened out my reading to general pre-existing metastatic cancer situations and meds that all of us have to take every day. And what happens if one is arrested and has to go to jail. There's the initial period before bail, and then if one is convicted for a period of time the question of reliable and timely access to one's own prescriptions.

Also in a situation of incarceration, what about chain of custody for the meds? And security for the meds against tampering?

I found it oddly difficult to find out what one could expect if one is jailed and where one has a pre-existing medical situation that requires daily meds.

It was distressing to learn, maybe I'm naive, that one is at significant risk for not having secure and timely access to one's meds in jail. Although there seems to be a lot of variation by type of institution and jurisdiction. And as for supplements, even for something essential like Vitamin D, probably forget it.

My initial concern was both curiosity and just wanting to be prudent. Being a person with metastatic cancer is a strange situation, even if it not as uncommon as we would like.

But it's now in my mind that the situation for many people is likely very dire. There is incarceration and then there may be a "metastasis" of punishment, unintended but permitted.

[Ian99]

Thoughtful post. Keeping track of pills especially when travelling is a big deal. I have a 7x4 pill matrix which I load up before travelling, with buffer if return is delayed. Jail is another scenario which would need special arrangements.

[JohnInTheMiddle in reply to Ian99]

Bravo! (And then you have to keep track very carefully of that 7x4 pill matrix 😃.)

One thing I learned, when I was away from home briefly and I was keeping pills wrapped up in tin foil in my breast pocket, was that the pills became quite warm even though they were several layers of fabric between my body and the pills. Who knows the impact?