I have been prescribed a double daily dose of Orgovyx (120X2) while taking Erleada (240mg) by my MO and been approved by my insurance (Premera, but I'm going on Medicare in February 2025). However, another oncologist, Dr. Lam at Prostate Oncology Specialists said a single 120mg dose was sufficient and that taking more was contingent on a testosterone level greater than 50ng/dl. Chat GPT tells me that 120mg of Orgovyx daily is sufficient as long as I'm not taking any P-gp or CYP3a inducers--I'm not. So, I have dueling oncologists. The Orgovyx and Erleada websites are no help.
Can anyone shed more light on the subject?
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I was initially on 240mgs. Erleada with Lupron, after 2-4 weeks I started to have Vertigo which didn’t go away. Started 180mgs.(3-60mgs.) and Vertigo went away.
Turns out that Erleada is a CYP3A inducer so FDA has recommended doubling the Orgovyx 120mg dose to 240mg when using Erleada. Switching to Nubeqa--not a cyp3a inducer--is an option as is Lupron.
I am aware of those manufacturers dosage recommendations, however my Premera insurance agreed to my mo prescription doubling up on Orgovyx to 240mg/day. Why would they agree if there was no basis? Orgovyx is not handed out like Halloween candy!
Safety and efficacy or Orgovyx at 120 mg/day (with 360 mg loading dose on day one) has been tested clinically for safety and efficacy and it has met the FDA standards of proof to induce the FDA to put its approval to that protocol.
Conventional thought is that Orgovyx is not "dose proportional" in its action. It either is sufficient to block the production of T (as promoted by loading up the receptors in the hypothalmus-pitutiary-testes axis and blocking signals to the testes to produce testoserone) or it is not. If sufficient, there is no reason to have excess Orgovyx in a man's system. Kind of like putting two quarts of water in a one quart bucket. Or taking more vitamin C than your body can process. All it does is give you very costly urine, as the excess is simply excreted. Unless you have a special situation similar to the P-gp or CYP3a situations which you do not have. Do you have any such other special considerations?
The higher dose one of your oncologists want to give you is technically "off-label", but many off label treatments are used and paid for by insurance companies.
As I understand it, off-label treatments are commonly approved for payment, particularly if they are listed in any of the several "compendiums" of treatments used by enough practitioners to be considered for coverage.
When I used Orgovyx, my T levels got down to castrate levels fairly quickly. Estradiol now has me (19 weeks into using E2 alone, without Orgovyx or any other T suppressor) with T levels around 10 to 20 ng/dl (PSA hovering at 0.014 ng/mL) and with fewer adverse side effects. This is, of course, off-label use of E2 and, I guess, more unconventional that doubling the approved Orgovyx protocol. But I prefer the gynecomastia from E2 over the hot flashes, irritability, depression, greater fatigue and cognitive decline I got from Orgovyx (not to mention the osteoporosis, insulin resistance, weight gain, etc that are practically inevitable with so-called "Standard of Care" agents of ADT. Those are just the results from my clinical trial of one, but convincing to me. Added to the other research, I am more convinced than (apparently) the FDA that parenteral estradiol is superior to Lupron or Orgovyx with the same safety profile. (My CMP and CBC labs are assiduously monitored)
Very good information Lost_Sheep. Thanks for the thoughtful and informative response. I too am tired of those SEs and very much interested in the E2 treatment. Thank you, thank you!
Check out the recently completed (not yet published the final results, but reported to the European Society of Medical Oncologists (ESMO) at their September 2024 Congress and having several preliminary reports already published. Search for the PATCH (Prostate Adenocarcinoma TransCutaneous Hormone) study/trial. I have found more supporting clinical trial reports as well if you need them.
There is a drug interaction between Relugolix(Orgovyx) and Apalutamide(Erleada): "Apalutamide may significantly reduce the blood levels of relugolix, which may make the medication less effective in treating your condition." drugs.com/drug-interactions... You could switch from Orgovyx to Lupron if you do not want the double dose.
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