I will be starting abiraterone and prednisone. My doctor has prescribed 250mg daily with a low fat breakfast and 5mg prednisone twice a day.
Has anyone else taken this dose? What constitutes a decent low fat meal/breakfast?
Can the first dose of prednisone be taken at the same time?
Has there been a decrease in side effects with this lower dose or does it not matter?
Also, will be switching from Eligard to Orgovyx, has anyone else taken this combination and can the Orgovyx be taken at the same time as the abiraterone?
Thanks guys.
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Vman1
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The only reason to guess about abi dosing was cost. But now that it is available as a low-cost generic, cost ($84), it is not a big issue for most men.
Wow I am paying over $300 /month until my deductible completes in a few months then about $50 through Wellcare. I suppose I need my doctor to write a new script for costplus.
There are many posts in our H.U. history file that reference abiraterone (abiraterone acetate) which you can review. Refer to the top left of your screen to access the history file.
I just read your bio - In my opinion I think you need to start getting some more opinions in your care ASAP. The low dose / diet approach is very out of date due to the current costs. I also wonder how you are just now being put on Abi? I saw 9 different Drs before putting my care team together - you are your best advocate.
my husband diagnosed in 2008 with one bone met in his femur took full doses Abiraterone for 6 years 2012 - 2018 on NHS with Dexamethasone good QOL put him into remission but became toxic to his liver tried reducing initially to half, then increase to 750 but toxic to liver again so was stopped on consultants recommendation, I believe that endalutimide doesn’t affect the liver but in the Uk not eligible after having Abi
I was on 1000mg abi without food, 2 x 5mg pred, and orgovyx for about 2 and 1/2 years. Currently on first vacation. I always took abi separate from all other meds.
Congratulations on being able to start a vacation from these medications. Did you tolerate both of them well? Especially interested in the Orgovyx. I’ll be switching from Eligard (one 6 month injection) to Orgovyx.
My treatment originally started with monthly Lupron injection. A second opinion MO suggested changing to Orgovyx. So I made the change about 5 months in. Yes, I tolerated it well, and found it significantly reduced hot flashes.
Vman1 said: ... "starting abiraterone and prednisone... 250mg daily with a low fat breakfast and 5mg prednisone twice a day. Can the first dose of prednisone be taken at the same time?Has there been a decrease in side effects with this lower dose or does it not matter?... will be switching from Eligard to Orgovyx, has anyone else taken this combination and can the Orgovyx be taken at the same time as the abiraterone..."
The usual Abiraterone dose is 250mg x 4 daily without food. Maybe 250 mg daily with food is a cost thing, but my being responsible for the correct food factor would concern me.
Prednisone says take with food, but this article says when taking with Abiraterone for glucocorticoid replacement, taking with the Abiraterone (so without food) is best. endocrine-abstracts.org/ea/...
A year ago I was prescribed Abiraterone 250 mg x 4, and Prednisone 5 mg x 2. After 6 months the Prednisone skin effects were very unpleasant, and I found the article above, so I cut my dose to 5 mg and told the Urologist why.
I started taking Orgovyx a few months before the Abiraterone, and it is a really nice drug that can be taken at any time independent of the Abiraterone.
7 months on abi 1000mg plus prednisone 5 mg. I take the prednisone with breakfast so no chance of sleep problems. Abi later usually 5 pm. Eat after 6 pm. So far ok. Just hot flashes and oddly the occasi9nal skin pimple.
First month liver enzymes spiked, then returned to elevated, slightly above normal.
3 months later I started feeling a constant nausea and liver enzymes began to rise, nausea for me began around the 160 mark for AST.
Being a very active person, I was hiking the Adirondacks and got a tick bite.
Doxycycline pushed me over the edge, I felt like I was at deaths door… MO immediately pulled the Abiraterone and I was given a break from May until Sept, during Radiation Therapy… still no rise in PSA during this time.
I was put on half dose and immediately the nausea returned and AST soared to 265.
Blood pressure elevated to 150/87
Normally, 120/78
Blood sugar elevated as well 115 fasting
Normally, 110 non fasting and in the 80’s fasting.
I was taken off of Abiraterone and moved to Nubeqa, No liver involvement with Nubeqa at all.
More importantly, no identifiable liver damage.
My dosage was 1000 daily of Abiraterone 500 in morning 500 at night on empty stomach, take prednisone with your meals… mine was 5mg morning and night.
I have heard low dose Abiraterone ingestion can be maximized by taking with oatmeal.
When I started Abiraterone, cost was 10k a month to insurance.
Thanks, I was despondent that I couldn’t remain on Abiraterone… felt like my body was conspiring to keep me from being able to get the standard of treatment needed for survival.
Neurologist felt my 46 yrs on Dilantin may have sensitized my liver.
Anyhow, on Nubeqa for two months, one month on full dose and alls good!
I take 250mg with my morning oatmeal with added tablespoon of peanut butter and a little milk in it for the last 2 1/2 years blood numbers are good. Was prescribed 1000mg but I started out with 250 dose and take 5mg prednisone at the same time. Jokingly 1000mg of abiraterone is a meal
I wake up and have about 3/4 cup of non sugared yogurt whole milk, add blueberries and a half of banana. Sometimes I had a small amount of Catalina crunch cereal, of course with some non sugar sweetener. I like it, would prefer some fried eggs and toast, but low fat is the rule.
I am there now, year 10. Started on Arbiterone after Casodex failed in year 9. Same prescription from oncologist PW Van Zijl, probably the best that you will get in SA.
250 mg Arbiterone plus 5 mg Prednisone. I eat a small pineapple and a sardine from a can, in soy oil. So, I break the 250 in half. 125 in the morning, 125 in the evening with 5mg Prednisone. I feel good, has got a lot of energy. Headaches are with me now and then. No mets anywhere. Has got 1 lymph node in the upper stomach area that floats between 10 - 15 mm. PSA floats between 0.03 and 0.3.
And I do like the yellow!! But I stand by the Havard research on choline. I know it is impossible (and not good) to cut out all choline, but I try to eat no more than one egg yellow per month. At the same time I am quite a hypocrite: here in the Kalahari desert we eat meat, meat and meat. And chicken for salad. Which is all high in choline.
Hi. Allow me to apply my sceptic self. Choline is ubiquitous and central to membrane function in all cells (phospholipids). Aberration of its metabolism could make it a good target for imaging.
Howver can you point to any single human trial which shows that manipulation of choline intake has any effect whatever on any cancer? If not, do not deny yourself or manipulate choline, a valuable and essential part of your diet.
Yes, choline is the fuel of the brain. With no choline in your body you will not remember a single word. As for trials: The Havard University had a trial published in 2012 where they took away the yolk of the egg from a prostate cancer patient. His PSA responded immediately, dropping from 18 to 16. But read a little bit more about. Cancer cells will rather choose choline before they choose oxygen to keep them running.
Sorry mate there is a misunderstanding here I think.
Without oxygen (ie an anaerobic environment), cells revert to “anaerobic glycolysis” to provide energy (ATP), they do not use choline. Cancer cells have relatively high rates of anaerobic glycolysis.
Choline is a methyl donor and is involved in synthesis of phosphatidyl choline (cell membrane), methylation of DNA (alters gene expression) and synthesis of neurotransmitter (acetylcholine). It is not a primary source of energy for the cell.
I should add that PSA from 18to 16 on one person has no clinical significance.
Everything I said is widely spread on the internet. And I will not ask anybody to stop eating egg yellow. Please scrap everything I said. I relied on an article published by a reputable institution. Kind Regards, Thinus Coetzee
Hi Vman . I take mine every morning with eggs, toast with butter, coffee and 3/4 cup of delicious cottage cheese. I target 5mg of total fat along with the med. I take the prednisone later with lunch an all other daily meds.
250mg Zytiga and 5mg prednisone at lunch. I should add that we eat fresh fruit with these meals. I am a huge fan of avoiding processed foods. The closer to the farm, the better.
I’m unfamiliar with this “low fat meal”’approach. I’ve been on ABI 1000mg before breakfast and Prednisone 5mg after for 2.5 years. To my understanding the reason Prednisone is after is because it can irritate your stomach. 5mg is a small dose though.
A comment about the "low fat" diet. If the doc is "prescribing" it he should tell you what he means, because the term does not mean much. The term fat covers both oils and hard fats. It is the choice of fat which is important.
BAD: The fats that are really bad for you are trans-fats/saturated fatty acids which were widely used in food processing, but are now banned and should not be in the foods you buy.
GOOD: Plant based oils are generally healthy - olive oil, avocado oil, sesame oil, sunflower oil, and flaxseed oil. So having a salad for example with one of these is fine and good for you. It is impossible to consume too much as you quickly become satiated (unlike sugar which does not satiate)
GOOD: Fish oils are good for you (contain omega 3 fatty acids) - a couple of meals/week of an oily fish (eg salmon, trout, mackerel, sardines, anchovies, trout, kippers)
GOOD: Fermented milk products eg natural yogurt are good for you even though made from full fat milk.
BAD: Cooking/frying in healthy oil can be a problem because over heating causes oxidation and lead to formation of unhealthy fats. You can look up the safe temp to cook at.
BAD: So called "low fat" products in the supermarket (eg low fat yogurt) are generally unhealthy because they often substitute fats with sugar or sweeteners to make it palatable, which are even worse for your health than fat!
CHOLESTEROL: The world obsesses about cholesterol but there is a poor correlation between dietary intake and circulating blood cholesterol (eg review PMCID: PMC9143438 PMID: 35631308)( pubmed.ncbi.nlm.nih.gov/299... . Statins lower chol but probably actually work by reducing vascular inflammation . Lots of really healthy foods contain cholesterol - eggs, meat etc. and are good for you. It is trans fats and saturated fatty acids that are the culprit. Personally I eat butter and hate anything like maragerine which has been processed. Your cholesterol levels are mostly genetically determined.
SUGAR & FATS: Table sugar (a disaccharide) contains glucose and fructose. Glucose is the brains only nutrient and without it you die; excess is stored as glycogen in muscle and liver mainly. But, fructose (bad news) is metabolised tounhealthy fats and deposited in the abdomen (obesity) and contributes to fatty liver disease. Fructose (10X more sweet than glucose) is also found free in many soft fruits but also used as a sweetener in many soft drinks (coke and the rest). Avoid the latter completely. Moderate amount of soft fruits (in season and dont binge); hard fruits eg apples are great. Smoothies are bad news because they give you a lot of fructose and disrupt the fruit cells which releases the sugar quickly.
Hope that gives you some guidance to a healthy way to consume healthy essential fats/oils.
my oncologist has just started me on abiraterone. 1,000mg on empty stomach which I take about 3am when get up for a pit stop and 5mg prednisone once per day with food. I’m 3 weeks into it and no side effects so far.
I have done both, 250 with low-fat meal and 1000 on empty stomach. Testosterone undetectable on low dose no test results on 1000 mg yet. I shoot for 300 to 350 calories. 5 mg prednisone daily.
I was put on 5 because I am allergic to prednisone at high doses, the mega 6 day regimine for back pain. Biggest issue is a very thin weak skin. Everyone thinks prednisone is absolutely necessary when in fact it is just to mitigate the side effects of the abiraterone. Studies have shown that individual drugs can alleviate these side effects caused by abi. I just switched to .5mg of dexamethasone because it appears that in some folks prednisone can actually produce testtosterone like androgen that feed the cancer. Studies have also found Abi without lupron works. In the very near future I plan to discuss these issues with my doctors.
It's important to approach your treatment plan thoughtfully, especially when considering adjustments to medications like corticosteroids or androgen deprivation therapy (ADT). Below is a structured summary of key points to discuss with your oncologist:
### 1. **Corticosteroids with Abiraterone**
- **Purpose**: Abiraterone inhibits CYP17, blocking androgen synthesis. This triggers a feedback loop increasing ACTH, leading to mineralocorticoid excess (e.g., hypertension, hypokalemia). Corticosteroids like prednisone or dexamethasone suppress ACTH, mitigating these effects.
- **Dexamethasone vs. Prednisone**:
- Dexamethasone is more potent (1 mg dexamethasone ≈ 6–7 mg prednisone), allowing lower doses (e.g., 0.5 mg) to suppress ACTH effectively. This might reduce skin thinning side effects and minimize potential androgen precursor production due to better ACTH suppression.
- **Caution**: Dexamethasone has a longer half-life and may increase risks of glucose intolerance, osteoporosis, or mood changes. Regular monitoring is essential.
### 2. **Prednisone and Androgen Concerns**
- Prednisone itself isn’t converted to androgens, but inadequate ACTH suppression could allow adrenal production of androgen precursors. Dexamethasone’s potency may more effectively block this pathway, theoretically reducing androgen-related risks.
### 3. **Abiraterone Without Lupron (ADT)**
- **Current Evidence**: Abiraterone is typically combined with ADT (e.g., Lupron) to suppress testicular testosterone. However, studies in specific contexts (e.g., non-metastatic castration-sensitive cancer or patients intolerant to ADT) explore abiraterone monotherapy. For example:
- In **high-risk localized prostate cancer**, abiraterone + prednisone + ADT showed benefit, but monotherapy data are limited.
- **STAMPEDE trial** demonstrated efficacy in metastatic castration-sensitive cancer with combination therapy.
- **Considerations**: ADT-free regimens remain experimental in most settings. Discuss whether your cancer biology (e.g., low-volume disease) or personal tolerance supports this approach.
### 4. **Key Discussion Points with Your Doctor**
- **Dexamethasone Suitability**: Address skin fragility and allergy history. Is 0.5 mg dexamethasone sufficient for ACTH suppression? Are there alternatives (e.g., topical skin treatments)?
- **ADT Reassessment**: Review recent studies (e.g., androgen-axis biomarkers, genomic profiling) to determine if Lupron could be paused or omitted in your case.
- **Monitoring**: Plan for regular labs (potassium, blood pressure, glucose) and imaging to assess treatment efficacy and side effects.
### 5. **General Recommendations**
- **Personalized Care**: Treatment should align with your cancer stage, prior therapies, and comorbidities.
- **Avoid Self-Adjusting**: Corticosteroid/ADT changes require close medical supervision to avoid adrenal insufficiency or disease flare.
- **Explore Clinical Trials**: If considering non-standard approaches, trials may offer structured protocols (e.g., abiraterone monotherapy or steroid-sparing regimens).
### Final Note
Your proactive approach is commendable. Collaborate with your care team to balance evidence, safety, and quality of life. Ensure all decisions are guided by your unique medical history and the latest research.
A. **ACTH (Adrenocorticotropic Hormone)** is a hormone produced by the **pituitary gland** (a small gland at the base of your brain). Its primary role is to regulate the production of **cortisol** and other steroid hormones by stimulating the **adrenal glands** (located above your kidneys). Here's a breakdown of its function and relevance to your treatment:
---
### **Key Roles of ACTH:**
1. **Stimulates cortisol production**:
- ACTH signals the adrenal glands to release **cortisol**, a hormone critical for managing stress, blood sugar, inflammation, and blood pressure.
- Cortisol is a **glucocorticoid**, a type of corticosteroid naturally made by your body.
2. **Regulates adrenal androgens**:
- ACTH also prompts the adrenal glands to produce small amounts of **androgen precursors** (e.g., DHEA), which can be converted into testosterone or other hormones in tissues.
---
### **Why ACTH Matters in Your Treatment with Abiraterone:**
- **Abiraterone** blocks **CYP17**, an enzyme required for making androgens (like testosterone).
- However, blocking CYP17 triggers a **feedback loop**:
- Your body senses low cortisol and androgens → **ACTH levels rise** → overstimulates the adrenal glands.
- This can lead to **mineralocorticoid excess** (e.g., high blood pressure, low potassium) and potentially allow adrenal glands to produce androgen precursors.
- By replacing cortisol’s action, they “trick” the pituitary into reducing ACTH production.
- This prevents adrenal overactivity and mitigates side effects of abiraterone (e.g., hypertension, hypokalemia).
---
### **Why Switching to Dexamethasone Might Help:**
- Dexamethasone is a **more potent glucocorticoid** than prednisone:
- At very low doses (e.g., 0.5 mg), it can suppress ACTH more effectively.
- Better ACTH suppression may reduce the risk of adrenal-derived androgen precursors (which could theoretically feed prostate cancer).
- It may also reduce skin-thinning side effects (common with higher-dose prednisone).
---
### **Key Takeaway for You:**
- ACTH is a critical hormone in the chain reaction caused by abiraterone.
- Controlling ACTH with corticosteroids (like dexamethasone) helps manage both side effects and potential risks of androgen production.
- Discuss with your doctor whether **ACTH suppression** is being adequately monitored (e.g., via blood tests for cortisol/ACTH levels or symptoms like fatigue).
My husband has been taking FOUR 250 mg abiraterone (1,000 mg) daily with 5 mg. prednisone for over a year. He takes the abiraterone in the morning with his coffee and the prednisone after he’s eaten at least an hour after the abiraterone. He gets an Eligard injection every months. So far, good. His PSA has been undetectable for several months.
So glad to hear that your husband is doing well. God bless him. I see that he is taking 5mg a day of prednisone and have noticed others taking 10mg. Has he been experiencing any side effects from his medication? How long are the doctors recommending that he be on this regimen? Thank you.
“A low-fat breakfast increases the absorption of abiraterone, resulting in blood levels equivalent to approximately 4 times the standard dose, due to several factors:
1. Food effect: Abiraterone exhibits a significant "food effect," which means its absorption is greatly influenced by the presence of food in the digestive system26. This effect is particularly pronounced with abiraterone, as it has one of the most dramatic food effects among marketed drugs.
2. Increased bioavailability: When taken with a low-fat meal, the bioavailability of abiraterone increases substantially. Studies have shown that the bioavailability can be 3.8 times higher when taken with a low-fat meal compared to the fasted state3.
3. Extended absorption: The presence of food in the digestive system extends the absorption period of abiraterone, allowing more of the drug to be absorbed over time3.
4. Solubility enhancement: Abiraterone is classified as a Biopharmaceutics Classification System (BCS) class IV drug, which means it has low solubility and low permeability. The presence of food, even with low fat content, may help improve the solubility of the drug in the gastrointestinal tract, leading to better absorption.
5. Reduced first-pass metabolism: Food may slow gastric emptying and hepatic blood flow, potentially reducing the first-pass metabolism of abiraterone and increasing its bioavailability.
These factors combined result in significantly higher blood levels of abiraterone when taken with a low-fat meal, allowing for a reduced dose to achieve similar therapeutic effects as the standard fasting dose48. This phenomenon has important implications for both patient convenience and potential cost savings in the treatment of prostate cancer.
(from perplexity.ai)
When abi was $3,000 a month, well, cutting the dose to ¼ and adding the “food effect,” made sense. Today, not so much, as pointed out, copay may be $84 (and that is for 2 grams, so cutting the one gram tabs in half = 500mg (check w/ your doc but I think that’s ok, it’s not time release). Therefore a guy can buy one bottle which will last him 4 months, therefore total annual cost= about $350. So, there’s a POV for either.
The prednisone is taken at the same time, every day, unless prescribed otherwise, it’s a tiny dose, probably 5mg. The concept is (as I understand it) to re-equilibrate what is normally there).
As an increase of side effects? Unknown, as above the 500mg x 3.8 is equivalent to 1900mg which is a tiny bit less than the full dose (the normal prescribed 2 grams/day) without food. Therefore, adverse effects should be about the same.
I take Orgo + Abi, and have now for a bit over 2 months. I experience very little adverse effects, mild hot flashes at night and a stuffy nose, and a dastardly mad craving for chocolate ice cream (and I'm not kidding!). Eligard sucks, IMHO (not that I should have an opinion) if only because Orgo has a better adverse effect profile, especially related to cardio. Also when you stop Orgo, your testosterone seems to return much faster than it does on Eligard (YMMV).
Low fat meal: Thank you @Concerned-wife in one of the comments above:
Thank you for the very thorough reply. I will definitely be discussing the 5mg v. 10mg dose of prednisone. I’m starting on 250mg Zytiga with a low fat meal until all the applied for grants come to fruition. I agree, can’t wait to get off Eligard and on Orgovyx. Initial PSA 16. Started Eligard and IMRT on October 8, 2024. December 23, 2024 PSA: 0.162 and T: <10. Repeat PSA on 2/17/25: 0.057 and T: <10.
My Testosterone was 13 on lupron alone tested every six months. After starting Abi it went to <1. That was 250 abi and low fat breakfast and 5mg prednisone.
Hi Vman. I'm on abiraterone and prednisone. I am officially on the 4 tabs on an empty stomach. But, if taking the drugs 2-hours after breakfast will be inconvenient, I'll take a tab with cereal and skim milk. Supposedly, this increases the bioavailability of abir by 4x. So, effectively, you are getting 1000mg. Taking abir with a fatty meal can increase the dose by 8x. So, if your eating bacon, olive oil, omega 3 oils, etc, break at 250mg tab into half and you'll still get the 1000mg equivalent. India has been using 1 x 250mg tab with a low-fat meal for a few years. The IMPORTANT thing is to eat LOTS of high potassium foods (avocados, cantaloupe, dairy, hummus, etc) and even supplement with slow release potassium chloride (600mg) / day. 1/3 of everyone on abir will develop hypokalemia (potassium deficiency) within 6 months. I did at 3 months. Had SEVERE dry mouth and my heart rate dropped to the low 40 bpm with high blood pressure. My Dr. called me a hypochondriac. - the dummy! I have been supplementing and am fine once again.
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