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My oncologist has prescribed 250 mg Zytiga daily with a low fat meal. He also prescribed 5 mg of prednisone twice a day.
For those who are on the 250 mg Zytiga with a low fat meal regime, how much prednisone are you taking? Did anyone adjust their prednisone due to taking less Zytiga?
I was taking 5 mg prednisone daily but recently switched to dexamethasone because my psa was rising. Prednisone is to mitigate side effects of the Zytiga such as high bp and edema etc. Now I take .5 mg of dexamethasone and will soon cut that in half hopefully. Prednisone doesn’t last long in your body hence 2 doses. Here are some of the notes from my visit with Dr. Sam Denmeade at JHUH which may be helpful to you if your psa rises on prednisone.
Even though you are taking less Zytiga you are getting about the same as 1000 mg because absorbtion is increased with food.
Thank you. I was thinking the same thing. My oncologist agrees with the 250mg daily dose with a low fat breakfast (300 cal approx 9 grams fat) and never hesitated when I asked him about taking 5 mg prednisone twice a day.
It was easy for me because I have been eating the same breakfast for years. My MO monitors my ast,alt and T levels. All my labs are good and my T is <1. It has nothing to do with cost for me because I get my abi free through a grant. It’s amazing all the concerns of getting improper absorbtion with food when the 1000 mg without food is the same for a 150# man as it is for a 250# man. Now ya really think that makes sense? But if you want to pop 4 abis instead of one you will probably get the same results. I actually do that if I’m planning on having breakfast with family or friends and don’t want to be limited on what I can eat.
When I had a visit with Dr Sam Denmeade and I told him of one of my doctors asking if it was about the money and I said no, why take 4 if 1 will do the job and Denmeades reply was, “exactly”.
Thank you. How much prednisone do you take with your Zytiga?
One month ago I stopped 5mg prednisone once daily and switched to 0.5mg dexamethasone. My psa was climbing and had reached 9.89. Today it was checked again and dropped to 7.06 and alp also dropped.
There is no reason to take a lower dose of Zytiga with food now that generics are much cheaper. You can get a 30-day supply of 1000 mg/day for $85e :
costplusdrugs.com/medicatio...
Food increases the absorption of the drug, but it varies from person to person depending on what is in your gut. So by taking the full dose fasting you are more assured of getting the full dose absorbed.
Because the side effects depend only on the dose absorbed, there is no reduction in side effects if the absorption is the same.
The need to replace prednisone doesn't change with the dose taken.
Thank you
afaik the normal Prednisone starting dose for non metastatic disease , such as yours, is 5mg per day.
I really don't understand why people would do "low dose" Abi. Absorption is very sensitive to fat content and you just add more variability.
Agree 💯 with TA.
I pay for mine (120 euro per month) which daily is about the price of a cup of coffee these days.
Prednisone is meant as a cortisol replacement. Cortisol is highest just before waking and reduces through the day. I try to mimic natural cortisol by taking mine when I wake and to reduce the potential for sleep disturbance.
Hello V-Man , that was the same amount I was taking for 3 yrs . My script was from University of Chicago per Dr. Smulewitz . Im currently off all meds since Sept. 2024 and still undetectable . Yes 5mg pred , per day with breakfast .
thank you, your comments are very encouraging and supportive of what I’m doing. Can you please tell me what you used for a low-fat breakfast? Was it the same every morning? And approximately how many calories?
I normally had a slice of sour dough bread , cup of coffee some berries . After some time i just ate anything even left over from dinner the day before . It does get boring with what and what not to eat . Its so nice now not having to plan that morning breakfast as I stopped all meds as of Sept 2024 after 3yrs of ADT ( Eligard ) Zytiga 250mg , and prednisone 5mg . Good Luck !
Has your testosterone gone up since you went off the meds ?
No. In fact it has decreased and now is at 0.017. I’m waiting to obtain my Orgovyx.
As Petabyte said, the normal Prednisone starting dose for non metastatic disease , such as yours, is 5mg per day. That is explained in this article once posted here by Tall_Allen: prostatecancer.news/2019/06...
My Uro started me on 10 mg and after a six months it had caused purple arm bruising and skin tears, a fat belly, and pre-diabetes. After reading the article I reduced myself to 7.5 and then 5 mg. At the next appointment, after seeing my good bloodwork and that article, the Uro agreed with 5 mg. After another couple of months, all the bad symptoms are gone.
During ADT I was 5mg prednisone, once daily. I'm getting ready to start chemo so they up'd it to 10mg a day, 5mg in the am and 5mg at noon.
FDA recently approved taking Lutetim Pluvicto before taking chemo
Did you consider that alternative
That's true but still n/a for me. It's still only approved for mCRPC and I am not mCRPC yet. Yes, I wanted Pluvecto while still ADT but missed some studies.
Ok and why are u taking steroids??? Be careful for they tend to have bad affects on your biology later in life after long term usage.
So I read some of ur bio, ummmmm I don't like the way it interacts with the body because u easily become dependent on it for strength, chemo n radiation are horrible choices but I understand the level of aggression needed. Dang, godspeed and good health with the challenge sir.
Thank you
Of course my friend, the more information we obtain the easier it is to make an informed decision, And thank You.
FDA approval includes 2x250 mg dosage and I didn't see taking with meals. Recent second opinion said 5 mg Prednisone is sufficient and should reduce side effects.
FYI- While most MO's appear to prescribe 10mg for the 1000mg dose of Abiraterone, mine, Dana Rathkoph (and my preceding doctor there, Howard Scher) at MSKCC in NYC has only been prescribing me 5mg for more than 10 years.
I have taken 250 mg of Zytiga, 5 mg of Prednisone and 120mg of Orgovyx with a low fat breakfast for 20 months. I also underwent 26 rounds of radiation at the same time I started the drugs. Side effects include weight gain, lower stamina and (most likely) declining bone density. Osteopenia diagnosed 4 months ago,
I target 7 grams of fat for breakfast. My PSA has declined from 5 to 0.03, as of two weeks ago, during this time period. I truly hate Prednisone - helping to keep me alive while trying to destroy my body - but it's a necessary evil. I'm happy to still be here! Best of luck to everyone.
Thank you. I also dislike using prednisone. That’s why I was confused/concerned that even with using 250 mg of Zytiga and a low fat meal, my oncologist prescribed 5 mg of prednisone twice a day. I am hormone sensitive and the literature seems to recommend only 5 mg once a day. Starting Eligard last October (6 month shot) and 45 radiation treatments, my PSA dropped from 16 to 0.017 and testosterone <10 (lab on April 1st) before beginning Zytiga. Am switching to Orgovyx starting next week. I really appreciate the opinions, experiences and expertise of this group. And most importantly the support and encouragement.
Initially, I was advised to take Prednisone twice a day. I asked about dropping the second pill and my doc agreed saying we would see a problem with the lower dosage should one arise. 18 months later, no additional side effects. Best to you.
Following the CSPC Prednisone recommendations from Zytiga? 
Zytiga with/without food ?
Prednisone dosage and meal
Fluctuating sugar levels on Zytiga and Prednisone
Is stopping zytiga and 5 mg prednisone cold turkey safe?
