Bicaltumide 50mg / Arrhythmia

[CJB5569]

Good morning, havent posted for a while no news is good new right?.... brief recap AF previous 6 yrs, finally had courage to go for RF Ablation 7 months ago (btw wish I'd had done it sooner). Anyway so far so good until now sadly; diagnosed with Prostrate Cancer. I've elected for Hormone and Radiation Therapy. However the drug I have been given to start off with called Bicalutamide has quite clear warnings re those being treated / taking medication for arrhythmia's including blood thinners (their words not mine). I currently take Flecainide 100mg bd, Bisoprolol 2.5mg od, Apixaban 5mg bd.... My question is has anyone come across this before where there is kind of potential conflict with drug interaction?.. (I'm currently waiting to hear back from Urology (prescribers) and arryhthmis nurses.....Thank you for reading

[CDreamer]

That is something that you need to take back to your GP and specialists treating you. Maybe first talk to your Pharmacist as you are more likely to get to speak to them quickly? They will also monitor your medications and be able to note on your medical file.

Sometimes it’s a judgement call about benefits over risks. To your knowledge, was your urologist aware of your arrhythmias and that you were taking these meds? Don’t ever rely on specialists reading your medical notes - in my experience some don’t.

[CJB5569 in reply to CDreamer]

You have hit it on the nail there CD reamer. I contacted the Pharmacist first .. sharp intact of breath .. speak to the prescriber (Urologist) whom I am pretty confident did not read the notes properly. Thing is if I had known it may have altered my PC treatment options (may) I'm waiting to hear back from Urology and the arryhthmia nurse to help make that judgement call. Thanks for replying.

[Desanthony]

You should only be on bicalutamide tablets for 10 days to a month before and during the first few days/weeks of starting Hormone Therapy by injection this apparently stops a cancer flare up with the hormones if started before or without the bicalutamide tablets. Usually you will have an injection that lasts a month the first time so that if there are any bad side effects from that particular injection it can be changed and then you will go on to 3 monthly injections. My GP surgery messed this up completely and I started the tablets on the day I had my first injection and it was a 3 monthly injection not the 1 month! It was up to my GP to organise the injections and whether or not I was given the Bicalutamide tablets as apparently not all practices do this and my consultant rad.onc told me this so did not know what I would be given. I went to see my GP and as far as I knew everything was going as planned and I thought I wasn't going to be given the Bicalutamide tablets and this must be the usual system with my GP. Within a week or so I was given an appointment with the nurse for the injection and I was pleased to be starting treatment. Sat in the nurses room and she said to me "This is your second injection so you are used to this" Um no 1st. "You'll have been given the tablets a week ago though?" um again NO! At this point my wife loses her cool and asks what the heck has been happening, has no one read anything from the consultant urologist and rad.onc and can they please just sort things out before she takes this to a higher authority. Nurse rushes out to ask GP what to do. GP sends through prescription for Bicalutamide and tells nurse to give the injection anyway. I was later told that this probably was not the right thing to do and had no effect on the so called "cancer flare" that can come from so suddenly changing the hormones but heck I was just so thankful to start the treatment. Thankfully, it seems to have made no difference and nearly 8 years on I am clear of prostate cancer. My stats were PSA 12.8, Gleason Score 7(3+4) Staging T2N0M0 but T3 disease could not be ruled out due to the tumour bulging out at the back of the prostate and therefore some cancer cells could have escaped to the surrounding area this meant that from diagnosis I went from having a choice of pristate removal to just Hormone Therapy (HT) and a month of Radiotherapy (RT) as this would treat the whole area and "mop up" any escapee cancer cells which were likely to be too small to see on PET Scans. - Whatever was the case the HT and RT did their job. I had HT for 9 months followed by the RT and was back to normal within 9 months of finishing my treatment.

Unfortunately, the Hormone Therapy is not always good for the heart and can cause problems for some - it could even have been one of the causes of my AF - but not the only cause. Hope your medics get back to you soon and can sort out different treatments and get started on them. All the best to you and I hope you get very few and only mild side effects if any from your course of treatment.

I don't know how your system works but I found it very difficult to get in touch with my Hospital key worker assigned to me and I think with all the questions I had to ask her I only managed to get in touch with her once as she was so busy; I actually never spoke to her or saw her but managed that once to get an answer by e mail! My wife and I found the Prostate Cancer UK helpline staffed by specialist prostate cancer nurses invaluable and I think we called them a few dozen times. Their free phone number is 0800 074 8383 and the lines are open Mon, Tues, Thur, Fri, 9am until 6pm and on Wednesdays 10am until 8pm. They were absolutely invaluable to me and my family.

All the best.

[CJB5569 in reply to Desanthony]

Very many thanks for your reply - agree Prostate Community have been helpful as indeed have the AF community which I'm very grateful for. I understand we aren't alone, and suffering in silence like years ago is hopefully a thing of the past. However communication could be better and there is occasionally a necessary 'insistence' to reach the objective which I'm about to deploy.. (sorry to many years in the armed forces )🤣 Thank you for your good wishes

[BobD Volunteer in reply to Desanthony]

My PSA was high 30s when they finally found it using transperineal biposy "hiding round the front" . I insisted on surgery which was good because they found it had spread so lost a few other bits you can live without and part of bladder. First 22 radio shots were broad focus to attack anything lurking outside the prostate bed and the last 11 were focussed on the bed itself. First 22 shots fried my intestines so mainlining imodium. Worth it long run though and vat free Tena!

[BobD Volunteer]

Not the sort of question we can answer really and you need to discuss with your medical team.

When I had PC I was put on monthly Zoladex implants for three years post surgery (it had spread) following 33 shots of radiotherapy. Nothing affected my arrhythmias though I did loose all chest hair (not head). I did not grow boobs as some do which would have been fun.

The good news is that was 13 years ago and six monthly PSA tests show as undetectable.

[CJB5569 in reply to BobD]

Agree not the usual Q & A but thanks for replying BobD. I already have boobs and no wish to add to them, an hair well thats a distant mammory..

[MarkS]

I was diagnosed with prostate cancer last autumn (Gleeson 9 local PC). I started bicalutamide within an hour of all the scans being done. Started prostap 2 weeks later and stopped the bic 2 weeks after that. I'm on warfarin and it didn't affect my INR. I think some of these warnings are a bit OTT. I started radiotherapy (VMAT) in early March and finish a week on Friday - 37 sessions as they did the prostate bed and lymph nodes to be on the safe side.

The oncologist has been great, much better than the urologists. She sends me a copy of the reports and instructions to the surgery so I can monitor/drive what happens. She takes a much more scientific approach than the urologists who just want to get stuck in with their Da Vinci toys! Radiotherapy has come on in leaps and bounds over the last 10 years or so compared with the radical prostatectomy.

[CJB5569 in reply to MarkS]

Thanks for reply Mark S ... weighing it up I just didn't fancy prospect of Prostatectomy especially when I was told it could be a little tricky !.. Still waiting to hear back what 'name/brand' the Injection will be. I have since spoke to Arrhythmia nurse about Bicalutamide. Oncologist appt 30 May.

[Ppiman]

An elderly friend, now 90, did the same nearly ten years ago. He was later given enzalutamide. It’s been a brilliant drug. He’s on warfarin only for his permanent AF.

He had some side effects early on, including visual effects, I recall and hot flushes, otherwise fine. He, too, read the long list of this, that and the other… but he’s never had any troubles so far as I know.

Steve

[CJB5569 in reply to Ppiman]

Thanks Steve

[kitenski]

the only thing I'd add is (another question for your cardiologist) why are you still on flecainide and bisoprolol if your ablation was succesful?

[CJB5569 in reply to kitenski]

Thanks kitenski actually discussed with Arrhythmia nurse recently and medication review being brought forward

[Mrwoo]

I take Apixaban b.d . I have taken the other three you mention which did not suit . I have exhausted the medicine cupboard in fact ! Anyway on a new regime completely due to further challenges with my heart . And the regime I am on seems to be okay with me. In addition to Apixaban, I take Nebivolol 2.5, Dapagliflozin 10 mgms Spironalactone 25gms, Atorvastatin 80mgm, Felodopine 2.5mgms and Ramipril 10mgms with a view to changing this Sacubitril/valsartan and have to face a change of pacemaker due to left side of heart not working as it should. in addition I take Levothyroxine and Omeprazole. I have had ablation, but this new medication mix seems to keep the arrythmias fairy controlled. I am doing okay and getting on with my life . I was an active sportsperson until 7 years ago . Still involved to a certain degree . I wish you the best

[CJB5569 in reply to Mrwoo]

Thank you Mrwoo I understand about the medicine cabinet and liked to think I was a fairly active sportsperson myself but since retiring it's just been one thing after another, with a knee replacement sandwiched inbetween 🤣 Anyway onwards & upwards 🚀 Sink or swim !

[Davidpeaty]

So many interesting replies, my brief comment on Apixaban is that following a Prostate enlargement holep op it was very difficult to decide when to restart the drug (as you stop taking it pre op) as I discovered it takes some time for your urine to become totally clear of blood which is instructive advice for restarting etc……so I am currently on half meds and will go on full when clear….anyway good luck with your meds and treatments