Adrenal suppression

The main reason you took Zytiga is because it does cause adrenal suppression of steroids. Your adrenals manufacture several different kinds of steroids. While you want it to stop making androgenic steroids, an unwanted side effect of Zytiga is that it stops the production of cortisol too. When cortisol levels decline, the pituitary uses a hormone, ACTH, to tell the adrenals to pump out mineralocorticoids, androgens and glucocorticoids to replace what was lost. The excess mineralocorticoids cause edema, hypertension and hypokalemia (low potassium), and you certainly don't want more androgens. To avoid this, you have to replace the cortisol with low doses of prednisone. That tricks the pituitary, so that it doesn't try to replace what the Zytiga is taking away. Some doctors prefer dexamethasone.

When you stopped taking Zytiga, it takes some time for the normal production of steroids by the adrenals to resume. So the idea is to taper off the prednisone as your nature production of steroids resumes. It sounds like your natural production didn't kick in fast enough, so you were suffering from a condition called adrenal insufficiency (this can also be caused by stress or infections, which eat up cortisol). You can ask your doctor to monitor you for this as you taper off, and adjust the prednisone accordingly.

It is well documented that ADT can cause cognitive issues. Guys often describe slowed or fuzzy thinking, as well as the emotional roller coaster.

- Allen

I was also taking prednisone with Zytiga. While I can't recall the exact taper that I did, I know it was much slower than what you did. I think perhaps it was 2-3 months and at the end I was taking 2.5 mg every other day.

I assume you're still on Lupron. If so, I wouldn't expect the muddle to be any better until you finish. And even then it takes a month or two. But it does get better!

Allen, thanks for your description of what's going on with Zytiga. I understand it better now than when I was actually taking it!

Dear Herefishy2001,

I have also been on ZYTIGA, with the low dosage of required prednisone steroid pills each day (two 5 mg pills per day = 10 mg total), as required when taking ZYTIGA. I'm on ADT shots and have also done chemo treatments --- now, the ZYTIGA is there to help me knock down my PSA --- and ZYTIGA helps take care of residual testosterone produced in the adrenal glands and other locations in the body --- so it is designed to work together with the ADT shots to suppress testosterone.

As you know, ZYTIGA has to be taken on an EMPTY stomach --- four large 250 mg tablets a day = 1,000 mg total for ZYTIGA. I take my ZYTIGA tablets in the morning, before leaving for work, on an empty stomach as required. I do NOT ever eat breakfast --- but I do have a snack LATE in the morning, often a banana --- building up the potassium level !

I learned a lesson the hard way about taking ZYTIGA and have shared it with other friends of mine, some of whom have experienced nausea. One morning, in a rush, I wolfed down all four ZYTIGA pills in quick succession. That was a big mistake --- about an hour later, I had the dry heaves and learned my lesson --- not to be forgotten !

Since then, I start the morning by drinking a large glass of water FIRST --- then taking each pill, one at a time --- with quite a bit of water in between each of the four ZYTIGA pills. Other friends of mine have since adopted this same strategy and we have found that the mild nausea has disappeared --- so I think it's important to share this strategy with others. Water, water, WATER ! (Seems that WATER is very important in so many regards with our cancer treatments ?!!)

Unlike ZYTIGA, the two small prednisone steroid pills are to be taken WITH MEALS. Quite honestly, I have accidentally forgotten to take the 2 little steroid pills on occasion --- because I take those later in the day. I've made a conscious effort now to remember those 2 little pills --- as my oncologist said, those 2 little pills help the body TOLERATE the ZYTIGA medication --- those who take XTANDI don't need the 2 small prednisone steroid tablets ---

You asked about energy level and mental alertness --- I did experience just a bit of "brain fog" when I was going through chemo treatments --- but not to any great extent. During chemo, I found it a bit harder to concentrate on things like reading an in-depth novel or concentrating on an epic movie --- I kept my head in the game during the day at work, but found it a bit harder to concentrate for great lengths of time late at night. This "chemo brain" sensation soon faded away after my last chemo treatment was over, as I discovered.

With ZYTIGA, my energy and mental alertness has stayed intact. I'm thankful for that each day. I honestly feel that staying active and exercising each day is one thing that helps keep my energy and alertness intact. I go for long walks at night and I also have a stack of passes for occasional visits to the local gym. I firmly believe that some exercise or physical activity each day helps anyone who is going through cancer treatments ...

I know when you post, it's important to hear from a range of people with various experiences. I hope that you are feeling some relief as you wean yourself SLOWLY from the prednisone steroid pills. Stay in touch with your doctor on this, and I hope that you continue to feel relief in the days to follow.

Keep forging ahead in the battle,

"Cyclone" From Iowa State

I had the Cortisol/ACTH test and it confirmed that the adrenals were not so functional - injecting the ACTH was supposed to raise the cortisol levels, but only raised a tiny amount. So, at least I know that is what is making me tired and sore. Will stay with the 10 mg prednisone till I feel better, then decrease 1 mg every 3 weeks and see if that works better. Thanks for your help.

Bob(Herefishy)

Bob,
My skin is like paper while taking the Zytiga and Prednisone. My 70lb American Bulldog has left his fair share of scars on my arms, but anything can leave scars with this skin. Wishing you the best with the tapering process.
Michael

Cyclone, it sounds like I don't have near the problems that you do, good luck with your treatment. And you too, Michael.

Bob(herefishy)