Lauren Engel explains how to safely take common oral prostate cancer therapies, including medications such as abiraterone, enzalutamide, apalutamide, and darolutamide. She discusses proper dosing, monitoring for side effects, and the importance of communicating early with your healthcare team to manage symptoms and stay on treatment whenever possible.
Lauren Engel:
With something like Abiraterone, it's important to take it on an empty stomach. So we usually explain what that means. And so empty stomach, so two hours after eating and then you have to wait an hour after you take your pills before you can eat again. So that is sometimes just explaining what an empty stomach means as part of my teaching.
Then they take it with Prednisone. So that's another thing we have to explain. We tell them to take the Prednisone dosing in the morning. So usually with breakfast because it's a little easier on the stomach if you take it with food.
The Abiraterone means that we'll have to watch your liver function when you come into clinic. We'll watch your blood pressure to make sure that doesn't go up. Some men do need some increase in their blood pressure meds if they're already on medication. And in some cases if they're not, we do need to start it.
So I say if you have a blood pressure cuff at home, it's a good idea to check it a couple times a week. And if you don't, when you go into the pharmacy or things like that, check your blood pressure. If you would start to have issues with your blood pressure in clinic, most likely would have you get a blood pressure cuff, check it a little bit more regularly at home.
I always say that I don't expect a pill like Abiraterone or Darolutamide or Enzalutamide or any of them to cause nausea, but if you did throw up for another reason, say you got food poisoning or something like that, don't take your pills for a second time that day. Even if you see it in the vomit or anything like that, just skip that day. We would never want you to double up on your dose. So if you can't remember if you took it that morning and you're back and forth, just skip that day and get back to it the next day.
For the Prednisone, like I said, we want you to take it with food in your stomach. And sometimes the Prednisone can cause some side effects of insomnia so that's why we have you take it earlier in the morning.
Sometimes Apalutamide can cause a rash in some folks and usually it starts off pretty mild, but it can get worse. And so that's another instance where if you have even the slightest rash, call us. Sometimes we'll have you take a picture and send it to us. I think sometimes people are really worried that, "Oh no, if I have a side effect, I'll have to stop my cancer treatment," which can be anxiety provoking.
And that's not always the case, but if you let us know when it's early, sometimes we can keep you on therapy. Sometimes we give you topical creams, steroid creams to help with the rash as well. Keeping your skin well moisturized is the other thing. Sometimes that happens in the winter when your skin's a little bit drier.