What are the warnings for abiraterone?

Abiraterone (brand name Zytiga) is a medication used primarily to treat metastatic castration-resistant prostate cancer (mCRPC) and high-risk, localized prostate cancer when combined with prednisone. While it can be very effective, it also comes with some important warnings and precautions that patients should be aware of. Here are the main warnings associated with abiraterone:

1. Adrenal insufficiency and cortisol deficiency

Warning: Abiraterone can cause adrenal insufficiency (low cortisol levels) because it inhibits the enzyme CYP17A1, which is involved in the production of corticosteroids, including cortisol. This can cause fatigue, weakness, nausea, vomiting, loss of appetite, and low blood pressure.

Management: To manage this risk, prednisone is usually given with abiraterone. Prednisone helps to maintain normal cortisol levels and reduce the risk of adrenal insufficiency. Dose adjustment may be needed if symptoms occur.

2. Hypertension (high blood pressure)

WARNING: Abiraterone may cause high blood pressure (hypertension) in some patients, which may be severe. This may be due to fluid retention and changes in electrolyte levels (such as low potassium).

MONITORING: Blood pressure should be monitored closely during treatment. If hypertension develops, this may require adjustments in antihypertensive treatment or abiraterone dose.

3. Hypokalemia (low potassium levels)

WARNING: Abiraterone may decrease potassium levels, causing hypokalemia, which can cause muscle weakness, tiredness, and cardiac arrhythmias.

Management: Regular monitoring of potassium levels is important during treatment. Potassium supplementation or adjustments in diet may be needed if levels fall.

4. Liver Toxicity (Hepatotoxicity)

WARNING: Abiraterone can cause liver damage, including increases in liver enzymes (ALT, AST), and in rare cases, liver failure.

MONITORING: Liver function should be monitored regularly (especially during the first 12 weeks of treatment). If significant liver toxicity occurs, treatment with abiraterone may need to be discontinued or adjusted.

5. Cardiovascular Events

WARNING: Abiraterone has been associated with an increased risk of cardiovascular events, including heart failure, myocardial infarction (heart attack), and arrhythmias.

MONITORING: Patients with existing heart conditions should be monitored closely for signs of heart problems, especially if they develop symptoms such as shortness of breath, swelling, or fatigue.

6. Risk of fractures

WARNING: Long-term use of abiraterone may cause bone loss and increase the risk of bone fractures due to low testosterone levels and changes in bone metabolism.

MANAGEMENT: Bone health should be monitored, and patients may be prescribed bisphosphonates or denosumab to reduce the risk of fractures.

7. Pregnancy Category X (Teratogenic)

WARNING: Abiraterone is prohibited in pregnancy as it may harm the developing fetus. Women who are pregnant or planning to become pregnant should not take abiraterone. If taken during pregnancy, it may cause birth defects.

CAUTIONS: Women of childbearing potential should use effective contraception during treatment and for some time after abiraterone is discontinued.

8. Sexual Function and Reproductive Effects

WARNING: Since abiraterone reduces testosterone levels, it may cause sexual side effects such as decreased libido, erectile dysfunction, and infertility. These effects may be reversible when the drug is stopped.

9. Immune System Effects

WARNING: In rare cases, abiraterone may cause autoimmune conditions, such as autoimmune hepatitis, pancytopenia, and other immune-related side effects.

MANAGEMENT: Patients should be monitored for symptoms of autoimmune disorders and receive appropriate treatment if these occur.

GENERAL RECOMMENDATIONS:

MONITORING: Close monitoring of blood pressure, liver function, potassium levels, and other vital signs is necessary during treatment.

USE OF PREDNISONE: Since abiraterone can cause adrenal insufficiency, it is usually prescribed with prednisone to help reduce this risk.

Key points:

Abiraterone can cause serious side effects, including adrenal insufficiency, liver toxicity, high blood pressure, and cardiovascular problems.

Regular monitoring by healthcare professionals is important to ensure the safe use of this medication.

Patients should be aware of possible interactions with other medications and should avoid taking abiraterone during pregnancy.

Patients should discuss these warnings and any concerns with their doctor before starting abiraterone, and they should report any new symptoms or side effects promptly and Abiraterone Price in Malaysia.