PRECAUTIONARY MEASURES WHEN BISPHOSPHONATES OR LHRH AGONISTS ARE TO BE ADMINISTERED FOR THE FIRST TIME, OR ADMINISTERED AFTER A LENGTHY PERIOD OFF THOSE MEDICATIONS
Below are important details to be aware should your physician conclude that you should be administered a bisphosphonate like Zometa or Aredia..... or should your physician conclude that you should begin androgen deprivation treatment with an LHRH (Luteinizing hormone-releasing hormone) agonist (like Lupron or Zoladex).
As regards the intention to administer a bisphosphonate like Zometa or Aredia because of osteopenia, osteoporosis, or other bone issues........it is absolutely IMPORTANT to have all dental work (particularly examined and treated for any extractions, root canals, implants, peridontal surgery, or diseases) completed BEFORE permitting the oncologist to start you on a bisphosphonate. Bisphosphonates have the potential to cause osteonecrosis of the jaw. That likelihood is considered only in the 1-5% range though there are reports of higher ranges. It is also important to have the parathyroid hormone (PTH) level checked to insure the level is in normal range. And it is also important to be on a calcium supplement. The best recommended is called Bone Up by Jarrow or Bone Assure or Bone Restore that can be ordered online from the Life Extension Foundation at www.lef.org.
THE INITIAL ADMINISTRATION OF BISPHOSPHONATES ZOMETA OR AREDIA: You should INSIST that the initial dosage be at the lowest dosage possible (Zometa 1 or 2mg....Aredia 30mg) and that either of these drugs be administered over at least 30 minutes to prevent a side effect known as Acute Phase Response (APR)(fever, chills, bone & muscle aches) that can occur when the system is initially exposed to this medication. Should you experience little or no side effects after this initial treatment, your next scheduled administration of the drug can be increased either in steps or directly to the normal dose level.
LHRH AGONISTS: Should your physician tell you that you are to be treated with androgen deprivation treatment to include an LHRH agonist like Lupron, Zoladex, or other agonists, IT IS IMPORTANT that an anti-androgen (Casodex, Eulexin, etc.) and a 5AR inhibitor (Avodart or Proscar) be prescribed to be taken daily at least a week before and up to any first injection of a LHRH agonist - or if returning to an LHRH agonist after being off that medication - to prevent the side effect "FLARE."
FLARE: When an LHRH agonist is first administered, there is an approximate two week period after injection wherein there is significantly increased production of testosterone and stimulation of PSA and prostate cancer cell growth before the LHRH agonist kicks in. In patients with bulky disease that is compromising spinal cord, ureters, or seriously involving bone, this stimulation at the start of LHRH therapy can result in medical emergencies such as spinal cord compression, ureteral blockade or severe increase in bone pain. Even in patients without bulky disease, increases in LH, testosterone and PSA have been detected despite using seven days of an anti-androgen. However, even though the PSA does increase, this effect is markedly dampened by the priming doses of anti-androgen which results in a fall in PSA within 24 hours. Therefore, the anti-androgen prevents testosterone released during the initial surge from the LHRH agonist from doing major damage.
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