Abiraterone requires medical supervision because CYP17 inhibition changes steroid production and can affect cardiovascular, hepatic and endocrine physiology.
Mineralocorticoid excess
Abiraterone can increase mineralocorticoid-related effects, resulting in:
- Hypertension
- Hypokalemia
- Fluid retention
- Edema
Patients with cardiovascular disease require particular clinical attention.
Hepatotoxicity
Liver injury is an important safety consideration. Liver function should be assessed before and during treatment according to the applicable prescribing information. Treatment interruption, dose modification or permanent discontinuation may be necessary if significant hepatic toxicity occurs.
Cardiovascular considerations
Patients with significant cardiovascular disease, uncontrolled hypertension, heart failure, arrhythmias or other relevant conditions may require careful assessment before treatment.
Adrenocortical insufficiency
Abiraterone is used with prednisone or prednisolone partly because CYP17 inhibition alters steroid production. Clinicians should consider adrenocortical insufficiency when corticosteroid treatment is interrupted or during significant physiologic stress.
Food interaction
Food significantly increases abiraterone exposure. It must therefore be taken on an empty stomach according to the applicable label.
Drug interactions
Strong CYP3A4 inducers can reduce abiraterone exposure, while abiraterone can affect CYP2D6 and CYP2C8 substrates. A complete medication review is necessary before treatment.
Pregnancy and reproductive exposure
Abiraterone is not indicated for women. Because the medicine can pose a risk to a developing fetus, handling and contraception precautions should follow the applicable prescribing information.
Monitoring
Clinical monitoring can include:
- Blood pressure
- Serum potassium
- Liver function
- Fluid retention
- Cardiovascular symptoms
- Corticosteroid-related issues