Abiraterone requires medical supervision because CYP17 inhibition can affect mineralocorticoid balance, liver function and other physiological processes.
Mineralocorticoid excess
CYP17 inhibition can increase mineralocorticoid-related activity, resulting in hypertension, hypokalemia and fluid retention. Blood pressure and potassium should be monitored, and hypertension or hypokalemia should be addressed before and during treatment.
Cardiovascular considerations
Patients with cardiovascular disease require particular attention because hypertension, fluid retention and hypokalemia can contribute to cardiovascular complications.
Hepatotoxicity
Abiraterone can cause serious liver toxicity. Liver function should be monitored and treatment modified, interrupted or discontinued according to the applicable label when clinically significant abnormalities occur.
Adrenocortical insufficiency
Adrenocortical insufficiency can occur, particularly when corticosteroid therapy is interrupted or when the body is exposed to physiological stress. Healthcare professionals may need to adjust corticosteroid therapy in appropriate circumstances.
Drug interactions
Abiraterone can affect CYP enzymes. Strong CYP3A4 inducers may lower abiraterone exposure, while abiraterone can increase exposure to some CYP2D6 substrates. Medication reconciliation is therefore important.
Radium Ra 223
Use of abiraterone acetate with prednisone or prednisolone in combination with radium Ra 223 dichloride is not recommended because increased fractures and mortality were identified in clinical data.
Pregnancy
Abiraterone can harm a developing fetus. Women who are pregnant or may be pregnant should not handle damaged, crushed or broken tablets without appropriate protection.
Breastfeeding
Abiraterone is not indicated for use in women, and the product’s reproductive-risk information should be followed where relevant.