Firmagon (Degarelix) Initial dose

MCD54
MCD54 Member Posts: 13
in Prostate Cancer #1

Hi 

I´m new in this forum so I hope you can all bear with me.

My husband has an aggressive prostate cancer with metastasis in bone region (L2). Gleason>7  T3, N1 M1 PSA 36.

His docter wants to start hormone therapy immediately tomorrow, but because he has heart problems (arythmias and myocardiopathy, takes sotalol) and is quite weak he thinks it is better to start with 120mg initially of firmagon, not the double dosage of 2 x120mg. My husband usually takes very small dosages of his meds because he reacts immediately to any drug, but I´m not sure if it´s going to work if he has just half the recommended amount?

Has anyone had experience with Firmagon(Degarelix) before? And started with a lower dosage? In Spain they have very little experience with this medication they normally just use Eligard, so I can´t ask anyone. Plus not even the docter has used it before.

Could anyone tell me please about their side effects or anything that could help him, I´m pretty desperate? 

Thank you for your time and I wish you all the very best.

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    edited January 2018 #2
    Better to follow maker's instructions

    MCD

    Welcome to the board. I am sorry for the diagnosis of your husband. I am thinking that Firmagon was recommended due to your husband’s heart issues. This drug has lesser cardiovascular related side effects than Eligard. However, the purpose of the hormonal treatment is to lower the testosterone circulating in the body to starve the cancer (it feeds on the stuff). And such can only be achieved if these drugs are concentrated in the body to a certain minimal volume.
     From trials it was found that Firmagon needs at least an initial dose of concentration of 240 mg which will then be maintained with a simple dose of 80 mg monthly. This is calculated via the half-life (43 days for 240 and 28 days for 80) of each dose concentration. The side effects were also verified according to patients taking this protocol (240+80), which you can read in below link.
    In this regard, I believe that your husband should not worry by following the maker’s recommendation in starting the medication with 240 mg (2x120mg).

    I am curious about your comment that his doctor is recommending Firmagon but do not know this drug’s details. Can you trust him?

    In regards to the drug's side effects on cardiovascular issues, they say this;

    https://www.drugs.com/sfx/firmagon-side-effects.html

    For Degarelix (Firmagon);
    Very common occurrences (10% or more): Hot flush (26%), QT/QTc interval prolongation (20%)
    Common occurrences (1% to 10%): Hypertension
    Uncommon occurrences (0.1% to 1%): Cardiac arrhythmia (including atrial fibrillation), palpitations, vasovagal reaction (including hypotension)
    Rare occurrences (less than 0.1%): Myocardial infarction, cardiac failure

    For Leuprolide (Eligard, Lupron, etc);
    Very common occurrences (10% or more): ECG changes (19%), ischemia (19%)
    Common occurrences (1% to 10%): Hypertension, murmur, phlebitis, thrombosis, arrhythmias, angina, myocardial infarction

    There is no interaction of Firmagon with the Sotalol but they comment to evaluate the benefit/risk ratio of firmagon in patients taking antiarrhythmic medication.

    Firmagon is also better for patients with metastases at bone joints. Contrary to Eligard, Firmagon does not cause flare which is a momentary surge in testosterone production that directly increases cancer activity. Such surge can be harmful causing pain or even paralyzes, in critical occurrences.

    I am your neighbor living in Portugal. Survivors in this forum are not doctors but can help you understanding things. Just inquire.

    Best wishes and luck in his journey.

    VGama

     

  • MCD54
    MCD54 Member Posts: 13
    edited January 2018 #3
    VascodaGama said:

    Better to follow maker's instructions

    MCD

    Welcome to the board. I am sorry for the diagnosis of your husband. I am thinking that Firmagon was recommended due to your husband’s heart issues. This drug has lesser cardiovascular related side effects than Eligard. However, the purpose of the hormonal treatment is to lower the testosterone circulating in the body to starve the cancer (it feeds on the stuff). And such can only be achieved if these drugs are concentrated in the body to a certain minimal volume.
     From trials it was found that Firmagon needs at least an initial dose of concentration of 240 mg which will then be maintained with a simple dose of 80 mg monthly. This is calculated via the half-life (43 days for 240 and 28 days for 80) of each dose concentration. The side effects were also verified according to patients taking this protocol (240+80), which you can read in below link.
    In this regard, I believe that your husband should not worry by following the maker’s recommendation in starting the medication with 240 mg (2x120mg).

    I am curious about your comment that his doctor is recommending Firmagon but do not know this drug’s details. Can you trust him?

    In regards to the drug's side effects on cardiovascular issues, they say this;

    https://www.drugs.com/sfx/firmagon-side-effects.html

    For Degarelix (Firmagon);
    Very common occurrences (10% or more): Hot flush (26%), QT/QTc interval prolongation (20%)
    Common occurrences (1% to 10%): Hypertension
    Uncommon occurrences (0.1% to 1%): Cardiac arrhythmia (including atrial fibrillation), palpitations, vasovagal reaction (including hypotension)
    Rare occurrences (less than 0.1%): Myocardial infarction, cardiac failure

    For Leuprolide (Eligard, Lupron, etc);
    Very common occurrences (10% or more): ECG changes (19%), ischemia (19%)
    Common occurrences (1% to 10%): Hypertension, murmur, phlebitis, thrombosis, arrhythmias, angina, myocardial infarction

    There is no interaction of Firmagon with the Sotalol but they comment to evaluate the benefit/risk ratio of firmagon in patients taking antiarrhythmic medication.

    Firmagon is also better for patients with metastases at bone joints. Contrary to Eligard, Firmagon does not cause flare which is a momentary surge in testosterone production that directly increases cancer activity. Such surge can be harmful causing pain or even paralyzes, in critical occurrences.

    I am your neighbor living in Portugal. Survivors in this forum are not doctors but can help you understanding things. Just inquire.

    Best wishes and luck in his journey.

    VGama

     

    Thank you so much

    Dear VGama,

    Thank you so much. Your thorough information has really helped. We actually recieved an email from Ferring Pharmaceuticals today saying that they only recommend starting with 240mg. Which corroborates your advice. So my husband´s decided to go ahead with the 240mg initial dosage.

    The problem we´ve had here is that docters only prescribe Eligard for HT, they don´t take into account the patients particularity and hence never use Firmagon. We did some research and found Firmagon more apt for my husband and my husband´s oncologist agreed, he was the only one to agree after going to three docters previously.

    Have you recieved HT? With Firmagon? If so was the injection painful? What side effects did you get please?

    Thank you again for your time and indeed we are neighbours.

    All the best,

    María

     

  • Bill91101
    Bill91101 Member Posts: 81 Member
    #4
    Firmagon
    Hi Maria,
    I received Firmagon injections in 2009. The injections were not ‘too bad’. Somewhat painful, and remained sore/tender for a couple of days (as I recall).
    Afterwards, I had hot flashes and lethargy. I’d stay home from work the day after the injection, not up to doing much of anything – napping, watching TV, etc. I’d get depressed, but that may have been due to the PC diagnosis. The hot flashes and lethargy subsided, but would recur every so often.
    Overall, I tolerated the Firmagon fairly well. But reactions vary from person-to-person. I’ve read accounts by guys who didn’t tolerate it so well.
    My PSA dropped fairly rapidly following the injection. My PSA was at 89 at the time of the injection and dropped to 22 at the end of a month. Continued downward over the next several months to settle in at 0.1.
    Best of luck to you and your husband!
    Bill
  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    edited January 2018 #5
    Similar experiences but not equal

    Maria

    I started hormonal treatment in 2010 and was under the influence of Eligard during 18 months. The symptoms I experienced would be similar to the ones I would have if taken Firmagon, in particular those caused by the low levels of testosterone circulating in my body (hypogonadism). These are similar to the ones experienced by women when in menopause. In any case, as Bill comments in his above post not everyone have the same experiences. Some guys report being very mild (my case) but others get nasty experiences. Expect fatigue, lesser sex drive and mood changes.

    The symptom reported by most guys on Firmagon was the pain at the injection site. However, this fact could be due to the lack of experience of the nurse administrating the injection as this is not the common type of injection. The needle is much thicker and applied under the skin. I did not experience pain but saw the nurse having difficulty, firstly when mixing the contents in the syringe and then in injecting it.
    Many guys prefer Firmagon over Eligard for the side effects but later move to Eligard because of the injection pain and convenience. Firmagon must be injected every month (28 days) whether Eligard can be injected once every six month (my case; 3 x 6 =18 months).

    In hormonal therapies, the level of testosterone is very important to check treatment efficacy. The T test should be done before the first injection and periodically together with the PSA.

    You can read my experiences with HT following the addresses of these links;

    https://csn.cancer.org/comment/1109725#comment-1109725

    https://csn.cancer.org/node/244938

    Best wishes,

    VG

  • MCD54
    MCD54 Member Posts: 13
    #6
    Bill91101 said:

    Firmagon
    Hi Maria,
    I received Firmagon injections in 2009. The injections were not ‘too bad’. Somewhat painful, and remained sore/tender for a couple of days (as I recall).
    Afterwards, I had hot flashes and lethargy. I’d stay home from work the day after the injection, not up to doing much of anything – napping, watching TV, etc. I’d get depressed, but that may have been due to the PC diagnosis. The hot flashes and lethargy subsided, but would recur every so often.
    Overall, I tolerated the Firmagon fairly well. But reactions vary from person-to-person. I’ve read accounts by guys who didn’t tolerate it so well.
    My PSA dropped fairly rapidly following the injection. My PSA was at 89 at the time of the injection and dropped to 22 at the end of a month. Continued downward over the next several months to settle in at 0.1.
    Best of luck to you and your husband!
    Bill

    Firmagon Injections

    Thanks so much Bill, it´s a great comfort to know your experience, it really does help since I felt that we were waging a solitary battle. Now we feel lees alone.

    María

  • MCD54
    MCD54 Member Posts: 13
    #7
    HT experience

    Hi Vasco,

    Thanks so much. I definitely will look into your links. All your insight has been great. These weeks have been exhausting because we didn´t get any of the first hand information we are getting here, so we were quite lost.

    Thanks again for all your time and I´m so happy to hear of your good results.

    María

     

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