Has anyone lowered their Abiraterone Dosage? To what effect?

I had persistent high PSA after RP. I started Eligard 3 months before SR. After SR, they put me on Orgovyx plus Abiraterone 1,000 mgs (5 mg prednisone). My insurance would only allow 15 day supplies for the first 90 days. I spent about half my time outside the country and it wasn’t practical to fly back every 15 days for refills. I did some research and found a study that concluded that the blood absorption of Abiraterone was basically equal when comparing 1,000 mgs taken after fasting versus 250 mgs taken with a high fat meal. I asked my MO about that and he said it was accurate and that they sometimes recommend the 250 mgs with a higher fat meal to people who either cannot easily afford the 1,000 mgs per day or for people experiencing difficulty SEs. As a point of reference, my PSA was 7 90 days post RP. My Gleason was 4+4. After 90 days of Eligard my PSA was 0.4. I was on Eligard for a total of 6 months and have now been on the Orgovyx plus 250 mgs Abiraterone for 2 months. My most recent PSA was 0.017 and most recent testosterone was 7.

Thanks for all the replies. I think continuing the thread may be of interest to some other men going forward.

My own situation has changed, however, I'm no longer on abiraterone: my liver tests were showing negative effects (I don't have access to the particulars right now to include in this posting), so I was taken off the abiraterone and prednisone.

Wow -- $18,000 to $20,000 per month for Abbie. I am afraid I would have told them where they could stick their Abbie!! I take 4 250 mg pills each morning the first thing I do when I get up for $36 per month and eat an hour or so later. The main issue is my energy level is very low, and I have a few hot flashes. I feel fortunate based on what I am reading -- wishing everyone on Abbie the best of luck.

I'm not sure how much this costs. I get the prescription at no charge

If any of you have VA benefits see if your Oncoloigists will work w the VA.
In my case Mayo Phoenix works with the VA oncologist at NAVAHC
( Northern AZ VA). The scripts have a relatively small copay.
I did have my Abiraterone lowered to 750 ml.. I couldn't do crossword puzzles like before. I still have difficulty w mild cognitive loss (temporary?). Also a few boughts with severe nausea with vomiting, diarrhea, chills and disorientation. Two weeks left until 24 mos and then watch PSA. GOOD LUCK GUYS.

It's been a while since you posted this, but I thought I'd add my two cents. I'm a member of two social media sites related to prostate cancer, specifically metastatic cases so we're all battling lesions outside the prostate. Anyway, I've been on Orgovyx since February, finished my RT in September. Have had only one real medical companion since starting this journey in Nov 2023: my RT Oncologist. Because of its rural nature, the hospital does not have a permanent MO. So, I've seen 4 different MOs since March. It was my RT Oncolgist who recommended Orgovyx for me, not an MO. (She said the Lupron injections can be a little rough and it takes longer to recover one's T on it.) After finishing RT, the MO I did see wanted me to start abiraterone immediately: 1000mg, plus 5 mg Prednisone. I've read of serious side effects from this ARPI and in all cases the MO reduced the prescription from 1000mg to 500mg to stem the SEs. So, brilliant me, I decided I'd start myself on 500 mg of the abiraterone. The primary effect that I've noticed is increased brain fog and blood pressure. I'd finally gotten my high BP under control, due the Orgovyx, but it has crept up to the 150s, systolic, (still way down from the 200's in my early Orgovyx days). But it's tolerable and I've not needed the prescribed nausea medications. Two months since RT, my PSA has fallen to "undetectable" for the last two tests (< 0.02). I'm being tested monthly. Recently, after further thought, I am now bifurcating the prednisone into 2.5 mg. I am an engineer, after all. If I'm halving the abi, why not the prednisone? For a couple of days, I notice increased joint pain, but then it ceased. At this point, I'm tolerating both the Orgovyx and Zytiga well, as far as I know. The hospital has promised to tell me if my blood tests get out of whack, although they didn't say who's looking at them. My question regarding the reduced dosage of abiraterone is how do we know if it's not enough? As long as PSA levels remain low for the next two years, it would appear that the Stampede Trial's recommended regimen of ADT+ARPI is working. My original logic for reducing dosage is that the same quantity of abiraterone is prescribed whether one weighs 300lbs or 160lbs. I'm consulting with the "new" MO in Feb 2025. (Must be the rain in the PNW that chases them away.) I fully expect to have my wrists slapped, but until I can see a study of patients who are in the lighter weight category, taking a reduced dosage and faring poorly in their cancer battle, I will continue on my 500 mg of A+ 2.5 mg of P regimen. I'll report how my encounter with the new MO goes and how I fare over the next two years in my battle with PCa.

I take 250 mg. With prednisone in the am with low fat breakfast per my MO. PSA< .01 for 23 months. Next month- bye bye Arbiterone/ Prednisone.