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Effects of Orgovyx & Nubeqa on pulse rate
My resting pulse rate is normally around 50. Yesterday my Oncologist noted it was 42 and ordered an EKG. Today he suspended the Orgovyx & Nubeqa (which I've been on for 5 months) and ordered a cardiac monitor & echocardiogram for next week.
At first I thought this might be a bit hyper-cautionary, but then did a Google AI search:
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A drop in your resting heart rate from 50 to 42 bpm is a significant change that requires medical evaluation by your oncologist or cardiologist. While a resting pulse of 50 can be normal for a highly physically fit individual, a sustained drop into the low 40s (sinus bradycardia) is a known potential cardiovascular complication when taking Orgovyx (relugolix) combined with Nubeqa (darolutamide).
Why this happens on Orgovyx and Nubeqa:
Synergistic Cardiac Effects:
Both medications independently impact the heart's electrical and vascular systems. Orgovyx is associated with ECG abnormalities and changes to the heart's electrical conduction pathways, while Nubeqa can cause general cardiac arrhythmias and a slow heart rate/weak pulse. Together, they can compound these effects over time.
The 5-Month Timeline:
Developing this side effect after 5 months is a typical clinical presentation. Drug-induced bradycardia often develops gradually as the medications reach long-term steady-state levels and progressively alter autonomic or electrical cardiac function.
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My BP has been around 123/78 for six decades, except for a brief excursion when I was on Abiraterone. Yesterday it was slightly lower at 117/66.
I have no dizziness when I suddenly stand up.
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Yep, this drug combo can send you to cardiology way more often than normal. I have a cardio-oncologist as part of my care team and when my heart rhythm starts doing whacky things, off to him I go. Earlier this year my pulse rate dropped to 40 which prompted oncology to send me off to him fearing a heart block. Echo and cardiac patch, followed by a heart med adjustment, cleared it up. I now get an echo every 4 months. Just another side effect that has to be dealt with. Lovely disease this PCa.
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3 ReactionsYes, Orgovyx (relugolix) can cause cardiac events. But, because that risk is much less than with the hormone therapy injections (leuprolide acetates), Orgovyx is preferred over those others. The HERO study showed significantly less risk of cardiac events with Orgovyx —> https://www.nejm.org/doi/full/10.1056/NEJMoa2004325
As for side-effects from Nubeqa (darolutamide), cardiac issues are one of the potential side-effects often mentioned (and is a common side-effect of all ARPIs). (See attached graphic.)
Remember that these are all very toxic pharmaceuticals we’re being given. They significantly change the metabolic, endocrine, and physiologic functioning of our bodies in order to (hopefully) kill prostate cancers. Experiencing adverse side-effects often happens.
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3 ReactionsC'mon guys. Chasing side effects is part of the fun. If everything went according to plan, this whole ordeal would be boring. 😁🤣😁
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3 ReactionsMy watch can measure pulse, so I waited until a full night's sleep, & then measured before getting up.
I looked at my watch. My pulse was too weak for it to measure. I had to do it manually. My pulse was hard to find, but I did it. 13 pulses over 20 seconds.
I got up, did some usual morning stuff, & the watch now measures it at 50.
Glad to read that your team is on top of this. I do hope that the apparent problem can be resolved without further issues.
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2 Reactions13 months on Orgo + Nub with no cardio/pulmonary changes. The divergence from one person another is what makes this a little like Russian Roulette. Research might show 6-10% of people experienced such n’ such side effect and you think, sounds pretty safe, until you are one of the 6-10%.
@lsk1000
Well, my resting pulse has been under 60 (the cutoff for normal) for decades. So, when I started off low, it doesn't take much of a drop to set off red flags.
I want to add that after my completing the EKG in another lab, my oncologist had seen the results, ordered the echocardiogram & monitor, and then called me to suspend taking Orgovyx & Nubeqa, all within 20 minutes.
This is in North Idaho.
I inquired of the cardiologist's office about detail of the cardiac monitor, & received the following reply:
Hello Dean,
Thank you for reaching out. We see you have an appointment on 09/03/26 to have the cardiac monitor placed.
I spoke with our monitor techs who manage the cardiac monitors. They said you will be having a "Boston Scientific Body Guardian Mini" cardiac monitor placed.
To answer your questions:
Swimming, showers, and baths are allowed while you are wearing the monitor. You just cannot go more than 3 feet under water while swimming/bathing.
This is a non-invasive device that tapes over the center of your chest. It does not penetrate under your skin and strictly just remains on the surface of skin.
Here is a link for more information on the cardiac monitor. There is a FAQ section that you may find helpful:
"https://www.cdx.bostonscientific.com/us/en/patients/cardiac-monitor/bodyguardian-mini.html;
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Additionally, when you come in to have the monitor placed, the tech will review all the necessary information and answer any questions you may have.
Have a great day,
Lisa, RN