Spirinolactone

Help 28 days ago

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Hello, I wonder if anyone can help please? My husband has metastatic PC treated with Degeralix which has worked well. Unfortunately he also has non alcoholic fatty liver disease and has now developed fluid in his abdomen. As a result he’s been prescribed a diuretic called Spirinolactone but we found information online that warns it can stop Degarlix working as well. Has anyone else needed this or any other diuretic medication.

with thanks

Moira

Alwayshope 28 days ago

Hi Moira. Firstly, none of us are medically trained and secondly if you are unsure about anything then speak to your doctor.

I can understand your concerns about possible interactions because of the warning about the effect of the diuretic on androgen binding but I am not sure it is relevant here.

Degarelix, a GnRH antagonist, works by blocking the action of GnRH receptors in the pituitary gland, effectively suppressing testosterone production. Spironolactone, while having some anti-androgenic properties, works differently and doesn't directly interfere with degarelix's mechanism.

Here's why:

Degarelix's mechanism:

Degarelix is a GnRH antagonist. It binds to the GnRH receptors in the pituitary gland, preventing GnRH from binding and triggering testosterone production.
Spironolactone's mechanism:

Spironolactone is a potassium-sparing diuretic that also acts as an androgen receptor blocker. It can reduce androgen levels and block the effects of androgens on target tissues according to the NHS.
No direct interaction:

While spironolactone can reduce androgen levels, its mechanism is distinct from degarelix. There's no evidence to suggest that spironolactone directly interferes with the ability of degarelix to bind to GnRH receptors or suppress testosterone production.

In essence, spironolactone and degarelix work through different pathways to reduce androgen levels, and there is no known pharmacological interaction that would suggest spironolactone negates the effects of degarelix.

When taking any kind of diuretics the electrolyte balance can be upset, particularly potassium levels so these should be monitored as they can affect the cardiovascular system which is also a risk with ADT's. It is a balancing act with any medication and the experts would have weighed up the risks of prescribing drugs against the risk of a build up of fluid in the abdomen.

Help 28 days ago in reply to Alwayshope

Thank you so much Alwayshope, this is extremely helpful. This is really clear. Mike has coped so well with the cancer diagnosis but this decompensated liver situation is like a ticking time bomb. It’s all starting to get him down as the prognosis for decompensated liver is very poor.

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