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Zytiga

Last reviewed on RxList: 10/8/2018
Zytiga Side Effects Center

Last reviewed on RxList 10/8/2018

Zytiga (abiraterone acetate) is is an inhibitor of CYP17 (17a-hydroxylase/C17,20-lyase) given in combination with prednisone and indicated for the treatment of patients with metastatic castration-resistant prostate cancer. Common side effects of Zytiga include:

Zytiga is prescribed in 250 mg dosage tablets. It is important that Zytiga be taken on an empty stomach. No food should be consumed for at least two hours before the dose of Zytiga is taken and for at least one hour after the dose of Zytiga is taken. Zytiga may interact with cough or cold medicines containing dextromethorphan, heart rhythm medicines, prostate or breast cancer medications, thioridazine, and antidepressants. Tell your doctor all medications and supplements you use. Zytiga may harm a developing fetus. Therefore, women who are pregnant or women who may become pregnant should not handle Zytiga without protection such as gloves. Patients should also be informed that it is not known whether abiraterone or its metabolites are present in semen. Patient should use a condom if having sex with a pregnant woman. The patient should use a condom and another effective method of birth control if he is having sex with a woman of child-bearing potential. These measures are required during and for one week after treatment with Zytiga.

Our Zytiga Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Zytiga Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • swelling in your ankles or feet, pain in your legs;
  • shortness of breath;
  • pain or burning when you urinate, blood in your urine;
  • fast heartbeats;
  • headache, confusion;
  • a light-headed feeling, like you might pass out;
  • muscle weakness; or
  • liver problems--stomach pain (upper right side), nausea, vomiting, dark urine, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • indigestion, vomiting, diarrhea, constipation;
  • painful or difficult urination;
  • swelling in your legs or feet;
  • feeling weak, feeling very hot;
  • muscle pain;
  • abnormal blood tests;
  • joint pain or swelling;
  • bruising; or
  • cold symptoms such as stuffy nose, sneezing, cough, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Zytiga (Abiraterone Acetate Tablets)

Zytiga Professional Information

SIDE EFFECTS

The following are discussed in more detail in other sections of the labeling:

  • Hypertension, Hypokalemia, and Fluid Retention due to Mineralocorticoid Excess [see WARNINGS AND PRECAUTIONS].
  • Adrenocortical Insufficiency [see WARNINGS AND PRECAUTIONS].
  • Hepatotoxicity [see WARNINGS AND PRECAUTIONS].

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Two randomized placebo-controlled, multicenter clinical trials (COU-AA-301 and COU-AA302) enrolled patients who had metastatic CRPC in which ZYTIGA was administered orally at a dose of 1,000 mg daily in combination with prednisone 5 mg twice daily in the active treatment arms. Placebo plus prednisone 5 mg twice daily was given to patients on the control arm. A third randomized placebo-controlled, multicenter clinical trial (LATITUDE) enrolled patients who had metastatic high-risk CSPC in which ZYTIGA was administered at a dose of 1,000 mg daily in combination with prednisone 5 mg once daily. Placebos were administered to patients in the control arm. Additionally, two other randomized, placebo-controlled trials were conducted in patients with metastatic CRPC. The safety data pooled from 2230 patients in the 5 randomized controlled trials constitute the basis for the data presented in the Warnings and Precautions, Grade 1-4 adverse reactions, and Grade 1-4 laboratory abnormalities. In all trials, a gonadotropin-releasing hormone (GnRH) analog or prior orchiectomy was required in both arms.

In the pooled data, median treatment duration was 11 months (0.1, 43) for ZYTIGA-treated patients and 7.2 months (0.1, 43) for placebo-treated patients. The most common adverse reactions (≥10%) that occurred more commonly (>2%) in the ZYTIGA arm were fatigue, arthralgia, hypertension, nausea, edema, hypokalemia, hot flush, diarrhea, vomiting, upper respiratory infection, cough, and headache. The most common laboratory abnormalities (>20%) that occurred more commonly (≥2%) in the ZYTIGA arm were anemia, elevated alkaline phosphatase, hypertriglyceridemia, lymphopenia, hypercholesterolemia, hyperglycemia, and hypokalemia. Grades 3-4 adverse events were reported for 53% of patients in the ZYTIGA arm and 46% of patients in the placebo arm. Treatment discontinuation was reported in 14% of patients in the ZYTIGA arm and 13% of patients in the placebo arm. The common adverse events (≥1%) resulting in discontinuation of ZYTIGA and prednisone were hepatotoxicity and cardiac disorders.

Deaths associated with treatment-emergent adverse events were reported for 7.5% of patients in the ZYTIGA arm and 6.6% of patients in the placebo arm. Of the patients in the ZYTIGA arm, the most common cause of death was disease progression (3.3%). Other reported causes of death in ≥5 patients included pneumonia, cardio-respiratory arrest, death (no additional information), and general physical health deterioration.

COU-AA-301

Metastatic CRPC Following Chemotherapy

COU-AA-301 enrolled 1195 patients with metastatic CRPC who had received prior docetaxel chemotherapy. Patients were not eligible if AST and/or ALT ≥2.5X ULN in the absence of liver metastases. Patients with liver metastases were excluded if AST and/or ALT >5X ULN.

Table 1 shows adverse reactions on the ZYTIGA arm in COU-AA-301 that occurred with a ≥2% absolute increase in frequency compared to placebo or were events of special interest. The median duration of treatment with ZYTIGA with prednisone was 8 months.

Table 1: Adverse Reactions due to ZYTIGA in COU-AA-301

System/Organ Class
   Adverse reaction
ZYTIGA with Prednisone
(N=791)
Placebo with Prednisone
(N=394)
All Grades1
%
Grade 3-4
%
All Grades
%
Grade 3-4
%
Musculoskeletal and connective tissue disorders
  Joint swelling/discomfort2 30 4.2 23 4.1
  Muscle discomfort3 26 3.0 23 23
General disorders
  Edema4 27 1.9 18 0.8
Vascular disorders
  Hot flush 19 0.3 17 0.3
  Hypertension 8.5 1.3 6.9 0.3
Gastrointestinal disorders
  Diarrhea 18 0.6 14 1.3
  Dyspepsia 6.1 0 3.3 0
Infections and infestations
  Urinary tract infection 12 2.1 7.1 0.5
  Upper respiratory tract infection 5.4 0 2.5 0
Respiratory, thoracic and mediastinal disorders
  Cough 11 0 7.6 0
Renal and urinary disorders
  Urinary frequency 7.2 0.3 5.1 0.3
  Nocturia 6.2 0 4.1 0
Injury, poisoning and procedural complications
  Fractures5 5.9 1.4 2.3 0
Cardiac disorders
  Arrhythmia6 7.2 1.1 4.6 1.0
  Chest pain or chest discomfort7 3.8 0.5 2.8 0
  Cardiac failure8 2.3 1.9 1.0 0.3
1 Adverse events graded according to CTCAE version 3.0.
2 Includes terms Arthritis, Arthralgia, Joint swelling, and Joint stiffness.
3 Includes terms Muscle spasms, Musculoskeletal pain, Myalgia, Musculoskeletal discomfort, and Musculoskeletal stiffness.
4 Includes terms Edema, Edema peripheral, Pitting edema, and Generalized edema.
5 Includes all fractures with the exception of pathological fracture.
6 Includes terms Arrhythmia, Tachycardia, Atrial fibrillation, Supraventricular tachycardia, Atrial tachycardia, Ventricular tachycardia, Atrial flutter, Bradycardia, Atrioventricular block complete, Conduction disorder, and Bradyarrhythmia.
7 Includes terms Angina pectoris, Chest pain, and Angina unstable. Myocardial infarction or ischemia occurred more commonly in the placebo arm than in the ZYTIGA arm (1.3% vs. 1.1% respectively).
8 Includes terms Cardiac failure, Cardiac failure congestive, Left ventricular dysfunction, Cardiogenic shock, Cardiomegaly, Cardiomyopathy, and Ejection fraction decreased.

Table 2 shows laboratory abnormalities of interest from COU-AA-301.

Table 2: Laboratory Abnormalities of Interest in COU-AA-301

Laboratory Abnormality ZYTIGA with Prednisone
(N=791)
Placebo with Prednisone
(N=394)
All Grades
(%)
Grade 3-4
(%)
All Grades
(%)
Grade 3-4
(%)
Hypertriglyceridemia 63 0.4 53 0
High AST 31 2.1 36 1.5
Hypokalemia 28 5.3 20 1.0
Hypophosphatemia 24 7.2 16 5.8
High ALT 11 1.4 10 0.8
High Total Bilirubin 6.6 0.1 4.6 0

COU-AA-302

Metastatic CRPC Prior to Chemotherapy

COU-AA-302 enrolled 1088 patients with metastatic CRPC who had not received prior cytotoxic chemotherapy. Patients were ineligible if AST and/or ALT ≥2.5X ULN and patients were excluded if they had liver metastases.

Table 3 shows adverse reactions on the ZYTIGA arm in COU-AA-302 that occurred in ≥5% of patients with a ≥2% absolute increase in frequency compared to placebo. The median duration of treatment with ZYTIGA with prednisone was 13.8 months.

Table 3: Adverse Reactions in ≥5% of Patients on the ZYTIGA Arm in COU-AA-302

System/Organ Class
   Adverse reaction
ZYTIGA with Prednisone
(N=542)
Placebo with Prednisone
(N=540)
All Grades1
%
Grade 3-4
%
All Grades
%
Grade 3-4
%
General disorders
  Fatigue 39 2.2 34 1.7
  Edema2 25 0.4 21 1.1
  Pyrexia 8.7 0.6 5.9 0.2
Musculoskeletal and connective tissue disorders
  Joint swelling/discomfort3 30 2.0 25 2.0
  Groin pain 6.6 0.4 4.1 0.7
Gastrointestinal disorders
  Constipation 23 0.4 19 0.6
  Diarrhea 22 0.9 18 0.9
  Dyspepsia 11 0.0 5.0 0.2
Vascular disorders
  Hot flush 22 0.2 18 0.0
  Hypertension 22 3.9 13 3.0
Respiratory, thoracic and mediastinal disorders
  Cough 17 0.0 14 0.2
  Dyspnea 12 2.4 9.6 0.9
Psychiatric disorders
  Insomnia 14 0.2 11 0.0
Injury, poisoning and procedural complications
  Contusion 13 0.0 9.1 0.0
  Falls 5.9 0.0 3.3 0.0
Infections and infestations
  Upper respiratory tract infection 13 0.0 8.0 0.0
  Nasopharyngitis 11 0.0 8.1 0.0
Renal and urinary disorders
  Hematuria 10 1.3 5.6 0.6
Skin and subcutaneous tissue disorders
  Rash 8.1 0.0 3.7 0.0
1 Adverse events graded according to CTCAE version 3.0.
2 Includes terms Edema peripheral, Pitting edema, and Generalized edema.
3 Includes terms Arthritis, Arthralgia, Joint swelling, and Joint stiffness.

Table 4 shows laboratory abnormalities that occurred in greater than 15% of patients, and more frequently (>5%) in the ZYTIGA arm compared to placebo in COU-AA-302.

Table 4: Laboratory Abnormalities in >15% of Patients in the ZYTIGA Arm of COU-AA-302

Laboratory Abnormality ZYTIGA with Prednisone
(N=542)
Placebo with Prednisone
(N=540)
Grade 1-4
%
Grade 3-4
%
Grade 1-4
%
Grade 3-4
%
Hematology        
  Lymphopenia 38 8.7 32 7.4
Chemistry        
  Hyperglycemia1 57 6.5 51 5.2
  High ALT 42 6.1 29 0.7
  High AST 37 3.1 29 1.1
  Hypernatremia 33 0.4 25 0.2
  Hypokalemia 17 2.8 10 1.7
1 Based on non-fasting blood draws

LATITUDE

Patients with Metastatic High-risk CSPC

LATITUDE enrolled 1199 patients with newly-diagnosed metastatic, high-risk CSPC who had not received prior cytotoxic chemotherapy. Patients were ineligible if AST and/or ALT ≥2.5X ULN or if they had liver metastases. All the patients received GnRH analogs or had prior bilateral orchiectomy during the trial. The median duration of treatment with ZYTIGA and prednisone was 24 months.

Table 5 shows adverse reactions on the ZYTIGA arm that occurred in ≥5% of patients with a ≥2% absolute increase in frequency compared to those on the placebos arm.

Table 5: Adverse Reactions in ≥5% of Patients on the ZYTIGA Arm in LATITUDE1

System/Organ Class
   Adverse reaction
ZYTIGA with Prednisone
(N=597)
Placebos
(N=602)
All Grades2
%
Grade 3-4
%
All Grades
%
Grade 3-4
%
Vascular disorders
  Hypertension 37 20 13 10
  Hot flush 15 0.0 13 0.2
Metabolism and nutrition disorders
  Hypokalemia 20 10 3.7 1.3
Investigations
  Alanine aminotransferase increased3 16 5.5 13 1.3
  Aspartate aminotransferase increased3 15 4.4 11 1.5
Infections and infestations
  Urinary tract infection 7.0 1.0 3.7 0.8
  Upper respiratory tract infection 6.7 0.2 4.7 0.2
Nervous system disorders
  Headache 7.5 0.3 5.0 0.2
Respiratory, Thoracic and Mediastinal Disorders
  Cough4 6.5 0.0 3.2 0
1 All patients were receiving an GnRH agonist or had undergone orchiectomy.
2 Adverse events graded according to CTCAE version 4.0
3 Reported as an adverse event or reaction
4 Including cough, productive cough, upper airway cough syndrome

Table 6 shows laboratory abnormalities that occurred in >15% of patients, and more frequently (>5%) in the ZYTIGA arm compared to placebos.

Table 6: Laboratory Abnormalities in >15% of Patients in the ZYTIGA Arm of LATITUDE

Laboratory Abnormality ZYTIGA with Prednisone
(N=597)
Placebos
(N=602)
Grade 1-4
%
Grade 3-4
%
Grade 1-4
%
Grade 3-4
%
Hematology        
  Lymphopenia 20 4.1 14 1.8
Chemistry        
  Hypokalemia 30 9.6 6.7 1.3
  Elevated ALT 46 6.4 45 1.3
  Elevated total bilirubin 16 0.2 6.2 0.2

Cardiovascular Adverse Reactions

In the combined data of 5 randomized, placebo-controlled clinical studies, cardiac failure occurred more commonly in patients on the ZYTIGA arm compared to patients on the placebo arm (2.6% versus 0.9%). Grade 3-4 cardiac failure occurred in 1.3% of patients taking ZYTIGA and led to 5 treatment discontinuations and 4 deaths. Grade 3-4 cardiac failure occurred in 0.2% of patients taking placebo. There were no treatment discontinuations and two deaths due to cardiac failure in the placebo group.

In the same combined data, the majority of arrhythmias were grade 1 or 2. There was one death associated with arrhythmia and three patients with sudden death in the ZYTIGA arms and five deaths in the placebo arms. There were 7 (0.3%) deaths due to cardiorespiratory arrest in the ZYTIGA arms and 2 (0.1%) deaths in the placebo arms. Myocardial ischemia or myocardial infarction led to death in 3 patients in the placebo arms and 3 deaths in the ZYTIGA arms.

Postmarketing Experience

The following additional adverse reactions have been identified during post approval use of ZYTIGA with prednisone. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Respiratory, Thoracic and Mediastinal Disorders: non-infectious pneumonitis.

Musculoskeletal and Connective Tissue Disorders: myopathy, including rhabdomyolysis.

Hepatobiliary Disorders: fulminant hepatitis, including acute hepatic failure and death.

Read the entire FDA prescribing information for Zytiga (Abiraterone Acetate Tablets)

Related Resources for Zytiga

© Zytiga Patient Information is supplied by Cerner Multum, Inc. and Zytiga Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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