There are two different dosage levels used for the administration of Ketoconazole (Keto), a commonly used 2nd line hormone deprivation drug used after the failure of the traditional drugs (Lupron, Zoladex etc.). Low dosage keto involves taking 200 mg three times a day (600 mg per day), while high dose keto uses 400 three times a day (1,200 mg per day). Both low and high dose keto should be taken along with hydrocortisone to avoid adrenal insufficiency.
Keto clears the body very quickly, so it is vital that you stay on a very strict schedule of a dose every eight (8) hours. Most men find it helpful set an alarm clock so they don’t accidentally miss the schedule.
Dosing of the hydrocortisone is different from the keto, adding to the complications of scheduling your drugs. The normal schedule for Hydrocortisone involves take two tablets with breakfast and one table with dinner. Including ydrocortisone regardless of the keto dose schedule is important to avoid adrenal insufficiency.
Most men begin keto using the low dose schedule. After you been on the low dose regimen for a couple of weeks and have no life threatening side effects, including liver functions and your PSA has deceased, you will probably move to the high dose schedule.
Proper absorption of the keto is important. To insure the proper absorption of the keto you must make sure that your stomach is in an acid state (see yesterday’s post “Ketoconazole – How To Take It So That It Works” at http://advancedprostatecancer.net/?p=2312).
An acid state can be achieved by drinking an acid drink, like orange juice or coke, but never should you drink grapefruit juice with keto. Do not eat any food with the keto as it will buffer the acidity in your stomach. However, when you take the Hydrocortisone always take it with a meal, even a small meal is adequate.
Never drink any alcoholic beverages (including just one beer) when taking keto no matter what dosing schedule you are using.
Try and have at least a regular, daily bowel movement to prevent the Keto from building up to a toxic level.
Many men do get added time with a controlled PSA using keto along with hydrocortisone. Make sure to include it in your treatment regiment when the first line therapies fail.
Joel T. Nowak, M.A., M.S.W.
Just a couple further thoughts about Keto. Three days ago I stopped using it after eighteen months and I was completely unprepared for waking up this afternoon (I work nights every other month). For the first time in a very long time, I woke actually feeling refreshed. Please understand that this is the start of my 6th night shift The world I awoke in had gone from black and white to technicolor. I haven’t seen a transformation this vivid since the Wizard of Oz! In addition my visual acuity is way better than it had been and my peripheral vision has increased at least ten percent. Not only do I feel more energetic, the perpetual fog my mind had been living in is gone. Dinner table conversation with my wife extended well beyond the simple, mundane topics that were all I could manage. Finally, dinner tasted better than it has in a very long time. Am I dying quicker at the moment – probably but damn, it’s almost worth it. With all the above and the single malt scotch that I have promised myself to accompany the superbowl, man I am in the tall cotton. I wonder if anyone has ever tried to study “Intermitent HDK?”
Kindly I am using Nizoral(Ketoconazole) 200 mg X 2 tablets twice a day together with hydrocortisone.I am following this after castration, hormonal therapy Casodex,chemotherapy Taxotere 9 circles and now since 4 months Ketoconacole.Only in the 4th months the PSA stoped in 77 ng.I have now a strong pain in the low part of back.I use to control pracetamol or ibuprofen thre times a day but problems appear during night stronger .
The doctor recommanded to follow this treatmens.I am getting Zometa every monts also since 1.8 yrs.Your experience or comments
Dear Mr. Nowak,
I was wondering what your thoughts were on castrate resistant patients taking Abiraterone after a successful period of taking Keto. Do you think there’s a relation there that would make Abiraterone less effective or even work at all?
Funny you should ask this question as there is a current study looking at this question. The study is called: Abiraterone Post Ketoconazole and you can view the information about the trial by clicking the link.
Ask the doctor about taking mitoxantrone plus prednisone or looking at another clinical trial. I do not think that you should just wait around and allow your PSA to continue to climb out of control. You can always seek a second opinion. Joel
I have chronic fatigue and my ability to process information is retarded since I started taking Keto. My dosage has been reduced from 1200mg/day to 600mg/day. My quality of life has deteriorated since taking it. Are there any studies that demonstrate increase survival rates?
I am not aware of any studies that show that Keto extends life, but it does help control PSA. However, PSA control has not demonstrated life extension, but many of us believe there may be some relationship for certain individuals. -Joel
I was wondering if the hydrocortisone acetate was fully necessary or could one use another perhaps more natural supplement to help with adrenal health and inflammation? Maybe I am not fully clear on why it is fully necessary to take this. Also what stage of treatment would you recommend doing the ketoconazole protocol? Should one try this if radiation didnt work but have yet to do the other methods?
Looking forward to hearing back from you.
Corey, Keto is usually used as a first line hormone therapy once the ADT has failed and he has been told that he is castrate resistant. Since Keto is not approved for this use you will need to find a doctor who will write the script “off label”. You ask a great question about the hydrocortisone, that is a question you would need to discuss with the doctor. = Joel
Corey- Keto is usually used post the failure of traditional ADT, or when a man is diagnosed as being castrate resistant. It is not FDA approved so you will need to find a doctor who will work with you in an off label matter for this treatment. The only possible drawback to using Keto in today’s landscape is the question if its use and eventual failure would prevent the use of Zytiga. Some docs claim this is the case, but I know one person from the advanced prostate cancer advanced group that used and failed Keto and has been having success with Zytiga over the last 8 months. – Joel