Akeega

• Risk factors: Previous treatment with platinum-based chemotherapy or other DNA-damaging treatments

Although rare, some people who received niraparib (one of the medications in Akeega) have developed a bone marrow problem called myelodysplastic syndrome (MDS) or a blood cancer called acute myeloid leukemia. But all of them have previously received other treatments that can raise risk for cancers, like radiation or platinum-containing chemotherapy. Talk to your oncology team if you’re concerned about the risk for other cancers with Akeega (niraparib / abiraterone).

Akeega (niraparib / abiraterone) can lower the amount of blood cells in your body. In clinical studies, the most common was lower red blood cell counts (anemia). In serious cases, people needed blood transfusions. Fewer people reported lower white blood cell counts and lower platelet counts. These conditions can raise your risk of infections that are difficult to treat or serious bleeds.

Your oncology team will monitor your blood cell counts weekly during the first month after you start Akeega (niraparib / abiraterone), then every other week for 2 months, and monthly after that. If your blood cell count drops too low, they will pause your treatment and might need to give you blood transfusions. Usually, your blood cell counts should recover once you pause Akeega (niraparib / abiraterone). But if they don’t after a month, your healthcare team will talk with you about other options for treating prostate cancer.

Talk to your healthcare team right away if you suddenly have unusual bleeding or bruising, muscle weakness, extreme tiredness, or a fever. These might be symptoms of low blood cell counts.

Akeega (niraparib / abiraterone) can cause low potassium levels and fluid buildup, which can lead to changes in heart rhythm and high blood pressure. These problems can be serious, especially in people that have other heart problems, like heart failure or a recent heart attack.

Your oncology team will monitor your blood pressure and potassium levels through lab work at least weekly during the first two months of treatment, then monthly after that. If needed, they’ll prescribe medications to help your blood pressure or potassium levels stay within a safe range. But if you develop dangerously high blood pressure or serious heart problems, they might ask you to stop taking Akeega (niraparib / abiraterone).

Let your oncology team know if you experience dizziness, fast heartbeat, lightheadedness, confusion, or pain or swelling in your legs or arms. These could be symptoms of side effects related to Akeega (niraparib / abiraterone).

Though rare, Akeega (niraparib / abiraterone) can cause liver problems. People who develop liver problems typically don’t experience any symptoms. So your oncology team will order blood work to check on your liver health. You’ll need to get bloodwork done before starting Akeega (niraparib / abiraterone), every 2 weeks in the beginning, then less frequently after that. If you develop serious liver problems, your oncologist will ask you to stop taking Akeega (niraparib / abiraterone). Let your oncology team know right away if you experience symptoms of liver damage, such as tiredness, loss of appetite, nausea or vomiting, dark urine, right-side stomach pain, or yellowing of the eyes or skin.

• Risk factors: Stopping corticosteroid too suddenly | Stress | Illnesses

There have been reports of people developing adrenal insufficiency (low levels of stress hormone) when they took abiraterone (one of the medications in Akeega) with prednisone. This typically happened when they missed doses of prednisone, or were sick or stressed at the same time.

When you’re taking Akeega (niraparib / abiraterone), it’s important to take prednisone daily as directed. If you suddenly stop taking prednisone or when you experience too much stress, your body won't be able to make enough of its own stress hormones to meet your needs. Let your oncology team know right away if you experience symptoms of low stress hormones, such as weight loss, tiredness, confusion or stomach pain.

• Risk factors: Taking certain blood sugar medications

People who took abiraterone (one of the medications in Akeega) along with certain diabetes medications, like pioglitazone (Actos) and repaglinide, have reported dangerous low blood sugar levels. If you’re currently taking medications that lower blood sugar levels, your oncologist might ask you to check your blood sugar levels more often while you’re taking Akeega (niraparib / abiraterone). If needed, your healthcare team might need to adjust the dose of your diabetes medications to prevent your blood sugar levels from dropping too low. Make sure to keep fast-acting sugars with you at all times so you can take it in case of an emergency. Take fast-acting sugars and call for medical help right away if you experience any symptoms of low blood sugar, like sweating, shaking, fast heartbeat, confusion, or dizziness.

Posterior reversible encephalopathy syndrome (PRES) is a very rare but potentially life-threatening side effect of niraparib, one of the medications in Akeega. This side effect typically affects your nervous system. Let your oncology team know if you have any symptoms of PRES, like headache, feeling sluggish or confused, or vision loss.

If you develop symptoms, your oncology team will confirm whether you have PRES by ordering a brain scan called a magnetic resonance imaging (MRI). You’ll need to stop Akeega (niraparib / abiraterone) if it’s confirmed that you have PRES.

Based on animal studies, Akeega (niraparib / abiraterone) can cause harm during pregnancy. If your partner is able to become pregnant, you should use birth control measures, such as condoms, while taking Akeega (niraparib / abiraterone), and for 4 months after your last dose. To lower their risk of exposure to the medication, your partner should also not touch the tablets or should wear gloves while handling the medication. Let your oncology team know right away if your partner becomes pregnant during this time.