Olaparib (Lynparza®) with abiraterone

Olaparib is also called Lynparza^®. It is a type of targeted therapy drug called a PARP inhibitor.

Abiraterone is a hormonal therapy. Abiraterone is given with steroid tablets. The steroids help reduce some of the side effects of abiraterone.

Olaparib and abiraterone are used together to treat prostate cancer when it has spread to other parts of the body, and it has stopped responding to existing hormonal therapy. This is called hormone-relapsed metastatic prostate cancer.

It is best to read this information with our general information about targeted therapy drugs, hormonal therapy, steroids and the type of cancer you have.

Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

You continue having your existing hormonal therapy while you are taking olaparib and abiraterone. 

You will be given olaparib and abiraterone as tablets to take at home. You will also be given steroid tablets called prednisolone to take every day.  

During treatment, you will meet someone from your cancer team, such as a: 

• cancer doctor 
• specialist nurse 
• specialist pharmacist.  

This is who we mean when we mention doctor, nurse or pharmacist in this information. 

During treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.

You will meet with a doctor, nurse or pharmacist regularly during treatment. They will talk to you about your blood results and ask how you have been feeling.  

You usually keep taking olaparib with abiraterone for as long as it is working for you and any side effects can be managed. Do not stop taking your treatment unless your doctor tells you to.

Your cancer team will give you the olaparib and abiraterone tablets to take home. They may give you tablets of different strengths.  They will also give you steroid tablets to take with the abiraterone.

These steroid tablets are usually called prednisolone. Always take olaparib, abiraterone and prednisolone exactly as they tell you to. This is important to make sure they work as well as possible for you. Follow any advice given about your steroid tablets.  

Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to. 
Olaparib is usually taken twice a day. It can be taken with or without food. Grapefruit or grapefruit juice can affect how olaparib works, so you should not eat or drink grapefruit while you are taking olaparib.  

Abiraterone is usually taken once a day. Taking abiraterone with food can affect how it works and increase side effects. So you should not eat for 2 hours before taking abiraterone and for 1 hour after taking it.  

When taking your treatment, make sure you: 

• swallow the tablets whole with a glass of water  
• do not chew, break or crush them 
• take them at the same times every day.    

If you forget to take a dose of olaparib, abiraterone or steroid tablets, take the next dose at the usual time. If you have missed more than 1 dose, contact the hospital for advice. Do not take a double dose to make up for the missed one. 

Other things to remember about your tablets: 

• Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight. 
• Keep them safe, where children cannot see or reach them. 
• If you are sick (vomit) just after taking them, do not take an extra dose. Take your next dose at the usual time. 
• Do not throw away unused tablets. Return them to your cancer team at the hospital. 

This treatment may contain lactose. If you have a lactose allergy or intolerance, ask your doctor, nurse or pharmacist for more information.

Abiraterone can cause low levels of potassium in the blood. You will have regular blood tests to check your potassium levels. 

If your levels are very low, you may need treatment and your doctor may tell you to stop taking abiraterone. Symptoms of low potassium include: 

• weakness 
• twitching muscles 
• feeling that you heart is beating harder or faster than usual. 

If you notice these symptoms, contact the hospital straight away on the 24-hour number.

This treatment can affect how the liver works. You will have regular blood tests to check this. If your liver is being affected, your doctor may reduce the dose or stop your treatment for a while. 

Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms: 

• yellow skin or eyes
• feeling very sleepy 
• dark urine (pee)
• unexplained bleeding or bruising
• pain in the right side of your tummy (abdomen). 

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have: 

• nosebleeds
• bleeding gums
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Some people can feel sick with this treatment. Your doctor, nurse or pharmacist may prescribe you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to. If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids.

If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

We have more information about coping with changes to taste.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

You may get pain in your tummy (abdomen), or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help. Contact the hospital straight away on the 24-hour number if your symptoms do not go away, or get worse.

This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• breathlessness
• dizziness
• changes to your heartbeat (palpitations)
• swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Always call 999 if you have:

• chest pain, pressure, heaviness, tightness or squeezing across the chest
• difficulty breathing.

Taking this treatment for several months or more can increase the risk of bone thinning. This is called osteoporosis. It can make you more likely to get a broken bone (fracture). 

You may have bone density scans to check your bone health before and during treatment. These scans can diagnose osteoporosis or osteopenia (low bone density) so that it can be monitored. If your scan shows osteoporosis, your doctor usually prescribes:

• drugs to protect your bones called bisphosphonates
• calcium and vitamin D supplements. 

Regular exercise where you support your body weight, like walking, running and dancing, can help look after your bones. This is called weight-bearing exercise. Other types of strength exercises are also helpful. If you have any bone thinning or the cancer is affecting your bones, get advice from your cancer team first. 

Eating a healthy diet and not smoking also helps take care of your bones.

This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help.

This treatment can raise your blood sugar levels and increase the risk of diabetes. 

Signs of raised blood sugar include:

• feeling thirsty
• needing to pass urine (pee) more often than usual
• feeling more tired than usual. 

Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.

If you already have diabetes, your blood sugars may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your diabetic doctor or nurse will talk to you about how to manage this.

You may get pain in your muscles or joints. If this happens, tell your doctor or nurse. They can give you advice and painkillers or other drugs to help. Being physically active and keeping to a healthy weight may help with the pain. It can keep your joints flexible and reduce stress on them. If the pain does not get better, tell your doctor or nurse. They may talk to you about changing to a different hormonal drug.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

You may feel dizzy during this treatment. Tell your doctor or nurse if this is difficult to cope with. If you feel dizzy, do not drive or operate machinery.

This treatment can affect how the kidneys work. This is usually mild. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee)
• are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor, nurse or pharmacist will advise you not to make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use
• how long after treatment you should continue to use contraception. 

Some cancer drugs can affect whether you can make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

You must not donate sperm while you are on this treatment and for 3 months afterwards.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.