| Drug | Dosage | Qty | When |
| Pterostilbene | 100mg | 2 tabs | 7:30 AM |
| Keppra | 500mg | 1 tab | 7:30 AM |
| Dexamethasone | 4mg | 2 tabs | 7:30 AM |
| Metformin | 500mg | 1 tab | 7:30 AM |
| Selenium | 200mcg | 1 tab | 7:30 AM |
| Verapamil | 180mg | 1 tab | 7:30 AM |
| Depakote | 500mg | 1 tab | 7:30 AM |
| Green Tea Extract | 500mg | 3 tabs | 7:30 AM |
| Ranitidine | 150mg | 1 tab | 7:30 AM |
| Reishi | 500mg | 6 tabs | 7:30 AM |
| Quercetin | 500mg | 3 tabs | 7:30 AM |
| Reservatrol | 125mg | 1 tab | 7:30 AM |
| Omeprazole | 20mg | 1 tab | 7:30 AM |
| Disulfiram | 250mg | 1 tab | NOON |
| Copper | 2mg | 3 tabs | NOON |
| Coriolus Versicolor (PSK) | 600mg | 2 tabs | NOON |
| Tumeric (NRF2) | 600mg | 2 tabs | NOON |
| Curcumin | 750mg | 1 tab | NOON |
| Celebrex | 200mg | 1 tab | NOON |
| Chloroquinine (Plaquenil) | 200mg | 1 tab | NOON |
| Pterostilbene | 100mg | 2 tabs | NOON |
| Pterostilbene | 50mg | 1 tab | NOON |
| Multi Vitamin | 1 tab | NOON | |
| Sulfamethoxazole | 1 tab | M/W/F NOON | |
| Vitamin D3 | 5000 IU | 1 tab | NOON |
| Green Tea Extract | 500mg | 3 tabs | NOON |
| Lycopene | 10mg | 1 tab | NOON |
| Maitake | 1000mg | 2 tabs | 5:00 PM |
| Reishi | 500mg | 4 tabs | 5:00 PM |
| Green Tea Extract | 500mg | 2 tabs | 5:00 PM |
| Coriolus Versicolor (PSK) | 600mg | 3 tabs | 5:00 PM |
| Keppra | 500mg | 1 tab | 5:00 PM |
| Dexamethasone | 4mg | 2 tabs | 5:00 PM |
| Depakote | 500mg | 1 tab | 5:00 PM |
| Metformin | 500mg | 1 tab | 5:00 PM |
| Ranitidine | 150mg | 1 tab | 5:00 PM |
| Fluoxetine | 20mg | 1 tab | 5:00 PM |
| Stool Softener | 100mg | 1 tab | 5:00 PM |
| Melatonin | 10mg | 2 tabs | 7:00 PM |
| Zofran | 8mg | 1 tab | 7:00 PM |
| Viagra | .25 tab | 7:30 PM | |
| Temodar | 140mg | 1 tab | 8:00 PM |
| Temodar | 20mg | 1 tab | 8:00 PM |
Thanks.
Annie
1) Dexamethasone 8 mg per day. Would be ideal if this could be tapered down to a lower dose, as low as possible. Dex is known to raise blood glucose levels, among other undesirable side-effects such as immunosuppression.
ReplyDelete2) Metformin - I would suggest staying on this, as it moderates blood glucose and insulin levels, both of which can be growth factors for GBM. Animal studies also show positive effects on anti-tumor immunity.
3) Verapamil. No strong opinion on this in relation to TMZ. The evidence is very sparse.
4) Depakote: for anti-seizure meds, its usually better to taper, rather than go cold-turkey, although this depends on the individual and how long they've been on the drug. Some online sources say taper by 25% every two weeks. If you're planning on continuing the Depakote through monthly chemotherapy cycles, might make sense just to continue with a stable dose. Does he have a history of seizures? Also could be good to get a doctor's opinion on this regarding stopping and re-starting.
5) Disulfiram. As with DCA, periodic breaks might be useful to help prevent the occurrence of peripheral neuropathy. I like the idea of higher dose disulfiram (500 mg) during the "on" week of the monthly TMZ cycles, and then reducing the dose and/or having a break in between the cycles.
6) Viagra 0.25 tabs. What is the size of the tab in mg? One of the benefits of sildenafil, at least in animal studies, is an inhibition of immune suppressor cells (myeloid-derived suppressor cells), and I would continue on this one. Viagra is patent-protected, but you can get generic sildenafil for hypertension at far lower prices.
This was an extensive cocktail, could you tell us in general how well it was tolerated? Thanks.
6) 100 mg tablets I believe. I will look into the generics. These are costing us $50 or $60 US each.
ReplyDeleteThe cocktail was tolerated very well! Dad has naturally low blood pressure (pulse is in the 50s) and is very healthy. Low cholesterol, HWP, no health concerns except for Lyme disease which has been in remission for 8 years. When we started with the cocktail before chemo, his pulse dropped to the 40s so we stopped the Verapamil. Somehow something he's taking must be increasing his heart rate as we were able to add the Verapamil back in and his pulse is still mid/high 50s.
I only checked blood sugar a few times and it was a little low but not concerning. He doesn't eat much as I'm sure others on chemo can attest to. He hasn't complained of any neuropathy or stomach pains. His liver values are a little low but the Dr. was not concerned.
I had him taking 93 pills a day for a short time (additional antibiotics added by his Lyme doctor). But then he needed a break so we dropped the antibiotics, keeping the Sulfamethoxazole and a probiotic 3x a week. We also dropped many of the supplements and just retained the PSK, Melatonin, Multivitamin, D3, and all of the Rx pills.
Of the 6 week cycle:
Entire cocktail (60+/- pills, less the Lyme treatment): weeks 1 thru 4
Cocktail + Lyme pills (93 pills): week 3-4
Reduced cocktail (see note above): weeks 4 thru 6
Let me know if there are any specific questions on symptoms I'm not thinking of.
Annie
Annie,
ReplyDeleteI wanted to chime in on the Depakote:
Our NO said that the effects of radiation play out for a few months after the radiation has been completed. By the time we found an NO willing to prescribe Depakote, she was almost done with radiation. We still added it and have continued it since. Based on this, I think it would be a good idea to continue the Depakote for at least 3 months after radiation.
Kendall
Thanks Kendall,
DeleteAnd beyond that, some retrospective evidence suggests Depakote is also a chemosensitizer, although a new, large, retrospective, still unpublished study (by Weller et al.) will be calling into question the idea that Depakote improves outcomes in GBM. Personally I would still include it as part of a cocktail.
Thank you Kendall, Stephen! I will continue Depakote, Metformin and Viagra. We will stop the Disulfiram, Copper, and Verapamil.
DeleteHere is some study about Depakote Temodar combo.
Deletehttp://www.researchgate.net/publication/49854725_Enhancement_of_temozolomide-induced_apoptosis_by_valproic_acid_in_human_glioma_cell_lines_through_redox_regulation
I'm impressed Annie, that you can get your father to take so many vit/supplements, pharma and on a schedule! My husband takes about 24 various pills a day not including his anti-depressants pills. I give his "supplements" in the morning and he takes them during the course of the day. To try and put him on any sort of schedule is nearly impossible. It is enough of a challenge just to have him stay the course on the cbd-thc spray that needs to be taken 5 times a day. GBM with long-term depression makes everything much more difficult.
ReplyDelete