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Mitotane (Lysodren® )

Warning:  Mitotane is a medication that suppresses the action of your body’s adrenal glands, so you won’t be able to react normally to stress, injury, shock, or trauma. Your body will not be able to produce adequate amounts of the hormone cortisol, so if you do experience shock, injury, infection, or trauma, your doctor may prescribe a different medication. Your doctor may also choose to discontinue your Mitotane treatment.

 

Indications: Doctors most frequently prescribe Mitotane as part of a course of treatment for cancer of the adrenal glands that can‘t be treated with surgery; the medication works by suppressing the hormone production of the adrenal glands or stopping or slowing the growth of cancer cells.  The adrenal glands are responsible for releasing hormones into the body.  Hormones help maintain normal body function, as well as fight infection and control stress.  This is why it is very important that your doctor be told if you experience any injury or shock while taking Mitotane.

Mitotane is also used to treat other conditions related to excess hormone production, such as Cushing’s syndrome. 

 

Dosage: Mitotane comes as a tablet to be taken by mouth. However, the treatment will begin in a hospital or clinic setting so your doctor can monitor your response to the drug.  Once it has been determined what dose is best for you, your doctor will allow you to continue taking it on your own. The fact that Mitotane comes in tablet form, patients should swallow each dose with a glass of water.  Most patients taking Mitotane will take three to four doses each day; you may take it with or without meals, or as your doctor has instructed.

Even if you feel better, you should continue to take Mitotane.  It is very important to follow the dosing instructions exactly. Don’t increase the amount you take or take it more frequently. You should also not skip any doses or stop taking the medication unless your doctor has told you to.

 

Storage: store Mitotane at room temperature (15-25 ° C), away from heat, light and moisture. Always keep your medications out of the reach of children . Mitotane and all drugs should not be used beyond the expiration date printed on the container.      

Overdose: it is very important that you take Mitotane as indicated by your health care provider. Regardless of the circumstance, do not take Mitotane more often. Even when taken at normal dose , Mitotane can reduce the amount of steroid hormones (cortisol) synthesized by the adrenal cortex, which can lead to the development of life-threatening conditions. If you think you have taken an overdose, contact your doctor or the poison control center nearest you as soon as possible. 

Missing dose: Take Mitotane as indicated your doctor or pharmacist. In case you forget to take a dose, take the missed one as soon as you remember it. However, if it is almost time for your next dose, do not double the next dose to recover the missed one; it can be dangerous. Contact your doctor or wait to go back to your regular schedule.  

Contraindications:   There are certain health conditions that contraindicate the use of Mitotane.  You need to tell your doctor if you have recently had any kind of viral infection such as herpes (including cold sores) or chicken pox.  Tell your doctor if you are allergic to any medications, including Mitotane or any of its inactive ingredients.  Also, be sure to tell your doctor if you have or have had any of the following conditions:  Liver disease; pregnancy; if you may become pregnant; producing milk or breastfeeding; or high blood pressure problems.  This is not a complete list of contraindications, so you should talk to your doctor about any concerns you have.

  

Mechanism of action (MOA): Mitotane is an antineoplastic agent that works by reducing the amount of steroid hormones synthesized by the adrenal cortex, which slows or stops division or reproduction of cancer cells that need these hormones to survive.  

Interactions: There are a number of drugs known to interact with Mitotane.  This includes (but isn’t limited to) “blood thinners” such as warfarin, diuretics, “water pills”, and corticosteroids such as dexamethasone and prednisone.  Also, tell your doctor if you are taking any medication that can cause drowsiness.  This potentially includes antihistamine, muscle relaxants, psychiatric medications, anti-seizure drugs, and narcotic pain relievers. 

 

Side effects: in certain patients, Mitotane can lead to the following side effects:  

  • hair loss
  • nausea
  • vomiting
  • diarrhea
  • dizziness
  • depression
  • insomnia problems
  • lack of energy
  • decreased appetite
  • unusual drowsiness
  • Rash or changes in skin color

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor if you experience any of these symptoms:  

  • vision changes 
  • severe clinical depression 
  • anxiety or confusion 
  • deterioration of heart health or abnomal heartbeat 
  • abdominal or side pain  
  • high fever or shaking chills 
  • excessive sweating, mainly at night 
  • Purple, blue, or black discoloration of the skin.