Uses of Mitotane

What is Mitotane? This is a drug to treat patients with adrenal cancer. This drug has a toxic effect on the mitochondria in the adrenocortical cells, causing these cells to die. This also helps reduce cortisol production and alter steroid metabolism. You may need to take steroids (such as hydrocortisone) by mouth to make up for this loss.
Some cancer patients cause the adrenal glands to produce too much cortisol and other hormones, causing Cushing's syndrome. Excessive amounts of adrenal hormones can cause a number of problems such as changes in blood pressure, weight changes, thinning of the skin and diabetes, and muscle or bone weakness.
Mitotane may be used alone or in combination with certain other medicines to treat some other forms of Cushing's syndrome that are not caused by adrenal cancer. Typically the tumor resembles a pituitary tumor.

Mitotane is available in tablet form for oral administration. It is usually taken three to four times a day. Dosage for patients is:
Initial dose: Take from 2-6v/day, divided into 3 to 4 doses; Maintenance dose: Take 9-10v/day, divided into 3 to 4 doses; The dose can be increased to 16v/day if the patient tolerates it. The highest dose ever used was 18-19v/day. Patients should take mitotane at about the same time each day and should swallow the tablet whole with a glass of water; Do not crush, chew or break. Mitotane should be taken with meals containing high-fat foods such as milk, chocolate, and oils.
Doctors will determine the dose according to each patient's condition, which may vary based on each person's blood levels and the severity of side effects the patient may be experiencing. If you miss a dose, just take your next scheduled dose. Do not arbitrarily double the dose to make up for the missed dose.
You may be asked to take steroids while you are taking mitotane. You will need to temporarily stop using Mitotane if you have a severe shock or injury and steroids will be given until your adrenal glands are back up and running.
During the use of Mitotane you need to avoid some drugs, including: antiepileptic drugs, rifabutin, rifampicin, griseofulvin, St. John's wort, sunitinib, spironolactone, itraconzole, nimodipine, ranolazine, rivaroxaban, tofacitinib, aripiprazole, corticosteroids, linagliptin, quetiapine, among others. This medicine may affect the blood levels of warfarin or other anticoagulants used to treat and prevent blood clots. Tell your treating doctor about all medications and supplements you take.

Store your medicine in its original, labeled packaging at room temperature and in a dry place (unless otherwise directed by your healthcare provider or pharmacist). Keep container out of reach of children and pets.
If a caregiver is preparing a dose for you, they should consider wearing gloves or pouring the medication directly from their container into a lid, small cup, or directly into your hand. They should avoid touching the pill and should always wash their hands before and after giving you the medicine.

Mitotane is available through retail pharmacies. This drug may be covered under a prescription drug plan for cancer patients. Your medical facility or health care team can help you find these resources, if they are available.

When using Mitotane, you may experience some side effects. Here are some of the most common side effects:
Nausea and/or Vomiting
Tell your treating doctor right away so they can prescribe medicine to help you control nausea and vomiting. Also, changing your diet can help you avoid this side effect while you're taking it. Avoid things that can worsen symptoms, such as greasy/fatty, spicy, or acidic foods (lemon, tomatoes, oranges). You can also use salt water or ginger ale to ease mild symptoms.
Decreased appetite or altered appetite
Nutrition is an important part of cancer care. Cancer treatment can affect your appetite, and in some cases, side effects of treatment can make it difficult to eat. You can use the nutrition counseling services at your treatment center to help with food choices.
Try to eat five or six small meals or snacks during the day, instead of 3 larger meals. If you are not eating enough, you can take nutritional supplements. Avoid any food that you think smells or tastes bad. If you have a problem with red meat, eat chicken, turkey, eggs, dairy products, and fish that don't have a strong odor. Sometimes cold foods have less of an odor. Spice up meat or fish by seasoning with sweet juices, sweet and sour sauces or marinades. Use spices like basil, oregano, or rosemary for extra flavor. Bacon, ham, and onions can add flavor to vegetables. You may experience a metallic taste or find that food has no taste at all. You may not like foods or drinks that you enjoyed before cancer treatment. These symptoms may persist for several months or longer after treatment ends.
Diarrhea
When you experience persistent diarrhea, notify your treating doctor for prescription medication. Also, try eating bland, low-fiber foods, such as steamed rice and boiled or grilled chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluids, which can help relieve diarrhea.
Foods rich in soluble fiber include: apple sauce, bananas (ripe), canned fruit, orange parts, boiled potatoes, white rice, white flour products, oatmeal, cream of rice , cream of wheat and french fries. Drink 8-10 glasses of non-alcoholic, caffeine-free water each day to prevent dehydration.
Rash
Some patients may develop a rash, scaly skin, or an itchy red rash. Use an alcohol-free moisturizer on your skin and lips; Avoid moisturizers with perfumes or scents. Your doctor may recommend a topical medication if itching is bothersome. If your skin cracks or bleeds, be sure to keep the area clean to avoid infection.
Some other important possible side effects include :
Central nervous system toxicity : Prolonged use of mitotane (more than 2 years) can lead to neurotoxic side effects including including brain damage and impaired function. The level of mitotane in your blood will be closely monitored to prevent these problems, and your neurological condition will be closely monitored. Ovarian Cysts: These cysts have been reported in premenopausal women taking mitotane. Report any gynecological symptoms including vaginal bleeding or pelvic pain to your treating physician. Reproductive concerns: Exposure of the fetus to this drug may cause birth defects. Therefore, you should not become pregnant while taking this medicine. Effective birth control is needed during treatment and until mitotane is undetectable in your blood. You should not breast-feed while taking this medicine. Mitotane is a medicine to treat patients with adrenal cancer. To ensure effective use and avoid unwanted side effects, patients need to use the drug exactly as directed by the doctor, professional pharmacist.
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