II. Indications

  1. Adrenocortical adenocarcinoma (non-operable, palliative management)

III. Contraindications

  1. Acute shock states or Trauma

IV. Mechanism

  1. Synthetic derivative of the banned Pesticide DDT (dichlorodiphenyl trichloroethane)
  2. Mitotane deposits in fatty tissue and is slowly released
  3. Mitotane is toxic to cells of the Adrenal Cortex, resulting in anti-adrenocorticoid activity
    1. Metabolized in the Adrenal Cortex to a reactive acyl chloride intermediate
    2. Metabolites bind adrenal Proteins, and inhibits adrenal cortical Hormone synthesis

V. Medications

  1. Mitotane oral tablets (scored): 500 mg

VI. Dosing

  1. See other references for disease specific dosing protocols

VII. Adverse Effects

  1. Does not suppress the Bone Marrow
  2. Adrenal Insufficiency
  3. Bleeding Diathesis
  4. Gastrointestinal distress
  5. Central Nervous System toxicity
    1. Cognitive Impairment
    2. Major Depression
  6. Constitutional symptoms
    1. Lethargy
    2. Weakness
    3. Dizziness

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Neurologic and psychiatric periodic testing (prolonged use >2 years)

IX. Drug Interactions

  1. Mitotane decreases the effect of other agents
    1. Warfarin
    2. Corticosteroids

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