II. Indications
- Adrenocortical adenocarcinoma (non-operable, palliative management)
III. Contraindications
- Acute shock states or Trauma
IV. Mechanism
- Synthetic derivative of the banned Pesticide DDT (dichlorodiphenyl trichloroethane)
- Mitotane deposits in fatty tissue and is slowly released
- Mitotane is toxic to cells of the Adrenal Cortex, resulting in anti-adrenocorticoid activity
- Metabolized in the Adrenal Cortex to a reactive acyl chloride intermediate
- Metabolites bind adrenal Proteins, and inhibits adrenal cortical Hormone synthesis
V. Medications
- Mitotane oral tablets (scored): 500 mg
VI. Dosing
- See other references for disease specific dosing protocols
VII. Adverse Effects
- Does not suppress the Bone Marrow
- Adrenal Insufficiency
- Bleeding Diathesis
- Gastrointestinal distress
- Central Nervous System toxicity
- Constitutional symptoms
- Lethargy
- Weakness
- Dizziness
VIII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
- Neurologic and psychiatric periodic testing (prolonged use >2 years)
IX. Drug Interactions
- Mitotane decreases the effect of other agents