Last Modified: January 14, 2012
Classification: Antineoplastic Agent
Mitotane is used to treat cancer of the adrenal gland. The drug has toxic effects on the mitochondria in adrenal cortical cells, causing these cells to die. This also decreases the production of cortisol and alters metabolism of steroids. You may need to take a steroid (such as hydrocortisone) by mouth to make up for this loss. Your oncology team will monitor you for this side effect. The exact mechanism of action is unknown.
Mitotane comes as a tablet to take by mouth. It is usually taken three to four times a day. Take mitotane at around the same times every day.
There are a number of things you can do to manage the side effects of Mitotane. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
While receiving treatment, you are at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
Some less common side effects that have been reported include: skin rash or darkening, dizziness, blurred vision, flu-like symptoms, bladder irritation, and changes in blood pressure.
Aug 2, 2011 - Dihydrotestosterone synthesis from adrenal precursor steroids in castration-resistant prostate cancer bypasses testosterone synthesis, and occurs through an alternative pathway involving conversion of Δ4-androstenedione to 5α-androstanedione by 5α-reductase isoenzyme-1, according to an experimental study published online July 27 in the Proceedings of the National Academy of Sciences.