Classification: Adrenal cytotoxic agent
About: Mitotane (Lysodren®)
This medication has toxic effects on a certain part of 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.
How to Take Mitotane
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. The pill should be swallowed whole with a glass of water. Do not crush, chew or break. Mitotane should be taken with meals containing fat-rich foods such as milk, chocolate, and oil.
Your care provider will determine your dose, which may change based on the levels in your blood and the side effects you may have. If you miss a dose, take the next dose as scheduled. Do not take two doses to make up for a missed dose. You may be need to take a steroid while you are taking mitotane.
If you are involved in any type of severe trauma or experience shock while taking mitotane, the medication will need to be stopped. Your body will not respond as it should because of the effect of mitotane on your adrenal glands. Steroids will be given until your adrenal gland works normally again.
It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: anti-epileptics, rifabutin, rifampicin, griseofulvin, St. John’s wort, sunitinib, spironolactone, itraconzole, nimodipine, ranolazine, rivaroxaban, tofacitinib, aripiprazole, corticosteroids, linagliptin, quetiapine, among others. This medication can affect the level in your blood of warfarin or other anticoagulants that are used to treat and prevent blood clots. Be sure to tell your healthcare provider about all medications and supplements you take.
Storage and Handling
Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Mitotane is available through retail and mail order pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network pharmacy for distribution of this medication.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Mitotane
There are a number of things you can do to manage the side effects of mitotane. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
Nausea and/or Vomiting
Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. 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 saltines, or ginger ale to lessen symptoms.
Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Decrease in Appetite or Taste Changes
Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your oncology care team about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
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 and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, 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.
Some patients may develop a rash, scaly skin, or red itchy bumps. Use an alcohol free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your oncology care team can recommend a topical medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Be sure to notify your oncology care team of any rash that develops, as this can be a reaction. They can give you more tips on caring for your skin.
Less common, but important side effects can include:
- Central Nervous System Toxicity: Prolonged use (greater than 2 years) of mitotane can lead to neurotoxic side effects including brain damage and functional impairment. The levels of mitotane in your blood will be closely monitored to prevent these problems and your neurological status will be closely monitored.
- Ovarian Marcocysts: These cysts have been reports in premenopauasal women taking mitotoane. Report any gynecologic symptoms including vaginal bleeding and/or pelvic pain to your healthcare team.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and until mitotane is not detectable in your blood. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breast feed while receiving this medication and until mitotane is not detectable in your blood.