🍽️ mitotane,(prescription)

Cytotoxic Effects: Mitotane exerts its therapeutic effects by inhibiting the production of cortisol and other hormones by the adrenal cortex and by directly damaging adrenal cortical cells. This leads to a decrease in cortisol levels and a reduction in the size and activity of the adrenal glands, which is beneficial in the treatment of ACC.

Treatment of Adrenal Cortical Carcinoma: Mitotane is considered the mainstay of therapy for patients with ACC, particularly in cases where surgical resection of the tumor is not feasible or as adjuvant therapy following surgery. It helps control tumor growth and reduce the production of adrenal hormones, which can alleviate symptoms and improve overall survival in affected individuals.

Adrenal Insufficiency: Due to its suppressive effects on adrenal function, mitotane can induce adrenal insufficiency or hypocortisolism, a condition characterized by inadequate production of cortisol and other adrenal hormones. Patients receiving mitotane therapy may require replacement with glucocorticoid medications such as hydrocortisone to maintain normal physiological function.

Monitoring of Hormone Levels: During mitotane therapy, patients require close monitoring of adrenal hormone levels, including cortisol, aldosterone, and adrenal androgens, to assess treatment response and adjust medication dosages as needed. Regular blood tests and clinical evaluations are necessary to prevent complications associated with hormonal imbalances.

Side Effects: Common side effects of mitotane may include gastrointestinal disturbances such as nausea, vomiting, diarrhea, and abdominal pain, as well as neurological symptoms such as dizziness, headache, and fatigue. These side effects are often dose-dependent and may improve with dose adjustments or supportive care measures.

Hepatotoxicity: Mitotane has the potential to cause liver toxicity or hepatotoxicity, manifesting as elevated liver enzyme levels (transaminases) and, rarely, more severe liver dysfunction. Liver function tests should be monitored regularly during mitotane therapy, and treatment may need to be discontinued or adjusted if significant liver abnormalities occur.

Central Nervous System Effects: Mitotane can cross the blood-brain barrier and may cause central nervous system (CNS) side effects such as sedation, confusion, depression, and memory impairment. Patients should be advised to report any changes in mood or cognition to their healthcare providers for evaluation and management.

Teratogenicity: Mitotane is known to be teratogenic, meaning it can cause birth defects if used during pregnancy. Female patients of childbearing potential should use effective contraception during mitotane therapy and should be counseled about the risks of fetal harm. Pregnancy should be avoided for at least several months after discontinuation of mitotane treatment.

Drug Interactions: Mitotane may interact with other medications, including anticoagulants, corticosteroids, and certain antiepileptic drugs, potentially affecting their efficacy or safety. Patients should inform their healthcare providers about all medications, supplements, and herbal products they are taking to avoid potential drug interactions.