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indicationFor treatment of inoperable adrenocortical tumours; Cushing's syndrome
pharmacologyMitotane is an oral chemotherapeutic agent indicated in the treatment of inoperable adrenal cortical carcinoma of both functional and nonfunctional types. Mitotane can best be described as an adrenal cytotoxic agent, although it can cause adrenal inhibition, apparently without cellular destruction. The administration of Mitotane alters the extra-adrenal metabolism of cortisol in man; leading to a reduction in measurable 17-hydroxy corticosteroids, even though plasma levels of corticosteroids do not fall. The drug apparently causes increased formation of 6-B-hydroxyl cortisol.
mechanism of actionIts biochemical mechanism of action is unknown, although data are available to suggest that the drug modifies the peripheral metabolism of steroids as well as directly suppressing the adrenal cortex.
biotransformationHepatic and renal
absorptionAbout 40% oral Lysodren is absorbed
half life18-159 days
route of eliminationA variable amount of metabolite (1%-17%) is excreted in the bile and the balance is apparently stored in the tissues.
drug interactionsAcenocoumarol: Mitotane may decrease the anticoagulant effect of acenocoumarol.
Anisindione: Mitotane may decrease the anticoagulant effect of anisindione.
Dicumarol: Mitotane may decrease the anticoagulant effect of dicumarol.
Spironolactone: Spironolactone antagonizes the effect of mitotane
Warfarin: Mitotane may decrease the anticoagulant effect of warfarin.