Adrenocortical cytotoxic
Mitotane (Specialist drug)
Brand names: Lysodren
Adult dose
Dose: Specialist initiation only — refer to BNF/SmPC
Route: PO
Frequency: divided
Clinical pearls
- Advanced adrenocortical carcinoma; specialist oncology
- Co-prescribe hydrocortisone + fludrocortisone replacement
Contraindications
- Severe hepatic impairment
- Pregnancy
- Concurrent live vaccines
Side effects
- Adrenal insufficiency (mandatory hydrocortisone replacement)
- CNS effects (sedation, lethargy)
- GI upset
- Hepatotoxicity
- Hypercholesterolaemia
- Skin rash
Interactions
- Many CYP3A4 substrates — induces metabolism
- Warfarin
- Hormonal contraceptives
Monitoring
- Mitotane levels
- Cortisol
- Lipids
- LFTs
Reference: BNF; SmPC; https://bnf.nice.org.uk/drugs/mitotane-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Vancomycin Dosing Calculator · Drug Dosing
- Phenytoin Correction for Albumin / Renal Failure · Drug Dosing
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Tisdale Risk Score for QT Prolongation · Arrhythmia
- Bazett Corrected QT Interval (QTc) Calculator · Arrhythmia
- DAPT Score for Dual Antiplatelet Therapy Duration · Antiplatelet Therapy
Pathways
- Acute Myeloid Leukaemia Presentation · BSH; NICE — NG146
- Tumour Lysis Syndrome · Cairo-Bishop; BSH; NICE — Best Practice
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022