Mitotane is a powerful medication used to treat adrenal cancer. Because it works differently than many other cancer treatments, it’s important to take it correctly and monitor your body’s response closely. This guide explains how to take mitotane, what to expect, and how to manage possible side effects.
1. How Should Adults Take Mitotane?
Starting with a Low Dose:
- Begin with 1 gram per day.
- If there are no major side effects, increase the dose by 0.5 grams every 3 days starting on Day 4.
- Continue increasing the dose slowly until reaching 3–4 grams per day.
- After 2–3 weeks, your doctor will start checking mitotane levels in your blood.
- The goal is to reach a blood level of 14–20 mg/L, or the highest dose your body can handle.
Note: If you feel nausea or stomach discomfort, your doctor may reduce the dose or delay the increase.
Starting with a Higher Dose (For Faster Results):
- Begin with 1.5 grams on Day 1.
- Increase to:
- 2–3 grams on Day 2
- 4.5 grams on Day 3
- 6 grams on Day 4
- Blood levels should be tested after 2–3 weeks to make sure they are within the safe range.
2. How Should Children Take Mitotane?
Mitotane can also be used in children, though dosing is based on body size.
- Starting dose: 1.5–3.5 grams per square meter of body surface (g/m²/day)
- Maintenance dose: up to 4 g/m²/day
- Blood levels must be monitored closely, especially when they reach 10 mg/L or higher.
Example: An 8-year-old child (135 cm, 32 kg, BSA = 1.08 m²) may start with 1.6 grams/day (about 3 tablets). If tolerated, this can be gradually increased to 8 tablets/day. Always monitor blood levels and adjust as needed.
3. How Is Mitotane Monitored in the Body?
Mitotane levels in the blood must be monitored regularly to ensure the treatment is working safely.
Target Range: 14–20 mg/L
- Above 14 mg/L: Better survival outcomes.
- Above 20 mg/L: May cause temporary nerve or muscle problems.
Testing Schedule:
- If your level is below 14 mg/L: Test every 3–4 weeks.
- If your level is above 14 mg/L: Test every 6–12 weeks.
It may take weeks or even months to reach steady levels. If you’re tolerating the drug well, your doctor may continue to increase the dose until you’re in the target range.
4. What If You Have Side Effects?
Mitotane can cause side effects, so your doctor will monitor your liver, kidneys, hormones, and electrolytes regularly.
Common Side Effects:
- Stomach problems (up to 80%): Nausea, vomiting, diarrhea, poor appetite.
- Nervous system issues (15–40%): Dizziness, depression, or balance problems.
What to Do:
- If symptoms are moderate to severe:
- Reduce the dose by 1–1.5 grams/day.
- If symptoms are severe or life-threatening:
- Stop mitotane immediately.
- Restart at 50–75% of the last dose once symptoms improve.
5. Do You Need Other Medications or a Special Diet?
Corticosteroids (Steroid Hormone Replacement):
Mitotane lowers your body’s natural cortisol, which helps manage stress and maintain blood pressure, sugar, and electrolytes.
- You may need to take hydrocortisone 5 mg twice daily to prevent symptoms like fatigue, low blood pressure, or dizziness.
- Your doctor may also test your cortisol levels and adjust the steroid dose as needed.
Diet Tips for Better Absorption:
Mitotane is absorbed better with fatty foods. Take it with meals that include:
- Healthy fats: Nuts, olive oil, avocados
- Protein-rich foods: Egg yolks, meat, dairy
Important Reminder:
This information is based on guidance from Lucius Pharmaceutical, but every patient is different.
Always follow your doctor’s instructions for your specific treatment plan.
