The principal application of mitotane (o,p'-DDD) is in the treatment of neoplasms derived from the adrenal cortex. The drug causes a rapid reduction in the levels of corticosteroids and their metabolites in blood and urine, a response that is useful both in guiding dosage and in following the course of hypercorticism resulting from an adrenal tumor or adrenal hyperplasia.
Mitotane (lysodren) is administered in initial daily oral doses of 2-6 g, usually given in 3 or 4 divided portions, but the maximal tolerated dose may vary from 2 to 16 g/day. Treatment should be continued for at least 3 months; if beneficial effects are observed, therapy should be maintained indefinitely. Spironolactone should not be administered concomitantly, since it interferes with the adrenal suppression produced by mitotane. Treatment with mitotane is indicated for the palliation of inoperable adrenocortical carcinoma, producing symptomatic benefit in 30-50% of such patients. Although the administration of mitotane produces anorexia and nausea in ~80% of patients, somnolence and lethargy in 34%, and dermatitis in 15-20%, these effects do not contraindicate the use of the drug at lower doses. since this drug damages the adrenal cortex, administration of corticosteroids is indicated, particularly in patients with evidence of adrenal insufficiency, shock, or severe trauma.
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