Several things patients must know when taking the drug: What are the warnings and precautions for mitotane?

In clinical studies of Mitotane (Mitotane), warnings and precautions have emerged regarding adrenal crisis in shock or severe trauma, chlorinated naphthalene toxicity, adrenal insufficiency, embryo-fetal toxicity, and large ovarian cysts in premenopausal women. Discontinue and resume at reduced dose upon recovery, or permanently discontinue based on severity.

1. Adrenal crisis in the setting of shock or severe trauma: In patients taking mitotane, adrenal crisis occurs in the setting of shock or severe trauma, and the response to shock is impaired. Administer hydrocortisone, monitor for worsening of shock symptoms, and discontinue lesudran until resolution.

2. Chlorinated naphthalene toxicity: Mitotane treatment may cause central nervous system toxicity, including sedation, drowsiness and dizziness. Mitotane plasma concentrations exceeding20mcg/mL are associated with a higher incidence of toxicity.

3. Adrenal insufficiency: Treatment with mitotane can cause adrenal insufficiency. Steroid replacement therapy was performed as clinically indicated. Measure free cortisol and adrenocorticotropic hormone levels for optimal steroid replacement.

4. Embryo-Fetal toxicity: Mitotane taken by pregnant women can cause harm to the fetus. Patients exposed to mitotane during pregnancy may experience abnormal pregnancy outcomes, such as preterm birth and early pregnancy loss. Inform pregnant women of potential risks to the fetus. Advise females of childbearing potential to use an effective method of contraception during treatment with lesodran and after discontinuation of treatment as long as mitotane plasma levels are detectable.

5. Macroovarian cysts in premenopausal women: Macroovarian cysts, usually bilateral and multiple, have been reported in premenopausal patients receiving mitotane. Reported complications of these cysts include adnexal torsion and hemorrhagic cyst rupture. Improvement after discontinuation of mitotane has been described in some cases. Advise female patients to seek medical care if they experience gynecological symptoms such as vaginal bleeding and/or pelvic pain.