This page tells you about the chemotherapy drug mitotane and its possible side effects. There is information about
Mitotane is pronounced my-toe-tain. It is also called Lysodren. It is a chemotherapy drug used to treat a rare type of cancer of the adrenal glands (adrenal cortical cancer) that has spread or come back.
Researchers are still looking into how mitotane works. We know that it reduces the amount of hormones produced by the adrenal gland. This can control or shrink the cancer for some time.
You take mitotane as tablets 2 or 3 times a day. You should take the tablets with a glass of water during, or straight after, a meal. it is best to take them with foods that contain fats, such as milk, chocolate or vegetable oils.
It is very important to take tablets according to the instructions your doctor or pharmacist gave you. Taking tablets with a meal can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
You start on a low dose of mitotane and your doctor gradually increases the dose until you have the correct amount of mitotane in your bloodstream. You may have to take a lot of tablets each day to reach the correct amount. You will have regular blood tests to check the level. At first you will have blood tests at least once a week. Once the level is stable you may be able to have the tests once a month.
If you forget to take your mitotane don’t take a double dose the next time. Just continue with your usual dose.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with mitotane. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having mitotane with other medicines.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of these.
- Loss of appetite occurs in 4 out of 5 people (80%)
- Feeling or being sick happens in about 4 out of every 5 people (80%) but is usually well controlled with anti sickness medicines
- Diarrhoea occurs in 1 out of 5 people (20%) – drink plenty of fluids. Tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
- Tiredness (fatigue) and drowsiness during and after treatment – don't drive or operate machinery if you feel very drowsy
- Stomach pains
- Tingling in fingers and toes can be uncomfortable. This starts within a few days or weeks and usually goes within a few months of finishing treatment
- Muscle coordination and movement may be more difficult
- A skin reaction happens in 15 out of 100 people (15%). You may have a rash or your skin may be dry and itchy and your face may become swollen
- Sadness and depression – let your doctor or nurse know if you are depressed
- A sore mouth
- Increased risk of getting an infection from a drop in white blood cells happens in between 5 and 25 out of 100 people (5 to 25%). It is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Breast tenderness and swelling in men – this can be uncomfortable. Let your doctor or nurse know if you have it as they may prescribe treatments to help
- Confusion and difficulty in thinking normally
- Dizziness and loss of balance – you may feel as though the room is spinning (vertigo)
- Muscle weakness
- Liver changes that are very mild and unlikely to cause symptoms. The liver will almost certainly go back to normal when treatment is finished
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Bruising and bleeding due to low numbers of platelets
- Rise in levels of fats in the blood, such as cholesterol and triglycerides
Between 1 and 10 in every 100 people have one or more of these effects.
- Muscle wasting
- Hot flushes and sweats
- Difficulty sleeping
- Memory loss and difficulty concentrating
- Low levels of red blood cells (anaemia) leading to pale skin, breathlessness and tiredness
- Yellowing of the skin and whites of the eyes – let your doctor or nurse know straight away if you have this
Fewer than 1 in 100 people have these.
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Steroids and mitotane
You may need to take a steroid when you are taking mitotane. This is because mitotane lowers the amount of natural steroids produced by the adrenal glands. These steroids help our body to react quickly in stressful situations such as shock, injury or infection.
If you have a severe injury or become very unwell you may need to stop taking mitotane. You will have a card to carry saying that you are taking mitotane. In the case of an accident or sudden illness the card tells the doctor that you are taking mitotane and may also be taking steroids.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together. Medicines and herbal supplements that contain CYP enzymes can interfere with how mitotane works.
This drug may have a harmful effect on a developing baby. It is important not to become pregnant or father a child while having treatment and for a few months afterwards. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant.
Do not breast feed during this treatment and for a few months afterwards because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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