Mitotane is a chemotherapy drug usually given to treat a rare cancer of the adrenal glands called adrenal cortical carcinoma. It can be used to treat advanced adrenal cancer that can't be removed by surgery or has come back after treatment (relapsed).
This information should ideally be read with our general information about chemotherapy and about tumours of the adrenal glands.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
What mitotane looks like
Back to top
Mitotane is available as a 500mg white tablet.
You should swallow the tablets whole with water during, or at the end of, a fat-rich meal.
Your specialist will decide on the starting dose of mitotane that's right for you. The total daily dose can be divided up and taken two or three times a day. Your doctor will monitor the amount of drug in your bloodstream by taking blood tests at regular intervals. Mitotane is usually started at a low dose and gradually increased.
Sometimes the drug level in the blood needs to be checked twice a week. Once your dose has been established, this can be reduced to about once a month.
You’ll be given steroid tablets to take while you're having mitotane. This is because mitotane can reduce the production of steroids in the body. Steroids are natural hormones produced by the adrenal glands. Not producing enough steroids can affect the body’s defence system (immune system) and how quickly we respond to stress situations. Your specialist will monitor this closely.
Each person’s reaction to chemotherapy is different. Most people taking mitotane will have side effects but they will be closely monitored by a specialist. The side effects described here won't affect everyone who has mitotane.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Reduced steroid levels
This can cause side effects such as feeling extremely tired (fatigue), muscle weakness, dizziness, fainting and vomiting. The steroid tablets prescribed by your doctor will reduce the risk of these effects. If you're feeling unwell with any of the above symptoms, contact your doctor immediately.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful..
Mitotane can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful
Effects on the nervous system
Feeling dizzy, difficulty with movement and co-ordination, feeling confused, and unusual sensations like pins and needles are common when taking mitotane. You may also feel sleepy and lethargic. You must not drive or use dangerous machinery until you know how this drug affects you. Avoid drinking alcohol while you're taking mitotane.
Risk of infection
Mitotane can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell even with a normal temperature.
Bruising and bleeding
Mitotane can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Mitotane can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Breast tenderness or fullness
Some men may notice breast swelling and tenderness, which is known as gynaecomastia. Your doctor can prescribe medicines or other treatments to reduce any discomfort.
Mitotane can cause a rash, blisters, itching or peeling, and redness of the skin. Tell your doctor or nurse if you notice any of these. They can prescribe tablets to stop the itching. Bathing with a mild soap may be soothing. If skin problems are severe, your treatment dose may need to be altered or stopped.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Less common side effects
Back to top
Treatment with mitotane may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Mitotane may affect your eyesight, however this is very rare. Let your doctor know if you notice any blurred vision or clouding.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned here.
Back to top
Mitotane can reduce the body’s steroid level, which may decrease it's ability to respond quickly to stress (such as shock, severe injury or infection). If you experience an injury, infection or other stressful situations, your treatment may need to be stopped.
Your pharmacist will give you a card to carry at all times to let people know you're taking mitotane in case you suddenly become unwell or have an accident.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
You should not take the herbal drug St John’s wort or the water tablet (diuretic) spironolactone (known as Aldactone and Aldactide®) when you're taking mitotane.
If you're taking blood-thinning drugs (anticoagulants), such as warfarin, your dose may need to be monitored more closely.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while taking mitotane as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about mitotane tablets
Back to top
It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in their original packaging, and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place and out of the reach of children.
The tablets should not be handled by pregnant women and carers should wear disposable gloves.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets, tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take it unless it's less than three hours since you should have taken it. If it's more than three hours, wait until the next scheduled dose.
This section has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).