Spironolactone Mitotane

Wortsman J, SolerNG. Mitotane Spironolactone antagonism in Cushing s syndrome. J/IA (1977)238,2527... 

Drugs that may affect spironolactone include ACE inhibitors, salicylates, and food. Drugs that may be affected by spironolactone include anticoagulants, digitalis glycosides, mitotane, digoxin, and potassium preparations. 

Mitotane (Lysodren) is administered in initial daily oral doses of 2 to 6 g, usually given in three or four divided portions, but the maximal tolerated dose may vary from 2 to 16 g per 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 because it interferes with the adrenal suppression produced by mitotane. 

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. 

In an isolated report, the effects of mitotane appeared to be inhibited by spironolactone in a patient with Cushing s disease. 

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