Mitotane is a chemotherapy drug used to treat a rare cancer of the adrenal glands called adrenocortical carcinoma.

HOW IS MITOTANE ADMINISTERED?

Mitotane is normally given on an outpatient basis. During your treatment, you will probably see an oncologist, a chemotherapy nurse, or a specialist nurse.

Taking your chemotherapy pills

Mitotane is taken in tablet form. Always take the tablets exactly as you are instructed. This is important to ensure that it is working as well as possible.

Mitotane pills are taken twice or three times a day. Swallow the pills whole with a glass of water during or after a meal consisting of fatty foods.

You will usually take a low dose of mitotane. The dose will then be gradually increased. Your doctor will monitor the levels of the drug in your bloodstream through regular blood tests. You will need to have a blood test once or twice a week when after you start taking the tablets. Once your doctors are happy with your dose, your blood will be tested monthly.

You will be given steroids while you take mitotane. This is because mitotane can lower the body's production of steroids. Steroids are natural hormones produced by the adrenal glands. Failure to produce sufficient steroids may affect the body's defenses (immune system). Your body's ability to respond quickly to stress—such as shock, serious injuries, or infection—may be reduced. If you suffer an injury, infection, or similar situations, your treatment may have to be put on hold.

If you forget to take a dose, do not double the dose the next time. Take your normal dose and tell your nurse or doctor what has happened.

POSSIBLE SIDE EFFECTS OF MITOTANE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Mitotane may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 ° C
• you suddenly feel unwell, even if your temperature is normal.
• You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

BRUISING AND BLEEDING

Mitotane may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Mitotane may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

REDUCED STEROID LEVELS

This can cause side effects such as feeling very tired (fatigue), muscle weakness, dizziness, fainting, and vomiting. Doctor-prescribed steroid tables will lower the risk of these effects. If you feel you have any of these symptoms, talk to your doctor immediately.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

LOSS OF APPETITE

You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.

EFFECTS ON THE NERVOUS SYSTEM

Mitotane can affect the nervous system. You may feel anxious or restless, have trouble sleeping or experience mood swings. You may feel drowsy, confused, or dizzy. You can have tingling in your arms and legs. Tell your doctor or nurse immediately if you have any of these symptoms. They can make changes in your treatment if they become a problem for you.

It is important not to drive or operate machinery if you notice these effects.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

SKIN CHANGES

Mitotane can produce a rash, which may cause itchiness. Always tell your doctor or nurse about any change to your skin. They can advise you and prescribe creams or medication that may help. Normally, changes in the skin are temporary and get better as soon as the treatment is over.

BREAST TENDERNESS

Some men may develop breast swelling. Your doctor can prescribe medicines to reduce any discomfort.

CHANGES IN THE LIVER

Mitotane can affect the functioning of your liver. These changes are normally mild and return to normal after the treatment. You will have blood tests done to see how your liver is working.

LESS COMMON SIDE EFFECTS OF MITOTANE

EYE PROBLEMS

While rare, mitotane can affect your vision. Tell your doctor if you notice that your vision becomes blurry.

MORE INFORMATION ABOUT MITOTANE

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

ALCOHOL

Your doctor will advise you against drinking alcohol while taking mitotane, as it can interact with the medication.

FERTILITY

Mitotane may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.