미토탄

용도

• Hyperadrenocorticism
• Medical treatment of hyperadrenocorticism
• Pituitary-dependent hyperadrenocorticism (Induction - Protocol A)
• Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol A)
• Pituitary-dependent hyperadrenocorticism (Induction - Protocol B)
• Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol B)
• Pituitary-dependent hyperadrenocorticism (Induction - Protocol C)
• Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol C)
• Total adrenal ablation (Alternative Protocol D)
• Total adrenal ablation (Alternative Protocol E)
• Palliative medical treatment of adrenal carcinomas or adenomas
• Pituitary-dependent hyperadrenocorticism (Induction)

투여 방법

가능한 부작용

• Lethargy
• Ataxia
• Weakness
• Anorexia (loss of appetite)
• Vomiting
• Diarrhea
• Neurologic signs (uncommon)
• Liver changes (congestion, centrolobular atrophy, fatty degeneration)
• Iatrogenic hypoadrenocorticism (requiring long-term glucocorticoid/mineralocorticoid replacement in ~5% of dogs)
• Anorexia
• Diarrhoea
• Acute-onset neurological signs (2-3 weeks post-initiation)
• Iatrogenic hypoadrenocorticism

주의사항 및 금기

• Known hypersensitivity to mitotane
• Pregnancy (FDA Category C in humans; Class D in veterinary medicine - embryotoxic/teratogenic)
• Patients that are not eating well (should never be administered to anorexic animals)
• Not recommended in cats (trilostane is more effective and mitotane efficacy is highly variable)
• > **Warning:** Mitotane should never be administered to animals that are not eating well. * **Diabetes Mellitus:** Concurrent diabetes requires close monitoring as insulin requirements may rapidly decrease during initial treatment. * **Organ Dysfunction:** Dogs with preexisting renal or hepatic disease should receive the drug with extreme caution and intense monitoring. * **Stress Supplementation:** All dogs receiving mitotane therapy must receive additional glucocorticoid supplementation if undergoing physiological stress (e.g., surgery, trauma, acute illness). * **Human Safety:** Mitotane is a cytotoxic drug. Caregivers should avoid direct skin contact (wear gloves) and wash hands after administration.

약물 상호작용

• CNS Depressants: Additive depressant effects may be seen if used concomitantly.
• Insulin: Diabetic dogs receiving insulin may have their insulin requirements rapidly decreased when mitotane therapy is instituted.
• Phenobarbital: Can induce enzymes and reduce the efficacy of mitotane; conversely, mitotane can induce hepatic microsomal enzymes and increase the metabolism of phenobarbital.
• Spironolactone: Has been demonstrated to block the action of mitotane in dogs; an alternate diuretic is recommended.
• Barbiturates: Increases the hepatic metabolism of mitotane
• Corticosteroids: Increases the hepatic metabolism of mitotane

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