Lysodren

Risk for adrenal insufficiency and adrenal crisis. Temporarily withhold and give exogenous steroids until recovery during shock, trauma, infection, or adrenal suppression. Withhold treatment prior to planned surgeries. CNS toxicity (esp. mitotane levels >20mg/L). Monitor closely for infections, behavioral and neurologic assessments. Monitor mitotane plasma levels periodically (eg, monthly); consider monitoring levels every 2 weeks after starting treatment, dose adjustments, and regularly (every 2 months) after discontinuation. Evaluate thyroid function if cognitive dysfunction occurs. Ovarian macrocysts in premenopausal women. Perform pelvic ultrasound in premenopausal women at baseline and in regular intervals. Hepatotoxicity. Hematologic toxicity. Monitor LFTs, CBCs including neutrophils prior to initiation, at dose titration, and periodically during treatment. Platelet function disorders. Prolonged bleeding time. Perform ADP-inducted platelet aggregometry testing prior to surgery or dental procedures. Overweight or recent weight loss; monitor mitotane levels closely. Hepatic or renal impairment (mild or moderate): monitor closely and adjust dose; (severe): not recommended. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective nonhormonal contraception during and after discontinuation until mitotane levels are undetectable. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended.