Mitotane, as a therapeutic drug for adrenal cortical cancer, has multiple systemic side effects that require targeted management. The following is a detailed explanation of the main side effects and mitigation measures:

1. Common side effects and treatment

(1) Gastrointestinal reactions: The incidence rate is about 80%, manifested as nausea, vomiting, and diarrhea. It is recommended to take medication after meals and use antiemetic drugs such as ondansetron if necessary.

(2) Nervous system: Dizziness (45%), drowsiness (60%). Avoid driving and operating machinery, and adjust the medication administration time to bedtime when symptoms are severe.

(3) Skin reactions: rash (30%), photosensitivity. Use SPF50+sunscreen to avoid direct sunlight.

Serious side effects that require immediate medical attention

(1) Adrenal insufficiency: manifested as extreme fatigue and low blood pressure. Urgent supplementation of glucocorticoids is required.

(2) Hepatotoxicity: Medication should be suspended when ALT levels increase by more than three times.

(3) Neurotoxicity: Ataxia or confusion require immediate discontinuation of medication.

3 Precautions for Special Groups

(1) Patients with liver dysfunction: need to reduce dosage by 50% and monitor liver function weekly.

(2) Elderly patients are more prone to central nervous system side effects, and it is recommended to reduce the initial dose by 25%.

4 Laboratory Monitoring Requirements

(1) Initial treatment: Monitor plasma drug concentration weekly (target 14-20mg/L).

(2) Long term treatment: Monthly check of thyroid function and blood lipid levels.

5 Drug Interaction Management

(1) Warfarin: Mitotan can reduce its anticoagulant effect, and the dose of warfarin needs to be increased by 30-50%.

(2) CYP3A4 inducer: It can reduce the blood concentration of mitoxan and should be avoided in combination.