Mitotane

INTRODUCTION

Indications

Inoperable carcinoma of the adrenal cortex.

Unlabeled Use: Cushing's syndrome due to pituitary disorders.

Action

Suppresses adrenal function. Has a direct cytotoxic effect on adrenal tumors. Structurally related to DDT (an insecticide). Therapeutic Effects: Regression of adrenal cortical tumors.

Adverse Reactions/Side Effects

CNS: lethargy, somnolence, brain damage, dizziness, fatigue, functional impairment (high-dose, long-term therapy), headache, irritability, mental depression, tremors, vertigo, weakness. EENT: blurred vision, decreased hearing, diplopia, lens opacities, optic neuritis, toxic retinopathy. Resp: shortness of breath, wheezing. CV: hypertension, hypotension. GI: anorexia, diarrhea, nausea, vomiting, increased salivation. GU: albuminuria, hematuria, hemorrhagic cystitis. Derm: maculopapular rash, flushing. Endo: adrenal suppression, gynecomastia. Metab: hypercholesterolemia, hypouricemia. MS: aching, arthralgia, myalgia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of CNS toxicity, including irritability, headache, dizziness, decreased mental acuity, lethargy, tremors, vertigo, and functional impairments. Notify physician because toxicity can lead to permanent brain damage.

• Assess blood pressure (BP) periodically, and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) or low blood pressure (hypotension) that causes dizziness and syncope.

• Assess any muscle pain, joint pain, or body aches to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor any breathing problems such as wheezing or shortness of breath. Report severe or prolonged respiratory impairments.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Because of cardiovascular and pulmonary impairments (changes in BP, respiratory problems), use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.

• Instruct patient to report any hearing loss or vision problems (blurred vision, double vision).

• Advise patient about the likelihood of GI reactions such as diarrhea, nausea, vomiting, and loss of appetite. Instruct patient to report severe or prolonged GI problems.

• Instruct patient to report signs of kidney dysfunction, including blood in the urine and painful or difficult urination.

• Instruct patient or family/caregivers to report other bothersome side effects such as severe or prolonged fever, skin warmth/flushing, or breast enlargement in men.

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