Drug interactions
Mifepristone + Mitotane
Severity: Major
Mifepristone and Mitotane: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mitotane strongly induces CYP3A4 and can substantially lower mifepristone concentrations. This may reduce the glucocorticoid receptor blockade needed to control hyperglycemia and other signs of Cushing syndrome, and the effect can persist for weeks after mitotane is stopped.
What this interaction means in plain words
Mifepristone and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Mifepristone belongs to Endocrine; Mitotane belongs to Oncology.
Why it happens
Mitotane induces hepatic and intestinal CYP3A4, increasing the metabolic clearance of mifepristone.
What to do
Avoid the combination where possible; if it is necessary, monitor clinical and glycemic response closely and be prepared to titrate mifepristone upward within labeled limits. Reassess dosing after mitotane is discontinued.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Mifepristone
- Apixaban + Mifepristone Contraindicated
- Argatroban + Mifepristone Contraindicated
- Cisapride + Mifepristone Contraindicated
- Cortisone + Mifepristone Contraindicated
- Cyclosporin + Mifepristone Contraindicated
- Dabigatran etexilate + Mifepristone Contraindicated
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Mifepristone with Mitotane?
MediHelp rates the interaction as major. Mifepristone and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mitotane strongly induces CYP3A4 and can substantially lower mifepristone concentrations. This may reduce the glucocorticoid receptor blockade needed to control hyperglycemia and other signs of Cushing syndrome, and the effect can persist for weeks after mitotane is stopped.
How serious is the interaction between Mifepristone and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible; if it is necessary, monitor clinical and glycemic response closely and be prepared to titrate mifepristone upward within labeled limits. Reassess dosing after mitotane is discontinued.
What other medicines interact with Mifepristone?
MediHelp also lists interactions of Mifepristone with, for example, Apixaban, Argatroban, Cisapride. The full list is on the Mifepristone page.
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