Drug interactions
Mitotane + Pimavanserin
Severity: Major
Mitotane and Pimavanserin: 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 is a strong CYP3A4 inducer whose effect persists for weeks after stopping. It can substantially lower pimavanserin levels and reduce its antipsychotic effect.
What this interaction means in plain words
Mitotane and Pimavanserin 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 belongs to Oncology; Pimavanserin belongs to Central Nervous System.
Why it happens
Mitotane induces CYP3A4, increasing pimavanserin clearance.
What to do
Avoid the combination where possible; if it is needed, monitor psychosis symptoms and consider increasing the pimavanserin dose. Reassess the dose after mitotane is stopped because induction wears off slowly.
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 Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
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 Mitotane with Pimavanserin?
MediHelp rates the interaction as major. Mitotane and Pimavanserin 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 is a strong CYP3A4 inducer whose effect persists for weeks after stopping. It can substantially lower pimavanserin levels and reduce its antipsychotic effect.
How serious is the interaction between Mitotane and Pimavanserin?
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 needed, monitor psychosis symptoms and consider increasing the pimavanserin dose. Reassess the dose after mitotane is stopped because induction wears off slowly.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
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