Drug interactions
Mitotane + Quetiapine
Severity: Major
Mitotane and Quetiapine: major interaction.
Last updated Sources: UK SmPC
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 and can substantially lower quetiapine concentrations. This may lead to loss of antipsychotic efficacy and relapse. The induction can persist for weeks to months after mitotane is stopped.
What this interaction means in plain words
Mitotane and Quetiapine 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; Quetiapine belongs to Central Nervous System.
Why it happens
Mitotane induces CYP3A4, increasing quetiapine metabolism and reducing plasma levels.
What to do
Monitor psychiatric response and titrate quetiapine upward as needed, or choose an antipsychotic not dependent on CYP3A4. Reduce the quetiapine dose again if 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
- Biquelle XL 150mg prolonged-release tablets - SmPC sections 4.3/4.5 (class statement: hepatic enzyme inducer; "In patients receiving a hepatic enzyme inducer, initiation of quetiapine treatment should only occur if the physician considers that the benefits of quetiapine ") — electronic medicines compendium (UK SmPC)
Other interactions of Quetiapine
- Adagrasib + Quetiapine Major
- Amiodarone + Quetiapine Major
- Amisulpride + Quetiapine Major
- Amoxapine + Quetiapine Major
- Anagrelide + Quetiapine Major
- Apalutamide + Quetiapine 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 Quetiapine?
MediHelp rates the interaction as major. Mitotane and Quetiapine 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 and can substantially lower quetiapine concentrations. This may lead to loss of antipsychotic efficacy and relapse. The induction can persist for weeks to months after mitotane is stopped.
How serious is the interaction between Mitotane and Quetiapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor psychiatric response and titrate quetiapine upward as needed, or choose an antipsychotic not dependent on CYP3A4. Reduce the quetiapine dose again if mitotane is discontinued.
What other medicines interact with Quetiapine?
MediHelp also lists interactions of Quetiapine with, for example, Adagrasib, Amiodarone, Amisulpride. The full list is on the Quetiapine page.
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