Drug interactions
Mitotane + Quinidine
Severity: Major
Mitotane and Quinidine: major interaction.
Last updated Sources: EMA 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 markedly reduce quinidine plasma concentrations, risking loss of antiarrhythmic or antimalarial efficacy. The induction effect may persist for weeks after mitotane is stopped.
What this interaction means in plain words
Mitotane and Quinidine 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; Quinidine belongs to Anti Parasitic.
Why it happens
Mitotane induces CYP3A4, increasing the metabolic clearance of quinidine.
What to do
Avoid the combination if possible or monitor quinidine concentrations and ECG and increase the dose as needed. Reassess dosing when mitotane is discontinued because induction wanes 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 Quinidine
- Adagrasib + Quinidine Contraindicated
- Arsenic trioxide + Quinidine Contraindicated
- Artemether / lumefantrine + Quinidine Contraindicated
- Chloroquine + Quinidine Contraindicated
- Dofetilide + Quinidine Contraindicated
- Dronedarone + Quinidine 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 Mitotane with Quinidine?
MediHelp rates the interaction as major. Mitotane and Quinidine 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 markedly reduce quinidine plasma concentrations, risking loss of antiarrhythmic or antimalarial efficacy. The induction effect may persist for weeks after mitotane is stopped.
How serious is the interaction between Mitotane and Quinidine?
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 if possible or monitor quinidine concentrations and ECG and increase the dose as needed. Reassess dosing when mitotane is discontinued because induction wanes slowly.
What other medicines interact with Quinidine?
MediHelp also lists interactions of Quinidine with, for example, Adagrasib, Arsenic trioxide, Artemether / lumefantrine. The full list is on the Quinidine page.
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