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Source overview
Recorded excerpts for one species. Each dose remains a separate source entry; no regimen is selected.
Choose one species to view its source overview. All-species evidence remains available below.
View full clinical evidence and sources ↓Clinical evidence
Pending clinical review (PROPOSED)Rule-based (RULE_BASED)— applies to the facts and dose entries in this species selection; individual source records retain their own status.
Indications1
Pituitary-dependent hyperadrenocorticism (PDH) — medical adrenalectomy-by-drug; adrenal tumors (cytotoxic shrinkage); palliative adrenal carcinoma
DogExtra-label (EXTRA_LABEL)1 source record · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Pituitary-dependent hyperadrenocorticism (PDH) — medical adrenalectomy-by-drug; adrenal tumors (cytotoxic shrinkage); palliative adrenal carcinoma — Extra-label (human drug)
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Dose regimens3
This calculator performs arithmetic only on the sourced dosing field shown for each result — it does not verify the field's accuracy, does not select which field to use for a patient, and does not replace a veterinarian's order. Not for clinical use. Confirm every result against the primary source before dispensing.
Choose one species above to view its dose calculator.
Adverse effects104
Lethargy, ataxia, weakness, anorexia, vomiting, diarrhea — The stop-signals of induction
DogNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Adrenal crisis (hypocortisolism) — Over-induction — corticosterone/cortisol collapse: collapse, vomiting, bradycardia
DogNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Liver changes; Coagulopathy (vWF-related bleeding tendency in Cushing dogs on mitotane — monitor) — Occasional
DogNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Relapses during maintenance — Common
DogNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
These are counts of spontaneously reported events, not proven adverse effects, causal relationships, or incidence rates.
Bars compare report counts within each species; they do not show incidence.
More reportsFewer reportsDog
- Hypoadrenocorticism8 reports
- Lethargy (see also Central nervous system depression in 'Neurological')8 reports
- Elevated serum alkaline phosphatase (SAP)7 reports
- Diarrhoea6 reports
- Elevated alanine aminotransferase (ALT)6 reports
- Weight loss6 reports
- Death by euthanasia5 reports
- Seizure NOS5 reports
- Abnormal adrenocorticotropic hormone (ACTH) stimulation test4 reports
- Decreased appetite4 reports
- Pancreatitis4 reports
- Underdose4 reports
Monitoring2
Owner-watch (induction): appetite, water intake (goal ~60 mL/kg/day), vomiting/lethargy/diarrhea → STOP
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Monitoring Parameters · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
ACTH stimulation test (end-point + q3–6 mo maintenance), electrolytes, BUN/glucose, LFTs; stress-steroid plan always in place
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Monitoring Parameters · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Contraindications1
Hypersensitivity; poor appetite — "Mitotane should never be administered in animals that are not eating well" (Scott-Moncrieff)
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Precautions5
Diabetes mellitus (insulin needs shift rapidly during induction), renal/hepatic disease, pregnancy
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Mitotane = controlled chemical adrenalectomy vs trilostane's reversible enzyme blockade — different risk philosophy: mitotane destroys the zona fasciculata/reticularis (glucocorticoids ± some androgen), classically "sparing" glomerulosa (aldosterone usually preserved — why Addisonian crisis is rarer than with bilateral adrenalectomy).
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Owner-driven induction: reduce food by ⅓ the day before (hungry dog = sensitive appetite indicator), 25 mg/kg PO q12h WITH food, daily phone contact — appetite drop is the end-point.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
The fat depot + weeks-long half-life means toxicity can progress after stopping — one more reason prednisone must be on hand at home and given at any stress.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Compare-and-contrast exam pair: mitotane (cytolytic, irreversible, adrenal crisis risk, cheaper) vs trilostane (reversible 3β-HSD inhibitor, safer monitoring, now first-line in many regions).
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Interactions3
Insulin — Requirement drops as cortisol falls — hypoglycemia risk during induction
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Spironolactone — Blocks mitotane action — avoid
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
CNS depressants, warfarin (human) — Metabolic interactions reported
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pharmacokinetics4
Half-life — 18–159 days (human) — adipose depot release
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Metabolism — Hepatic; biliary/urinary metabolites
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Absorption — Poor; ↑ with food (high oil/fat); ~40% (human)
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Distribution — All tissues; stored in FAT (depot), minimal adrenal accumulation
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pregnancy / lactation considerations1
Contraindicated/caution — fetotoxicity expected for a cytotoxic; unknown placenta/milk passage.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 852–853 — Pregnancy & Lactation · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Literature references19
References are linked to this drug. Species applicability is not recorded here, so the species filter does not narrow this list. Imported dates do not retain their original precision; confirm dates in the original citation.
- Treating canine Cushing's syndrome: Current options and future prospects.
Study summary not available in the imported record. Open the original citation to review the study.
- Outcomes of the addition of pasireotide to traditional adrenal-directed treatment for dogs with pituitary-dependent hyperadrenocorticism secondary to macroadenoma: 9 cases (2013-2015).
Study summary not available in the imported record. Open the original citation to review the study.
- Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment.
Study summary not available in the imported record. Open the original citation to review the study.
- Comparison of 2 Doses for ACTH Stimulation Testing in Dogs Suspected of or Treated for Hyperadrenocorticism.
Study summary not available in the imported record. Open the original citation to review the study.
- Long-term survival of dogs with adrenal-dependent hyperadrenocorticism: a comparison between mitotane and twice daily trilostane treatment.
Study summary not available in the imported record. Open the original citation to review the study.
Sources: PubMed, National Library of Medicine; openFDA, U.S. Food and Drug Administration; Plumb DC. Plumb's Veterinary Drug Handbook. 7th ed. PharmaVet Inc; 2011.
Owner information handout
Plain-language medication information to review with the owner. Open the handout to print it or download a PDF.