미토탄
Mitotane
o,p'-DDD (1-chloro-2-[2,2-dichloro-1-(4-chlorophenyl)ethyl]benzene)
다른 이름: Lysodren · o,p'-DDD · CB-313 · NSC-38721 · WR13045 · Lisodren
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Pituitary-dependent hyperadrenocorticism (Induction - Protocol A) | 25 mg/kg twice a day, PO with food | PO | q12h | Until clinical endpoints occur (usually 4-9 days) | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol A) | 25-50 mg/kg per week | PO | Divided in as many doses as possible weekly | Long-term | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Induction - Protocol B) | 30-50 mg/kg/day PO with a meal once daily or divided q12h | PO | q24h or q12h | 7-10 days | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol B) | 35-50 mg/kg per week in 2-3 divided doses | PO | Divided weekly | Long-term | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Induction - Protocol C) | 50 mg/kg divided q12h | PO | q12h | Until water consumption decreases to <100 mL/kg/day or adverse signs observed (usually 3-7 days) | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol C) | 50 mg/kg every 7-10 days | PO | Every 7-10 days | Long-term | 🌎 NA |
| Total adrenal ablation (Alternative Protocol D) | 75-100 mg/kg per day for 25 consecutive days, given in 3-4 doses per day with food | PO | Divided q6-8h | 25 days | 🌎 NA |
| Total adrenal ablation (Alternative Protocol E) | 100 mg/kg/day divided twice daily for 30 days | PO | q12h | 30 days | 🌎 NA |
| Palliative medical treatment of adrenal carcinomas or adenomas | 50-75 mg/kg PO in daily divided doses | PO | Divided daily | 10-14 days initially | 🌎 NA |
| Pituitary-dependent hyperadrenocorticism (Induction) | 30-50 mg/kg | PO | q24h | to effect (generally 3-10 days) | 🌍 EU |
| Pituitary-dependent hyperadrenocorticism (Maintenance) | 50 mg/kg | PO | q7-14 days | Ongoing | 🌍 EU |
| Adrenal carcinomas | 50-150 mg/kg | PO | q24h | Ongoing | 🌍 EU |
- Pituitary-dependent hyperadrenocorticism (Induction - Protocol A): Reduce food by 1/3 the day before. Stop therapy if water consumption approaches 60 mL/kg/day, appetite reduces, vomiting, listlessness, or diarrhea occurs.
- Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol A): Adjust based on ACTH stimulation test results.
- Pituitary-dependent hyperadrenocorticism (Induction - Protocol B): Goal is basal and post-ACTH cortisol between 1-5 micrograms/dL.
- Pituitary-dependent hyperadrenocorticism (Induction - Protocol C): Max 5-7 days prior to ACTH stim test if water consumption cannot be monitored.
- Pituitary-dependent hyperadrenocorticism (Maintenance - Protocol C): Dose is highly variable (26-330 mg/kg/week).
- Total adrenal ablation (Alternative Protocol D): Requires lifelong prednisone and mineralocorticoid therapy.
- Total adrenal ablation (Alternative Protocol E): Requires cortisone acetate and fludrocortisone acetate supplementation.
- Palliative medical treatment of adrenal carcinomas or adenomas: May increase to 100 mg/kg/day based on ACTH response. Maintenance is 100-200 mg/kg/week.
- Pituitary-dependent hyperadrenocorticism (Induction): Give with/after food high in fat/oil to improve absorption.
- Pituitary-dependent hyperadrenocorticism (Maintenance): Given in 2-3 divided doses as required. Give with/after food high in fat/oil.
- Adrenal carcinomas: Higher doses may become necessary. Give with/after food high in fat/oil.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Hyperadrenocorticism | 30-50 mg/kg | PO | q24h | to effect | 🌍 EU |
- Hyperadrenocorticism: Efficacy in cats is very variable, with many showing no response at non-toxic levels. Not recommended.
페렛
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Medical treatment of hyperadrenocorticism | 50 mg per ferret PO once daily for one week, then 50 mg PO 2-3 times per week | PO | q24h then 2-3 times/week | Long-term | 🌎 NA |
- Medical treatment of hyperadrenocorticism: Have a compounding pharmacy make 50 mg capsules. Can be coated with Nutrical.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
미토탄(o,p'-DDD로도 알려짐)은 수의학에서 주로 개의 뇌하수체 의존성 부신피질기능항진증(PDH)(쿠싱 증후군)의 내과적 치료에 사용되는 부신 세포독성제입니다. 살충제인 DDT와 구조적으로 유사합니다.
부신피질의 표적 괴사를 유발하여 과도한 코르티솔 생성을 효과적으로 감소시킵니다. 또한 사람과 개의 부신암에 대한 고식적 치료에도 사용됩니다.
임상 요점: 치료는 일반적으로 유도기(임상적 목표에 도달할 때까지 매일 투여하여 증식된 부신 조직을 빠르게 파괴)와 유지기(부신피질의 재성장을 방지하기 위해 주 1~2회 투여)의 두 단계로 나뉩니다. 과도한 치료는 의인성 부신피질기능저하증(애디슨병)을 유발할 수 있으므로 철저한 모니터링이 필수적입니다.
작용 기전
Mitotane acts as a targeted adrenocortical cytotoxic agent.
- It causes severe, progressive necrosis and atrophy of the zona fasciculata and zona reticularis of the adrenal gland → drastically reducing the synthesis of glucocorticoids (cortisol).
- It relatively spares the zona glomerulosa, meaning mineralocorticoid (aldosterone) synthesis is usually unaffected, though clinically significant effects on aldosterone production can occasionally occur.
- The exact intracellular mechanism of cytotoxicity is not fully understood, but it is believed to involve metabolic activation within the adrenal mitochondria, leading to irreversible binding to cellular macromolecules and subsequent cell death.
안전성·주의사항
금기사항
- Known hypersensitivity to mitotane
- Pregnancy (FDA Category C in humans; Class D in veterinary medicine - embryotoxic/teratogenic)
- Patients that are not eating well (should never be administered to anorexic animals)
- Not recommended in cats (trilostane is more effective and mitotane efficacy is highly variable)
부작용
- Lethargy
- Ataxia
- Weakness
- Anorexia (loss of appetite)
- Vomiting
- Diarrhea
- Neurologic signs (uncommon)
- Liver changes (congestion, centrolobular atrophy, fatty degeneration)
- Iatrogenic hypoadrenocorticism (requiring long-term glucocorticoid/mineralocorticoid replacement in ~5% of dogs)
- Diarrhoea
- Acute-onset neurological signs (2-3 weeks post-initiation)
주의
Warning: Mitotane should never be administered to animals that are not eating well.
- Diabetes Mellitus: Concurrent diabetes requires close monitoring as insulin requirements may rapidly decrease during initial treatment.
- Organ Dysfunction: Dogs with preexisting renal or hepatic disease should receive the drug with extreme caution and intense monitoring.
- Stress Supplementation: All dogs receiving mitotane therapy must receive additional glucocorticoid supplementation if undergoing physiological stress (e.g., surgery, trauma, acute illness).
- Human Safety: Mitotane is a cytotoxic drug. Caregivers should avoid direct skin contact (wear gloves) and wash hands after administration.
약물 상호작용
Additive depressant effects may be seen if used concomitantly.
Diabetic dogs receiving insulin may have their insulin requirements rapidly decreased when mitotane therapy is instituted.
Can induce enzymes and reduce the efficacy of mitotane; conversely, mitotane can induce hepatic microsomal enzymes and increase the metabolism of phenobarbital.
Has been demonstrated to block the action of mitotane in dogs; an alternate diuretic is recommended.
Increases the hepatic metabolism of mitotane
Increases the hepatic metabolism of mitotane
모니터링
- Physical exam and history (especially water consumption, food consumption, and weight)
- ACTH response test (crucial for dose adjustment)
- Serum electrolytes (Na+/K+)
- BUN
- CBC
- Liver enzymes
- Appetite (daily during induction)
- ACTH stimulation test (to monitor treatment efficacy)
- Blood glucose (in diabetic patients)
- Clinical signs of weakness, vomiting, or neurological changes
약동학
흡수
Systemic bioavailability in dogs is poor. Oral absorption is significantly enhanced by giving the drug with food (especially food high in oil/fat content). In humans, ~40% is absorbed with peak serum levels at 3-5 hours.
분포
Distributes to virtually all tissues in the body. It is highly lipophilic, stored in fat, and does not accumulate in the adrenal glands. A small amount may enter the CSF.
대사
Metabolized in the liver.
배설
Excreted as metabolites in the urine (10%) and bile (15%) within 24 hours of dosing.
과다투여
Because of the drug's toxicity and very long half-life, acute overdosage should be managed aggressively.
- Decontamination: Emptying the stomach and administering activated charcoal and a cathartic should be considered after a recent ingestion.
- Monitoring & Treatment: The patient must be closely monitored. Administer systemic glucocorticoids (e.g., dexamethasone or prednisone) and IV fluids if signs of acute hypoadrenocorticism (Addisonian crisis) develop.
제품
제형
- Tablets
- 500 mg tablet
- 500 mg capsule
인용의약품
- Mitotane Tablets (scored): 500 mg (Lysodren)
- Lysodren 500 mg tablet
규제 현황
Available from Europe for animals that have failed trilostane therapy. POM.
POM (Prescription Only Medicine). Used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store at room temperature (15-30°C), in tight, light-resistant containers.
보호자 정보
- 식후 투여: 적절한 흡수를 위해 항상 식사(가급적 지방이나 기름이 포함된 식사) 직후에 이 약을 투여하십시오.
- 부작용 주의: 이 약의 목적은 코르티솔 수치를 낮추는 것이지만, 때로는 너무 많이 낮출 수 있습니다. 무기력, 쇠약, 구토, 설사 또는 갑작스러운 식욕 상실과 같은 '애디슨 위기'의 징후가 있는지 반려동물을 주의 깊게 관찰하십시오.
- 아플 때 중단: 반려동물이 먹지 않거나 위의 징후를 보이면 즉시 약 투여를 중단하고 수의사에게 연락하십시오. 스테로이드(예: 프레드니손) 응급 용량을 투여하라는 지시를 받을 수 있습니다.
- 안전 예방 조치: 미토탄은 강력한 세포독성 약물입니다. 알약을 만질 때는 장갑을 끼거나 투여 후 손을 깨끗이 씻으십시오. 어린이와 다른 반려동물의 손이 닿지 않는 곳에 엄격히 보관하십시오.
- 스트레스 상황: 수술, 위탁 또는 급성 질환과 같은 스트레스 상황에서는 반려동물에게 추가적인 스테로이드 약물이 필요할 수 있습니다. 수의사와 상의하십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.