Pharmacological effects

Mitotan is structurally similar with insecticide DDT and DDD and can selectively cause the atrophy and necrosis of adrenal cortex-zona fasciculata and reticularis cells but without affecting the zona, therefore the secretion of aldosterone will not affected. After the drug administration, the cortisol and its metabolites level in blood and urine decreased rapidly after treatment. At the same time, the in vivo adrenocorticotropic hormone and metabolite products level also decrease rapidly. It is suitable for the treatment of inoperable, functional and non-functional adrenal cortical carcinoma, adrenal tumor, adrenal hyperplasia-caused Klinefelter’s syndrome, adrenal hyperplasia, and the adjuvant therapy of postoperation cortical cancer and tumor-induced Cushing's syndrome. After oral administration, about 40% of Mitotan is absorbed through the gastrointestinal tract with the remaining 60% of the prototype excreted together with the feces. At a dose of 5~10 g daily, the plasma concentration can be up to 10~90μg/ml, the concentration of metabolites can be up to 30~50μg/ml. At 6-9 weeks after discontinuation, it can be still detected of o-alkyl chloride in the plasma. Mitotan has a high fat-solubility and is mainly stored in fat. The water soluble metabolites discharged from the urine can account for about 25% of the administered dose. The above information is edited by the lookchem of Dai Xiongfeng.

Production method

It can be prepared from O-bromo-chlorobenzene (see 05820) by the following steps.

Toxicity grading

Poisoning.

Acute toxicity

Oral-rat; LD50> 5000 mg/kg; Oral-Mouse LD50> 4000 mg/kg.

Flammability and hazard properties

Thermal decomposition can release toxic chloride fume.

Storage characteristics

Low-temperature, dry and ventilated warehouse.

Extinguishing media

Water, carbon dioxide, foam, powder.

Indications

Mitotane (Lysodren) produces selective atrophy of the zona fasciculata and zona reticularis, which results in a decrease in the secretion of 17-hydroxycorticosteroids. Direct inhibition of cholesterol side-chain cleavage and 11/18-hydroxylase activities has also been demonstrated.

Manufacturing Process

From dichloroacetaldehyde and 2-chlorphenylmagnesiumbromide was prepared 1-(2-chlorphenyl-2,2-dichloroethanol. By action of H2SO4 on 1-(2- chlorphenyl)-2,2-dichloroethanol in chlorobenzene was prepared 1,1-dichloro- 2,2-bis(2,4'-dichlorophenyl)ethane.

Therapeutic Function

Antineoplastic

Air & Water Reactions

Insoluble in water.

Reactivity Profile

Mitotan dehydrohalogenates with strong alkalis. Simple aromatic halogenated organic compounds are very unreactive; halogenated aliphatic compounds are moderately or very reactive. For both subgroups, reactivity generally decreases with increased degree of substitution of halogen for hydrogen atoms. Materials in this group are incompatible with strong oxidizing and reducing agents. Also, they are incompatible with many amines, nitrides, azo/diazo compounds, alkali metals, and epoxides.

Fire Hazard

Flash point data for Mitotan are not available. Mitotan is probably combustible.

Pharmacology

Mitotane, a derivative of the insecticide DDT, quickly lowers the level of corticosteroids, and is metabolized in the blood and urine and used on non-operable metastatic prostate carcinomas. Synonyms of this drug are lysodren and others.

Side effects

Mitotane is capable of inducing remission of Cushing’s disease, but only after several weeks of therapy and at the price of severe gastrointestinal distress. Moreover, more than half of patients relapse following cessation of therapy. Other side effects include lethargy, mental confusion, skin rashes, and altered hepatic function. Being a lipid-soluble substance, mitotane remains stored in body tissues for extended periods. This may account for the marked patient-to-patient variability in its therapeutic and/or toxic effects.

Synthesis

Mitotane, 1,1-dichloro-2-(o-chlorophenyl)ethane (30.5.8), is made by alkylating chlorobenzene with 1-(2-chlorophenyl)-2,2-dichloroethane (30.5.7) in the presence of sulfuric acid. The necessary 1-(2-chlorophenyl)-2,2-dichloroethanol (30.5.7) is in turn made from reacting 2-chlorophenylmagnesiumbromide with dichloroacetic aldehyde.

Veterinary Drugs and Treatments

In veterinary medicine, mitotane is used primarily for the medical treatment of pituitary-dependent hyperadrenocorticism (PDH), principally in the dog. It has also been used for the palliative treatment of adrenal carcinoma in humans and dogs.

Drug interactions

Potentially hazardous interactions with other drugs Anticoagulants: possibly reduced anticoagulant effect of coumarins. Antipsychotics: avoid with clozapine (increased risk of agranulocytosis). Diuretics: avoid with spironolactone.

Metabolism

Metabolised in the liver and other tissues and excreted as metabolites in urine and bile. From 10-25% of a dose has been recovered in the urine as a water-soluble metabolite and 1-17% in the faeces as metabolites

Purification Methods

Purify Mitotane by recrystallisation from pentane, MeOH or EtOH. It is soluble in isooctane and CCl4. [Haller et al. J Am Chem Soc 67 1600 1945, Beilstein 5 IV 1883.]

Category

Toxic substances.

Brand name

Lysodren (Bristol-Myers Squibb).