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Home > Adrenocortical carcinoma Advanced - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane

Adrenocortical carcinoma Advanced - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane

Treatment Overview

Commence pre-phase ONE week prior to cycle 1.

Pre-phase - 7 days - mitotane dose escalation

Cycle length:
7

If daily antiemetics are required inadequate glucocorticoid replacement may be the likely cause of nausea and increased hydrocortisone replacement is warranted.

Cycle 1 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane dose escalation

Cycle length:
28

In the period of time between one cycle and the next, particular attention must be given to the management of nausea and, more rarely, vomiting as they may be due to either the effect of cytotoxic drugs or consequent to hypoadrenalism. An extra dose of glucocorticoids should be considered in case of persistent nausea.

Cycles 2 to 6 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane

Cycle length:
28

In the period of time between one cycle and the next, particular attention must be given to the management of nausea and, more rarely, vomiting as they may be due to either the effect of cytotoxic drugs or consequent to hypoadrenalism. An extra dose of glucocorticoids should be considered in case of persistent nausea.

Cycle 7 (and all further cycles) - 28 days - mitotane continuation

Cycle length:
28

If daily antiemetics are required inadequate glucocorticoid replacement may be the likely cause of nausea and increased hydrocortisone replacement is warranted.

Cycle details

Pre-phase - 7 days - mitotane dose escalation

Medication Dose Route Days Max Duration
hydrocortisone [Dose - see details] oral administration 1 to 7
fludrocortisone acetate 100 microgram Once daily oral administration 1 to 7
mitotane 1000 mg Daily in divided doses oral administration 1, 2, 3
mitotane 1500 mg Daily in divided doses oral administration 4, 5, 6
mitotane 2000 mg Daily in divided doses oral administration 7
cyclIZINE 50 mg Three times daily oral administration 1

If daily antiemetics are required inadequate glucocorticoid replacement may be the likely cause of nausea and increased hydrocortisone replacement is warranted.

Cycle 1 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane dose escalation

Medication Dose Route Days Max Duration
hydrocortisone [Dose - see details] oral administration 1 to 28
fludrocortisone acetate 100 microgram Once daily oral administration 1 to 28
mitotane 2000 mg Daily in divided doses oral administration 1, 2
mitotane 2500 mg Daily in divided doses oral administration 3, 4, 5
mitotane 3000 mg Daily in divided doses oral administration 6, 7, 8
mitotane 3500 mg Daily in divided doses oral administration 9, 10, 11
mitotane 4000 mg Daily in divided doses oral administration 12, 13, 14
mitotane [Dose - see details] oral administration 15 to 28
dexamethasone * 8 mg oral administration 1 to 6
ondansetron 8 mg oral administration 1, 3, 4
DOXOrubicin * 40 mg/m² intravenous 1 15 minutes
etoposide (as phosphate) * 100 mg/m² Once daily intravenous 2, 3, 4 60 minutes
olanzapine * 2.5 mg oral administration 3 to 6
aprepitant 125 mg oral administration 3
aprepitant 80 mg oral administration 4, 5
magnesium sulfate heptahydrate 10 mmol intravenous 3, 4 60 minutes
cISplatin * 40 mg/m² intravenous 3, 4 60 minutes
sodium chloride 0.9 % intravenous 3, 4 60 minutes
ondansetron 8 mg oral administration 1, 3, 4
cyclIZINE 50 mg Three times daily oral administration 1

In the period of time between one cycle and the next, particular attention must be given to the management of nausea and, more rarely, vomiting as they may be due to either the effect of cytotoxic drugs or consequent to hypoadrenalism. An extra dose of glucocorticoids should be considered in case of persistent nausea.

Cycles 2 to 6 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane

Medication Dose Route Days Max Duration
hydrocortisone [Dose - see details] oral administration 1 to 28
fludrocortisone acetate 100 microgram Once daily oral administration 1 to 28
mitotane [Dose - see details] oral administration 1 to 28
dexamethasone * 8 mg oral administration 1 to 6
ondansetron 8 mg oral administration 1, 3, 4
DOXOrubicin * 40 mg/m² intravenous 1 15 minutes
etoposide (as phosphate) * 100 mg/m² Once daily intravenous 2, 3, 4 60 minutes
olanzapine * 2.5 mg oral administration 3 to 6
aprepitant 125 mg oral administration 3
aprepitant 80 mg oral administration 4, 5
magnesium sulfate heptahydrate 10 mmol intravenous 3, 4 60 minutes
cISplatin * 40 mg/m² intravenous 3, 4 60 minutes
sodium chloride 0.9 % intravenous 3, 4 60 minutes
ondansetron 8 mg oral administration 1, 3, 4
cyclIZINE 50 mg Three times daily oral administration 1

In the period of time between one cycle and the next, particular attention must be given to the management of nausea and, more rarely, vomiting as they may be due to either the effect of cytotoxic drugs or consequent to hypoadrenalism. An extra dose of glucocorticoids should be considered in case of persistent nausea.

Cycle 7 (and all further cycles) - 28 days - mitotane continuation

Medication Dose Route Days Max Duration
hydrocortisone [Dose - see details] oral administration 1 to 28
fludrocortisone acetate 100 microgram Once daily oral administration 1 to 28
mitotane [Dose - see details] oral administration 1 to 28
cyclIZINE 50 mg Three times daily oral administration 1

If daily antiemetics are required inadequate glucocorticoid replacement may be the likely cause of nausea and increased hydrocortisone replacement is warranted.

Full details

Pre-phase - 7 days - mitotane dose escalation

Day: 1

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 2

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 3

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 4

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 5

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 6

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 1500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 7

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycle 1 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane dose escalation

Day: 1

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

DOXOrubicin * 40 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes

Day: 3

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 4

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 5

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 2500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 6

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 7

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 8

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 9

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 10

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 11

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 3500 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 12

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 4000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 13

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 4000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 14

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane 4000 mg Daily in divided doses oral administration
Instructions:

Daily in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 15

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 16

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 17

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 18

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 19

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 20

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 21

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 22

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 23

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 24

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 25

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 26

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 27

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 28

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycles 2 to 6 - 28 days - EDP [etoposide, DOXOrubicin and cISplatin] and mitotane

Day: 1

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

DOXOrubicin * 40 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes

Day: 3

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 4

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

etoposide (as phosphate) * 100 mg/m² Once daily intravenous 60 minutes
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 5

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 6

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 7

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 8

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 9

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 10

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 11

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 12

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 13

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 14

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 15

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 16

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 17

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 18

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 19

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 20

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 21

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 22

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 23

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 24

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 25

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 26

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 27

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 28

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycle 7 (and all further cycles) - 28 days - mitotane continuation

Day: 1

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 2

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 3

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 4

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 5

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 6

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 7

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 8

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 9

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 10

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 11

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 12

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 13

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 14

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 15

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 16

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 17

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 18

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 19

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 20

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 21

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 22

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 23

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 24

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 25

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 26

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 27

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Day: 28

Medication Dose Route Max duration Details
hydrocortisone [Dose - see details] oral administration
Instructions:

Usually 50 mg daily in THREE divided doses; 20 mg in the morning, 20 mg at lunchtime and 10 mg at night. Take with food.

  • Adjust dose according to adrenal function and endocrinology input.
  • Do not stop taking this medicine without consulting your doctor.
fludrocortisone acetate 100 microgram Once daily oral administration
Instructions:
  • Adjust dose according to adrenal function and endocrinology input. 
  • Do not stop taking this medicine without consulting your doctor.
mitotane [Dose - see details] oral administration
Instructions:

Dose as per levels and tolerability, in THREE to FOUR divided doses.

  • Aim for a blood level of 14 to 20 mg/L.
  • Take each dose with food.
  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hydration: Variable

Emetogenicity:

  • mitotane alone: MEDIUM to HIGH—As required antiemetics may be recommended initially; an individualised approach is appropriate. If daily antiemetics are required inadequate glucocorticoid replacement may be the likely cause of nausea and increased hydrocortisone replacement is warranted.
  • EDP and mitotane:
    • MEDIUM day 1.
    • LOW day 2.
    • HIGH days 3 and 4.
    • MEDIUM to HIGH days 5 to 28 (mitotane)—As required antiemetics may be recommended initially; an individualised approach is appropriate.

Hydration: Routine hydration recommended for cycles 1 to 6 (EDP).

References

Fassnacht M, Terzolo M, Allolio B, et al; FIRM-ACT Study Group. Combination chemotherapy in advanced adrenocortical carcinoma. N Engl J Med. 2012 Jun 7;366(23):2189-97. , PMID: 22551107

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641., PMID: 25089112

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021).

Bristol Myers Squibb Company US Limited. Lysodren prescriber information. November 2013. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/016885s025lbl.pdf (Accessed 01 February 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.