Hydrocortisone and Mitotane interaction
Hydrocortisone and Mitotane: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.
Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.
What the FDA labels say
From the Mitotane (Lysodren) label · effective 2026-03-03
If shock, severe trauma or infection occurs or develops, temporarily discontinue LYSODREN and administer exogenous steroids.
Monitor for both glucocorticoid and mineralocorticoid insufficiency and replace systemic corticosteroids accordingly.
Due to increased steroid clearance and increase of steroid-binding protein, high-dose replacement therapy may be required and free cortisol and corticotropin (ACTH) should be monitored to adapt the systemic corticosteroids.
Hormone binding protein Mitotane has been shown to increase plasma levels of hormone binding proteins (e.g., sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG)).
Steroid replacement may be necessary.
From the Hydrocortisone (Alkindi Sprinkle) label · effective 2026-04-21
Concomitant administration of inducers of CYP3A4 may lead to decreases in serum concentrations of ALKINDI SPRINKLE and increase the risk of adverse reactions, including adrenal crisis.
Intervention: Concomitant use of CYP3A4 inducers may require an increase in the ALKINDI SPRINKLE dose.
CYP3A4 Inducers : concomitant administration may require an increase in the ALKINDI SPRINKLE dose.
Examples: Anti-fungals: itraconazole, posaconazole, voriconazole Antibiotics: erythromycin and clarithromycin Antiretrovirals: ritonavir Grapefruit juice CYP3A4 Inducers Clinical Impact: Hydrocortisone is metabolized by cytochrome P450 3A4 (CYP3A4).
Taking more than these two? Interactions stack. Check your whole list at once; it stays in your browser.
Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.