PRIME PHARMACOTHERAPY PROBLEMS

P PHARMACEUTICAL-BASED PROBLEMS
Current Medications:
1. Levonorgestrel 0.1mg, Ethinyl estradiol 0.02 mg (Lessina) PO once daily as directed
2. Mometasone furoate monohydrate (Nasonex) 50 mcg two sprays in each nostril once daily PRN
allergic symptoms
3. Doxylamine succinate (Unisom ) SleepTabs 25mg PO Q HS PRN sleep
4. Ibuprofen (Advil) 200 mg one to two tablets PO Q 6 H PRN headache
All medications taken at the usual recommended dose, route, duration, form, frequency and time.
Suggested Pharmacotherapy Plan:
Adjunctive drug therapy with Mitotane 500 mg Tablets 2 tablets daily.

R RISKS TO PATIENT
Current Medications:
1. Lessina is an OCP which may be the cause of the patients increase in Blood pressure, weakness
and fatigue as well as depression. In this case, the OCP should be discontinued.
2. PRN use of Mometasone for Allergic rhinitis may suggest the exacerbation of Hypercortisolism,
however, unlikely to be the sole cause of the patients Cushing syndrome. However, this
medication should be discontinued and the patient switched to Anithistamines such as Ceritizine
10 mg tablets once a day.
3. Doxylamine is used for the patients insomnia and there is no known direct effect on the patients
Cushing syndrome. However, Doxylamine increases the risk for depression exacerbation and
should be discontinued.
4. Patient uses Advil for headache, however, the headache may be caused by the pituitary
enlargement. Use of Advil should be discontinued and perhaps Acetaminophen be used for
patients headache.
Suggested Pharmacotherapy Plan:
Adjunctive drug therapy with Mitotane 500 mg Tablets increases risk for side effects such as nausea,
vomiting, diarrhea, loss of appetite, drowsiness and fatigue. Mitotane is also unsafe during pregnancy
so patient should be advised about the risk.

I- INTERACTIONS
Suggested Pharmacotherapy Plan:
- Mitotane is a strong inducer of CYP3A4 so monitor for any changes in the dosage for
concomitant medications such as Cetirizine for Allergic Rhinitis.
- Mitotane should not be used with alcohol.
- There are no known food or lab interactions with Mitotane.

M - MISMATCH BETWEEN MEDICATION AND INDICATIONS/CONDITIONS/COMPLAINTS

Current Medications:
1. Lessina is used for an unknown compelling indication and should be discontinued.
2. Mometasone for Allergic rhinitis may suggest the exacerbation of Hypercortisolism. This
medication should be discontinued and the patient switched to Anithistamines such as Ceritizine
10 mg tablets once a day.
3. Doxylamine increases the risk for depression exacerbation and should be discontinued.
4. Advil for headache, however, the headache may be caused by the pituitary enlargement. Use of
Advil should be discontinued.
Suggested Pharmacotherapy Plan:
Mitotane no mismatches noted since used for adjunct of the disease to be treated.

E EFFICACY ISSUES
No known efficacy issues with regards to the suggested Pharmacotherapy plan if the patient takes the
Adjunct at the prescribed dose.