Mitotane and Bortezomib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Mitotane
Bortezomib
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced bortezomib exposure
Interaction Deep Dive
Concomitant use of bortezomib (CYP3A4 substrate) and a strong CYP3A4 inducer may result in decreased bortezomib exposure and efficacy. In a pharmacokinetic trial coadministration of bortezomib (CYP3A4 substrate) with rifampin (a strong CYP3A4 inducer)reduced bortezomib exposure by approximately 45%. Avoid coadministration of bortezomib with strong CYP3A4 inducers1.
Why it happens (mechanism)
Induction of CYP3A4-mediated bortezomib metabolism
Common questions
Can I take Mitotane and Bortezomib together?
Reduced bortezomib exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mitotane and Bortezomib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Mitotane or Bortezomib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: VELCADE(R) subcutaneous injection, intravenous injection, bortezomib subcutaneous injection, intravenous injection. Millennium Pharmaceuticals Inc (per FDA), Cambridge, MA, 2019. DailyMed
Keep reading about Mitotane
Keep reading about Bortezomib
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist