Mitotane and Clindamycin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Mitotane
Clindamycin
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.
Here's what's going on. Mitotane (Lysodren) is a strong "speed-up" signal for a liver enzyme called CYP3A4. Clindamycin (Cleocin) is broken down by that same enzyme. So when you take mitotane, your body may clear the clindamycin faster than usual. That could leave less antibiotic in your blood, which means it might not fight your infection as well as it should.
The good news is this is very manageable. Your care team knows about this and can adjust your antibiotic dose or watch your progress more closely. Please don't stop or change either medicine on your own. Just let your pharmacist or doctor know you take both so they can plan around it.
Mechanism: Mitotane is a strong CYP3A4 inducer; clindamycin is a CYP3A4 substrate. Induction increases clindamycin metabolism, lowering its serum concentration and potentially reducing antibacterial efficacy (risk of treatment failure).
- Direction: Reduced clindamycin exposure / effect.
- Onset: Unspecified; enzyme induction is typically delayed and mitotane's effect is long-lasting given its long half-life.
- Evidence: Theoretical.
- Management: Avoid combination where subtherapeutic levels risk failure. If unavoidable, consider increasing the clindamycin dose as clinically appropriate and monitor closely for clinical response to the infection.
What happens
Reduced CYP3A substrate with NTI exposure and reduced efficacy of CYP3A substrate with NTI exposure
Interaction Deep Dive
When mitotane, a potent inducer of CYP3A, is taken together with CYP3A substrates, the levels of those substrates can fall, potentially diminishing how well they work. For certain CYP3A substrates in which even small shifts in concentration could cause treatment to fail, mitotane should not be given alongside them. Should combined use be unavoidable, raise the dose of the CYP3A substrate as needed1.
Why it happens (mechanism)
Induction of CYP3A4-substrate metabolism by mitotane
How to manage this interaction
What your care team may do:
- Consider whether a different antibiotic is a better fit while you're on mitotane.
- If clindamycin is needed, the dose may need to be adjusted and individualized to keep it effective.
- Monitor you more closely to make sure the infection is responding.
What you can do: Keep taking both exactly as prescribed. Tell your pharmacist and prescriber that you take mitotane and clindamycin together. Let them know right away if your infection isn't improving or seems to be getting worse, since that could mean the antibiotic needs a boost.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Mitotane and Clindamycin together?
Mitotane can speed up how your body clears clindamycin, so the antibiotic may not work as well; your care team can manage this by adjusting the dose, choosing another antibiotic, or watching your response more closely. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mitotane and Clindamycin 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 is the Mitotane and Clindamycin interaction managed?
What your care team may do: Consider whether a different antibiotic is a better fit while you're on mitotane. If clindamycin is needed, the dose may need to be adjusted and individualized to keep it effective. Monitor you more closely to make sure the infection is responding. What you can do: Keep taking both exactly as prescribed. Tell your pharmacist and prescriber that you take mitotane and cli… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Mitotane or Clindamycin 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: LYSODREN(R) oral tablets, mitotane oral tablets. HRA Pharma Rare Diseases (per FDA), New York, NY, 2024. DailyMed
Keep reading about Mitotane
Keep reading about Clindamycin
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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.
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