Korlym (Mifepristone) Dosing for Hypercortisolism

Critical Monitoring Considerations

• No reliable biochemical markers exist for monitoring cortisol levels during mifepristone therapy, as it blocks the glucocorticoid receptor while cortisol levels remain elevated, according to The Lancet Diabetes and Endocrinology 1, 2
• Close monitoring for hypokalemia is essential, as this was a common adverse event and can be severe, as reported in The Lancet Diabetes and Endocrinology 1

Key Clinical Pitfalls

• Mifepristone should only be used by clinicians with extensive experience in Cushing's disease, as the inability to monitor cortisol levels biochemically increases risk for unrecognized adrenal insufficiency, according to The Lancet Diabetes and Endocrinology 1, 2
• If adrenal insufficiency develops, it requires stress-dose glucocorticoid replacement, preferably dexamethasone, as recommended in The Lancet Diabetes and Endocrinology 2
• The drug's antiprogestin effects cause vaginal bleeding and endometrial changes that require monitoring, as noted in The Lancet Diabetes and Endocrinology 1
• Extensive drug-drug interactions exist due to effects on multiple cytochrome P450 enzymes, as reported in The Lancet Diabetes and Endocrinology 1