Acitretin
Indications
Acitretin is used for severe psoriasis (including pustular and erythrodermic types) and some other severe skin disorders of keratinisation (abnormal thickening and scaling of the skin), such as Darier's disease and severe ichthyosis, when other treatments have not worked. It is prescribed by a skin specialist.
How It Works
Acitretin is a retinoid, a medicine related to vitamin A. It slows down the overproduction of skin cells and helps them grow and shed normally. It also reduces inflammation in the skin, so thick scaly plaques become thinner and calmer.
Dosage and Administration
Take exactly as prescribed by your dermatologist. Treatment usually starts at 25 mg to 30 mg once a day taken with a meal or with milk, and the doctor adjusts the dose depending on response and side effects. Full benefit can take 2 to 3 months. Blood tests for liver function and fats (lipids) are done before and during treatment.
Interactions
- Alcohol: in women, alcohol turns Acitretin into a longer-lasting substance (Etretinate); women must avoid alcohol during treatment and for 2 months after.
- Methotrexate: higher risk of liver damage; do not combine.
- Tetracyclines such as Doxycycline and Minocycline: risk of raised pressure in the skull; do not combine.
- Vitamin A supplements or other retinoids: risk of vitamin A toxicity.
- Low-dose progestogen-only pills may not work well; use reliable contraception as advised.
Contraindications
- Pregnancy, or women who may become pregnant within 3 years of stopping and cannot use reliable contraception.
- Breastfeeding.
- Severe liver or kidney disease.
- Very high blood fats.
- Use with Methotrexate or tetracyclines.
- Allergy to Acitretin or other retinoids.
Side Effects
Very common effects are dry and cracked lips, dry skin, peeling of palms and soles, dry eyes, dry nose and nosebleeds, hair thinning and itching. Raised blood fats and liver enzymes, joint and muscle pain and sensitivity to sunlight can also occur.
Get urgent medical help if you have severe headache with nausea, vomiting or blurred vision, yellowing of the skin or eyes, dark urine, severe stomach pain, sudden mood changes or depression, or signs of a severe allergic reaction.
Pregnancy and Lactation
Acitretin causes serious birth defects. Women who could become pregnant must have a negative pregnancy test before starting, use effective contraception for 1 month before, throughout treatment and for 3 years after stopping, and must not drink alcohol during and for 2 months after treatment. Do not breastfeed. Do not donate blood during treatment and for 3 years afterwards.
Precautions and Warnings
Regular liver and blood fat tests are needed. Avoid strong sunlight and sunbeds; use sunscreen. Contact lenses may become uncomfortable. Night vision may get worse; take care driving at night. Use with care in diabetes, as blood sugar control may change.
Overdose
An overdose may cause headache, dizziness, vomiting, drowsiness and other signs of vitamin A excess. Seek medical help. In women, a pregnancy test is advised after overdose.
Therapeutic Class
Systemic retinoid; antipsoriatic.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.
All brands of Acitretin