Acitretin

DEA Class; Rx

Common Brand Names; Soriatane

• Antipsoriatics, Systemic; 
• Retinoid-like Agents

Oral retinoid
Used for severe psoriasis in adults
Teratogenic; women must avoid becoming pregnant for at least 3 years after discontinuation and must avoid alcohol

• Hypersensitivity to retinoids (eg, angioedema, urticaria), parabens
• Coadministration with methotrexate (increased risk for hepatitis)
• Coadministration with tetracyclines (increases ICP, pseudotumor cerebri)
• Alcohol 
• Severely impairment of liver or kidney function and in patients with chronic abnormally elevated blood lipid values 
• Pregnancy: teratogenic

• Cheilitis (>75%)
• Alopecia (50-75%)
• Hypertriglyceridemia (50-75%)
• Skin peeling (50-75%)
• Dry skin (25-50%)
• Dysglycemia (25-50%)
• Increased LFT (25-50%)
• Nail disorder (25-50%)
• Pruritus (25-50%)
• Rhinitis (25-50%)
• arthralgia (10-25%)
• changes in phosphorus, potassium, sodium, & magnesium levels (10-25%)
• Dry mouth (10-25%)
• Epistaxis (10-25%)
• Erythematous rash (10-25%)
• Hepatotoxicity (10-25%)
• Hyperesthesia (10-25%)
• Paresthesia (10-25%)
• Paronychia (10-25%)
• Rigors (10-25%)
• Skin atrophy (10-25%)
• Spinal hyperostosis (10-25%)
• Sticky skin (10-25%)
• Xerophthalmia (10-25%)

Check LFTs 1 day before starting, pregnancy test 2 wk prior to starting therapy

Hyperostosis reported with long-term treatment

New or progression of preexisting vertebral/skeletal abnormalities (eg, degenerative spurs, anterior bridging of spinal vertebrae, diffuse idiopathic skeletal hyperostosis, ligament calcification, and narrowing and destruction of cervical disc space)

Exfoliative dermatitis and erythroderma reported

Depression and/or other psychiatric symptoms such as aggressive feelings or thoughts of self-harm reported in patients taking retinoids; since other factors may contribute to these events, it is not known if they are related to therapy; counsel patients to stop taking this drug and to notify their prescriber immediately if they experience psychiatric symptoms

Minimize exposing treated areas to sun or other UV light; significantly lower doses of phototherapy are required when this drug is used; effects on the stratum corneum induced by this drug can increase the risk of erythema (burning)

May cause severe birth defects; female patients must not be pregnant when therapy is initiated; they must not become pregnant while taking this drug and for at least 3 years after stopping therapy, so that the drug can be eliminated to below a blood concentration that would be associated with an increased incidence of birth defects

Studies on lactating rats have shown that retinoids are excreted in the milk; there is one prospective case report where acitretin is reported to be excreted in human milk

50 mg/day PO.

50 mg/day PO.

Safety and efficacy have not established.

Safety and efficacy have not established.

Acitretin 

capsule

• 10mg
• 25mg