Acitretin

Indications

Acitretin is used for: Lichen planus, Psoriasis, Congenital icthyosis, Darier's disease

Adult Dose

Oral Darier's disease Adult: Initially, 10 mg daily for 2-4 wk. Max: 50 mg/day. Congenital icthyosis Adult: Initially, 25-30 mg daily for 2-4 wk before dose adjustments are done. Usual range: 25-50 mg daily for further 6-8 wk. Max: 75 mg daily for short periods. Severe psoriasis Adult: Initially, 25-30 mg daily for 2-4 wk before dose adjustments are done. Usual range: 25-50 mg daily for further 6-8 wk. Max: 75 mg daily for short periods. Severe lichen planus Adult: Initially, 25-30 mg daily for 2-4 wk before dose adjustments are done. Usual range: 25-50 mg daily for further 6-8 wk. Max: 75 mg daily for short periods.

Child Dose

Renal Dose

Administration

Should be taken with food. Take w/ main meals or w/ a glass of milk.

Contra Indications

Pregnancy (before the start, during and at least 2-3 yr after cessation of therapy), lactation. Hepatic and renal impairment. Hyperlipidaemia.

Precautions

Female patients to avoid alcohol during and 2 mth after treatment. Avoid blood donation during therapy or at least 1-3 yr after stopping therapy. Children. Radiographic treatment for prolonged therapy. Therapy should not last >6 mth. Monitor plasma lipid and glucose levels (especially diabetics) regularly. Monitor LFTs. Lactation: enters breast milk/not recommended.

Pregnancy-Lactation

Pregnancy Category: X Major human fetal abnormalities have been reported including meningomyelocele, meningoencephalocele, multiple synostoses, facial dysmorphia, syndactyly, absence of terminal phalanges, malformations of bones (hip, ankle, forearm, skull, cerebral vertebrae), low-set ears, high palate, decreased cranial volume, and cardiovascular malformations Lactation: enters breast milk/not recommended

Interactions

Concomitant use with keratolytics or high dose vitamin A. Reduces anticoagulant effect of coumarins e.g. warfarin. Concomitant use of microdised progestin oral contraceptives. Concomitant use of methotrexate can potentiate hepatotoxicty. Concomitant use with tetracycline.

Adverse Effects

Side effects of Acitretin : 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%) 1-10% Edema, Flushing, Depression, Fatigue, Headache, Insomnia, Somnolence, Abdominal pain, Anorexia, Diarrhea, Gingivitis, Increased appetite, Nausea, Stomatitis, Vomiting, Hot flashes, Vision changes, Corneal epithelial abnormality, Sinusitis Potentially Fatal: Phototoxicity, jaundice, hepatitis and hepatotoxity.

Mechanism of Action

Acitretin is an active metabolite of etretinate but its mechanism of action is unknown.