Note: This is a summary only. The full FDA and packaging information should be consulted before prescribing acitretin. Acitretin is a second generation monoaromatic retinoid, and is the major active metabolite of etretinate.
Acitretin is approved for patients with psoriasis. The TAPP program (take action to prevent pregnancy) is to prevent pregnancy in woman of child-bearing potential receiving acitretin.
Precautions, Especially for Women
- Do not get pregnant during therapy and for 3 years after treatment discontinuation (acitretin can cause
- Do not breast-feed
- Do not consume alcohol (women of reproductive
- Do not donate blood during therapy and for 3 years after treatment discontinuation. Other women who
could get pregnant must not receive blood from patients being treated with acitretin
- Do not share acitretin with anyone, even if they have the same symptoms
- Avoid night driving
- Avoid nonmedical ultraviolet (UV) light
- Avoid dietary supplements containing vitamin A
Typical doses for psoriasis are 25-50 mg PO QD
When patient on acitretin drinks alcohol, acitretin can convert back to etretinate.
Pregnancy Category X
Because acitretin can be metabolized to etretinate, a 3 year post therapy contraceptive period is recommended.
- For men and woman not of childbearing potential, obtain CBC, LFT's and lipid profile baseline and periodically during therapy.
- For woman of child-bearing potential, also enroll in the TAPP program (see above).
- X-rays may be indicated if therapy is long term (e.g. over years).
The side effects are many and include, but are not limited to:
- Dry chapped lips.
- Muscle aches, e.g. low back ache
- Dry skin, redness and peeling
- Hair thinning
- Elevated liver enzymes
- Elevated triglycerides
- Nose bleeds
When given longterm, bony abnormalities may rarely occur. In one prospective study, radiographs of the pelvis, forearms and knees were of most practical value [BJD 1996;134;1151]. They should be done at baseline and every second year. Pain in the arm or limited mobility were signs in one patient of ossification of an interosseous membrane between the ulna and the radius. Extraspinous ossification may occur even if spinal xrays are normal [JAAD 1995;32;322]. Thus, ask for pain and decreased mobility, e.g. of hips.
Acitretin was reported to cause severe proximal weakness of all four extremities plus elevated CPK [BJD 1996;134;977]. Isotretinoin has caused reversible myopathy [BMJ 1986;293;425].
Acitretin may thin the hair. In one of my patients, the hair grew back curly and slowly reverted back to normal (straight) over 18 months. Repigmenation and curling of hair has been described [CED 2014;39;58O].
1-10% of patients may develop edema of the legs.
The combination of acitretin and occluded clobetasol for the treatment of palmoplantar psoriasis lead to Cushing's syndrome in 2 children [PD 2017;34;219].
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