Acitretin

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Acitretin is an oral medication primarily used to treat severe psoriasis and other skin conditions, including congenital ichthyosis and Darier’s disease. It belongs to the retinoid class of drugs, which are related to vitamin A and work by normalizing skin cell growth and reducing cell overgrowth. Acitretin is typically prescribed for long-term use when other treatments are ineffective. It’s crucial for patients, especially women of childbearing age, to follow specific safety precautions due to the significant risks of birth defects and other side effects. Common adverse effects include joint pain, headaches, and skin redness.

Product Overview

Acitretin is a potent oral retinoid used extensively to manage and treat severe skin conditions like plaque psoriasis, erythrodermic psoriasis, and congenital ichthyosis. As a derivative of vitamin A, it functions by binding to specific receptors in the body, slowing down the excessive production and thickening of skin cells, which is characteristic of psoriasis and similar disorders.

The medication is particularly effective as a systemic therapy, often employed when topical treatments fail to provide relief. It may also be combined with phototherapy to enhance treatment outcomes in psoriasis. Additionally, Acitretin has shown effectiveness in treating other complex skin conditions such as Darier’s disease, palmoplantar pustulosis, and certain forms of lichen planus. For patients with a high risk of skin cancers, particularly organ transplant recipients, Acitretin may play a preventative role.

Acitretin’s use is accompanied by a range of possible side effects, from everyday issues like back pain, altered taste sensations, and headaches to more severe effects, including hair loss, depression, and potential hearing loss. Due to its teratogenic effects, it is critically important that it not be used by pregnant women or those planning to become pregnant within three years of cessation of treatment. The drug’s safety profile also necessitates abstaining from alcohol consumption during and after treatment, as alcohol can extend the duration Acitretin remains active in the body, increasing the risk of birth defects. Dosages of Acitretin vary based on the severity of the condition but typically start at 25 to 50 milligrams daily, adjusted according to patient response and tolerance. Due to the nature of the diseases it treats, the benefits of Acitretin may take several months to manifest fully. Consistent dosing, taken with meals, is recommended to maximize the drug’s efficacy and minimize side effects.

Uses of Acitretin

Acitretin is used to treat:

• Skin disorders such as severe psoriasis.

Benefits of Acitretin

• Effectively treats severe psoriasis, including plaque psoriasis and erythrodermic psoriasis.
• Helps manage symptoms of congenital ichthyosis, a group of rare genetic skin disorders.
• Can be used to treat Darier’s disease, a rare skin condition.
• Reduces excessive skin cell production and promotes normal cell differentiation.
• May improve nail psoriasis symptoms.
• Can be effective in treating palmoplantar pustulosis, a chronic inflammatory skin condition.
• Often used as a systemic therapy when topical treatments are insufficient.
• Can be combined with phototherapy for enhanced efficacy in psoriasis treatment.
• May help prevent skin cancers in high-risk individuals, such as organ transplant recipients.
• Generally well-tolerated for long-term use in appropriate patients.
• May be effective in treating certain cases of lichen planus, another inflammatory skin condition.

Side Effects of Acitretin

Common Acitretin side effects may include:

• Difficulty with walking or moving
• Muscle tension, stiffness, or tightness
• Tingling in the feet and hands
• Nausea & headache (severe & continuing)
• Mood changes or depression
• Hearing loss
• Tongue irritation
• Feeling of warmth
• Back pain
• Excessive muscle tone
• Thinning of the skin with easy bruising
• Severe vomiting
• Change in taste
• Insomnia
• Redness of the skin
• Hair loss
• Pain in the joint or bone
• Trouble sleeping
• Bad, unpleasant, or unusual (after) taste
• Increased sensitivity to  touch and pain
• Continued buzzing, ringing, or other unexplained noise in the ears

[Note: This list is not exhaustive, if you notice any other symptoms that are not mentioned above, consult your doctor immediately.]

Acitretin Dosage

Forms & Strengths

It comes in a capsule form and is available in these two strengths:

• Acitretin 10 mg capsule
• Acitretin 25 mg capsule

Recommended Dosages

Dosage for Severe Psoriasis

• Adults Starting Dose: 25 to 50 mg one time every day with the main meal.
  • Your primary caregiver will adjust the dose based on:
    • Your body’s response
    • The specific condition being treated.
• Children (under 18 years): Not approved for use. If necessary, a pediatrician must determine the dosage.

How to Take Acitretin?

• Before starting Acitretin, read the patient information leaflet that comes with your prescription. It contains essential details about the medication.
• Take Acitretin precisely as your doctor prescribes. Avoid altering the amount, frequency, or duration of the dosage to prevent increased risk of side effects.
• You’ll be introduced to the “Do Your P.A.R.T.” program, which focuses on preventing pregnancy during and after treatment with Acitretin. Discuss any questions about this program with your doctor.
• Take Acitretin with your main meal of the day to maximize absorption.
• It might take two to three months before you notice improvements from Acitretin.
• For the best results, maintain a consistent dosage schedule and take your medication simultaneously each day.

Missed Dose 

If you miss a dose of Acitretin, take it as soon as you remember.

[Note: Do not take two doses of Acitretin simultaneously to compensate for a missed dose. This may increase the risk of experiencing side effects.]

Overdose

If you overdose on Acitretin, it is important to seek emergency medical help immediately.

[Note: If you notice you have taken too much medication, call your local emergency number immediately.]

How Does Acitretin Work?

Acitretin is often prescribed for long-term management when other treatments for psoriasis are not effective or suitable. It is part of a group of medications known as retinoids, which are related to Vitamin A. Acitretin works by attaching to specific receptors in the body, helping to regulate the speed at which skin cells grow. This action helps to reduce the excessive growth and thickening of skin cells, making it especially useful in treating psoriasis.

Important Safety Precautions

• Do not use Acitretin if you are pregnant, think you may be pregnant, or plan to become pregnant within three years after stopping this drug due to the possible risk of birth defects.
• Start using two effective methods of birth control one month before beginning Acitretin, and continue for three years after stopping treatment.
• Women who can become pregnant should only use Acitretin if no other treatment options have worked. Prior to starting, you should have two negative pregnancy tests.
• It is unsafe to drink alcohol during treatment with Acitretin and for two months following the final dose.
• Do not donate blood while on Acitretin and for three years after your last dose to prevent the risk to pregnant recipients.
• Stop taking Acitretin and seek immediate medical attention if you experience symptoms of severe liver disease, such as nausea, loss of appetite, vomiting, yellowing of the skin or eyes, or dark-colored urine.

Storage 

• Store Acitretin in its original container at room temperature.
• Keep Acitretin in a safe location that is out of sight and reach of children.
• Do not keep medications that are outdated or no longer needed. 

Acitretin Interactions

Acitretin may interact with the following medications:

• Pexidartinib
• Rolitetracycline
• Minocycline
• Tetracycline
• Meclocycline
• Demeclocycline
• Lymecycline
• Tigecycline
• Palovarotene
• Doxycycline
• Methacycline
• Omadacycline
• Levonorgestrel
• Eravacycline
• Sarecycline
• Ethanol
• Oxytetracycline
• Chlortetracycline

[Note: This list of interactions isn’t complete. Talk to your doctor if you notice any interaction with food, over-the-counter drugs, prescriptions, or supplements.]

Acitretin Alternatives

• Triamcinolone topical (triamcinolone acetonide)
• Remicade (infliximab)
• Stelara (ustekinumab)
• Methotrexate (methotrexate)
• Skyrizi (risankizumab)

[Note: Your healthcare provider will choose which Acitretin alternative is best for you. Taking or consuming them by yourself may cause serious side effects.] 

Frequently Asked Questions

Who should not take Acitretin?

This medication is contraindicated for use in patients with the following conditions:

• High Cholesterol
• Diabetes
• Liver Disease
• Depression
• Heart Disease
• Kidney Disease

Can Acitretin damage the liver?

Yes, while it is rare, Acitretin can cause acute liver injury. This type of liver damage occurs in approximately 0.1% to 0.5% of patients taking the medication.

How long can you stay on Acitretin?

The duration of treatment with Acitretin varies. Some patients may use the medication for a few months at a time, with breaks in between, while others might need to stay on it long-term. Acitretin can also be used with other antipsoriatic drugs and phototherapy, especially in cases resistant to treatment.

What is the black box warning for Acitretin?

The black box warning for Acitretin states that it is extremely harmful to the fetus. Therefore, it should not be used by women who are pregnant, plan to become pregnant during treatment, or within three years after stopping the medication. Additionally, it is advised against use in women who aren’t using reliable methods of contraception.

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