Generic
Acitretin
6 brands available in the market
At a glance
Acitretin is a second-generation retinoid used for severe psoriasis and other keratinization disorders. It is a synthetic vitamin A analog that regulates abnormal skin cell growth.
Description
Acitretin is an oral retinoid used for severe psoriasis (pustular and erythrodermic types) and other keratinization disorders (ichthyosis, Darier's disease) when other therapies have failed. It is a synthetic analog of vitamin A that modulates cellular differentiation in the epidermis, re-establishing a more normal pattern of cell growth. Acitretin is highly teratogenic, requiring strict contraceptive measures in women of childbearing potential.
Indications
Severe extensive psoriasis (resistant to other therapies); palmo-plantar pustular psoriasis; severe congenital ichthyosis; severe Darier's disease (keratosis follicularis).
Therapeutic class
Oral Retinoid Preparations
Pharmacological class
Retinoid (Vitamin A Analog)
Pharmacology
Acitretin is an aromatic retinoid related to vitamin A. Its exact mechanism is unknown, but it modulates cellular differentiation in the epidermis, re-establishing a more normal pattern of cell growth. It has antiproliferative, anti-inflammatory, and anti-angiogenic effects.
Mechanism of action
Acitretin's exact mechanism is not fully understood, but it modulates epidermal cellular differentiation to control abnormal skin cell growth and thickening. It reduces plaque formation and scaling in psoriasis.
Dosage
Adults and Elderly:
- Initial dose: 25-30 mg/day for 2-4 weeks.
- Maintenance dose: 25-50 mg/day for 6-8 weeks.
- Maximum dose: 75 mg/day.
- Darier's disease: Starting dose may be 10 mg/day, not exceeding 50 mg/day.
Children:
- Approximately 0.5 mg/kg/day (maximum 35 mg/day).
Administration
Take once daily with a meal or a glass of milk. Swallow capsules whole.
Missed dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Side effects
Very common (>10%): Dry lips (cheilitis), dry skin, peeling, hair loss (alopecia).
Common (1-10%): Joint pain, muscle pain, itching, runny nose, nosebleeds, nail changes, headache, dry mouth.
Laboratory abnormalities: Increased triglycerides and cholesterol, decreased HDL, elevated LFTs.
Serious (rare): Liver damage (hepatitis), severe headache, nausea, vision problems, night blindness, depression, hyperglycemia.
Precautions & warnings
- Teratogenicity: Highly teratogenic. Absolutely contraindicated in pregnancy.
- Contraception: Women of childbearing potential must use 2 effective methods of contraception 1 month before, during, and for 3 years after treatment.
- Alcohol: Acitretin plus alcohol forms teratogenic etretinate. Alcohol is strictly prohibited during treatment and for 2 months after.
- Blood donation: Prohibited during and for 3 years after treatment.
- Liver and lipid monitoring: Regular LFTs and lipid profiles before and during treatment.
- Sun exposure: Skin becomes more sensitive; use sunscreen and protective clothing.
Contraindications
- Pregnancy and lactation
- Women of childbearing potential without strict contraception
- Severe hepatic or renal impairment
- Chronic abnormally elevated blood lipids
- Concomitant use with methotrexate, tetracyclines, vitamin A, or other retinoids
- Hypersensitivity to acitretin or other retinoids
Drug interactions
Alcohol: Forms etretinate, increasing teratogenicity; strictly prohibited during treatment and for 2 months after.
Methotrexate and tetracyclines: Contraindicated together (risk of hepatitis and increased intracranial pressure).
Vitamin A and other retinoids: Contraindicated together (risk of hypervitaminosis A).
Microdosed progestins (minipill): Ineffective as contraception.
Phenytoin: Partial reduction in protein binding possible.
Warfarin: No interaction observed.
Food interactions
Alcohol consumption is strictly prohibited.
Use in pregnancy
Acitretin is highly teratogenic and absolutely contraindicated during pregnancy.
Pregnancy Category: X — always consult a doctor before taking during pregnancy.
Use in lactation
Contraindicated during breastfeeding.
Pediatric use
Children: 0.5 mg/kg/day (maximum 35 mg/day). Long-term side effect risks must be considered.
Geriatric use
No dose adjustment needed for elderly patients.
Renal / hepatic impairment
Contraindicated in severe hepatic or renal impairment.
Overdose effects
Overdose symptoms: severe headache, vertigo, nausea, vomiting. Treatment: drug discontinuation and symptomatic care.
Storage conditions
Store below 25C in a cool and dry place, protected from light. Keep out of reach of children.
Chemical structure
Acitretin