ACITRETIN
(a-ci-tree'tin)
Soriatane
Classifications: skin and mucous membrane agent; antiacne; retinoid
Prototype: Isotretinoin
Pregnancy Category: X
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10 mg, 25 mg capsules
The mechanism of action of acitretin is unknown.
Acitretin is a highly toxic metabolite of retinol (vitamin A).
Treatment of severe psoriasis in adults.
Pregnancy (category X), sensitivity to parabens, lactation.
Patients with impaired hepatic function, hepatitis, diabetes mellitus, obesity, alcoholism, history of pancreatitis, hypertriglyceridemia,
hypercholesterolemia, coronary artery disease, retinal disease, degenerative joint disease.
Psoriasis
Adult: PO 25–50 mg q.d. with main meal
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Oral
- Administer as single dose with main meal because food enhances absorption.
- Store at 15°–25° C (59°–77° F) and protect from light. After opening, avoid exposure to high
temperatures and humidity.
Body as a Whole:
Hyperesthesia, paresthesias, arthralgia, progression of existing spinal hyperostosis, rigors, back pain, hypertonia, myalgia, fatigue, hot flashes, increased appetite. CNS: Headache, depression, aggressive feelings and thoughts of self-harm, insomnia, somnolence. CV: Flushing, edema. GI:
Dry mouth, increased liver function tests, increased triglycerides and cholesterol, hepatitis, gingival bleeding, gingivitis, increased saliva, stomatitis, thirst, ulcerative stomatitis, abdominal pain, diarrhea,
nausea, tongue disorder. Special Senses: Blurred vision, blepharitis, conjunctivitis, decreased night vision/night blindness, eye pain, photophobia; earache, tinnitus;
taste perversion. Respiratory: Sinusitis. Skin:
Alopecia, skin peeling, dry skin, nail disorders, pruritus, rash, cheilitis, skin atrophy, paronychia, abnormal skin odor and hair texture, cold/clammy skin, increased sweating, purpura, seborrhea, skin ulceration, sunburn. Other:
Rhinitis, epistaxis, xerophthalmia.
Drug: Combination with ethanol can create etretinate, which has a significantly longer half-life than acitretin; interferes with the contraceptive efficacy of progestin-only oral contraceptives. Food: Avoid excess vitamin A.
Absorption: Rapidly absorbed from GI tract, optimal absorption when taken with food. Peak: 2–5 h. Distribution: Crosses placenta, distributed into breast milk. Metabolism: Metabolized active metabolite, cis-acitretin. Elimination: Excreted in both urine and feces. Half-Life: 49 h acitretin, 63 h cis-acitretin.
Assessment & Drug Effects
- Monitor for S&S of pancreatitis or loss of glycemic control in diabetics. Report either condition immediately to physician.
- Lab tests: Before initiating therapy and at 1- to 2-wk intervals until response to drug is known, do lipid profile and liver
function tests. Monitor blood glucose and HbA1-C periodically.
Patient & Family Education
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Note: Transient worsening of psoriasis may occur during early therapy.
- Review common adverse effects of drug; lag time of 2–3 mo may be necessary before drug effect is evident.
- Discontinue drug and report immediately to physician if visual problems develop.
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Note: Dry eyes with decreased tolerance for contact lenses may occur.
- Do not drink alcohol while taking this drug; it increases risk of hepatotoxicity and hypertriglyceridemia; females should
avoid alcohol during and for 2 mo following therapy.
- Do not donate blood for 3 y following therapy.
- Avoid excessive exposure to sunlight or UV light.
- Use two forms of effective contraception for 1 mo before and at least 3 y following therapy because of the serious risk of
fetal deformities that could result from exposure to this medication.
- Do not breast feed while taking this drug
1%)
Canadian drug name; 
Prototype drug