Acitretin
Acitretin (Soriatane)
Acitretin
(ah-sih- TREH-tin)
Pregnancy Category: X Soriatane (Rx)

Classification: Antipsoriasis product.

Action/Kinetics: Retinoic acid derivative that is the main metabolite of etretinate. Mechanism is not known. Absorption optimal when given with food. t 1/2, terminal: 49 hr. Extensively metabolized; excreted through feces and urine.

Uses: Severe psoriasis, including erythrodermic and generalized pustular types. Investigational: Darier's disease, palmoplantar pustulosis, lichen planus, children with lamellar ichthyosis, non-bullous and bullous ichthyosiform erythroderma, Sjögren-Larsson syndrome, lichen sclerosus et atrophicus of the vulva and palmoplantar lichen nitidus.

Contraindications: Use during pregnancy or in those who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Use by females who may not use reliable contraception during treatment or for at least 3 years following treatment. Use of ethanol in women either during treatment or for 2 months after cessation of treatment. Lactation.

Special Concerns: Use with caution in those with severely impaired liver or kidney function. Safety and efficacy have not been determined in children.

Side Effects: Dermatologic: Alopecia, skin peeling, dry skin, nail disorder, pruritus, erythematous rash, hyperesthesia, paresthesia, paronychia, skin atrophy, sticky skin, abnormal skin odor, abnormal hair texture, bullous eruption, cold/clammy skin, dermatitis, increased sweating, infection, psoriasis-like rash, purpura, pyogenic granuloma, rash, seborrhea, skin fissures, skin ulceration, sunburn. CNS: Rigors, headache, pain, depression, insomnia, somnolence. GI: Abdominal pain, nausea, diarrhea, tongue disorder, altered taste, hepatotoxicity. Ophthalmic: Xerophthalmia, blurred vision, abnormal vision, blepharitis, irritation, conjunctivitis, corneal epithelial abnormality, decreased night vision, blindness, eye abnormality, eye pain, photophobia. Musculoskeletal: Arthralgia, spinal hyperostosis, arthritis, arthrosis, back pain, hypertonia, myalgia, osteodynia, peripheral joint hyperostosis. Mucous membranes: Cheilitis, rhinitis, epistaxis, dry mouth, gingival bleeding, gingivitis, increased salivation, stomatitis, thirst, ulcerative stomatitis. Body as a whole: Anorexia, edema, fatigue, hot flashes, increased appetite, flushing, sinusitis. Otic: Earache, tinnitus.

Laboratory Test Alterations: AST, ALT, GGT, LDH, triglyceride, cholesterol. HDL.

Drug Interactions: Ethanol / Possible formation of etretinate which has a longer half-life than acitretin Glyburide / Enhanced clearance of blood glucose Methotrexate / Risk of hepatotoxicity Oral contraceptives, "minipill" / Acitretin interferes with the contraceptive effect

How Supplied: Capsules: 10 mg, 25 mg

Dosage
?Capsules Psoriasis.
Must individualize dosage. Initial: 25 or 50 mg/day given as a single dose with main meal. Maintenance: 25 to 50 mg/day.