AcitretinWhat is it?
Acitretin is a type of medicine called a ‘retinoid’ Retinoids have a structure similar to vitamin A and it is involved with the production and growth of skin cells How does it work?
Acitretin works by inhibiting the over-production of skin cells and the protein within them, thus reducing plaques, scaling and the redness connected with this process
Who is it for?
Acitretin is for moderate to severe psoriasis, plaque, guttate and PPP, which has not responded adequately to other treatments
How is it taken?
Acitretin is taken by tablet or capsule form once a day and normally with a meal It is best to try and take it at roughly the same time each day Prescribed amounts can vary, but it is usual to start on a lower dose and have this increased as and when it is necessary to control psoriasis clearance Some people get excellent results on a lower dose, others need to have their dose upped frequently The lowest starting dose is approx 10mg per day and the maximum is usually no more than 75 mg Be careful when taking your dose – check you are taking exactly the right amount! What are the side effects and contra-indications? As with all systemics, there is a long list of possible side effects Similarly, some people suffer no effects, others a few on the list and a few unlucky people cannot tolerate it at all
Common side effects include:
· Peeling, dry, itchy, scaling, cracked, blistered, sticky or infected skin
· brittle or weak fingernails and toenails
· dandruff
· sunburn
· abnormal skin odour
· excessive sweating
· hair loss
· changes in hair texture
· dry eyes
· loss of eyebrows or eyelashes
· hot flashes or flushing
· weak nails
· chapped or swollen lips
· swollen or bleeding gums
· excessive saliva
· tongue pain, swelling, or blistering
· mouth swelling or blisters
· stomach pain
· diarrhea
· increased appetite
· difficulty falling or staying asleep
· sinus infection
· runny nose
· dry nose
· nosebleed
· joint pain
Acitretin can cause low blood sugar (hypoglycemia) even in patients who are not diabetic. If you have any of these symptoms, eat or drink a food or beverage with sugar in it and call your doctor immediately; symptoms of low blood sugar include:
· shakiness
· dizziness
· rapid heartbeat
· sweating or confusion
· blurred vision
· headache
· numbness or tingling of the mouth
· weakness
· fatigue
· pale colour
· sudden hunger
Acitretin can also cause high blood sugar (hyperglycemia). If you have any of these symptoms, call your doctor immediately; symptoms of high blood sugar include:
· thirst
· dry mouth
· tiredness
· flushing
· dry skin
· frequent urination
· loss of appetite
· trouble breathing Contra-indications for Acitretin include:Pregnancy – absolutely essential good contraception is used for the duration of its use AND for two years afterwards.
Do not take MTX, tetracycline antibiotics or any vitamin A supplements. Make sure you tell your pharmacist that you are taking Acitretin when you have any prescription filled at the chemists, as there are many other drugs that interact negatively with it.
Do not expose yourself unnecessarily to UV whilst taking Acitretin, as it can make the skin photosensitive. However, some derms like to use low dose Acitretin with UVB therapy.
Do not donate blood whilst using Acitretin and for at least one year after stopping treatment.
Be aware that Acitretin can cause ‘night blindness’, therefore be careful when driving at night. It can also make the wearing of contact lenses uncomfortable. It is best to avoid over-us of alcohol whilst taking Acitretin. Acitretin can cause the cholesterol count to rise, therefore checking your diet for food high in cholesterol and limiting it may be necessary if the regular blood tests show a need.
What monitoring will I need?
Baseline Monitoring:
· Full history and physical examination
· Pregnancy test (women)
· Check of contraception (women)
· Full blood count
· Liver Function
· U&E (kidney)
· Eye test
· Lipids (cholesterol)
Some or all of these tests will be required on a monthly/bi-monthly basis. Careful monitoring can indicate the potential for problems before it becomes one.
There are many threads and posts on Acitretin, including questions and answers perhaps not dealt with above, and experiences of those PHO members who use it in the forums.
SJ October 2004  |
