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Pharmacologic class: Second-generation retinoid
Therapeutic class: Antipsoriatic
Pregnancy risk category X
FDA Box Warning
• Drug may harm fetus and must not be used by pregnant patients, those who intend to become pregnant, or those who may not use reliable contraception during therapy and for at least 3 years afterward.
• Patient must commit to using two effective contraceptive forms simultaneously. At least one form must be primary, unless patient chooses absolute abstinence, has had a hysterectomy, or is postmenopausal.
• Drug should be prescribed only by clinicians with special competence in diagnosing and treating severe psoriasis, experience using systemic retinoids, and understanding of teratogenicity risk.
• Consider drug only for women with severe psoriasis unresponsive to other therapies or whose clinical condition contraindicates other therapies.
• Instruct patient not to donate blood during therapy and for at least 3 years afterward.
Unclear. Promotes normal growth cycle of skin cells, possibly by targeting retinoid receptors in these cells and adjusting factors that affect epidermal proliferation and synthesis of RNA and DNA.
Capsules: 10 mg, 17.5 mg, 25 mg
Indications and dosages
➣ Severe psoriasis
Adults and elderly patients: Initially, 25 to 50 mg/day P.O. as a single dose with main meal. If initial response is satisfactory, give maintenance dosage of 25 to 50 mg/day P.O.
• Darier's disease (keratosis follicularis)
• Lamellar ichthyosis (in children)
• Lichen planus
• Nonbullous and bullous ichthyosiform erythroderma
• Palmoplantar pustulosis
• Sjögren-Larsson syndrome
• Hypersensitivity to drug or paraben (used as preservative in gelatin capsule)
• Pregnancy or anticipated pregnancy within 3 years after drug discontinuation (drug has teratogenic and embryotoxic effects)
• Women of childbearing age who may not use reliable contraception during therapy and for at least 3 years after drug discontinuation
Use cautiously in:
• hepatic or renal impairment, diabetes mellitus, obesity
• elevated cholesterol or triglyceride levels
• elderly patients.
☞ Verify that patient isn't pregnant before giving drug.
• Give as a single dose with main meal.
CNS: headache, depression, insomnia, drowsiness, fatigue, migraine, rigors, abnormal gait, nerve inflammation, hyperesthesia, paresthesia, pseudotumor cerebri
EENT: abnormal or blurred vision, dry eyes, eye irritation, eyebrow and eyelash loss, eyelid inflammation, cataract, conjunctivitis, corneal epithelial abnormality, reduced night vision, photophobia, recurrent styes, earache, tinnitus, hearing loss, epistaxis, rhinitis, sinusitis, papilledema
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, gastritis, stomatitis, esophagitis, melena, painful straining at stool, pancreatitis, lip inflammation and cracking, dry mouth, anorexia
GU: abnormal urine, dysuria, atrophic vaginitis, leukorrhea
Hepatic: abnormal hepatic function, jaundice, hepatitis
Metabolic: poor blood glucose control
Musculoskeletal: joint, muscle, back, and bone pain; arthritis; bone disorders; spinal bone overgrowth; increased muscle tone or rigidity; tendinitis
Respiratory: coughing, increased sputum, laryngitis
Skin: dry skin, pruritus, skin atrophy, skin peeling, abnormal skin odor, sticky skin, seborrhea, dermatitis, diaphoresis, cold clammy skin, skin infection, rash, pyrogenic granuloma, skin ulcers, skin fissures, sunburn, flushing, purpura, nail disorder, inflammation of tissue surrounding nails, abnormal hair texture, alopecia
Other: abnormal taste, glossitis, tongue ulcers, gingival bleeding, gingivitis, edema, thirst, hot flashes
Drug-drug. Glyburide: increased blood glucose clearance
Methotrexate: increased risk of hepatotoxicity
Oral contraceptives ("minipill"): decreased contraceptive efficacy
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, triglycerides: increased levels
Low-density lipoproteins: decreased level
Drug-behaviors. Alcohol use: interference with acitretin elimination, possible drug toxicity
• Monitor patient who has early signs or symptoms of pseudotumor cerebri, such as headache, nausea, vomiting, and visual disturbances. Discontinue drug immediately if papilledema occurs.
• Check blood lipid levels before therapy begins and every 1 to 2 weeks during therapy.
• Monitor blood glucose levels and kidney and liver function test results.
• If drug causes open skin lesions resulting from dermatitis or blisters, watch for signs and symptoms of infection.
• Assess for pain, stinging, and itching. Apply cool compresses as needed for relief.
☞ Be aware that women taking this drug must avoid alcohol-containing foods, beverages, medications, and over-the-counter products during therapy and for 2 months afterward.
• Instruct patient to take drug with main meal to minimize GI upset.
• Tell patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
• Caution patient not to drink alcohol during therapy.
☞ Advise females to use effective contraception for at least 1 month before starting drug, throughout entire course of therapy, and for 3 years after discontinuing drug.
• Explain that disease may seem to worsen at start of therapy.
• Tell contact lens wearers that lens intolerance may develop.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.