What are the aims of this leaflet?
This leaflet has been written to help you understand more about acitretin. It tells you what it is, how it works, how it is used to treat skin conditions, and where you can find out more about it.
What is acitretin and how does it work?
Acitretin (trade name Neotigason) is a member of a group of drugs called retinoids, closely related to Vitamin A. It works by slowing down cell reproduction in the skin.
What skin conditions are treated with acitretin?
Acitretin is licensed for, and most commonly used to treat psoriasis. Your dermatologist may also use acitretin to treat other skin conditions, including lichen planus, lupus erythematosus, ichthyosis and Darier’s disease.
Will acitretin cure my skin condition?
Acitretin is not a cure for these conditions, and when the medication is stopped, the condition is likely to return. However, most patients will see a gradual improvement of their skin starting after about two weeks and continuing for up to twelve weeks. This improvement should then remain whilst taking the medication.
What dose should I take?
Your dose will depend on your body weight and the type of skin condition your doctor is treating. Acitretin capsules come in 10 mg and 25 mg strengths with most patients taking between 10 mg and 50 mg of acitretin each day. It is not recommended to take more than 75 mg each day.
What time of day should I take acitretin?
Acitretin is best absorbed into the body alongside fats. It is therefore best to take the medication after a meal.
When should you not take acitretin?
If a woman becomes pregnant whilst taking acitretin it is highly likely that the baby will be damaged by the medication; because of this, acitretin is not normally given to women of child bearing age. Women who have taken acitretin should wait at least 3 years after stopping it before attempting to conceive. Men taking acitretin can father children with no additional risk. Patients must not donate blood (for at least 2 years after stopping treatment) in case the blood containing acitretin is given to a pregnant woman. If you have had problems with your liver, kidneys or suffer from high cholesterol or diabetes you should discuss this with your doctor prior to starting the medication.
What are the common side effects of acitretin and what to do if they occur?
In general the side effects of acitretin are mild and settle when the dosage is reduced. An initial worsening of psoriasis may be seen when the drug is first taken. High doses of acitretin may cause dryness of the skin, lips, nostrils and eyes. The skin may also peel and become fragile. It is recommended to use a regular moisturiser and lip salve. There is an increased risk of sunburn and you should use a regular sunscreen. An increased risk of skin infections is seen if the skin becomes dry and cracked. Nosebleeds may occur if the inside of the nose becomes very dry.
What are the rare side effects of acitretin?
A number of more serious side effects may be seen although these are fortunately rare. Increased pressure in the brain may present with headaches and visual disturbance. You might experience abdominal pain, diarrhoea or a feeling of sickness. Muscles and joints may ache after exercise, and hands, ankles and feet can become swollen. Hair loss and hair thinning may occur, as well as changes to the texture. Increased fat levels in the blood and inflammation of the liver can be seen and will be monitored with blood tests. There may also be a link between acitretin and mood change although this remains unproven. If acitretin is taken for prolonged periods it may affect the bones and your doctor may organise for X-rays to check this.
How will I be monitored for side effects of acitretin treatment?
Prior to starting acitretin and at regular intervals whilst on the medication, your doctor will organise blood tests. If you have not had a blood test for some time please inform your doctor.
The BAD Biologic Interventions Register (BADBIR)
If you have been prescribed acitretin for treatment of your psoriasis, you may be asked to take part in the national biologics register. This register is to compare the safety of different treatments for psoriasis and to see how well they work. It was set up to monitor some new treatments for psoriasis called biological treatments. The register will give doctors information on how best to use the treatments available for moderate to severe psoriasis. No information will be passed to the register without your informed consent.
May I drink alcohol whilst taking acitretin?
Yes, but within limits (keep to less than 1 large (250 ml) glass of wine or 1 pint of premium (5%) beer per day for men, and 1/3 less for women; this corresponds to the government recommended guidelines for alcohol consumption).
Can I take other medications at the same time as acitretin?
Many drugs can be taken safely with acitretin but some medications may interact. It is important that you tell your doctor and pharmacist before taking any new prescription or over-the-counter medications.
Drugs that may interact with acitretin include:
- Vitamin A: Doses above the recommended daily allowance should be avoided
- Mini-pill: Progestin only pill
- Antibiotics: Tetracyclines
- Antifungals: Ketoconazole
- Anticonvulsants: Carbamazepine
- Anticoagulants: Warfarin
This is not an exhaustive list and it is important that you always inform your doctor and pharmacist that you are taking acitretin.
Where can I find out more about acitretin?
If you would like any further information about acitretin, or if you have any concerns about your treatment, you should discuss this with your doctor or pharmacist. This information sheet does not list all the side effects this drug can cause. For full details, please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to side effects that may be relevant in your particular case.
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For details of source materials used please contact the Clinical Standards Unit ([email protected]).