Acitretin: Uses, side effects, and interactions

What is acitretin?

Acitretin is a prescription drug. It is available as an oral capsule and as a brand-name drug called Soriatane. It’s also available as a generic drug.

Acitretin belongs to a class of drugs called retinoids. Retinoids relate to retinol, or vitamin A. Acitretin works by binding to receptors in the body. These receptors help normalize the speed of skin cell growth, reducing the effects of conditions that include psoriasis.

A doctor will likely only prescribe acitretin if other drugs are not effective for a case of psoriasis or if an individual cannot use other psoriasis drugs.

This drug is used on a long-term basis. If prescribed, it is worth calling the pharmacy ahead of time as not all pharmacies stock this item.

Uses

The drug is used to treat severe psoriasis.

Psoriasis is a skin condition that causes cells in the outer layer of the skin to grow faster than normal and build upon the surface of the skin. This leads to inflammation and red, thickened areas of skin, often with silvery scales.

Side effects

Acitretin carries a United States Food and Drug Administration (FDA) black box warning. This is the most serious health warning a drug can carry.

The medication carries the following warnings:

• Severe warning regarding congenital anomalies: Avoid this drug if you are pregnant or planning to become pregnant within the following three years. Acitretin can cause severe congenital anomalies. Women who are able to bear children should use effective birth control while on acitretin.
• Liver problems warning: This drug can cause liver problems, include abnormal liver function test results and inflammation. A doctor will run blood tests before prescribing acitretin. These serve to check liver function before and during acitretin treatment.
• Vision problems: This drug can decrease vision in the dark, causing a condition called night blindness that can onset suddenly. Take extreme caution when driving at night while taking acitretin. This condition usually resolves after the course of treatment has drawn to a close.
• Avoid giving blood: Do not donate blood while taking this drug and for at least 3 years after stopping. The presence of acitretin in the blood can harm an unborn baby if given to a woman who is pregnant.
• Depression: This drug may cause depression or aggressive behavior, and combined with the condition may cause self-harming urges. Call a doctor right away if these urges occur. The doctor may recommend a medication change

Side effects that can occur when taking acitretin include:

• chapped lips
• peeling fingertips, palms, and soles of the feet
• itching
• scaly skin all over your body
• weak nails
• sticky or fragile skin
• runny or dry nose
• nosebleeds
• dry mouth
• joint pain
• tight muscles
• hair loss
• dry eyes
• high cholesterol
• drowsiness

The drug can also lead to serious complications in people that may already have a predisposition towards them, including:

• liver problems
• heart attack
• stroke
• serious skin conditions
• vision problems
• pancreatitis
• blood vessel issues
• high pressure on the brain
• depression
• abnormal muscle or bone changes
• high blood sugar levels

People with the following conditions should completely avoid this drug:

• severe liver and kidney disease
• high cholesterol
• diabetes or hyperglycemia
• obesity
• allergy to retinoids or acitretin

Interactions

Acitretin can interact with other drugs and chemicals in the body to create adverse effects. It is important to know what to take and avoid when on a course of acitretin.

This drug is known to increase the risk of congenital abnormalities, and alcohol can further enhance the duration of this risk to beyond 3 years after taking acitretin. Avoid alcohol at all costs while taking acitretin.

There are several types of medication to avoid while taking acitretin, including:

• Tetracycline antibiotics: These increase the risk of dangerous pressure levels in the brain.
• Methotrexate: Taking these drugs alongside acitretin can greatly increase the risk of liver problems.
• Progestin-only birth control pills, or minipills: Acitretin can reduce the effectiveness of minipills, and it is vital not to become pregnant while taking acitretin. A doctor may stop the minipill and prescribe a different method of birth control.
• Phenytoin: Acitretin can enhance the side effects of phenytoin, including slurred speech, confusion, and coordination or balance problems.
• Vitamin A supplements and other oral retinoids: Taking these drugs with acitretin may cause nausea, vomiting, loss of balance, and blurry vision.

Dosage

Acitretin is available in its generic form in 10-milligram (mg), 17.5-mg, 22.5-mg, and 25-mg capsules and under the brand Soriatane in 10-mg, 17.5-mg, and 25-mg capsules.

A typical starting dose is around 25 to 50 mg once per day, to be taken with the largest meal. The doctor who prescribed the drug will monitor the reaction to this dosage and make amendments if side effects are becoming disruptive.

There is no dosage recommended for children under 18 years of age, as they should not take the medication. Adults over the age of 65 years will often start on a lower dose.

If a dose is accidentally missed, do not take a double dose next time. It is vital never to miss a dose, as this can reduce or block the effectiveness of the drug.

Extra information

Here are several extra considerations to bear in mind when transporting, acquiring, or storing acitretin:

• Always take acitretin with food.
• Always carry the medication on your person. When flying, never put it into a checked bag but keep it in the carry-on luggage.
• Airport x-ray machines will not damage the medication.
• Always carry the original prescription-labeled box, as airport security may wish to see this.
• Avoid putting medication in the glove compartment of a vehicle or leaving it in the car. Be sure to avoid doing this in extreme temperatures.
• Many insurers require pre-authorization before approving this treatment. Contact your insurer ahead of time.
• Wear protective clothing in the sun, as acitretin makes the skin more sensitive.

Prescriptions for acitretin are not refillable.

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