Acitretin (Oral)

Acitretin is used to treat severe psoriasis in adults, a condition in which cells begin to build up quickly on the surface of the skin. It is not a cure for psoriasis, however, and patients may need to begin treatment again in the future if their psoriasis returns.

Overview

Acitretin is a medication used to treat cases of severe skin disorders in adults, such as psoriasis. Psoriasis is a skin condition which alters the life cycle of skin cells, causing them to build up quickly on the skin's surface. Because of this abnormal accumulation of cells, the skin thickens in patches and can be itchy and dry, with painful red areas. Use of Acitretin helps to clear up these excessive skin cells, and as it dries up the excessive cells, will reduce the red patches on the skin, and alleviate the itching that accompanies the condition.

Acitretin is available in capsule form, by prescription as both a branded and generic drug. Patients taking Acitretin should be aware that the drug remains in the body after they stop taking it, and drinking alcohol may also extend the effects of the medication after the patient finishes their course of treatment. While it provides relief, Acitretin does not cure psoriasis, so that at some point in the future, the patient may need to begin taking it again if their condition returns.

The most important risk for patients taking Acitretin is that it can cause birth defects in a human fetus; this warning is the subject of a black box warning on the packaging. For women who are pregnant or are considering becoming pregnant within three years of taking this medication, it is advised that they do not take this drug without the advice of a doctor. A treating physician may schedule regular blood tests and pregnancy screenings for female patients for up to three years following the use of this drug, or longer if deemed necessary.

Conditions treated

Type of medicine

  • Retinoid

Side effects

Acitretin causes a variety of side effects, both common and rare. Because Acitretin, in combination with other medications, can lead to serious and unwanted side effects, it is important that a patient provides a complete medical history to their doctor when seeking treatment for psoriasis. For patients taking Acitretin, some of the reported side effects are likely to last only during the initial two or three weeks of taking the medication. Once the medication begins to work, some of the discomfort will begin to lessen as the drug takes effect.

The most common side effects caused by Acitretin include dry mouth, dryness or irritation of the gums or throat, dryness or irritation of the eyes, irritation of the digestive system which can affect bowel movements, and continued or changed skin irritation other than in those areas of psoriasis that is being treated.

The most severe side effect of Acitretin is causing birth defects to the unborn child of a woman taking this medication who becomes pregnant, or comes into contact with Acitretin through a blood transfusion. Since the medication remains in the system for as long as three years after treatment, it is not recommended for women who may not be pregnant at present, but are planning to get pregnant in the near future. Patients considering pregnancy should read the warnings on the packaging thoroughly and understand all of the dangers and risks of taking Acitretin, and decide with their physician whether, in light of those risks, to go ahead with treatment.

For other side effects reported in both male and female patients, the most common of these affect approximately one in ten patients taking Acitretin. As the drug works on clearing up the condition from the skin, many side effects are skin related, such as chapped or swollen lips, itching, scaly skin, peeling fingertips, palms or soles, weak finger and toe nails, and a runny or dry nose. Other common side effects are sensitivity to sun, irritation in the mouth or gums, dry eyes, being thirstier than usual, and constipation or diarrhea. In some cases, the physician may determine that the beneficial effect of taking Acitretin will outweigh the discomfort of some of these side effects.

To alleviate some of this discomfort, patients can try chewing sugar free gum or using a lozenge to help with dry mouth related side effects. Where skin irritation and itchiness is reported, the patient can use a moisturizing lotion or lip balm, as long as the lotion does not contain an irritant, such as alcohol, or a drying agent, such as benzoyl peroxide. There are also some additional medications that a doctor may prescribe to use with Acitretin which will help reduce some of these temporary side effects. Given the possibility that Acitretin can irritate the stomach, it is also recommended that this medication should be taken with food.

While taking Acitretin, there are other slightly less common side effects reported in patients, such as bone or muscle inflammation or pain. Side effects that fall into this category include back pain, bone or joint pain, muscle stiffness or tightness, and difficulty moving or walking have been reported. A doctor may prescribe or recommend an over the counter (OTC) painkiller to help alleviate these symptoms.

Other side effects are:

  • having a bad taste in the mouth or experiencing an unpleasant aftertaste or any other changes in taste
  • having an unusual ringing or buzzing in the ears
  • an overall feeling of being overly warm
  • experiencing other than ordinary headaches which are severe and continuing
  • usual nausea or vomiting which is severe and ongoing
  • an usually strong reaction to pain or touch

Patients may find that these side effects will lessen as their body gets used to the medication; however, if they do not being to go away during the first few weeks of taking Acitretin, or if these effects become more severe, a doctor should be consulted immediately.

There are also some rarer side effects which have been reported, which may indicate a serious condition that needs immediate medical attention. These effects include:

  • a sore mouth or tongue
  • redness or soreness of the fingernails or losing nails altogether
  • sour stomach or excess stomach acid resulting in severe heartburn or indigestion
  • having blurred vision or night vision problems that may or may not begin suddenly
  • having unusual chest pains
  • any kind of eye pain, eye problems or pain sensitivity to light

In some cases, a patient may have an unexplained general feeling of illness. While these side effects may be rare, a patient should seek medical attention if they occur.

Finally, there is a group of side effects which may indicate a more severe problem with taking Acitretin. If a patient is experiencing any of the following, they should contact their doctor immediately. These include:

  • abdominal or stomach pain
  • bleeding gums or other swelling in the mouth or gums
  • coughing or throat irritation or flu-like symptoms
  • longer than normal bleeding for cuts or menstrual flow
  • shortness of breath or difficulty breathing or swallowing
  • chest pain
  • darkened urine
  • continued skin problems, such as burning or stinging, redness, infection, ulcers or small red spots on the skin

Some of these side effects may indicate that there is kidney or liver damage resulting from taking Acitretin, and this must be treated immediately.

In any case where the above side effects either continue for a prolonged period of time, or if a new serious side effects appear, it is recommended that a patient seek the advice of their doctor immediately.

Dosage

The dosage of Acitretin that is prescribed will depend on the severity of the patient's case of psoriasis. In addition, when determining the right dosage, a doctor will take into account the patient's other illnesses, such as liver or kidney disease, to determine how much can safely be taken.

As a result, it is very important when taking Acitretin to avoid taking more or less than the doctor prescribes, to only take the amount prescribed and not to take it more frequently or less frequently than prescribed, and to only take it for the length of time prescribed, and not for a longer or shorter period of time. Failing to take this medication as ordered by the doctor can increase the potential for serious and unwanted side effects.

The prescribing doctor will base the effectiveness of the medication on the strength of the dosage, and will let the patient know specifically how many doses are needed per day, how long between each dose, and how long a patient will continue to take Acitretin. The medication is provided as a capsule, at the following average dose:

  • Adults - patients with severe psoriasis will start at a dose of 25 to 50 milligrams (mg) once a day as a single dose. A doctor will adjust this as required.
  • Children - this medication is not recommended for children, and will only be prescribed as determined by a doctor.

When the patient receives their prescription for Acitretin, in the packaging will be a patient information form and a Medication Guide. It is very important that the patient reads and understands all of this information, and, if they have any questions, that they raise them with their doctor prior to taking this medication. The instructions must be followed very carefully, and before the patient can begin taking this medication, they will be asked to sign a consent form that states they understand these instructions.

Due to the high risk of side effects, including birth defects in human fetuses, it is very important that this medication never be shared with anyone else.

If the patient misses a dose of this medicine, they should then take it as soon as they can, but if it is near the time for the next dose, the missed dose should be skipped, and the next dose should be taken according to the regular schedule. In no case should a patient take a double dose of Acitretin.

As with all medications, patients should, in all cases, follow their doctor's orders, or refer to the directions on the label. Because of the potential side effects of Acitretin, and because the effectiveness of this drug will depend on the dose taken, patients should not change their dosage without specific instruction to do so from their doctor.

Major drug interactions

There are several medications with which Acitretin should not be taken. In each case, there may be instances where a physician determines that the risk of taking Acitretin with any of the medications below will outweigh the potential problems. A patient should be sure to provide a complete medical history in order that their doctor can make the best determination.

The use of Acitretin with any of the medicines listed below is not recommended. A physician may decide to change your medication or not treat you with Acitretin if you are taking any of the drugs listed below:

  • Chlortetracycline
  • Demeclocycline
  • Doxycycline
  • Lymecycline
  • Meclocycline
  • Methacycline
  • Minocycline
  • Oxytetracycline
  • Rolitetracycline
  • Tetracycline

It is also not recommended that patients drink alcohol, as it can result in side effects. Certain over the counter medications and supplements should also be avoided, such as vitamin A, St. John's Wort, any type of drying acne medicine, such as benzoyl peroxide, and any medication containing alcohol as a major ingredient.

Warnings

For Acitretin, the most serious warning is for women who are or intend to become pregnant, as the use of this medication can cause serious birth defects in an unborn child. While Acitretin is not recommended for women of childbearing age, with carefully managed precautions, a patient may choose to proceed with treatment using Acitretin with the advice and oversight of their doctor. A physician will schedule regular pregnancy and blood tests during the period a patient is taking this medication, and for three years after stopping the medication.

In addition, it is recommended that women who are sexually active while taking Acitretin use forms of birth control which will be most likely to prevent pregnancy. Patients must use two forms of birth control together for the month prior to starting this medicine. This practice should continue for the entire course of the patient's treatment, and should additionally be used for the three years after taking their last dose of this medication.

Another step required to prevent birth defects is that before a woman can begin taking Acitretin, she will have to have two negative pregnancy tests to be sure that she is not pregnant. In addition, during the treatment, the patient will have to have pregnancy tests every month, as well as every three months for a period of three years after she stops taking the medicine. If at any time a patient believes she may have become pregnant while taking this medicine, she should immediately stop taking Acitretin and call her doctor to determine how to proceed.

Some patients who have certain other conditions or diseases may not be able to take Acitretin. If a patient has any of the following medical issues, the patient should discuss with their physician whether they can take Acitretin, or whether there is an alternative:

  • Depression, or a history of depression
  • Eye or vision problems such as dryness or night blindness
  • Heart disease
  • Hypercholesterolemia (high cholesterol in the blood)
  • Hyperostosis (bone growth that is not normal)
  • Hypertriglyceridemia (high triglycerides or fats in the blood)
  • Hypervitaminosis A (too much vitamin A in the body), or a history of hypervitaminosis
  • Pancreatitis (inflammation of the pancreas)
  • Pseudotumor cerebri (brain problem)
  • Psychosis, or a history of psychosis (caution required as Acitretin may make this condition worse)
  • Sugar diabetes mellitus or a family history of sugar diabetes
  • Obesity (caution is required as this condition may increase the risk for side effects)
  • Hyperlipidemia, severe (high fats in the blood)
  • Severe kidney disease (not recommended for patients with this condition)
  • Severe liver disease (not recommended for patients with this condition)

Patients should not use any type of a methotrexate or a tetracycline medicine to treat an infection (such as doxycycline, minocycline, tetracycline) while using Acitretin. With taking these medications, there is a greater risk of unwanted side effects.

A patient should always check with their doctor first before taking any prescription medications, non-prescription medications, vitamin supplements, herbal supplements, or other nutritional supplements. Of special concern is St John's Wort, as this herbal remedy can cause birth control to be ineffective.

Another vitamin supplement that should be avoided is vitamin A. Because Acitretin is a form of vitamin A, patients should not take vitamin A or any supplement containing vitamin A while they are taking this medicine, unless otherwise directed by their doctor. Taking vitamin A while on this medication may increase the chance of side effects.

Patients may notice that their skin condition may improve or get worse during the first few weeks of treatment. In addition, a patient may also experience some additional skin irritation from the medicine, beyond the skin condition being treated. After using Acitretin for a period of time, the expected skin irritation will lessen after a few weeks. If the skin irritation becomes worse or if the patient does not see their skin condition improve within 8 to 12 weeks, the patient should contact their doctor.

Due to the potential for additional skin irritation while taking Acitretin, patients should also avoid exposure to sun, wind and cold weather, even if it's a cloudy day. It is recommended that patients regularly use a sunscreen with at least a sun protection factor (SPF) of 15, especially during the first two or three weeks of using Acitretin, and should not use a tanning bed or lamp.

Some over the counter products can irritate the skin as well, and should be avoided without the advice of a doctor. Some of these include acne medications, hair products such as permanent kits or hair removal lotions, and anything that includes alcohol, such as shaving cream or astringents.

All patients taking Acitretin, but specifically women who are able to bear children, must not ingest any forms of alcohol during the treatment period of this medication, and should also avoid alcohol for a period of two months after they stop taking this medication. Patients should also refrain from eating any foods, drinking beverages, or taking and other medicines that contain alcohol, for example, cough syrups that contain alcohol. Drinking alcohol will cause the medicine to stay in the patient's body for a longer period than intended, and can increase the chance for unwanted or severe side effects.

Patients taking Acitretin should not donate blood during treatment, and also for a period of three years following treatment, unless they are directed by their doctor. Any women who are pregnant or considering becoming pregnant should not receive blood which contains this medication.

Patients suffering from liver problems should not take Acitretin. In addition, Acitretin may cause liver problems while a patient is using this medicine. If a patient is experiencing any one or more of the following symptoms, they should contact their doctor right away: headache, itching, nausea and vomiting, stomach tenderness or abdominal pain, light colored stools, darkened urine, a lower than normal appetite, a skin rash unrelated to the condition being treated, the swelling of legs or feet, unusual tiredness or weakness, or yellow eyes or skin.

Patients should be aware that Acitretin may cause side effects involving muscle or joint pain, and as a result may find that they get hurt more easily during rough sports, or may heal more slowly than usual.

While Acitretin can cause eye problems or night blindness, this night blindness may appear suddenly. While experiencing vision problems, a patient should not drive or use machinery which could be dangerous, and should check with their doctor right away for any changes in their vision.

Patients who are diabetic should note that Acitretin can affect blood sugar levels. If there is any change in a patient's blood or urine sugar tests, the patient should talk to their doctor. It is also possible that pancreatitis can occur while taking Acitretin. If patients notice symptoms such as sudden or severe stomach pain, constipation, nausea, vomiting, chills, fever, or lightheadedness, they should contact their doctor immediately.

One rare but serious condition called capillary leak syndrome may occur while taking Acitretin. If a patient experiences fever, a decrease or increase in the amount of urine or cloudy urine, has fainting spells or lightheadedness, nausea, stomach pain, or swelling of hands, ankles, feet, or lower legs, they should contact their doctor immediately.

Storage

Acitretin should be stored in a closed bottle or container and kept at room temperature. This medication should be kept away from heat, moisture, and direct light. Do not freeze this medication.

This medication should be kept out of the reach of children. It's always good practice to properly dispose of this or any other medication when it is no longer needed, or if it has expired. A healthcare or law enforcement professional can assist with disposing of this and any other medications that are not being used or have expired.

Summary

Acitretin is a medication taken for severe skin conditions, such as psoriasis, in which skin cells grow abnormally causing there to be thick, scaly red patches on the skin. These patches can be painful, itchy and embarrassing. Over the course of two to three weeks, the medication will begin to reduce the thick scaly spots, and reduce the associated itching and redness. Where this painful and unattractive disease can cause pain and embarrassment, using Acitretin as directed by a doctor can relieve those symptoms.

The correct dose of Acitretin for any given patient will depend on the severity of the skin condition, the other medical history of the patient, and whether the patient is pregnant or intends to become pregnant within three years of stopping the medication. This medication should be taken with food, and should be taken only as prescribed, to lessen or prevent the occurrence of side effects.

There are a number of common side effects for Acitretin, which affect approximately one in ten patients. These include dryness of the mouth, throat, eyes, muscle or joint pain, swelling or stiffness, and swollen or red skin patches beyond those being treated with Acitretin. There are a number of serious but rarer side effects, which can include back pain, muscle or joint stiffness or swelling, and mouth or throat redness or soreness, as well as increased redness in areas not being treated by the medication.

The most serious side effect of Acitretin is that it can cause birth defects in an unborn fetus. It is highly recommended that any patient who is pregnant or who intends to become pregnant within three years of stopping this medication should notify their doctor before taking this drug. The patient will be required to undergo blood tests, pregnancy tests, and to use two forms of birth control to prevent pregnancy while on this medication. She and her doctor can discuss how taking Acitretin will impact her future plans for pregnancy.

Using Acitretin has been beneficial to many adults who have the skin condition psoriasis. However, a patient must work with their doctor to avoid and manage the side effects that come with its use. With a thorough review of the patient's medical history and by strictly following a treatment plan, patients can achieve relief from this painful condition.

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Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018