acitretin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
acitretin: clinical details
Prescribing considerations
- Initiation and supervision require experience with systemic retinoids and their teratogenic risk.
- Assess pregnancy potential and apply the Pregnancy Prevention Programme where relevant.
- Review psychiatric history and monitor for depression, behavioural change or suicidal ideation.
- Counsel about mucocutaneous dryness, photosensitivity, possible reduced night vision, blood-donation restrictions and not sharing capsules.
- Consider musculoskeletal effects where prolonged treatment is contemplated, particularly in children.
Contraindications and cautions
- Pregnancy or pregnancy potential unless every Pregnancy Prevention Programme condition is met
- Breastfeeding
- Hepatic or renal failure
- Severe hyperlipidaemia
- Concurrent tetracyclines, methotrexate, vitamin A, other retinoids or low-dose progestogen-only contraceptive pills
- Hypersensitivity to acitretin, another retinoid or an excipient
Monitoring
- Liver function before treatment and regularly thereafter
- Fasting cholesterol and triglycerides before treatment and periodically thereafter
- Pregnancy testing before and during treatment and periodically for three years after stopping where the Pregnancy Prevention Programme applies
- Mood, behaviour and suicidal ideation
- Visual symptoms, especially impaired night vision
- Bone pain, restricted mobility, growth and skeletal development when clinically relevant
Clinical pharmacology
Oral bioavailability is improved by food. Acitretin is highly lipophilic and more than 99% protein bound; it is metabolised to cis-acitretin and other metabolites, which are eliminated through urine and bile. Alcohol can promote conversion to etretinate, a highly teratogenic metabolite with prolonged persistence.
Formulation and product differences
- The selected product is a hard gelatin capsule with a white to off-white body, brown cap, black “A10” marking and yellow powder filling.
- It contains gelatin and is essentially sodium-free.
- It is supplied in moisture-protective blister packaging and should remain in its original package.
acitretin preparations and strengths
Capsule
Route: Oral
Strengths: 10 mg, 25 mg
acitretin interactions
Check prescription, over-the-counter and complementary products before treatment. Important interactions include:
Tetracycline antibiotics
Concurrent use is contraindicated because both can increase pressure around the brain.
Methotrexate
Concurrent use is contraindicated because of the risk of liver inflammation.
Vitamin A supplements or other retinoids
Avoid concurrent use because vitamin A toxicity may be increased.
Low-dose progestogen-only contraceptive pills
Acitretin may reduce their contraceptive effect, so they must not be relied upon during treatment.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.