alitretinoin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
alitretinoin: clinical details
Prescribing considerations
- Reserve for severe chronic hand eczema unresponsive to potent topical corticosteroids and not adequately controlled by skin protection and avoidance measures.
- Prescribing should be undertaken by dermatologists or clinicians experienced with systemic retinoids.
- Assess pregnancy potential and meet Pregnancy Prevention Programme conditions where applicable.
- Review psychiatric history, cardiovascular and metabolic risk, diabetes, visual symptoms, renal and hepatic function, and concurrent medicines.
- Advise against blood donation during treatment and for one month afterwards.
Contraindications and cautions
- Pregnancy or failure to meet Pregnancy Prevention Programme conditions where pregnancy is possible
- Breastfeeding
- Hepatic impairment or severe renal impairment
- Uncontrolled hypercholesterolaemia, hypertriglyceridaemia or hypothyroidism
- Hypervitaminosis A
- Concurrent tetracycline treatment
- Hypersensitivity to alitretinoin, other retinoids or excipients, including peanut or soya allergy
- Rare hereditary fructose intolerance because the capsules contain sorbitol
Monitoring
- Document pregnancy testing and ongoing pregnancy-prevention measures where applicable.
- Check fasting cholesterol and triglycerides; consider closer lipid or glucose surveillance in higher-risk patients.
- Ask about depression, mood disturbance, aggression and other psychiatric symptoms before treatment and at reviews.
- Review thyroid and liver blood-test changes and investigate clinically relevant abnormalities.
- Assess new visual symptoms promptly.
- Watch for severe diarrhoea, pancreatitis symptoms and features of intracranial hypertension.
Clinical pharmacology
Alitretinoin is 9-cis-retinoic acid, an endogenous pan-agonist at RAR and RXR receptors. It has immunomodulatory and anti-inflammatory actions, is metabolised mainly through CYP2C9, CYP2C8 and CYP3A4, and has an active circulating metabolite. Absorption is low and variable when fasting and substantially increased with food.
Formulation and product differences
- The selected product comprises soft capsules in two strengths, distinguished by colour, size and the imprints A1 and A3.
- Capsules contain refined soya-bean oil, gelatin and sorbitol and must be swallowed whole.
- Retain the blister in the outer carton to protect capsules from light.
alitretinoin preparations and strengths
Capsule
Route: Oral
Strengths: 10 mg, 30 mg
alitretinoin interactions
Check all prescribed, over-the-counter and complementary products with the specialist or pharmacist.
Tetracycline antibiotics
The combination is contraindicated because it can increase the risk of raised pressure around the brain.
Vitamin A supplements or other retinoids
Avoid concurrent use because additive effects can cause vitamin A toxicity.
Ketoconazole and other strong CYP3A4 inhibitors
They may increase alitretinoin exposure and require specialist review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.