Acitretin
SORIATANE
Pronunciation: a-si-TRE-tin (sor-RYE-a-tayn)
What it isSystemic retinoid normalizing keratinization; severe psoriasis, particularly pustular and erythrodermic.
Why this oneIt is not immunosuppressive, so it can be used where biologics are contraindicated, including in HIV.
What limits it⚑ Teratogenicity persists because alcohol converts it to etretinate; pregnancy must be avoided for three years. Hyperlipidemia and dryness occur.
FDA-approved for
- severe psoriasis (1996)
Off-label
- lichen planus
- chemoprophylaxis of skin cancer in transplant recipients
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe psoriasis | Adult | 25–50 mg QD with main meal | 25–50 mg QD |
Renal Contraindicated in severely impaired kidney function
Hepatic Contraindicated in severely impaired liver function
Instructions
- Take as a single daily dose with the main meal.
- Dispense no more than a 1-month supply; provide Medication Guide at each dispensing.
- Females of childbearing potential: no ethanol during therapy and for 2 months after.
Available strengths
- cap 10, 17.5, 22.5, 25 mg
Contraindications
- Pregnancy (teratogenic — see Boxed Warning)
- Severely impaired liver or kidney function
- Chronic abnormally elevated blood lipid values
- Concomitant methotrexate — increased risk of hepatitis
- Concomitant tetracyclines — both can cause increased intracranial pressure
- Microdosed “minipill” progestin preparations not recommended as contraception — acitretin interferes with their contraceptive effect
Cautions
- Hepatotoxicity — monitor liver function; hepatitis reported.
- Hyperlipidemia (elevated triglycerides/cholesterol, decreased HDL) with cardiovascular risk.
- Pseudotumor cerebri (intracranial hypertension).
- Psychiatric: depression, aggressive feelings, suicidal thoughts reported.
- Skeletal hyperostosis; capillary leak syndrome and thromboembolism reported.
Adverse reactions
- Cheilitis, dry skin, skin peeling/fragility
- Alopecia, nail disorders, paronychia
- Xerophthalmia, rhinitis, epistaxis
- Arthralgia, pruritus, paresthesia
- Elevated LFTs; elevated triglycerides/cholesterol, decreased HDL
Pregnancy Contraindicated — teratogenic; prevent pregnancy during therapy and for ≥3 years after (see Boxed Warning).
Lactation Undefined
Cost
Generic entry2013
⚠ BOXED WARNING
- Embryo-fetal toxicity; avoid pregnancy for three years
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.