Acitretin

Notice! Control of values: transaminases, alkaline phospatase, gamma-GT, creatinine, triglycerides, cholesterol, glucose. In patients with a history of abnormal kidney, liver or lipid metabolism: urea, uric acid, urine status, bilirubin, lipid electrophoresis (every 4 weeks).

• Adults initially 3 Kps./day neotigasone 10, over 2-4 Wo., then depending on the effect increase to a maximum 3 Kps./day neotigasone 25. maintenance dose usually 30 mg/day for another 6-8 Wo.
• Children: Very strict indication, careful benefit-risk assessment. Initial 0.5 mg/kg bw/day. Maintenance dose 0.1 mg/kg bw/day, in no case > 0.2 mg/kg bw/day or > 35 mg/day.

Notice! Pregnancy must be ruled out before therapy begins. During therapy and up to 2 years after discontinuation of the preparation, effective contraception must be used, although the effect of oral contraceptives may be impaired. Low-dose progesterone preparations (so-called minipills) should not be used for contraception as the contraceptive effect of these preparations can be reduced by interaction with acitretin. Regular monitoring of the skeleton during long-term therapy. In children, carefully monitor growth (bone development)!

• Skin and mucous membranes: Depending on the dose: dry, possibly inflamed lips, dry nose, dry eyes, especially when wearing contact lenses, xerosis cutis, classic retinoid dermatitis, granulation tissue in the nail wall, hyperhidrosis.
• Systemic: Substance is teratogenic: No prescription in women of childbearing potential; if there are no treatment options prescription only with simultaneous administration of anticontraceptives up to 2 years after taking the last tablet. Reversible increase in transaminases, possibly hepatotoxic (< 1%), centrilobular toxic liver necrosis, hyperostoses, osteoporosis, bone pain, calcification of muscles and ligaments, increase in triglycerides and cholesterol levels (in 20% of cases), increase in VLDL and decrease in HDL.

Notice! Special caution should be taken in patients with a history of hepatitis, diabetes mellitus, hyperlipidemia, pancreatitis and known retinal diseases! In rare cases a capillary leak syndrome has been reported.

• Alcohol: Possible conversion of Acitretin to Etretinate.
• Colestyramine: Simultaneous administration should be avoided as the absorption of etretinate is reduced. Acitretin should be given 1 hour before and > 4 hours after colestyramine intake. Effect on glucose tolerance readjustment of diabetes.
• Tetracyclines: danger of intracranial hypertension.
• Methotrexate: Possible additive hepatotoxic effect.
• Isotretinoin and vitamin A: cumulative vitamin A toxicity!

Neotigason, acicutane

1. Estival JL et al (2004) Capillary leak syndrome induced by Acitretin. Br J Dermatol 150: 150-52
2. Kuenzli S, Saurat JH (2001) Retinoids for the treatment of psoriasis: outlook for the future. Curr Opin Investig Drugs 2: 625-630
3. Farewell M et al (2003) Acitretin suppression of squamous cell carcinoma: Case report and literature review. J Dermatolog Treat 14 Suppl2: 3-6
4. Papadimou E et al (2003) Retinoids inhibit human epidermal keratinocyte RNase P activity. Biol Chem 384: 457-462
5. Rim JH et al (2003) The efficacy of calcipotriol + acitretin combination therapy for psoriasis: comparison with acitretin monotherapy. Am J Clin Dermatol 4: 507-510
6. Spuls Pet al. (2003) Retrospective analysis of the treatment of psoriasis of the palms and soles. J Dermatolog Treat 14(Suppl2): 21-25
7. Tsambaos D et al (2003) Peripheral sensory neuropathy associated with short-term oral acitretin therapy. Skin Pharmacol Appl Skin Physiol 16: 46-49
8. Vos LE et al (2007) Acitretin induces capillary leak syndrome in a patient with pustular psoriasis. J Am Acad Dermatol 56: 339-342
9. Zouboulis CC et al (2001) Retinoids--which dermatological indications will benefit in the near future? Skin Pharmacol Appl Skin Physiol 14: 303-315