acitretin (Soriatane)
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Introduction
Tradename: Soriatane.
Indications
- treatment of recalcitrant psoriasis
- cutaneous T-cell lymphoma[4]
- lichen planus[4]
- lamellar ichthyosis
- erythroderma
- Darier-White disease[4]
Contraindications
- pregnancy
- females must be tested for pregnancy prior to use
- females must be placed on effective contraceptive 1 month prior to & 3 years after therapy
- lactation[4]
- alchoholism
- increased intracranial pressure
- severe hepatic failure
- severe renal failure
- acute pancreatitis[4]
Dosage
25-50 mg PO QD-weekly. Give with food
Tabs: 10, 25 mg.
Monitor
- serum AST, serum ALT & serum LDH
- prior to initiation of therapy
- every 1-2 weeks for 1st 1-2 months of therapy
- as necessary > 2 months of therapy
- stop if evidence of hepatotoxicity
- lipid panel
- prior to initiation of therapy
- every 1-2 weeks until response to therapy is established, usually 4-8 weeks
- continue close monitoring in patients with diabetes, obesity, alcohol use, or personal or famility history of lipid disorder
- serum glucose:
- monitor carefully in patients with diabetes
- may increase or decrease serum glucose
Adverse effects
- mucous membranes
- chelitis (75%)
- rhinitis 25-50%
- xerostomia (10-25%)
- epistaxis (10-25%)
- skin & skin appendages
- alopecia, skin peeling (50-75%)
- dry skin, nail disorder, pruritus (25-50%)
- erythematous rash, hyperesthesia, paresthesia, paronychia, skin atrophy, sticky skin (10-25%)
- eye - xerophthalmia (10-25%)
- musculoskeletal
- arthralgia, spinal hyperostosis (10-25%)
- central nervous system - rigors (10-25%)
- increased triglycerides (25-50%)
- pseudotumor cerebri (uncommon)
- hepatotoxicity
- headache
Drug interactions
- may increase hepatotoxicity of methotrexate
- increased toxicity in combination with alcohol
- may increase hypoglycemic effect of glyburide
- may decrease effectiveness of 'minipill'
- increased toxicity of vitamin A
- risk of pseudotumor cerebri increased by coadministration of doxycycline
Mechanism of action
- unknown
- related to vitamin A activity
- possible reduction in cell proliferation
- anti-keratizing effects
- anti-inflammatory effects
Active metabolite of etretinate (Tegison).
More general terms
Additional terms
References
- ↑ The 1998 Physician's Desk Reference (PDR), Medical Economics
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 - not on National VA formulary
- ↑ Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Deprecated Reference