Formulary
Acitretin: Indications, Dosing, Side Effects and Interactions
Acitretin is a metabolite of etretinate.
MedNext Academy | 4 min read
Acitretin: Indications, Dosing, Side Effects and Interactions
Acitretin is a metabolite of etretinate.
Drug action
Acitretin is a metabolite of etretinate.
Indications and dose
**Severe extensive psoriasis resistant to other forms of therapy (under expert supervision),Palmoplantar pustular psoriasis (under expert supervision),Severe congenital ichthyosis (under expert supervision)**
- **Adult** (By Mouth): Initially 25-30 mg daily for 2-4 weeks, then adjusted according to response to 25-50 mg daily, increased to up to 75 mg daily, dose only increased to 75 mg daily for short periods in psoriasis.
**Severe Darier's disease (keratosis follicularis) (under expert supervision)**
- **Adult** (By Mouth): Initially 10 mg daily for 2-4 weeks, then adjusted according to response to 25-50 mg daily.
**Severe extensive psoriasis resistant to other forms of therapy (under expert supervision), Palmoplantar pustular psoriasis (under expert supervision), Severe congenital ichthyosis (under expert supervision) for acitretin**
- **Child 1 month-11 years** (By mouth): 0.5 mg/kg once daily; increased if necessary to 1 mg/kg once daily, to be taken with food or milk, careful monitoring of musculoskeletal development required; maximum 35 mg per day.
- **Child 12-17 years** (By mouth): Initially 25-30 mg daily for 2-4 weeks, then adjusted according to response to 25-50 mg daily, increased to up to 75 mg daily, dose only increased to 75 mg daily for short periods in psoriasis.
**Severe Darier's disease (keratosis follicularis) (under expert supervision) for acitretin**
- **Child 1 month-11 years** (By mouth): 0.5 mg/kg once daily; increased if necessary to 1 mg/kg once daily, to be taken with food or milk, careful monitoring of musculoskeletal development required; maximum 35 mg per day.
- **Child 12-17 years** (By mouth): Initially 10 mg daily for 2-4 weeks, then adjusted according to response to 25-50 mg daily.
**Harlequin ichthyosis (under expert supervision) for acitretin**
- **Neonate** (By mouth): 0.5 mg/kg once daily; increased if necessary to 1 mg/kg once daily, to be taken with food or milk, careful monitoring of musculoskeletal development required.
Cautions
Avoid excessive exposure to sunlight and unsupervised use of sunlamps; diabetes (can alter glucose tolerance-initial frequent blood glucose checks); do not donate blood during and for 3 years after stopping therapy (teratogenic risk); history of depression (risk of neuropsychiatric reactions); investigate atypical musculoskeletal symptoms
Contraindications
Hyperlipidaemia
Side effects
Common or very common Abdominal pain; arthralgia; brittle nails; diarrhoea; dry mouth; eye inflammation; gastrointestinal disorder; haemorrhage; hair texture abnormal; headache; increased risk of infection; mucosal abnormalities; myalgia; nausea; oral disorders; peripheral oedema; skin reactions; thirst; vomiting; xerophthalmia Uncommon Dizziness; hepatic disorders; photosensitivity reaction; vision disorders Rare or very rare Bone pain; exostosis; idiopathic intracranial hypertension; peripheral neuropathy Frequency not known Angioedema; anxiety; capillary leak syndrome; depression; drowsiness; dysphonia; flushing; glucose tolerance impaired; granuloma; hearing impairment; hyperhidrosis; malaise; mood altered; psychiatric disorder; pyogenic granuloma; retinoic acid syndrome; taste altered; tinnitus Side-effects, further information Exostosis Skeletal hyperostosis and extra-osseous calcification reported following long-term treatment with etretinate (of which acitretin is a metabolite) and premature epiphyseal closure in children. Benign intracranial hypertension Discontinue if severe headache, nausea, vomiting, or visual disturbances occur.
Interactions
**Other interactions (7):**
- An increased risk of hepatitis has been reported following the concomitant use of methotrexate and etretinate.
- Low dose progesterone-only products (minipills) may be an inadequate method of contraception during acitretin therapy, see section 4.6.
- In a study with healthy volunteers, concurrent intake of a single dose of acitretin together with alcohol led to the formation of etretinate which is highly teratogenic.
- Women of childbearing age must therefore not consume alcohol (in drinks, food or medicines) during treatment with acitretin and for 2 months after cessation of acitretin therapy.
- In concurrent treatment with phenytoin, it must be remembered that Acitretin partially reduces the protein binding of phenytoin.
- Interactions between Acitretin and other substances (e.g.
Pregnancy
Important safety information For acitretin MHRA/CHM advice: Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women (June 2019) New prescriber checklists, patient reminder cards, and pharmacy checklists are available to support the Pregnancy Prevention Programme in women and girls of childbearing potential taking oral acitretin, alitretinoin, or isotretinoin. Healthcare professionals are reminded that the use of oral retinoids is contra-indicated in pregnancy due to a high risk of serious congenital malformations, and any use in females must be within the conditions of the Pregnancy Prevention Programme (see Conception and contraception and Prescribing and dispensing information ). Neuropsychiatric reactions have been reported in patients taking oral retinoids. Healthcare professionals are advised to monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment, if necessary; particular care is needed in those with a history of depression. Patients should be advised to speak to their doctor if they experience any changes in mood or behaviour, and encouraged to ask family and friends to look out for any change in mood.
Breast feeding
Avoid.
Hepatic impairment
Manufacturer advises avoid in severe impairment.
Renal impairment
Avoid in severe impairment (increased risk of toxicity). M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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