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Alitretinoin: Indications, Dosing, Side Effects and Interactions
Alitretinoin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Alitretinoin: Indications, Dosing, Side Effects and Interactions
Alitretinoin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Severe chronic hand eczema refractory to potent topical corticosteroids**
- **Adult** (By Mouth): (prescribed by or under supervision of a consultant dermatologist) 30 mg once daily; reduced if not tolerated to 10 mg once daily for 12-24 weeks total duration of treatment, discontinue if no response after 12 weeks, course may be repeated in those who relapse.
Cautions
Avoid blood donation during treatment and for at least 1 month after stopping treatment; dry eye syndrome; history of depression (risk of neuropsychiatric reactions)
Contraindications
A; uncontrolled hyperlipidaemia; uncontrolled hypothyroidism
Side effects
Common or very common Alopecia; anaemia; conjunctivitis; dizziness; dry eye; dry mouth; eye irritation; fatigue; flushing; headache; hypercholesterolaemia; hypertension; hypertriglyceridaemia (risk of pancreatitis if triglycerides above 9 mmol/litre); joint disorders; myalgia; nausea; oral disorders; skin reactions; tinnitus; vomiting Uncommon Bone disorders; cataract; dyspepsia; epistaxis; vision disorders Rare or very rare Anxiety; behaviour abnormal; depression; hair texture abnormal; idiopathic intracranial hypertension; mood altered; nail disorder; photosensitivity reaction; psychotic disorder; suicidal behaviours; vasculitis Frequency not known Inflammatory bowel disease; peripheral oedema Side-effects, further information Dry eyes may respond to lubricating eye ointment or tear replacement therapy. Discontinue treatment if signs or symptoms of idiopathic intracranial hypertension such as headache, nausea, vomiting, papilloedema, or visual disturbances occur. Risk of pancreatitis if triglycerides above 9 mmol/litre-discontinue if uncontrolled hypertriglyceridaemia or pancreatitis.
Interactions
**Other interactions (9):**
- Pharmacokinetic interaction Alitretinoin is metabolized by cytochrome P450 (CYP) 2C9, CYP2C8, CYP3A4 and undergoes isomerisation.
- Concomitant medications that may affect the pharmacokinetics of alitretinoin Co-administration with CYP3A4 inhibitors such as ketoconazole increases the plasma level of alitretinoin and therefore...
- A reduction in dose to 10 mg should be considered when alitretinoin is co-administered with potent CYP2C9 inhibitors (e.g.
- Simvastatin did not affect the pharmacokinetics of alitretinoin.
- No pharmacokinetic interactions were observed when alitretinoin was co-administered with ciclosporin.
- Effect of alitretinoin on the pharmacokinetics of concomitant medications Alitretinoin may increase the exposure of CYP2C8 substrates; therefore co-administration with amiodarone (a CYP2C8 substrate...
Pregnancy
Important safety information For alitretinoin 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
Manufacturer advises avoid.
Hepatic impairment
Manufacturer advises avoid-limited information available.
Renal impairment
Avoid in moderate to severe impairment (no information available). M
Medicinal forms
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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