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Published: June 2010

Acitretin (Neotigason) - points to remember

Prescriber Update 31(2): 16
June 2010

Acitretin is a synthetic aromatic analogue of retinoic acid indicated for the treatment of severe psoriasis, disorders of keratinisation and other dermatoses responsive to etretinate.1 Acitretin is an active metabolite of etretinate.

Acitretin should only be prescribed by physicians who are experienced in the use of systemic retinoids and understand the risks associated with treatment. A number of important precautions must be considered when prescribing this medicine.

Acitretin is highly teratogenic and is contraindicated in pregnant women and nursing mothers. It should not be used in women of childbearing potential unless a number of prescribing conditions are met (see Neotigason data sheet).

If acitretin is used in a woman of childbearing potential, pregnancy must be avoided for two years following discontinuation of therapy. Strict contraception must be used for one month prior to, during, and for 24 months after treatment. In addition alcohol must be avoided during and for two months after treatment due to an interaction that increases the concentration of etretinate. Etretinate is also highly teratogenic and has a longer half life than acitretin. The mechanism for this interaction is not yet understood.

Acitretin is also contraindicated in patients with severely impaired hepatic or renal function and in patients with chronic abnormally elevated blood lipids. Hepatic function, serum cholesterol and serum triglycerides should be assessed prior to starting acitretin treatment and regularly during therapy.

In patients receiving acitretin, concomitant administration of vitamin A and other retinoids must be avoided due to the risk of hypervitaminosis A. Combined use of tetracyclcines or methotrexate with acitretin must also be avoided.

As for all medicines, prescribers are encouraged to familiarise themselves with the information contained in the data sheet before prescribing acitretin.

References
  1. Pharmacy Retailing NZ Ltd, trading as Healthcare Logistics. 4 February 2010. Neotigason (acitretin) data sheet. www.medsafe.govt.nz/profs/Datasheet/n/Neotigasoncap.pdf

 

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