Author: Dr Amanda Oakley, Department of Dermatology, Waikato Hospital, 1997. Updated February 2016.

What is acitretin?

Acitretin is an oral retinoid (vitamin-A derivative) used to treat severe psoriasis, usually at a dose of 0.25 – 1 mg per kg body weight per day. It is best taken after a meal because it needs fat to be absorbed through the gut wall.

Acitretin is available as 10 mg and 25 mg capsules. Trade names include Neotigason™ and Novatretin®. Since March 2009, PHARMAC funding in New Zealand requires Special Authority application by a dermatologist or vocationally registered general practitioner. Restrictions apply.

What is acitretin used for?

Acitretin is particularly effective for pustular psoriasis, erythrodermic psoriasis and psoriasis affecting hands and feet. It is not effective for psoriatic arthritis.

It is occasionally used to treat other skin conditions including:

Risk of acitretin in pregnancy and during breastfeeding

Acitretin MUST NOT be taken in pregnancy; it can damage an unborn child and cause birth defects. Strict birth control measures must be used during treatment and for two years after stopping acitretin. Therefore, acitretin is rarely prescribed to females of child-bearing potential. If it is, they will be asked to have a blood pregnancy test before treatment and regularly during treatment. People on acitretin should not donate blood during treatment or for two years afterwards. Acitretin should not be taken while breast-feeding.

It has no effect on male sexual function or offspring, so can be taken by males of all ages.

What is the mechanism of action of acitretin?

Acitretin is a metabolite of an earlier antipsoriatic retinoid, etretinate. Etretinate (Tigason™) is no longer available in New Zealand.

Acitretin is thought to work in psoriasis by slowing down the proliferation of the skin cells. A response is noted in more than half of treated patients. Improvement begins about two weeks after starting treatment, and is maximum after about twelve weeks. The affected skin either peels off or gradually clears.

Some patients are treated with acitretin for a few months, repeated from time to time, whilst others remain on the acitretin long term.

In resistant cases, acitretin can be combined with other antipsoriatic drugs and/or phototherapy.

What are the side effects and risks of acitretin?

Acitretin has side effects that may limit the dose that can be used.

Interactions with other medications

Acitretin should not normally be taken at the same time as the following medications (there may be rare exceptions):

It is best to avoid alcohol when on acitretin, especially if triglyceride levels are high.

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