Acitretin

Generic name: Acitretin
Brand names: Soriatane

Why is Acitretin prescribed?

Soriatane is prescribed for several types of severe psoriasis, a chronic skin condition that causes inflamed red patches with silvery scales. In more severe cases, the skin thickens with painful patches that fill with pus and crust over, sometimes on large portions of the body. Psoriasis can appear anywhere, but most commonly erupts on the chest and back, elbows and knees, feet and hands, scalp, and fingernails. Soriatane is used when milder forms of treatment have failed.

It's important to remember that Soriatane does not cure psoriasis; it merely helps keep it under control. Your condition may return if you stop treatment.

Most important fact about Acitretin

Soriatane must never be taken during pregnancy, as it can cause severe birth defects and physical abnormalities in a developing baby. You must not become pregnant while taking Soriatane, and you must also avoid becoming pregnant for a full 3 years after you stop taking it.

Before starting Soriatane therapy, women of childbearing age must receive birth control counseling and sign a detailed consent form stating they understand the consequences of birth control failure, the risk of birth defects, and the warning not to use alcohol (see "Special warnings about Acitretin"). You must have two negative pregnancy tests, one when you and your doctor decide on a course of Soriatane therapy and one immediately before starting treatment. You must take monthly pregnancy tests and continue to receive regular birth control counseling while using Acitretin.

In addition, you must use two forms of reliable birth control for at least 1 month prior to starting treatment, as well as for the entire time you take Soriatane and for a full 3 years after discontinuing therapy. It can take 3 years for Acitretin to be eliminated from the body.

You cannot choose progestin "mini-pill" products (such as Micronor, Nor-QD, and Ovrette) as a form of birth control because Soriatane interferes with their effectiveness. It is not yet known whether Soriatane interferes with the reliability of other hormone-based contraceptives (combination estrogen/progestin birth control pills, implants, and injections). A qualified counselor or doctor must clearly explain what kinds of birth control are effective. Women taking Soriatane who have previously taken the drug Tegison (etretinate) must continue to follow the birth control requirements for Tegison.

Your doctor can give you a referral for free birth control counseling and pregnancy testing. If you accidentally become pregnant, miss a menstrual period, or have unprotected sex while taking Soriatane, stop taking the drug and call your doctor immediately.

How should you take Acitretin?

Take Soriatane with food, exactly as prescribed by your doctor, at about the same time each day. Symptoms sometimes worsen after treatment begins, and it may take several months for your condition to improve.

--If you miss a dose...

Take the forgotten dose as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular schedule. Do not take two doses at once.

--Storage instructions...

Store at room temperature, away from light and humidity, in a childproof container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Soriatane.

More common side effects may include:
Abnormal bone growth or pain, abnormal skin changes (itching, peeling, rash, sensitivity, thinning), blood clot, changes in blood sugar or cholesterol and triglyceride (blood fat) levels, depression, eye symptoms (dryness, pain, redness, sensitivity), heart attack, joint pain, lip inflammation, liver disorders, muscle weakness, numbness or swelling of the hands or feet, inflammation of the pancreas, stroke, thoughts of suicide or self-injury, vision problems (blurring difficulty seeing at night)

Why should Acitretin not be prescribed?

Do not take Soriatane if it causes an allergic reaction or if you have ever had an allergic reaction to other drugs like it (retinoids such as Accutane and Tegison). You must also avoid Acitretin if you have kidney or liver disease, or if you have abnormally high cholesterol or triglyceride levels.

You must not take Soriatane if you are pregnant or if you plan to become pregnant within the next 3 years (see "Most important fact about Acitretin").

Soriatane must never be taken with the drugs methotrexate (Rheumatrex and Trexall) or tetracycline antibiotics (such as Achromycin V and Sumycin). The combination can cause serious, sometimes life-threatening illness.

Special warnings about Acitretin

You must not become pregnant while taking Soriatane or within 3 years of taking it (see "Most important fact about Acitretin").

Do not drink alcohol or take products containing alcohol while using Soriatane and for at least 2 months after discontinuing treatment. Combining alcohol with Acitretin causes a chemical change that makes it stay in your system longer. Read the labels on all foods and over-the-counter products to make sure they do not contain alcohol.

Soriatane causes significant changes in the level of sugar and fats in the blood. People with a history of alcoholism, diabetes, heart disease, or high levels of cholesterol or triglycerides, as well as those who are overweight, must be closely monitored when taking Soriatane.

People with degenerative spine or bone conditions must be checked regularly during treatment with Soriatane, since the drug can cause changes in their condition. Drugs like Soriatane are known to cause skeletal and bone growth problems in children. The safety and effectiveness of Soriatane have not been studied in children.

Soriatane may cause mental and behavioral changes. If you start to have symptoms of depression or aggression while taking Soriatane, or if you have thoughts of suicide or self-injury, call the doctor immediately.

Because eye conditions can worsen during Soriatane treatment, you must be carefully monitored by your doctor. The drug can cause decreased night vision and can interfere with the ability to drive or operate a vehicle safely at night. It can also interfere with the ability to wear contact lenses. Be sure to report any vision and eye problems to your doctor right away.

Soriatane increases the effects of sunlight. To prevent burning, do not stay in the sun for long periods; wear protective clothing, sunglasses, and sunscreen; and avoid using sun lamps or tanning beds. If you're being treated with phototherapy--that is, light therapy specifically used for certain skin conditions--your doctor may decrease the dosage of light while you're taking Soriatane.

Both men and women being treated with Soriatane may not give blood for at least 3 years.

Possible food and drug interactions when taking Acitretin

Do not drink alcohol or take products that contain alcohol while using Soriatane (see "Special warnings about Acitretin). Always check labels for alcohol content.

Avoid taking vitamin supplements that contain vitamin A without your doctor's approval. Soriatane is chemically related to vitamin A, and taking too much can cause harmful side effects or a toxic overdose.

If you take the herb St. John's wort, do not use hormonal estrogen/progestin pills, implants, or injections as a form of birth control. Women who take these products together can become pregnant. Make sure your doctor knows about any over-the-counter products you are taking.

If Soriatane is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Soriatane with the following:

Birth control "mini-pills" containing progestin, such as Micronor, Nor-QD, and Ovrette
Demeclocycline (Declomycin)
Doxycyline (Doryx, Vibramycin)
Etretinate (Tegison)
Methotrexate (Rheumatrex, Trexall)
Minocycline (Dynacin, Minocin)
Retinoids such as isotretinoin (Accutane) and tretinoin (Vesanoid)
Phenytoin (Dilantin)
Tetracycline (Achromycin V, Sumycin)

Special information if you are pregnant or breastfeeding

If taken during pregnancy, Soriatane can cause severe birth defects and physical abnormalities in a developing baby (see "Most important fact about Acitretin"). Do not take Soriatane if you are pregnant or plan to become pregnant within 3 years after you stop taking it.

Do not take Soriatane if you're breastfeeding, as it can harm a nursing baby.

Recommended dosage

ADULTS

The recommended dose is 25 to 50 milligrams once a day, taken with your main meal. The pharmacist who fills your prescription will also provide you with a Soriatane medication guide.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek emergency treatment immediately.

After an overdose of Soriatane, all women of childbearing age must take a pregnancy test. They must also be counseled on the risk of birth defects and the need to use two effective forms of birth control for the next 3 years.

Symptoms of overdose may include:
Headache, vertigo (dizziness and a feeling that you or the room is spinning or moving)


Image : Acitretin