How does this medication work? What will it do for me?

Acitretin is a derivative of vitamin A. It is used to treat severe psoriasis and other skin disorders. Acitretin reduces the speed at which the cells involved in psoriasis are formed. It may take 2 to 3 months before the full benefit of acitretin is seen.

Psoriasis is a skin condition that involves chronically occurring bright red patches covered with silvery scales. It cannot be passed from one person to another.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

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What form(s) does this medication come in?

10 mg
Each brown and white, hard gelatin capsule (No. 4) with "ACTAVIS" in black lettering contains acitretin 10 mg. Nonmedicinal ingredients: gelatin, glucose (liquid, spray-dried), microcrystalline cellulose, and sodium ascorbate; gelatin capsule shell: iron oxide (yellow, black, and red) and titanium dioxide.

25 mg
Each brown and yellow, hard gelatin capsule (No. 1) with "ACTAVIS" in black lettering contains acitretin 25 mg. Nonmedicinal ingredients: gelatin, glucose (liquid, spray-dried), microcrystalline cellulose, and sodium ascorbate; gelatin capsule shell: iron oxide (yellow, black, and red) and titanium dioxide.

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How should I use this medication?

The recommended starting dose of acitretin is 25 mg once daily.If the desired effect has not been seen after 4 weeks and side effects have been tolerated, your doctor may increase the dose to 50 mg once daily. The maximum dose is 75 mg once a day.

Acitretin should be taken once daily with food or just after a meal.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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Who should NOT take this medication?

Do not take acitretin if you:

  • are allergic to acitretin, vitamin A, or any of the ingredients of the medication
  • have certain types of abnormal cholesterol levels
  • have excess vitamin A in the body
  • have severely reduced kidney or liver function
  • are taking methotrexate or tetracyclines

A woman capable of becoming pregnant must not take acitretin unless ALL of the following criteria are met:

  • She is able to use 2 effective birth control methods.
  • She is reliable in understanding and carrying out instructions.
  • She has had 2 negative pregnancy tests before the start of treatment (the first at the screening appointment and the second up to 3 days before the first dose of acitretin).
  • She will have pregnancy tests at 28-day intervals throughout treatment.
  • She has received and understands information regarding the risks of having babies with deformities associated with acitretin exposure.
  • She has severe psoriasis or other severe skin disease, as judged by the doctor.
  • She will have pregnancy tests every 1 to 3 months for at least 3 years after the last dose of acitretin.

Acitretin must not be taken by pregnant women. As well, women must not become pregnant while taking acitretin and should use effective birth control for at least 3years after stopping this medication. Women should not breast-feed while taking acitretin or for 3 years after stopping the medication.

Alcohol must not be consumed while taking acitretin and for 2 months after stopping the treatment.

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What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

When acitretin is first started, you may experience more redness, itching, skin scaling, peeling, and dry skin for the first month as your body adjusts to the medication. This will normally fade as treatment continues. It is important that you see your doctor regularly (preferably once a month) and report any side effects that become bothersome.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • abnormal hair texture
  • back pain
  • change in appetite
  • cold or clammy skin
  • diarrhea
  • dry eyes
  • dry mouth, chapped lips (especially in the first few weeks)
  • dry skin
  • earache
  • fatigue
  • fluid retention
  • gum swelling or bleeding
  • hair loss (especially in the first few weeks)
  • headache
  • impotence
  • increased appetite
  • increased saliva
  • increased sweating
  • infection
  • inflammation around the fingernails
  • insomnia (difficulty sleeping)
  • itchiness (especially in the first few weeks)
  • mouth sores
  • muscle pain
  • nail disorders
  • nausea
  • nervousness
  • nosebleeds
  • numbness
  • rash
  • rhinitis (runny nose)
  • ringing in the ears
  • sensitivity of skin or eyes to light
  • skin peeling or scaling (especially in the first few weeks)
  • skin ulcers
  • sore joints
  • sticky skin
  • taste disturbances
  • thirst

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal vision
  • aches or pains in bones or joints
  • arthritis
  • bleeding or inflammation of the gums
  • blurred vision
  • dark urine
  • decrease in night vision
  • difficulty in moving
  • eye irritation
  • eye pain
  • eye sensitivity to light
  • flu-like symptoms
  • headaches
  • hearing problems
  • nausea (severe)
  • other visual problems
  • persistent feeling of dry eyes
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • vomiting
  • yellowing of the skin or eyes

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worst when breathing in, coughing, coughing up blood, sweating, or passing out)
  • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
  • signs of stroke (e.g., sudden headache, weakness or numbness in an arm or leg, difficulty speaking or understanding, sudden vision difficulty, dizziness)
  • signs of retinoic acid syndrome (e.g., fever, shortness of breath, swelling or puffiness of the arms, legs and feet, weight gain, difficulty in urination, yellowing of the skin or eyes)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Alcohol: Alcohol must not be consumed while taking acitretin and for 2 months after stopping the treatment. This includes alcohol in foods, drinks, and medicines.

Benign intracranial hypertension: Acitretin has been known to cause a condition called benign intracranial hypertension. Contact your doctor if you experience headaches, nausea and vomiting, or changes in vision.

Blood donation: Do not donate blood while taking acitretin and for at least 3 years after your last dose of acitretin, as your blood should not be given to pregnant women.

Cholesterol: Acitretin has been found to cause an increase in cholesterol and other lipids in the blood. You are more likely to experience this if you are already at an increased risk of developing high cholesterol, for example if you have diabetes or a family history of high cholesterol, are overweight, or have an increased alcohol intake.

If you are at any increased risk of developing increased blood lipids, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Contact lenses: If you wear contact lenses, you may find them uncomfortable during and after treatment with acitretin due to dry eyes.

Decreased night vision: Acitretin may cause decreased night vision. Do not drive or operate heavy machinery at night until you know how this medication affects you.

Depression and suicidal thoughts: Retinoid medications have been known to cause mood swings and symptoms of depression. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, or decreased interest in activities, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.

Diabetes: Acitretin can cause changes in glucose tolerance for people with diabetes. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Excessive bone growth: Long-term use of acitretin may lead to excessive bone growth or unusual bone formation. Your doctor may request that you have yearly X-rays to monitor for bone changes.

Liver function: Retinoids like acitretin have been linked to inflammation of the liver in some cases. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor as soon as possible.

Stomach and bowels: Other retinoid medications have occasionally caused inflammatory bowel disease (IBD). If you have inflammatory bowel disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience severe abdominal pain, rectal bleeding or severe diarrhea, you should stop using this medication and contact your doctor.

Sun sensitivity: Acitretin may make you more likely to burn in the sun. Use appropriate measures to prevent excessive exposure to the sun. Wear a hat and sunglasses when out in the sun, use a sunscreen with an SPF of 30 or higher, and avoid going out in the sun between 10 am and 2 pm when the sun is at its strongest. Avoid using sun lamps and tanning beds.

Women capable of becoming pregnant: See "Who should not take this medication?"

Pregnancy: Acitretin can cause birth defects. This medication must not be taken during pregnancy. If you become pregnant while taking acitretin, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking acitretin, it may affect your baby. Breast-feeding mothers must not take this medication.

Children: The safety and efficacy of using this medication have not been established for children.

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What other drugs could interact with this medication?

There may be an interaction between acitretin and any of the following:

  • alcohol
  • any medications or products containing vitamin A (including multivitamins)
  • any medications or products related to vitamin A
  • carbamazepine
  • methotrexate
  • phenytoin
  • progestin-only birth control
  • sulfonylureas (e.g., glyburide)
  • tetracyclines (e.g., tetracycline, doxycycline, minocycline)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.