Is Acitretin
Right For You?
Before beginning treatment with
acitretin, your doctor may ask you several questions,
examine you, and discuss with you the different treatments
available, side effects, and reasons patients should
not take acitretin. Some tests will also be performed,
including a pregnancy test (in fertile women), a complete
blood cell count, and liver and kidney function tests.
In addition, a blood lipid (fat) test will be done (you
will not be able to eat for 12 hours prior to the test).
Blood lipid tests include testing triglycerides and
cholesterol levels.
Acitretin is well known to cause
birth defects when given to pregnant women. Those who
are fertile should use two effective forms of birth
control for at least one month before starting acitretin,
and, a pregnancy test should be taken one week prior
to beginning treatment—which should be on day
two or three of your menstrual period. In women of childbearing
potential, alcohol should not be consumed during therapy
or for two months after therapy is stopped. Also, it
is very important that effective birth control is continued
for at least three years after stopping acitretin. No
one who is taking acitretin can donate blood—if
a pregnant woman was to receive blood from a person
on acitretin, the unborn fetus could be seriously harmed.
Retinoids
and Birth Defects
All retinoids can cause severe
birth defects in the developing fetus. Therefore, it
is critical that women who are pregnant or who could
become pregnant during therapy or for two years after
do not take acitretin. Females who could become pregnant
should continue birth control for up to two years after
stopping acitretin
Who Should
Not Take Acitretin?
Women of childbearing potential
must not drink alcohol during therapy and for two months
after therapy is stopped. If alcohol is consumed, acitretin
can change inside the patient's body to a form of the
drug that can remain in the body for an extended period
of time. This conversion increases the risk of birth
defects if a woman was to become pregnant after stopping
acitretin. Women of childbearing potential should not
use acitretin unless they are willing to use reliable
birth control— both while taking the medication
and for at least three years after treatment is stopped.
Before starting acitretin treatment
it is also important to consult your doctor if you are
taking any medication or supplement, especially vitamin
A, tetracyclines, methotrexate or supplements such as
St. John's Wort. These could increase your risk of side
effects.
Do not have surgical cosmetic
procedures on your skin while taking acitretin because
retinoids can increase your chance of scarring or inflammation.
Avoid such procedures or avoid oral retinoids for up
to six months before having such procedures.
As well, you should protect yourself
from the sun and avoid using tanning beds. Some patients
can expose themselves to ultraviolet radiation (UVB/PUVA)
if under a doctor's supervision. Retinoids are known
to increase your skin's sensitivity to ultraviolet light
in both natural and artificial sunlight.
Sun Safety
Tips
Avoid peak sun exposure when
the sun's rays are strongest (between 10:00 a.m. and
3:00 p.m.).
Seek the shade.
Use a broad-spectrum sunscreen
with an SPF of at least 15 that protects against both
UVA and
UVB.
Wear protective clothing, particularly
a broad-brimmed hat and long sleeves.
Reasons a Psoriasis Patient Should
Not Take Acitretin
pregnant or planning to become
pregnant
nursing women
unwilling to use birth control
experience an abnormal decrease
in the number of white blood cells (leukopenia)
experiencing moderate-to-severe
elevation of cholesterol or triglycerides
experiencing major liver abnormality
experiencing major kidney abnormality
Drugs and Supplements That Interact
with Acitretin
vitamin A or any other supplement
containing vitamin A that exceeds the minimum recommended
allowance
certain antibiotics (monocycline,
doxycycline, tetracycline)
cyclosporine
alcohol
methotrexate
St. John's Wort
Side
Effects
While there are many potential
side effects with acitretin, most are mild and short
lived. Acitretin has a better safety profile than most
other available systemic agents, and is a useful medication
for appropriate psoriasis patients.
Some side effects occur after
a few weeks of starting treatment but will often improve.
These include chapped lips, dry skin, nose bleeds, dry
mouth, dry or irritated eyes, and peeling of the skin
of the fingertips, palms and soles. Hair loss is not
common but can be very distressing to those affected;
however, hair loss will usually reverse and hair will
gradually regrow after treatment ceases. If you experience
joint and muscle pain, it is wise to avoid excessive
exercising, particularly weight lifting and contact
sports. Other adverse effects are less frequent but
can be more serious.
Increased pressure behind the
eye is relatively uncommon but can occur with acitretin
use. The risk of developing this condition (pseudotumour
cerebri) is increased in young, overweight women. Common
symptoms include severe headache, nausea, vomiting and
blurred vision. If these symptoms occur, immediately
contact your doctor, who might discontinue the treatment.
Although rare, depression and
suicide have been reported, mostly in association with
isotretinoin; however, there is insufficient information
to indicate that retinoids such as isotretinoin or acitretin
cause depression. Several studies based on drug use
registries in Saskatchewan and the United Kingdom showed
no increase in suicide or depression with acitretin,
compared to people who were not taking this medication.
Still, it is important to be aware of this association,
and to pay close attention to any changes in mood and
any symptoms of depression. If you happen to experience
feelings of sadness, irritability, fatigue, difficulty
concentrating or loss of appetite, you should immediately
contact your doctor. Other rare side effects include
injury to the liver, increase in blood lipids and inflammation
of the pancreas (pancreatitis).
Once acitretin therapy is started,
regular follow-up visits are necessary to monitor your
response to the medication, and to determine if you
have any side effects from the medication. Your doctor
will be able to increase your dosage if the results
need to be improved, decrease it to reduce any side
effects, or discontinue it altogether.
What Tests or Follow-ups Are Required
While on Acitretin?
Regular blood tests will be completed
while patients are on Acitretin to monitor the blood
cell count, liver and kidney function, and to ensure
female patients of child-bearing age do not get pregnant.
Also, the triglyceride and cholesterol levels will be
studied, where fasting will be required for 12 hours
prior to testing.
Stop taking acitretin and
contact your doctor immediately if you become pregnant
while on this medication or within two years after stopping
this medication.
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