Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Martina Bacharach-Buhles

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Last updated on: 19.01.2021

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Derivative of vitamin A acid, see also retinoids.

Pharmacodynamics (Effect)
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Inhibition of the hyperproliferation of keratinocytes in the psoriatic epidermis. Anti-keratinizing. The exact mechanism of action has not yet been elucidated. After uptake into the target cell, acitretin activates all 3 subtypes of the nuclear vitamin A acid receptors (RAR alpha, beta, gamma). Acitretin possibly reduces the enzymatic conversion of retinol into vitamin A acid by inhibiting interferon gamma. The reduction of the cellular vitamin A acid level leads to an inhibition of cellular proliferation. In addition, synthetic retinoids inhibit ribonuclease P (RNase P) to varying degrees depending on the dose.

Limited indication
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Sicca Syndrome.

Notice! Control of values: transaminases, alkaline phospatase, gamma-GT, creatinine, triglycerides, cholesterol, glucose. In patients with a history of abnormal kidney, liver or lipid metabolism: urea, uric acid, urine status, bilirubin, lipid electrophoresis (every 4 weeks).

Pregnancy/nursing period
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Dosage and method of use
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The effective dose is above 10 mg/day. The optimum effective dose is about 50 mg/day depending on body weight.
  • Adults initially 3 Kps./day neotigasone 10, over 2-4 Wo., then depending on the effect increase to a maximum 3 Kps./day neotigasone 25. maintenance dose usually 30 mg/day for another 6-8 Wo.
  • Children: Very strict indication, careful benefit-risk assessment. Initial 0.5 mg/kg bw/day. Maintenance dose 0.1 mg/kg bw/day, in no case > 0.2 mg/kg bw/day or > 35 mg/day.
Effect onset after 4-6 weeks at the earliest. Duration until complete healing 2-3 months. Therapy failure is to be expected in about 20% of treated cases.

Notice! Pregnancy must be ruled out before therapy begins. During therapy and up to 2 years after discontinuation of the preparation, effective contraception must be used, although the effect of oral contraceptives may be impaired. Low-dose progesterone preparations (so-called minipills) should not be used for contraception as the contraceptive effect of these preparations can be reduced by interaction with acitretin. Regular monitoring of the skeleton during long-term therapy. In children, carefully monitor growth (bone development)!

Undesirable effects
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  • Skin and mucous membranes: Depending on the dose: dry, possibly inflamed lips, dry nose, dry eyes, especially when wearing contact lenses, xerosis cutis, classic retinoid dermatitis, granulation tissue in the nail wall, hyperhidrosis.
  • Systemic: Substance is teratogenic: No prescription in women of childbearing potential; if there are no treatment options prescription only with simultaneous administration of anticontraceptives up to 2 years after taking the last tablet. Reversible increase in transaminases, possibly hepatotoxic (< 1%), centrilobular toxic liver necrosis, hyperostoses, osteoporosis, bone pain, calcification of muscles and ligaments, increase in triglycerides and cholesterol levels (in 20% of cases), increase in VLDL and decrease in HDL.

Notice! Special caution should be taken in patients with a history of hepatitis, diabetes mellitus, hyperlipidemia, pancreatitis and known retinal diseases! In rare cases a capillary leak syndrome has been reported.

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  • Alcohol: Possible conversion of Acitretin to Etretinate.
  • Colestyramine: Simultaneous administration should be avoided as the absorption of etretinate is reduced. Acitretin should be given 1 hour before and > 4 hours after colestyramine intake. Effect on glucose tolerance readjustment of diabetes.
  • Tetracyclines: danger of intracranial hypertension.
  • Methotrexate: Possible additive hepatotoxic effect.
  • Isotretinoin and vitamin A: cumulative vitamin A toxicity!

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Because of teratogenicity contraindicated in pregnancy, lactation and in all women of childbearing potential! Liver dysfunction, lipometabolic disorders, diabetes mellitus, combination with tetracyclines or methotrexate, renal insufficiency, hypersensitivity to acitretin.

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Neotigason, acicutane

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