Neotret

Acitretin (Neotret) is 2^nd generation oral retinoid (vitamin-A derivative) used to treat severe psoriasis, (abnormal growth of skin cells that causes red, thickened, or scaly skin) usually at a dose of 0.25–1 mg per kg body weight per day. Acitretin is available as 10 mg and 25 mg capsules.

KEY INGREDIENTS
Neotret containing Acitretin

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

MECHANISM OF ACTION

• 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, while others remain on the Acitretin long term.
• In resistant cases, Acitretin can be combined with other anti-psoriatic drugs and phototherapy

PREGNANCY AND BREASTFEEDING WARRNING

• Acitretin MUST NOT be taken in pregnancy; it can damage an unborn child and cause congenital disabilities.
• Strict birth control measures must be used during treatment and for three 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.
• Acitretin is also contraindicated while breastfeeding.
• It does not affect male sexual function or offspring, so males of all ages can take it.

CAUTION

• People on Acitretin should not donate blood during treatment or for three years afterwards.
• It is best to avoid alcohol when on Acitretin, especially if triglyceride levels are high.

DIRECTIONS
(Must read & understand before starting the treatment)

1. Acitretin comes as a capsule to take by mouth. It is usually taken once a day with the main meal.
2. It is best taken after a meal because it needs fat to be absorbed through the gut wall.
3. Take Acitretin at around the same time every day.
4. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
5. Take Acitretin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
6. Your doctor may start you on a low dose of Acitretin and gradually increase your dose.
7. Acitretin controls psoriasis but does not cure it. It may take 2–3 months or longer before you feel the full benefit of Acitretin.
8. Your psoriasis may get worse during the first few months of treatment. This does not mean that Acitretin will not work for you, but tell your doctor if this happens.
9. Continue to take Acitretin even if you feel well.
10. Do not stop taking Acitretin without talking to your doctor.
11. After you stop taking Acitretin, your symptoms may come back. Tell your doctor if this happens.
12. Do not use leftover Acitretin to treat a new flare-up of psoriasis. A different medication or dose may be needed.

INTERACTIONS WITH OTHER MEDICATIONS
Acitretin should not usually be taken at the same time as the following medications (there may be rare exceptions):

• Vitamin A or any other retinoid (e.g., Isotretinoin)
• Tetracycline or one of its derivatives is contraindicated as both tetracycline and retinoids can increase intracranial pressure
• Methotrexate

SIDE EFFECTS AND RISKS OF ACITRETIN
Acitretin has side effects that may limit the dose that can be used.

1. Dryness of lips — apply lip salve frequently, especially when outdoors.
2. Dry nostrils that may crust and bleed: petroleum jelly can help.
3. Dry eyes — use artificial tear eye drops.
4. Dry reddened skin: apply moisturizers’ frequently.
5. Peeling skin, especially hands and feet; apply moisturizers’ frequently.
6. Fragile soft skin: protect it from injury.
7. With long-term use, thin, ridged, and brittle nails.
8. Generalized hair shedding and thinning may occur; this is usually temporary although permanent thinning has been reported.
9. Change in color and texture of hair may occur.
10. Increased susceptibility to sunburn: protect your skin from the sun. Use a broad-spectrum sunscreen and dress up well. If you are receiving phototherapy, advise your therapist that you are taking Acitretin. A reduction in dose may be necessary.
11. Skin infections, especially with Staphylococcus aureus (impetigo, boils or nail fold paronychia).
12. Aggravation of skin complaint: this is often temporary and followed by improvement, but if a severe flare occurs you should tell your dermatologist and stop taking the Acitretin.
13. Headaches: if these are severe or accompanied by visual problems, inform your dermatologist and stop the Acitretin; the symptoms could be caused by an increase in pressure on the brain.
14. Muscle, joint or bone aches, especially with exercise; reduce exercise if needed.
15. Hyperlipidemia (raised blood fats — cholesterol and triglyceride), detected by blood tests, which are best taken when fasting (on an empty stomach). The level of the blood fats is compared with a pre-treatment test. High blood fats are more likely in people with diabetes and in those who drink a lot of alcohol. If the blood fats are too high, a particular low fat and low sugar diet may be recommended, a lipid-lowering medication may be prescribed, or the dose of Acitretin may be reduced or stopped.
16. Rarely, Acitretin may result in disturbed liver function (hepatitis). It should be discontinued if this occurs, and it would be unwise to retake it.
17. Mood changes; high dose retinoids can cause mood change including irritability, aggression and depression.