acitretin

Appropriate Use

use only by physicians experienced in severe psoriasis diagnosis/tx, systemic retinoid use, and retinoid teratogenicity risk; give Medication Guide w/ every prescription dispensed and ensure women of child-bearing potential meet all requirements of Take Action Against Pregnancy (T.A.P.P.) program

Pregnancy Contraindicated

do not use in female pts who are or may become pregnant during tx or for at least 3y after D/C; exposure may lead to major fetal abnormalities incl. meningomyelocele, meningoencephalocele, mult. synostoses, facial dysmorhpia, syndactyly, absent terminal phalanges, malformations of hip, ankle, and forearm, low-set ears, high palate, decr. cranial volume, cardiovascular malformation, and skull/cervical vertebrae alterations

Women of Child-Bearing Potential

only consider tx in women w/ severe psoriasis unresponsive or not candidate for other tx; prescribe only if pregnancy excluded and pt meets set criteria: 2 initial negative pregnancy tests then negative pregnancy tests qmo during tx and q3mo for >3y after D/C, use of 2 effective forms of contraception (avoid progestin-only forms) 1mo prior to tx start, during tx, and for >3y after D/C, and signed Patient Agreement/Informed Consent for Female Pts; prescriber must counsel pt qmo during tx and q3mo x3y after D/C about contraception and behaviors assoc. w/ incr. pregnancy risk

Avoid Alcohol in Female Pts

avoid alcohol during tx and x2mo after D/C due to formation of etretinate, a teratogen w/ significantly longer half-life than acitretin

Acitretin in Body Fluids

avoid blood donation during tx and >3y after tx to prevent transfusion to women of child-bearing potential; small amt acitretin in seminal fluid poses little if any fetal risk but no-effect limit for teratogenicity unknown

Hepatotoxicity

elevated LFTs and hepatitis reported; D/C tx if hepatotoxicity suspected