Neotigason (Acitretin)

• Acitretin is used in the management of severe keratinization disorders, primarily affecting the skin.
• Severe plaque psoriasis: reduces scaling, erythema and plaque thickness, leading to clearer skin and symptom relief.
• Psoriatic erythroderma: helps achieve disease control, decreasing widespread redness and scaling, and improves patient comfort.
• Other severe keratinization disorders (e.g., keratosis pilaris rubra, pityriasis rubra pilaris): provides systemic regulation of abnormal keratinocyte growth.

• Acitretin binds to nuclear retinoic acid receptors (RARα, RARβ, RARγ) and retinoid X receptors, modulating gene transcription that controls keratinocyte differentiation and proliferation. By normalizing epidermal cell turnover and reducing inflammatory cytokine expression, it restores skin architecture and reduces hyperkeratosis characteristic of severe psoriasis and related disorders. The effect is dose‑dependent and does not involve direct immunosuppression, consequently it primarily targets epidermal pathology rather than systemic immune pathways.

Acitretin may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Dry skin: pronounced xerosis leading to itching and flaking.
• Lipid abnormalities: elevations in triglycerides and total cholesterol that may require monitoring.
• Elevated liver enzymes: mild increases in ALT/AST observed during therapy.
• Mucocutaneous dryness: cheilitis, conjunctival irritation and nasal mucosal crusting are frequently reported.

Serious or Rare Side Effects

• Severe hypertriglyceridemia: marked rise in triglycerides that can precipitate acute pancreatitis.
• Hepatotoxicity: significant hepatic injury with marked transaminase elevation or jaundice, necessitating drug cessation.
• Skeletal toxicity: premature epiphyseal closure, hyperostosis or arthralgia with prolonged treatment, especially in younger patients.

• When prescribing Acitretin, several safety considerations are essential.
• Pregnancy contraindication: teratogenic risk requires effective contraception for women of childbearing potential.
• Breastfeeding: not recommended due to potential drug excretion in milk.
• Liver function: assess baseline hepatic enzymes and monitor periodically.
• Lipid profile: obtain baseline triglycerides and cholesterol; monitor during treatment.
• Skeletal monitoring: avoid use in patients with active bone disease; consider periodic radiographs for long‑term therapy.
• Drug interactions: review concomitant medications that affect lipid metabolism or hepatic function.
• Store at ambient temperature: keep capsules below 25 °C in original container, protect from moisture and light.

Acitretin interacts with several medicines; awareness of the interaction level guides clinical decisions.

Major Interactions (Avoid)

• Combined use with systemic retinoids (e.g., isotretinoin): additive teratogenic risk.
• Concomitant vitamin A supplements: risk of hypervitaminosis A.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): may markedly reduce acitretin exposure.

Moderate Interactions (Monitor Closely)

• Lipid‑lowering agents (e.g., fibrates, statins): may require dose adjustment due to altered lipid profile.
• Anticoagulants (e.g., warfarin): acitretin can enhance anticoagulant effect, monitor INR.
• Phototherapy: increased photosensitivity; adjust UV exposure.
• Oral contraceptives: reduced efficacy; advise additional non‑hormonal contraception.