Neotigason (Acitretin)

Neotigason is a retinoid used in the management of disorders characterized by abnormal keratinocyte proliferation and differentiation.

• Severe psoriasis: reduces plaque formation, scaling and erythema.
• Psoriatic erythroderma: helps control extensive skin inflammation and desquamation.
• Other keratinization disorders: normalizes epidermal cell turnover and improves skin appearance.

• Acitretin binds to nuclear retinoic acid receptors (RAR‑α, RAR‑β, RAR‑γ), modulating gene expression that controls epidermal cell proliferation and differentiation. This interaction leads to reduced keratinocyte hyperproliferation, normalization of skin cell maturation, and anti‑inflammatory effects in psoriatic lesions.

Acitretin may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Dry skin and mucous membranes
• Cheilitis (cracked lips)
• Hair thinning or loss
• Elevated liver enzymes
• Hyperlipidaemia
• Headache

Serious or Rare Side Effects

• Severe hepatic injury
• Pancreatitis
• Pseudotumour cerebri (intracranial hypertension)
• Major depression or suicidal ideation
• Severe hypertriglyceridaemia
• Bone demineralisation or fractures

Before initiating therapy, clinicians should assess several safety parameters.

• Pregnancy: contraindicated due to high teratogenic risk; ensure effective contraception.
• Contraception: maintain dual‑method contraception for at least 3 years after discontinuation.
• Liver function: obtain baseline tests and monitor periodically.
• Lipid profile: check fasting lipids before start and during treatment.
• Vision: monitor for symptoms of intracranial hypertension such as headache or visual changes.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Acitretin interacts with several medicines that may alter its safety or efficacy.

Major Interactions (Avoid)

• Tetracyclines: increased risk of intracranial hypertension.
• Vitamin A supplements: additive retinoid toxicity.
• Systemic corticosteroids: may reduce therapeutic response.
• Warfarin: potential alteration of INR.
• Other retinoids (e.g., isotretinoin): cumulative teratogenic and toxicity risk.

Moderate Interactions (Monitor Closely)

• Methotrexate: heightened hepatic toxicity.
• Oral contraceptives: possible reduction in contraceptive effectiveness.
• Statins: monitor liver enzymes.
• Lipid‑lowering agents (fibrates): may exacerbate hyperlipidaemia.
• Antifungal azoles (e.g., ketoconazole): can affect drug metabolism.