Neotigason (Acitretin)

Neotigason (acetretin) is used in the management of severe keratinization disorders and psoriasis.

• Severe plaque psoriasis: reduces scaling and erythema by normalizing skin cell turnover.
• Pustular psoriasis: controls widespread pustular eruptions and accelerates lesion clearance.
• Ichthyosis: improves skin barrier function and reduces hyperkeratosis in inherited forms.

• Acitretin exerts its therapeutic effect by binding to nuclear retinoic acid receptors (RAR‑α, RAR‑β, and RAR‑γ). This interaction modulates gene transcription involved in epidermal cell differentiation and proliferation, leading to normalization of keratinocyte growth, reduced hyperkeratosis, and anti‑inflammatory effects in the skin. The drug acts directly through receptor engagement without requiring conversion to an active metabolite, sustaining its activity in chronic skin disorders.

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

Common Side Effects

• Dry skin: increased xerosis and scaling.
• Cheilitis: inflammation and cracking of the lips.
• Elevated triglycerides: rise in blood lipid levels.
• Hair loss: temporary alopecia.
• Headache: mild to moderate intensity.
• Nausea: mild gastrointestinal upset.
• Mucosal dryness: dryness of nasal or oral mucosa.
• Photosensitivity: increased skin sensitivity to sunlight.

Serious or Rare Side Effects

• Hepatotoxicity: liver enzyme elevations or liver injury.
• Pseudotumor cerebri: increased intracranial pressure presenting with headache and visual changes.
• Severe hyperlipidaemia: marked increase in cholesterol or triglycerides requiring medical intervention.
• Bone toxicity: premature epiphyseal closure in children (use limited to adults).
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

When prescribing acitretin, several safety considerations should be observed to minimize risk.

• Pregnancy contraindication: teratogenic; avoid use in women of childbearing potential.
• Contraception requirement: effective birth control must be used during treatment and for at least 3 years after discontinuation.
• Liver monitoring: assess hepatic function before initiation and periodically during therapy.
• Lipid monitoring: check serum triglycerides and cholesterol regularly.
• Skeletal effects: avoid use in patients with active bone disease or in children due to risk of premature epiphyseal closure.
• Store at ambient temperature: keep tablets below 25 °C in the original packaging, protected from moisture and light.

Acitretin can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Tetracyclines: increased risk of intracranial hypertension.
• Vitamin A supplements: additive teratogenicity and hypervitaminosis A.
• Systemic corticosteroids: may reduce therapeutic effect and increase liver toxicity.

Moderate Interactions (Monitor Closely)

• Oral contraceptives: reduced effectiveness, requiring additional barrier methods.
• Lipid‑lowering agents (e.g., fibrates): potential for additive lipid changes.
• Antifungal azoles (e.g., ketoconazole): may increase acitretin plasma levels.
• Anticoagulants (e.g., warfarin): possible alteration of INR, requiring monitoring.