Systemic Medications: Soriatane (Acitretin)
What is Soriatane (acitretin)?
Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the FDA specifically for treating psoriasis.
The exact way Soriatane works to control psoriasis is unknown. In general, retinoids help control the multiplication of cells including the speed at which skin cells grow and shed.
How is Soriatane used?
Soriatane comes in 10 mg and 25 mg capsules. The prescribed dose is taken once a day with food. Several factors determine the dosage for each individual, including the type of psoriasis present.
Doses may be reduced after symptoms improve, depending on the person's response. Ordinarily, retinoid treatment is stopped when lesions have cleared significantly. When lesions or other symptoms reappear, the drug may be taken again.
Soriatane tends to work slowly for plaque psoriasis. Psoriasis may worsen before individuals start to see clearing. After eight to 16 weeks of treatment, the skin lesions usually will improve. It may take up to six months for the drug to reach its peak effect.
Soriatane is indicated for use in adults with severe plaque, guttate, pustular, erythrodermic, or palmoplantar psoriasis.
Do not take Soriatane if:
- You are pregnant, planning to become pregnant, or breastfeeding:
- You have severe liver or kidney disease:
- You have high triglycerides;
- You are allergic to retinoids.
Soriatane causes serious birth defects. Because of this risk, women of childbearing potential must have two negative pregnancy tests before starting Soriatane. They must use two effective forms of birth control at least one month before beginning treatment, while on the drug and for three years after stopping treatment. Progestin-only birth control pills may not work while taking Soriatane, so women should avoid using them as a primary form of birth control.
Individuals should not donate blood during treatment and for three years after stopping treatment. Donated blood could expose pregnant women to acitretin.
What are the possible side effects?
- Hair loss
- Chapped lips and dry mouth
- Dry skin and eyes
- Bleeding gums and nose bleeds
- Increased sensitivity to sunlight
- Peeling fingertips and nail changes
- Changes in blood fat levels
- Aggressive thoughts or thoughts of self-harm
- Joint pain
- Decreased night vision
- Elevated liver enzymes
These side effects, and others, tend to go away after stopping the medication or lowering the dosage.
What are the potential drug interactions?
Your doctor should always be aware of any other medications, therapies or supplements you are using. Avoid dietary supplements with vitamin A. Soriatane is related to vitamin A, and taking vitamin could add to the unwanted effects of Soriatane.
Women of childbearing potential who use Soriatane must not drink or eat any substance containing alcohol during treatment and for two months after treatment is stopped. Alcohol can cause Soriatane to convert to a form that is very slowly removed from the body, which increases the risk of birth defects if the woman becomes pregnant.
Soriatane can reduce the effectiveness of phenytoin, a common drug for epilepsy, when given at the same time. Soriatane should not be combined with tetracycline (an antibiotic), since both medications can cause increased pressure on the brain, which can have serious consequences.
Can Soriatane be used with other treatments?
Soriatane is most effective for treating psoriasis when it is used with phototherapy. Soriatane is sometimes used with Enbrel (etanercept), or Remicade (infliximab), and may also be prescribed in rotation with cyclosporine or methotrexate.
Accutane (isotretinoin) is another oral retinoid that is sometimes used in place of acitretin to treat psoriasis.