Acitretin


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Acitretin
Acitretin (Soriatane)
Acitretin
(ah-sih- TREH-tin)
Pregnancy Category: X Soriatane (Rx)

Classification: Antipsoriasis product.

Action/Kinetics: Retinoic acid derivative that is the main metabolite of etretinate. Mechanism is not known. Absorption optimal when given with food. t 1/2, terminal: 49 hr. Extensively metabolized; excreted through feces and urine.

Uses: Severe psoriasis, including erythrodermic and generalized pustular types. Investigational: Darier's disease, palmoplantar pustulosis, lichen planus, children with lamellar ichthyosis, non-bullous and bullous ichthyosiform erythroderma, Sjögren-Larsson syndrome, lichen sclerosus et atrophicus of the vulva and palmoplantar lichen nitidus.

Contraindications: Use during pregnancy or in those who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Use by females who may not use reliable contraception during treatment or for at least 3 years following treatment. Use of ethanol in women either during treatment or for 2 months after cessation of treatment. Lactation.

Special Concerns: Use with caution in those with severely impaired liver or kidney function. Safety and efficacy have not been determined in children.

Side Effects: Dermatologic: Alopecia, skin peeling, dry skin, nail disorder, pruritus, erythematous rash, hyperesthesia, paresthesia, paronychia, skin atrophy, sticky skin, abnormal skin odor, abnormal hair texture, bullous eruption, cold/clammy skin, dermatitis, increased sweating, infection, psoriasis-like rash, purpura, pyogenic granuloma, rash, seborrhea, skin fissures, skin ulceration, sunburn. CNS: Rigors, headache, pain, depression, insomnia, somnolence. GI: Abdominal pain, nausea, diarrhea, tongue disorder, altered taste, hepatotoxicity. Ophthalmic: Xerophthalmia, blurred vision, abnormal vision, blepharitis, irritation, conjunctivitis, corneal epithelial abnormality, decreased night vision, blindness, eye abnormality, eye pain, photophobia. Musculoskeletal: Arthralgia, spinal hyperostosis, arthritis, arthrosis, back pain, hypertonia, myalgia, osteodynia, peripheral joint hyperostosis. Mucous membranes: Cheilitis, rhinitis, epistaxis, dry mouth, gingival bleeding, gingivitis, increased salivation, stomatitis, thirst, ulcerative stomatitis. Body as a whole: Anorexia, edema, fatigue, hot flashes, increased appetite, flushing, sinusitis. Otic: Earache, tinnitus.

Laboratory Test Alterations: AST, ALT, GGT, LDH, triglyceride, cholesterol. HDL.

Drug Interactions: Ethanol / Possible formation of etretinate which has a longer half-life than acitretin Glyburide / Enhanced clearance of blood glucose Methotrexate / Risk of hepatotoxicity Oral contraceptives, "minipill" / Acitretin interferes with the contraceptive effect

How Supplied: Capsules: 10 mg, 25 mg

Dosage
?Capsules Psoriasis.
Must individualize dosage. Initial: 25 or 50 mg/day given as a single dose with main meal. Maintenance: 25 to 50 mg/day.

Acitretin Ratings

Overall Rating:

3.5***~

 

(based on 2 reviews)

Effectiveness:

****~

Ease of Use:

**~

Overall Satisfaction:

***

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Reviews

Acitretin
2.5

Effectiveness: *****

Ease of Use: *

Overall Satisfaction: **

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Coralie, Coralie - 03/06/2014

Merit rating is another way that basic rates are often modiļæ½fied. The type of merit rating QuotesChimp are most likely to run into is experience rating. In experience rating, factors that make a person a preferred, substandard, or standard risk (e.g., a person's driving record in auto insurance) are looked into and the premium is adjusted up, down, or not at all, as the underwriter deems appropriate.

Acitretin
4.0

Effectiveness: ****

Ease of Use: ****

Overall Satisfaction: ****

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Max, Max - 01/14/2014

Cayenne (Capsicum annuum, Cap sicum frnsutcees). Cayenne, its chief component being capsaicin, is one of the herbal medicines with documented effectiveness in the English medical literature. One hypothesis on the pathogenesis of psoriasis suggests a neurogenic inflammatory etiology mediated through substance-P (SP). SP activates inflammatory cells and ultimately perpetuates vasodilatation, angiogenesis, and kerat inocyte hyperproliferation (Farber, Nickoloff, Recht, Fraki, 1986). In accordance, psoriatic lesions are known to be more densely innervated with higher SP content than control or uninvolved psoriatic skin (Naukkarinen, Nickoloff, Farber, 1989). Capsaicin stimulates the re lease of SP by binding to the vanilloid receptor on slow-conducting, unmyelinated type C neurons and ultimately leads to its depletion.Two double-blind, vehicle-controlled studies demonstrated im prove ment of psoriasis with the use of topical capsaicin. In an intra-individual, 6-week comparative trial of 44 patients with psoriasis using four applications daily, significant overall improvement with reduction in scale and erythema accompanied the capsaicin-treated sites (Bernstein, Parish, Rapaport, Rosenbaum, Roenigk, 1986). In a study of 197 psoriatic patients treated with capsaicin 0.025% cream (98) or vehicle (99) four times daily, Ellis and colleagues (1993) found greater improvement in global evaluation (p=0.024 after 4 weeks and p=0.030 after 6 weeks), pruritus relief (p=0.002 and p=0.060, respectively), and reduction in combined severity scores after 4 and 6 weeks of treatment (p=0.030 and p=0.036, respectively). In both studies, concomitant use of other anti psoriatic agents was not permitted. Transient burning and stinging at the application sites were noted in approximately 50% of the active groups in both trials, which may have affected blinding of the trial.It is important to note that while effective topically, internal ingestion can lead to adverse hematological, gastrointestinal, and respiratory ef fects, in addition to interference with drugs such as salicylic acid, ACE inhibitors, and theophylline (Ellis et al., 1993; Fugh-Berman, 2000).Aloe (Aloe vera). Aloe vera is a popular plant used in cosmetic care and first aid products. Scientific studies and case reports support its use in the treatment of stasis ulcers in humans, as well as thermal injuries in animals (Klein Penneys, 1988). Aloe has a complex mixture of components, including anthroquinones, steroids, saponins, mucopolysaccharides, and salicylic acid.Syed and colleagues (1996) conducted a double-blind, placebo-controlled study on 60 patients with psoriasis with slight-to-moderate plaque-type psoriasis (Psoriasis Area and Severity Index 4.8-16.7) and an average 8.5 year duration of their disease. Patients self-administered topical aloe vera extract 0.5% cream or vehicle placebo three times a day without occlusion for 4 weeks to their psoriatic plaques. Notably, the aloe group showed significantly higher rates of clearing the psoriatic plaques in 25/30 patients (83.3%) when compared to the placebo in 2/30 patients (6.6%) (p<0> use of herbal remedies. Familiarity with these herbal names, uses, efficacies, and side effects may encourage dialogue with patients and improve clinical care.