acitretin
Acitretin is a retinoid. It's used to treat severe forms of psoriasis in adults. It's taken by mouth once a day, typically with your main meal of the day. Some of the more common side effects of this medication include chapped lips, peeling skin, and higher cholesterol levels. Acitretin has a black box warning for causing serious birth defects and should be avoided by people who are pregnant or plan to become pregnant within 3 years after treatment.
What is Acitretin?
What is Acitretin used for?
Severe psoriasis in adults
How Acitretin works
Acitretin is a retinoid. Retinoids are a form of vitamin A. It works by slowing down the production and inflammation of skin cells. By slowing down skin cell growth, it can help clear psoriasis.
Drug Facts
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What are the side effects of Acitretin?
Common Side Effects
- Chapped lips (over 75%)
- High cholesterol and fat levels (up to 66%)
- Skin peeling (50-57%)
- Hair loss (50-57%)
- Runny nose (25-50%)
- Itching or scaly skin (25-50%)
- Nail changes (25-50%)
- Dry eyes (10-25%)
- Dry mouth (10-25%)
- Nosebleed (10-25%)
- Shivering (10-25%)
- Joint pain (10-25%)
- Pain or stiffness in the back (10-25%)
- Nerve pain or tingling (10-25%)
- Sticky or fragile skin (10-25%)
- Red, circular rash (10-25%)
Other Side Effects
- Tiredness
- Trouble sleeping
- Changes in mood
- Changes in appetite
- Headache
- Flushing or hot flashes
- Vision changes
- Nausea
- Diarrhea
- Bleeding gums
- Taste loss
Serious Side Effects
- Allergic reaction: hives, itching, swelling of your face, mouth, or tongue, problems breathing, peeling skin
- Capillary leak syndrome: sudden weight gain, fever, low blood pressure
- High brain pressure: really bad headache, nausea, vomiting, blurry vision
- Vision loss or vision changes:
- Depression or thoughts of self-harm or suicide
- Heart attack, blood clot, or stroke: shortness of breath, dizziness, nausea, chest pain, weakness, trouble speaking, swelling of a leg
- Serious liver problems: yellowing of your skin or the whites of your eyes, dark urine, loss of appetite
- Dangerously high blood sugar levels: frequent urination, more thirsty or hungry
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Back pain
bad, unusual, or unpleasant (after) taste
bone or joint pain
change in taste
continuing ringing or buzzing or other unexplained noise in the ears
difficulty with moving or walking
excessive muscle tone
feeling of warmth
headache (severe and continuing)
hearing loss
increased sensitivity to pain
increased sensitivity to touch
muscle stiffness, tension, or tightness
nausea (severe and continuing)
redness of the face, neck, arms, and occasionally, upper chest
redness of the skin
thinning of the skin with easy bruising
tingling in the hands and feet
tongue irritation
trouble sleeping
vomiting (severe and continuing)
Less common
Abnormal sensation of burning or stinging
blurred vision
belching
breast pain
cracking, redness, skin irritation, or rash (including a rash that looks like psoriasis)
general feeling of discomfort or illness
increased hair growth on the forehead, back, arms, and legs
indigestion
infection, ulcers, unusual odor, or small red spots in the skin
itching of the vagina or genital area
loosening of the fingernails
loss of eyebrows or eyelashes
pain during sexual intercourse
redness of the eyes
redness or soreness around the fingernails
redness or swelling of the eyelid
sensitivity of the eyes to light
sore mouth or tongue
thick, white vaginal discharge with no odor or with a mild odor
watery eyes
white patches in the mouth or on the tongue
Rare
Bleeding gums
bleeding time increased
coughing up blood
darkened urine
difficulty in breathing or swallowing
double vision or other problems in seeing, including decreased night vision after sunset and before sunrise
hoarseness
increased menstrual flow or vaginal bleeding
itchy or painful ears
light-colored stools
nosebleeds
pale or cold hands or feet
paralysis
prolonged bleeding from cuts
red or dark brown urine
sore on the edge of the eyelid (stye)
stomach pain
thick, white, curd-like vaginal discharge
unpleasant breath odor
unusual tiredness or weakness
vaginal itching or irritation
vomiting of blood
yellowing of the skin or eyes
Incidence not known
Assault
attack
burning, numbness, tingling, or painful sensations
chest discomfort
confusion
difficulty with speaking
doing things to injure oneself
inability to move the arms, legs, or facial muscles
inability to speak
pain in the chest, groin, or legs, especially calves
pain or discomfort in the arms, jaw, back, or neck
slow speech
slurred speech
sudden loss of coordination
sudden, severe weakness or numbness in the arms or legs
sweating
thoughts of killing oneself
unsteadiness or awkwardness
vision changes
weakness in the arms, hands, legs, or feet
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Dizziness or lightheadedness
feeling of constant movement of self or surroundings
sensation of spinning
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Chapped, red, or swollen lips
difficulty in wearing contact lenses
dry or runny nose
dryness of the eyes
increased ability to sunburn
increased amount of ear wax (unusual)
irritation in the mouth or swollen gums
itchy skin
loss of hair (usually reversible)
scaling and peeling of the eyelids, fingertips, palms, and soles of feet
sticky skin
unusual thirst
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Acitretin
Pros
Taken by mouth
Only taken once a day
Option for severe psoriasis that's not controlled by topical medications
Available as a lower-cost generic
Cons
Risk of serious birth defects lasts at least 3 years after treatment ends
Must get blood or urine tests at least every month to check pregnancy status or monitor for side effects
Can cause your skin to be extra sensitive, especially to sunlight
Can cause your blood fats (lipids) to rise
Pharmacist tips for Acitretin
Acitretin works best when taken with food. Take your dose with your main meal of the day.
Taking acitretin can lead to skin peeling or dryness. Your psoriasis might seem to get worse before it gets better. Talk with your provider if you're not sure whether this medication is working. In general, you might need to continue treatment for 2 to 3 months before experiencing the full benefit of this medication.
People who can become pregnant and are taking acitretin must get a monthly pregnancy test (either through urine test or blood test) to confirm they're not pregnant. This is because acitretin can raise the risk of serious birth defects and should be avoided by people who are pregnant.
If you're able to have children, you need to use two forms of birth control starting 1 month before acitretin treatment to avoid serious birth defects. Continue using these birth controls for at least 3 years after stopping acitretin because the medication can remain in your body during this time. Let your healthcare provider know right away if you think you might be pregnant at any point during or after treatment.
Don't take progestin-only birth controls, such as the "minipill", while you take acitretin because they might not work well to prevent pregnancy. If you're currently using a progestin-only birth control, then talk to your healthcare provider about changing it a safer alternative birth control, such as combination birth control pills, before starting acitretin.
Avoid donating blood while taking acitretin or for 3 years after stopping it. This is because if the blood is given to someone who's pregnant or considering having a baby, it can cause harm harm to their unborn child.
It's important that you don't drink alcohol during treatment with acitretin and for 2 months after you stop. Drinking alcohol will cause acitretin to stick around longer in the body and raise your risk for serious side effect over a longer period of time. In addition, drinking alcohol can worsen liver problems caused by this medication.
Try to avoid direct sunlight and use of sun lamps while taking acitretin so you don't get sunburned. If you need to be outside, protect your skin from the sun by wearing sunscreen or wearing a hat and other clothing that covers your arms and legs. Sunburns can worsen and trigger psoriasis flares.
Acitretin can cause vision changes. Avoid driving if you start to notice changes to your vision.
Frequently asked questions about Acitretin
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What are the risks and warnings for Acitretin?
Acitretin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Harm to unborn baby
Risk factors: Lack or inappropriate use of birth control before, during, and after treatment | Getting pregnant sooner than 3 years after stopping treatment | Drinking alcohol during and within 2 months of stopping treatment
Acitretin can cause very serious harm to unborn babies. Don't take acitretin if you're pregnant or plan to become pregnant within the next 3 years. People who can become pregnant must use two forms of reliable birth control starting a month before, during, and for at least 3 years after treatment. Females should also avoid drinking alcohol during and for 2 months after treatment with acitretin because doing so causes this medication to stick around longer in your body. Your healthcare provider will make sure you aren't pregnant every month while you're taking acitretin.
Additionally, you shouldn't use this medication if you're breastfeeding. If you do become pregnant while using this medication, you should tell you healthcare provider right away. Talk to your healthcare provider or pharmacist for more information.
Males taking acitretin
Small amounts of acitretin have been found in the semen of males taking this medication. This small amount of acitretin in the semen can still be a little risky to an unborn child, since it might raise the risk of birth defects. You should discuss any concerns you have about this with your healthcare provider.
Donating blood
Don't donate blood for at least 3 years after stopping acitretin. Acitretin
in your blood can harm an unborn baby if your donated blood is given to someone who's pregnant.
Liver damage
Risk factors: Taking methotrexate | Liver problems
Acitretin can harm the liver. People using acitretin have experienced abnormal liver function tests and inflammation of their liver. Your healthcare provider should do blood tests to make sure your liver is healthy before and during treatment. Let your healthcare provider know right away if you experience any severe nausea or vomiting, yellowing of your skin or the whites of your eyes, loss of appetite, or dark urine.
Changes in cholesterol levels and pancreatitis
Risk factors: People with greater risk of developing high cholesterol, including those with disturbances in lipid metabolism, diabetes, obesity, alcohol use, or familial history of these conditions
Acitretin can raise cholesterol and triglycerides ("bad fats") while lowering HDL ("good fat"). This raises the risk of heart disease, heart attack, and stroke. Additionally, there have been reports of pancreatitis (inflammation of the pancreas) in people taking acitretin. Your provider will do blood draws to check your cholesterol level regularly, typically every 1-2 weeks when you first start the medication, then less often after your cholesterol level becomes stable. Call 911 right away if you experience chest pain, arm pain, shortness of breath, a cold sweat, weakness on one side of your body, confusion, bad headache, or trouble speaking or walking. These can be signs of a heart attack or stroke.
Skeletal changes
Risk factors: Skeletal abnormalities | Long-term use of acitretin
Acitretin can cause skeletal changes to your spine, knees, and ankles. These changes can happen at any time, but usually happen after long-term use of acitretin. Talk to your healthcare if you have trouble moving around while taking this medication.
Vision problems
Acitretin can cause changes in your vision. Since this can happen suddenly, you should be careful driving at night until you know how this medication affects you. Acitretin can also dry your eyes. People who wear contact lenses might be uncomfortable during and after treatment with acitretin. If this happens, you should remove your contact lenses and contact your healthcare provider. Finally, if you experience any vision issues while taking this medication, you should let your provider know because they'll likely ask you to stop acitretin and to go to an ophthalmologist or optometrist for an eye exam.
High blood pressure in the brain
Risk factors: Taking tetracyclines or isotretinoin
Acitretin can raise the pressure in the brain to dangerous levels. You should also not use any tetracyclines while taking acitretin at the same time as they both can raise brain pressure. Early symptoms include severe headache, changes in vision, or nausea and vomiting. Always let your healthcare provider and pharmacist know all the medications you are taking.
Capillary leak syndrome
Although rare, there have been some cases of capillary leak syndrome in some people who have received acitretin. Signs of this syndrome include swelling, weight gain, fever, and very low blood pressure. Muscle and joint pain can also happen. If you experience any of these symptoms while using acitretin, you should call your healthcare provider right away.
Severe skin peeling
Although rare, there have been some cases of skin peeling off of people taking acitretin. If this happens, you should stop taking the medication and call your healthcare provider right away.
Acitretin dosage forms
Typical dosing for Acitretin
Adults: The typical dose ranges from 25 mg to 50 mg by mouth once a day with your main meal of the day. Your provider might adjust your dose based on how you respond to acitretin.
Interactions between Acitretin and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Chlortetracycline
- Demeclocycline
- Doxycycline
- Eravacycline
- Lymecycline
- Meclocycline
- Methacycline
- Minocycline
- Omadacycline
- Oxytetracycline
- Rolitetracycline
- Sarecycline
- Tetracycline
- Tigecycline
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Pexidartinib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Acitretin cost?
Acitretin contraindications
Severe liver or kidney disease
People with abnormally high blood lipid values
Pregnant females
Taking with methotrexate
Taking with tetracycline antibiotics
Allergy to other retinoids
What are alternatives to Acitretin?
Active psoriatic arthritis
Plaque psoriasis
Mouth sores from Behçet’s disease
Acute lymphoblastic leukemia (ALL) in adults and children; given with other chemotherapy
Cutaneous T-cell lymphoma in adults; given by itself or with other chemotherapy
Advanced non-Hodgkin lymphoma in adults; given with other chemotherapy
Rheumatoid arthritis (RA) in adults
Polyarticular juvenile idiopathic arthritis (pJIA) in children
Severe psoriasis in adults
What is the latest news about Acitretin?
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References
Best studies we foundAvKARE. (2024). Acitretin capsule [package insert]. DailyMed.
Geiger, J. M., et al. (1994). Teratogenic risk with etretinate and acitretin treatment. Dermatology.
Vos, L. E., et al. (2007). Acitretin induces capillary leak syndrome in a patient with pustular psoriasis. Journal of the American Academy of Dermatology.
Waldman, A., et al. (2015). Acitretin for the treatment of psoriasis: A case report of long-lasting alopecia. Journal of Psoriasis and Psoriatic Arthritis.
Zito, P M., et al. (2024). Acitretin. StatPearls.
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