methoxsalen
Methoxsalen is used to treat severe cases of a skin disease called psoriasis. It must be used in combination with special light waves, called ultraviolet (UVA) radiation, but this treatment can sometimes lead to eye damage, skin aging, and skin cancer.
What is Methoxsalen?
What is Methoxsalen used for?
Severe psoriasis that’s not well-managed by other treatment options
How Methoxsalen works
Methoxsalen is a psoralen. It works as a photosensitizer, meaning it absorbs light and makes your skin more sensitive to UVA radiation. When given in combination with UVA radiation waves, methoxsalen damages the DNA in your skin cells, leading to inflammation. Psoriasis is a condition where your skin cells are growing too quickly. By damaging those skin cells, methoxsalen stops those cells from multiplying (growing) and after several days to weeks, your skin cells recover with improved color and thickness.
Drug Facts
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What are the side effects of Methoxsalen?
Common Side Effects
- Nausea (10%)
- Itching (10%)
- Skin redness
Other Side Effects
- Nervousness
- Difficulty sleeping (insomnia)
- Depression
- Swelling (edema)
- Dizziness
- Headache
- Weakness or discomfort
- Depression
- Loss of skin color
- Skin blisters
- Rash
- Herpes
- Heat rash
- Hives
- Inflammation of hair follicles
- Stomach pain or discomfort
- Leg cramps
- Low blood pressure
- Worsening psoriasis
Serious Side Effects
- Allergic reaction: itchy red rash (hives), shortness of breath, chest tightness, swelling of your lips, tongue, face, or eyes
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:
Blistering and peeling of skin
reddened, sore skin
swelling, especially of the feet or lower legs
There is an increased risk of developing skin cancer after use of methoxsalen. You should check the treated areas of your body regularly and show your doctor any skin sores that do not heal, new skin growths, and skin growths that have changed in the way they look or feel.
Premature aging of the skin may occur as a result of prolonged methoxsalen therapy. This effect is permanent and is similar to the result of sunbathing for long periods of time.
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 Methoxsalen
Pros
Available in a lower-cost generic form
Treats severe psoriasis when other therapies have failed
Available in a newer capsule form that’s absorbed into your body better and works faster than the older form that was previously on the market
Cons
Must use in combination with special light waves, called UVA radiation
Has many risks such as eye damage, skin aging, and skin cancer
Must protect skin from sunlight both before and after therapy
Pharmacist tips for Methoxsalen
Because methoxsalen is a strong medication, it's important to take it exactly as prescribed by your healthcare provider. Taking extra doses can cause burning or blistering of your skin when exposed to UVA light. Ask your pharmacist or healthcare provider if you have any questions about your dose.
If you or anyone around you accidentally overdoses on methoxsalen, stay out of sunlight and get emergency medical help or call your local poison control center at 1-800-222-1222 right away.
The most common side effect of methoxsalen is nausea, so taking it with food or a glass of low fat milk might help. Dividing your dose into two portions and taking each portion about 30 minutes apart might also help prevent nausea.
Mild skin redness is normal and expected 24 to 48 hours after methoxsalen and UVA radiation therapy. If you notice areas with severe redness, swelling, and blisters within 24 hours of therapy, it might be a sign of a severe burn and those areas must be protected from sunlight until the redness goes away. Maximum skin redness will occur at 48 hours or later, so it's important to wear a hat, gloves, and sunscreen with SPF 15 or greater for added protection of your skin and lips after treatment.
If methoxsalen causes skin tenderness or blistering, ask your pharmacist or healthcare provider for recommendations on skin products that might help. If these side effects bother you for longer than 24 to 48 hours, tell your provider because you might need to stop using the medication.
Protect your eyes with special wrap-around sunglasses designed to completely block and absorb UVA light. These sunglasses are different from your regular sunglasses, and wearing them right after taking methoxsalen and for 24 hours after UVA radiation treatment will help protect you from indirect sunlight that comes through windows and clouds. It's also important to visit your eye doctor for a routine eye exam before starting therapy, after the first year of therapy, and every 2 years after that because of the risk of eye damage and cataracts with methoxsalen.
Take methoxsalen with caution if you're using other light-sensitive medications because they can make your skin more sensitive to sunlight, causing you to burn more easily. These medications include anthralin (Drithocreme or Zithranol), coal tar, griseofulvin (Gris-PEG), phenothiazines, nalidixic acid, fluoroquinolone antibiotics, antibacterial or deodorant soaps, sulfonamide antibiotics, tetracycline antibiotics, thiazide water pills, and certain dyes, such as methylene blue, toluidine blue, rose bengal, and methyl orange. If you take any of these medications, discuss with your pharmacist or healthcare provider before starting methoxsalen.
Store methoxsalen capsules at room temperature in a place out of reach from children.
Frequently asked questions about Methoxsalen
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What are the risks and warnings for Methoxsalen?
Methoxsalen 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.
Physician supervision
Because it can cause serious side effects, methoxsalen with UVA radiation should only be used under the care and supervision of an experienced physician who has special training using this treatment. Your physician will discuss risks and serious side effects, such as eye damage, skin aging, and skin cancer, with you before starting treatment.
New dosage form
Methoxsalen is now available in a new dosage form as a softgel capsule. Compared to the old dosage form that was previously on the market, this new capsule form gets absorbed in your body better and works faster as well. It's important to follow the dose prescribed by your healthcare provider, and ask your pharmacist or provider if you have any questions regarding your dose.
Skin burns
Risk factors: Exposure to sunlight | Higher doses of methoxsalen | Excessive exposure to UVA radiation
Serious skin burns can result if you take higher doses of methoxsalen than prescribed or from having more exposure to UVA light than expected. Methoxsalen with UVA radiation therapy also makes your skin more sensitive to sunlight, even sunlight coming in through windows, so your skin might burn more easily. Follow your prescribed dose and don't make any dose changes without discussing with your healthcare provider first.
Skin cancer
Risk factors: Higher doses of methoxsalen | Exposure to UVA radiation | Exposure to sunlight | Fair skin that burns rather than tans | Using coal tar | UVB treatment | X-ray treatment | Arsenic therapy | Treatment with grenz rays
Taking methoxsalen raises your risk of developing certain skin cancers, such as melanoma and cutaneous squamous cell cancer, especially at higher doses. Lower doses of methoxsalen and less exposure to UVA radiation can greatly reduce your risk, but skin cancer can still occur even after you've stopped treatment. If you notice any unusual skin changes, such as a new growth or new mole that's odd in size, shape, or color, tell your healthcare provider right away.
Cataracts
Risk factors: Exposure to UVA radiation | History of cataracts | Older age
Exposing your eyes to UVA radiation waves after taking methoxsalen can damage the lens of your eyes and cause cataracts. To prevent cataracts, it's important to protect your eyes by wearing special UVA-absorbing, wrap-around sunglasses during UVA therapy and for 24 hours after having UVA treatment. Visit your eye doctor for routine eye exams before starting treatment and yearly.
Skin aging
Risk factors: Excessive exposure to sunlight | Long-term use of methoxsalen and UVA radiation treatment | People who tan poorly
Exposure to sunlight and long-term treatment with methoxsalen and UVA radiation can cause aging of your skin. Wear a hat or gloves and apply a sunscreen with SPF 15 or greater with ingredients that protect against UVA radiation, such as benzophenone and PABA esters, to help protect your skin and lips from sunlight. Don't use sunscreen on areas of your skin affected by psoriasis until after your scheduled UVA treatment.
Basal cell cancer
Risk factors: History of basal cell cancer | Exposure to sunlight
Take methoxsalen with caution if you have a history of basal cell cancer, which is a type of skin cancer. If you notice any changes in your skin, such as open sores that won't go away or itchy red patches on your face, chest, arms, or legs, let your healthcare provider know right away.
Liver problems
Risk factors: History of liver problems
Take methoxsalen with caution if you're older or have liver problems, because your liver helps break down methoxsalen so it can be cleared from your body through your urine. If you have liver problems, let your healthcare provider know, because the medication can buildup in your body and cause serious side effects.
Heart problems
Risk factors: History of heart problems | History of low blood pressure
Take methoxsalen with caution, especially if you're older and have heart problems, such as blood pressure problems, because exposure to UVA radiation can cause your blood pressure to drop. If you have trouble standing for long periods of time or you can't tolerate heat, let your healthcare provider know because you might need to be treated with a different type of UVA chamber.
Methoxsalen dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mg | 12 capsules | $132.42 | $11.03 |
Typical dosing for Methoxsalen
The dose of methoxsalen is based on your body weight and the number of doses you’ll take per week depends on your schedule of UVA radiation therapy, but all doses must be separated by at least 2 days. Older adults will typically be started on lower doses. Take your dose 1.5 to 2 hours before your scheduled UVA radiation therapy.
Interactions between Methoxsalen and other drugs
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.
- Anagrelide
- Tegafur
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 Methoxsalen cost?
Methoxsalen contraindications
History of light-sensitive health conditions, such as lupus and albinism
History of melanoma
Squamous cell cancer
Absence of lenses in one or both eyes (aphakia)
What are alternatives to Methoxsalen?
Severe psoriasis that’s not well-managed by other treatment options
Acute lymphoblastic leukemia (ALL); given with other chemotherapy
Treatment and prevention of meningeal leukemia
Non-Hodgkin lymphoma (NHL)
Osteosarcoma; given with other chemotherapy
Breast cancer; given with other chemotherapy
Gestational trophoblastic neoplasia (GTN); given with other chemotherapy
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References
Best studies we foundSkin Cancer Foundation. (2022). Basal cell carcinoma warning signs.
Skin Cancer Foundation. (2021). Melanoma warning signs.
Strides Pharma Science Limited. (2019). METHOXSALEN- methoxsalen capsule, liquid filled [package insert]. DailyMed.
Weller, R. B., et al. (2020). Does incident solar ultraviolet radiation lower blood pressure? Journal of the American Heart Association.
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