Classifications: antiacne; retinoid;
Therapeutic: antiacne

Prototype: Isotretinoin
Pregnancy Category: X


10 mg, 25 mg capsules


Acitretin binds to the retinoic acid receptors in the skin, thus modifying gene expression, epithelial cell growth, and cell differentiation.

Therapeutic Effect

Acitretin is a highly toxic metabolite of retinol (vitamin A).


Treatment of severe, recalcitrant psoriasis in adults.


Sensitivity to parabens, papilledema, severe renal impairment or renal failure, pregnancy (category X) for at least 3 y after use, lactation.

Cautious Use

Patients with impaired hepatic function, hepatitis, diabetes mellitus, obesity, alcoholism, history of pancreatitis, hypertriglyceridemia, hypercholesterolemia, coronary artery disease, retinal disease, degenerative joint disease.

Route & Dosage

Adult: PO 25–50 mg q.d. with main meal


  • Administer as single dose with main meal because food enhances absorption.
  • Store at 15°–25° C (59°–77° F) and protect from light. After opening, avoid exposure to high temperatures and humidity.

Adverse Effects (≥1%)

Body as a Whole: Hyperesthesia, paresthesias, arthralgia, progression of existing spinal hyperostosis, rigors, back pain, hypertonia, myalgia, fatigue, hot flashes, increased appetite. CNS: Headache, depression, aggressive feelings and thoughts of self-harm, insomnia, somnolence. CV: Flushing, edema. GI: Dry mouth, increased liver function tests, increased triglycerides and cholesterol, hepatitis, gingival bleeding, gingivitis, increased saliva, stomatitis, thirst, ulcerative stomatitis, abdominal pain, diarrhea, nausea, tongue disorder. Special Senses: Blurred vision, blepharitis, conjunctivitis, decreased night vision/night blindness, eye pain, photophobia; earache, tinnitus; taste perversion. Respiratory: Sinusitis. Skin: Alopecia, skin peeling, dry skin, nail disorders, pruritus, rash, cheilitis, skin atrophy, paronychia, abnormal skin odor and hair texture, cold/clammy skin, increased sweating, purpura, seborrhea, skin ulceration, sunburn. Other: Rhinitis, epistaxis, xerophthalmia.


Drug: Combination with ethanol can create etretinate, which has a significantly longer half-life than acitretin; interferes with the contraceptive efficacy of progestin-only oral contraceptives. Use with methotrexate increases the risk of heptatitis. Food: Avoid excess vitamin A.


Absorption: Rapidly from GI tract, optimal absorption when taken with food. Peak: 2–5 h. Distribution: Crosses placenta, distributed into breast milk. Metabolism: Active metabolite, cis-acitretin. Elimination: In both urine and feces. Half-Life: 49 h acitretin, 63 h cis-acitretin.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of pancreatitis or loss of glycemic control in diabetics. Report either condition immediately to physician.
  • Lab tests: Before initiating therapy and at 1- to 2-wk intervals until response to drug is known, do lipid profile and liver function tests. Monitor blood glucose and HbA1C periodically.

Patient & Family Education

  • Note: Transient worsening of psoriasis may occur during early therapy.
  • Review common adverse effects of drug; lag time of 2–3 mo may be necessary before drug effect is evident.
  • Discontinue drug and report immediately to physician if visual problems develop.
  • Note: Dry eyes with decreased tolerance for contact lenses may occur.
  • Do not drink alcohol while taking this drug; it increases risk of hepatotoxicity and hypertriglyceridemia; females should avoid alcohol during and for 2 mo following therapy.
  • Do not donate blood for 3 y following therapy.
  • Avoid excessive exposure to sunlight or UV light.
  • Use two forms of effective contraception for 1 mo before and at least 3 y following therapy because of the serious risk of fetal deformities that could result from exposure to this medication.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2018 Last Updated On: 03/15/2018 (0)
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