acitretin and phototherapy genegra

17. Some fans of comics writer Gail Simone and her comic The Movement (sort of a superhero version of the Occupy Wall Street Movement) are miffed -- miffed, I tell you! 2004 Oct;151(4):912-6. doi: 10.1111/j.1365-2133.2004.06181.x.Lebwohl M, Drake L, Menter A, Koo J, Gottlieb AB, Zanolli M, Young M, McClelland P.J Am Acad Dermatol. Donated blood could expose pregnant women to acitretin.These side effects, and others, tend to go away after stopping the medication or lowering the dosage.Your doctor should always be aware of any other medications, therapies or supplements you are using. Geiger JM, Baudin M, Saurat JH. 2001 Oct;45(4):544-53. doi: 10.1067/mjd.2001.116347.Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR.J Am Acad Dermatol. Philadelphia, PA: Lippincott Williams &Wilkins; 2005:19-22.19. Palmoplantar Keratadoma but so far the treatments have been the same as for psoriasis. (HealthDay)—Phototherapy use for psoriasis decreased from 2005 to 2018, while use of biologics increased, according to a research letter published online Sept. 4 in Dermatologic Therapy. Vanderbeck KA, Giroux L, Murugan NJ, et al. Elsevier Science ... Phototherapy is typically administered three times per week during the treatment phrase. Acitretin used in combination with phototherapy with UVB or PUVA in the treatment of psoriasis allows lower doses of both modalities to be used, resulting in fewer side effects. 9. Known human teratogen; very high risk of severe birth defects, generally characterized by malformations involving craniofacial, cardiovascular, skeletal, and CNS structures, if administered during pregnancy.Do Your PART program developed to educate females of childbearing potential and their clinicians about risks associated with acitretin and to aid in the prevention of pregnancies during and for 3 years following drug discontinuance.Counseling about contraception and behaviors associated with increased pregnancy risk must occur monthly during and at 3-month intervals following drug discontinuance for at least 3 years.If pregnancy occurs during therapy or at any time within at least 3 years following drug discontinuance, the clinician and patient should discuss the possible effects on the pregnancy.Concomitant use of acitretin and alcohol results in formation of etretinate, a known human teratogen with a longer elimination half-life than acitretin, prolonging the duration of potential teratogenic effects of acitretin; alcohol must Both male and female patients receiving acitretin should Risk of developing potentially serious hepatic injury.Monitor hepatic enzyme levels prior to initiating therapy, at weekly or biweekly intervals until stable, and thereafter at intervals based on clinician's discretion.If hepatotoxicity is suspected during acitretin therapy, discontinue the drug and investigate the cause of the abnormality.Active metabolite of etretinate (no longer commercially available in US); a retinoid.Relapse may occur when acitretin is discontinued; if clinically indicated, repeat courses of the drug may be used since clinical efficacy in relapse has been similar to that of the initial course.Has been used in a limited number of patients for the management of discoid lupus erythematosusAcitretin should only be prescribed by clinicians who have special competence in diagnosis and treatment of severe psoriasis, are experienced in use of systemic retinoids, and understand risk of teratogenicity.Individualize dosage according to therapeutic response and the appearance of adverse effects.Patients concomitantly receiving phototherapy may require dosage reduction of phototherapy.Maintenance dosage: 25–50 mg (dependent on patient's response to initial therapy) once daily.In clinical studies, acitretin therapy was continued for up to 18 months in some patients.Dosages >50 mg daily not evaluated in controlled studies.Select dosage with caution (usually starting at the low end of the dosage range) because of possible age-related decrease in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.Females who are or may become pregnant during acitretin therapy or within at least 3 years following drug discontinuance.Concomitant use with methotrexate, tetracyclines, or vitamin A and/or other oral retinoids.Known hypersensitivity to acitretin, any ingredient in the formulation, or other retinoids.Very high risk of severe birth defects if pregnancy occurs while receiving acitretin or upon drug discontinuance (birth defects reported ≥2 years after the last dose of acitretin).Jaundice, acute hepatic injury, toxic hepatitis, and cirrhosis reported in limited number of patients; generally, transaminase levels returned to normal after drug discontinuance.Elevations of AST, ALT, γ-glutamyltransferase (GGT), or LDH reported in approximately one-third of patients receiving acitretin; elevations generally were mild to moderate and resolved with continued therapy, a reduction in acitretin dosage, or upon drug discontinuance.If hepatotoxicity is suspected during therapy, discontinue acitretin and investigate the cause of the abnormality.Concomitant use of acitretin and methotrexate contraindicated.Hyperostosis (including diffuse interstitial skeletal hyperostosis syndrome [DISH]) reported.Periodically monitor patients receiving long-term acitretin therapy for ossification abnormalities; radiography recommended only in the presence of symptoms or long-term acitretin use.In clinical trials, 66, 33, and 40% of patients experienced elevated triglycerides, elevated cholesterol, and decreased HDL-cholesterol, respectively; lipid abnormalities usually were reversible with cessation of therapy.Monitor fasting blood lipid concentrations prior to initiating therapy and at weekly or biweekly intervals until lipid response is established (usually within 4–8 weeks).Increased risk of hypertriglyceridemia in patients with diabetes mellitus, obesity, increased alcohol intake, lipid metabolism disorder, or familial history of these conditions.Use contraindicated in patients with chronic, abnormally elevated blood lipid concentrations.Dietary modifications, acitretin dosage reductions, or lipid-lowering agents should be used to control clinically important triglyceride elevations;Dry eyes, irritation, and brow/lash loss reported in 23, 9, and 5%, respectively, of acitretin recipients evaluated in one study.If visual difficulties occur during therapy, discontinue the drug and perform an ophthalmologic examination.Lipid elevations reported in 25–50% of acitretin recipients;Pseudotumor cerebri (benign intracranial hypertension) has been reported with acitretin and other oral retinoids (e.g., isotretinoin); some patients with pseudotumor cerebri were receiving concomitant isotretinoin and tetracycline therapy.Screen patients who develop manifestations of pseudotumor cerebri (e.g., headache, nausea and vomiting, visual disturbances) for the presence of papilledema and, if present, discontinue the drug immediately and refer to a neurologist for further evaluation and care.Concomitant use of acitretin and tetracyclines contraindicated.Avoid exposure to natural or artificial (e.g., sun lamps) sunlight; effects of UV light enhanced by acitretin.Do Your PART program developed to reinforce importance of pregnancy prevention by providing information on risks of fetal exposure to acitretin and to help prevent pregnancy.Prior to issuing the initial prescription for acitretin, exclude pregnancy by 2 negative serum or urine tests (perform second test during the first 5 days of the menstrual period immediately prior to initiation of acitretin therapy); exclude pregnancy by monthly testing during therapy and every 3 months after therapy discontinuance.To enhance compliance with pregnancy testing, a limited supply of acitretin should be prescribed.For detailed information regarding the program's requirements, consult the manufacturer's prescribing information; prescribers should contact the manufacturer to obtain information on materials available for the program.Depression and other psychiatric symptoms (e.g., aggressive feelings, self-injurious thoughts or behaviors, suicidal thoughts) reported;Patients who experience symptoms of depression or other psychiatric symptoms during acitretin therapy should discontinue the drug and immediately notify their prescribing clinician.Concomitant use of phototherapy and acitretin may result in increased risk of erythema (e.g., burning); if concomitant use cannot be avoided, substantially reduce the phototherapy dose based upon patient response.Ossification of interosseous ligaments and tendons of the extremities, skeletal hyperostoses, decreases in bone mineral density, and premature epiphyseal closure reported in children with other systemic retinoids, including etretinate (no longer commercially available in US).Insufficient clinical trial experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.Cheilitis, alopecia, skin peeling, rhinitis, dry skin, nail disorder, pruritus, rigors, xerophthalmia, dry mouth, epistaxis, arthralgia, spinal hyperostosis, rash, hyperesthesia, paresthesia, paronychia, skin atrophy.Many reported adverse effects resemble those associated with hypervitaminosis A.Laboratory abnormalities (e.g., increased or decreased electrolytes, hematocrit, hemoglobin, and glucose; increased liver transaminases, uric acid, BUN, and total and LDL-cholesterol; decreased HDL-cholesterol).Acitretin is not metabolized by hepatic microsomal enzymes.Concomitant administration of alcohol and acitretin resulted in formation of etretinate, a known human teratogen with a longer elimination half-life than acitretin; may increase duration of teratogenic effects of acitretinAvoid concomitant use of alcohol from any source during and for 2 months after acitretin therapy cessation in women of childbearing potentialPossible potentiation of mucosal damage with high-dose aspirin therapyUnknown if pharmacokinetic interaction exists between acitretin and combination hormonal contraceptivesAcitretin interferes with contraceptive effect of low-dose oral progestin-only preparations (i.e., minipill)Unknown if other progestational contraceptives (e.g., implants, injectables) are adequate methods of contraception during acitretin therapyConcomitant use may result in hyperlipidemia or pseudotumor cerebriCareful monitoring recommended if used concomitantlyPotentiation of hypoglycemic effects of glibenclamideUse with caution; careful monitoring of diabetic patients recommendedPossible pharmacokinetic interaction (reduced phenytoin protein binding)Possible additive adverse effects (e.g., hypervitaminosis A)Possible risk of hormonal contraceptive failure during concomitant usePossible increased risk for pseudotumor cerebri and photosensitivityPossible additive adverse effects (e.g., hypervitaminosis A)Absorption from GI tract is linear with dose-proportional increases at doses of 25–100 mg.Following administration of a single 50-mg oral acitretin dose to healthy individuals, approximately 60–72% (range: 36–109%) of dose was absorbed.High interindividual and intraindividual variation in peak plasma concentrations;In patients with psoriasis, mean steady-state trough concentrations demonstrated dose-dependent increases with daily dosages of 10–50 mg.Improvement seen within first 8 weeks of treatment in clinical trials; full efficacy usually evident within 2–3 months.Food enhances absorption and reduces the interindividual variability in absorption.In healthy geriatric individuals receiving multiple doses of acitretin, plasma concentrations increased twofold compared with those in younger individuals.In patients with end-stage renal failure receiving a single 50-mg oral acitretin dose, lower plasma concentrations (by 50–59%) were seen compared with healthy individuals; acitretin not removed by hemodialysis.Distributes into skin with highest concentrations in stratum corneum.Small amounts of acitretin are distributed into semen; appear to pose little, if any, risk to an unborn child while a male patient is receiving the drug.Extensively metabolized by simple isomerization in liver by interconversion to 13-Excreted in urine (16–53%) and feces (34–54%) as metabolites.Acitretin, following multiple doses: Estimated at about 49 hours but has been reported to range from 24–96 hours.In healthy geriatric individuals, elimination half-life was similar to that in younger individuals.Exact mechanism of action in the treatment of psoriasis is not fully understood, but may involve inhibiting the conversion of retinol to retinoic acid, stimulating the metabolism and buffering of retinoic acid by increasing levels of cellular retinoic acid binding protein-2 (CRABP 2), and/or altering the metabolism of endogenous retinoids at the level of degradation.Modulates epidermal proliferation and cellular differentiation; demonstrates antiproliferative effect on epidermal keratinocytes in a hyperproliferative system, resulting in decreased scaling, erythema, and thickness of plaques and stratum corneum; promotes cellular proliferation in normoproliferative systems.Activates retinoid X receptors (RXR) and the α, β, and γ subtypes of retinoic acid receptors (RAR); potentiates epidermal growth factor-induced cell growth; increases activity of cyclic adenosine monophosphate (cAMP)-dependent protein kinases, RI (involved in cell proliferation), and RII (involved in cell differentiation and growth inhibition) in deficient areas of psoriatic fibroblasts; inhibits chemotactic responses; decreases polymorphonuclear leukocyte migration/accumulation; and increases the number of Langerhans cells in normal and psoriatic skin.Provide all patients with a copy of the medication guide upon initial and subsequent dispensing of drug.Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.Importance of discontinuing therapy and immediately notifying clinician if pregnancy, unprotected intercourse, or a missed menstrual cycle occurs during or within 3 years after drug discontinuance.Importance of warning both male and female patients not to share acitretin with anyone else and not to donate blood while receiving acitretin and for at least 3 years after cessation of therapy.Importance of women avoiding alcohol from any source (e.g., OTC preparations, foods) during therapy and for 2 months following drug discontinuance.Importance of discontinuing acitretin therapy and promptly reporting symptoms of depression or other psychiatric symptoms (e.g., aggression, self-injurious behaviors, suicidal thoughts) to clinician.Importance of informing clinicians if acute abdominal pain or emesis occurs; may be early indicators of pancreatitis.Risk of decreased night vision; importance of being cautious when driving or operating any vehicle at night.Importance of advising patients who wear contact lenses that they may experience decreased tolerance to the lenses during or after therapy with the drug; lubricating ophthalmic ointments or artificial tears may be needed.Importance of informing clinicians if concomitant phototherapy is being received.Importance of advising patients to avoid excessive exposure to natural or artificial sunlight (e.g., sun lamps).Importance of informing patients that a transient worsening of psoriasis may occur initially and that full clinical benefit may not be evident for 2–3 months.Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription or OTC drugs and herbal supplements, as well as any concomitant illnesses.Importance of informing patients of other important precautionary information.2.

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