What is the difference between soriatane and accutane

Hypothyroidism: Treatment with bexarotene is contraindicated in patient with hyperthyroidism. It is reported that increased peripheral degradation of thyroid hormones is responsible in contributing bexarotene induced hypothyroidism Significant Hepatic Dysfunction: Retinoids are reported to have caused hepatitis and abnormal liver function test results.

If the patient already has liver issues then he should not take systemic retinoids Significant Renal Dysfunction: Impaired kidney function may lead to inability of the kidney to clear retinoids from the body and might increase the level of retinoids such as isotretinoin and acitretin in the body which will further increase the risk of side effects Adverse Effects: Higher doses of acitretin are known to cause more uneasiness than etretinate when it comes to alopecia, muco-skeletal distress and peeling of skin.

Retinoids are comparatively safe when used in short term and is linked to least and reversible adverse effects provided that the patient is not contraindicated from its use. Whenever necessary, the patient should be prescribed systemic retinoids based on risk-benefit ratio along with careful monitoring of their side effects. A list of potentially serious adverse effects due to systemic retinoids and their management are listed in Table 3 and a list of relatively common minor adverse effects and their management are listed in Table 4.

Cessation of therapy Bone Diffuse skeletal hyperostosis. Etretinate Monitor patients for skeletal effects for those who are taking high dose retinoids for a long period 43 Lipids Hypercholesterolemia. Hepatic Transaminase elevations. Discontinuation, in case of severe elevation. Endocrine Hypothyroidism. Diabetes Mellitus Bexarotene Low dose levothyroxine and monitoring the thyroxine level is recommended when the patient is on bexarotene therapy 44 Hematologic Leukopenia.

Agranulocytosis Bexarotene Dose reduction or discontinuation of therapy 9 Neurologic PseudotumorCerebri. Depression- suicidal ideation Combination of other systemic retinoids with tetracyclines. Close monitoring of psychiatric sympotoms 22 Muscle Myopathy. Acitretin Drug discontinuation or dose reduction Hair and Nails Telogen effluvium. Bexarotene Discontinuation or dose reduction Oral Chellitis.

Acitretin Reducing dose or discontinuation of the drug 46 Nasal Epistaxis. Sore mouth and tongue Acitretin Dose reduction or drug continuation 47 Gastrointestinal Nausea.

Abdominal pain Isotretinoin Monitor the patient closely while he is on isotretinoin therapy 48 Ocular Dry eyes. Discontinue using contact lens 51 Mucoskeletal Arthralgias. Tendinitis Isotretinoin Monitor creatinine phosphate level Neurologic Headache. Mild depression Isotretinoin Cessation of therapy Drug Interaction: Only limited studies have been conducted for drug interaction with retinoids. Systemic retinoids are found to cause drug interactions of different levels of severity with the following drugs.

Tetracyclines: Systemic retinoids, when co-administered with tetracyclines causes serious adverse reaction. It may increase the risk of pseudotumor cerebri which is also known as benign intracranial hypertention.

Similar reactions are reported when retinoids are given together with other class of tetracyclines such as doxycycline, demeclocycline, lymecycline, minocycline and oxytetracycline. The combination is not recommended to be co-administered. The symptoms of pseudotumor cerebri such as visual disturbances, visual loss, headache, nausea, vomiting and papilledema typically tend to resolve after discontinuation of the treatment Vitamin A: Co-administration of Vitamin A and retinoids may result in hypervitaminosis and other additive toxicities.

Serious adverse effects such as vision impairment, pseudotumor cerebri, mucositis, pancreatitis, colitis, hepatitis and hyper- triglyceridemia can occur. If signs of hypervitaminosis such as inflammation of gums, pruritis, vertigo, dry scaly skin, alopecia and erythema occurs then the drug should be discontinued Methotrexate: Co-administration of methotrexate and retinoids tend to induce hepatotoxicity and potentiates the risk of liver injury and can lead to hepatitis, cirrhosis, chronic fibrosis, necrosis and elevation of liver enzymes.

Monitoring of hepatic function is very important These enzymes are inhibited by the action of mifepristone that decreases the clearance. Dose adjustment along with clinical and laboratory monitoring is important Gemfibrozil: Co-administration of bexarotene and gemfibrozil leads to increased bexarotene level due to the inhibition of enzyme CYP3A4.

This increases bexarotene toxicity and leads to serious side effects, so this combination is generally avoided Phenytoin: Co-administration with the inducers of CYP 3A4 may decrease the plasma concentration of bexarotene. Other drugs which are known to interact with similar mechanism include rifampicin, phenobarbital and carbamazepine.

The interaction is minor but can be given with close monitoring of the drug-plasma level Cyclosporin: Co-administration with bexarotene may reduce the plasma concentration of the drugs which are primarily metabolized by enzyme CYP 3A4 as a result of induction activity of bexarotene.

Other drugs which act by the same mechanism include atorvastatin, paclitaxel and tamoxifen. The co-administration of bexarotene with these drugs needs extreme cautiousness, especially those with narrow therapeutic index. Appropriate dose adjustment along with clinical and laboratory investigation is advisable With Isotretinoin and Acitretin : Using the teriflunomide with isotretinoin and acitretin is known to induce hepato-toxicity and tends to increase the risk of liver injury associated with leflunomide.

Elevated liver enzymes, jaundice, hepatic failure, hepatitis and acute hepatic necrosis have been reported for teriflunomide, which is the principal active metabolite of leflunomide. The combination has to be used with extreme caution. It is very important to measure the liver enzyme and bilirubin levels before starting teriflunomide therapy.

The combination should be avoided if the patient has elevated liver enzymes or any pre-existing liver disease. Teriflunomide should be discontinued if the patient develops elevated serum ALP levels and wash out procedures with activated charcoal should be performed With Bexarotene: Using these drugs in combination may increase the risk of infection. Studies have reported serious infection like sepsis, pneumocystis jiroveci pneumonia, pulmonary and extra-pulmonary tuberculosis and aspergillosis.

Similar interaction as that with isotretinoin and acitretin has been reported in recent studies. The combination with bexarotene may induce hepatotoxicity and may increase the risk of liver injury.

Close monitoring is essential as the interaction may appear even when these agents are initiated after discontinuation with teriflunomide because of its prolonged half-life. Treatment should be stopped if there is evidence of serious hepato-toxicity, infection or bone marrow suppression and activated charcoal can be administered for accelerated elimination Ciprofloxacin: The combination may increase the plasma concentration of bexarotene.

It is known that bexarotene is inducer of CYP 3A4 and tends to reduce plasma concentration of CYP 3A4 inhibitors that are the substrates of the isoenzyme like macrolides, mifepristone, azole antifungals and some calcium channel blockers. Other drugs which act by similar mechanism include fleroxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin.

The clinical significance is currently unknown Medroxyprogesterone: The combination of medroxyprogesterone along with systemic retinoids is contraindicated because of potential serious foetal malformation during retinoids therapy. The exact mechanism is currently unknown. The use of progestin-only contraceptives is not enough so at least two method of effective contraception is recommended during retinoid therapy Because of their promising therapeutic efficacy, the US-FDA has approved systemic retinoids for treatment of certain dermatological conditions.

Although retinoids are widely used, its adverse effects have limited their practice. These drugs, if used irrationally can lead to severe adverse reaction. These are also contraindicated for the use in certain conditions such as pregnancy because of higher risk of embryo-foetal abnormalities and also in combination with certain drugs such as tetracycline, medroxyprogesterone, teriflunomide, mifepristone and other similar drugs because of potential toxicities.

It is very important to monitor the patient closely by examining the improvement along with monitoring certain laboratory investigations. There is limited information on the accurate mechanism of adverse effects and drug interaction so conducting further studies is necessary for safe and effective use of retinoids. Aryal A and Upreti S: A brief review on systemic retinoids.

Int J Pharm Sci Res ; 8 9 : Article Information Sr No: 3. Download: Cited By: Authors: A. DOI: Published: 01 September, Acitretin for psoriasis. Alcohol can cause Soriatane to convert to a form that is very slowly removed from the body, which increases the risk of birth defects if the woman becomes pregnant. Soriatane can reduce the effectiveness of phenytoin, a common drug for epilepsy, when given at the same time.

Soriatane should not be combined with tetracycline an antibiotic , since both medications can cause increased pressure on the brain, which can have serious consequences. Soriatane is most effective for treating psoriasis when it is used with phototherapy. Soriatane is sometimes used with Enbrel etanercept or Remicade infliximab , and may also be prescribed in rotation with cyclosporine or methotrexate. As an off-label use, Accutane isotretinoin is another oral retinoid that is sometimes used in place of acitretin to treat psoriasis.

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We use cookies to offer you a better experience and analyze our site traffic. By continuing to use this website, you consent to the use of cookies in accordance with our Privacy Policy. Helpline Soriatane Acitretin. Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the Food and Drug Administration specifically for treating psoriasis.

How Is Soriatane Used? Its antineoplastic properties make it a useful agent for cancer prophylaxis. Evidence-based efficacy, side-effect profile, and approach to the use of acitretin would be discussed in this review. In addition to its approved uses, the various off label uses will also be highlighted in this section. Since its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity, this review would summarize the contraindications and precautions to be exercised before prescribing acitretin.

Introduction The skin absorbs, stores, and metabolizes vitamin A. First generation retinoids: Which include retinol, retinal, tretinoin retinoic acid, Retin-A , isotretinoin, and alitretinoin. Second generation retinoids: Which include etretinate and acitretin.

Third generation retinoids: Which include tazarotene, bexarotene, and adapalene. Acitretin, a synthetic retinoid, is the pharmacologically active metabolite of etretinate. The aromatic retinoids second generation were developed because they appeared to be more effective in treating psoriasis and other keratinizing disorders.

In , etretinate was approved for the treatment of psoriasis, but problems like long-term storage in fat led to its replacement with acitretin in With its more favorable pharmacokinetics acitretin being 50 times less lipophilic than etretinate has significantly shorter elimination half-life , acitretin became an established systemic therapy for severe psoriasis. Pharmacokinetics Acitretin is rapidly and extensively distributed throughout the body bound to plasma proteins without tissue accumulation.

Mechanism of Action Acitretin acts at cytosolic proteins and intranuclear receptors, which are part of the steroid-thyroid hormone super family. It also interferes with the esterification and incorporation of arachidonic acid into nonphosphorus lipids in human keratinocytes and causes inhibition of ornithine decarboxylase thus decreasing the synthesis of polyamines.

It also inhibits keratinocyte production of vascular endothelial growth factor. It inhibits cell growth and proliferation and decreases AMP-dependent protein kinases in fibroblasts. Antineoplastic effects: By normalizing abnormal epidermopoesis acitretin exerts its anticarcinogenic effects. It also inhibits tumor cell angiogenesis and modulates cellular apoptosis. Retinoids influence growth factors, can indirectly down-regulate proto-oncogenes and may act to increase intracellular levels of ceramides.

These changes may lead to decrease in cell growth and possibly inhibit malignant progression Wound healing: Retinoids lead to increased mucopolysaccharides, collagen, and fibronectin synthesis and decrease in collagenase production interfere with wound healing Antiacne and sebum effects: Caused by inhibition of sebocyte proliferation although the potency of acitretin Uses Psoriasis The effect is dose dependant.

Severe plaque type psoriasis: The efficacy of acitretin in chronic plaque psoriasis as a monotherapy is below methotrexate and cyclosporine. However, when used in combination with other topical and systemic therapies topical corticosteroids, topical vitamin D preparations, psoralen with UVA PUVA, ultraviolet B UVB therapy it is as potent as classical therapies. Nail psoriasis: In an open study of patients with nail psoriasis who received acitretin in doses of 0.

In a retrospective analysis of eight RCTs comparing acitretin with placebo and acitretin with etretinate, in patients with generalized pustular, severe and erythrodermic psoriasis patients, the results were heterogeneous, acitretin was found to be effective as compared with placebo with effect being dose dependant mg daily more effective than low dose.

Combination Therapy Acitretin and PUVA: The major advantage of this combination is reduced risk of malignancy by phototherapy especially squamous cell carcinoma. Other combinations A RCT showed similar efficacy from the combination regimen of acitretin 0.

Lichen sclerosus In a randomized controlled trial on 46 subjects, 14 of 22 patients on acitretin responded as compared to 6 of 24 in the placebo group. Nguyen EH, Wolverton S. Systemic retinoids.

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Low-dose acitretin is associated with fewer adverse events than high-dose acitretin in the treatment of psoriasis. Efficacy and safety of acitretin in adult patients with severe plaque type psoriasis: A randomized, double blind, parallel group, dose ranging study in three fixed doses of 25, 35 and 50 mg. Efficacy of low-dose acitretin in the treatment of psoriasis. J Dermatolog Treat ; A randomized comparison of acitretin-narrow-band TL phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis.

Acta Derm Venereol Stockh ; The efficacy of calcipotriol plus acitretin combination therapy for psoriasis: Comparison with acitretin monotherapy. Am J Clin Dermatol ; Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: A week, randomized, controlled, investigator-blinded pilot trial. Toxic hepatitis due to combination therapy with methotrexate and etretinate in psoriasis. Failure of combination therapy with acitretin and cyclosporin A in 3 patients with erythrodermic psoriasis.

Dermatology ; Acitretin monotherapy in Darier's disease. A double-blind comparison of acitretin and etretinate in the treatment of Darier's disease. Kirby B, Watson R. Pityriasis rubra pilaris treated with acitretin and narrow-band ultraviolet B Re-TL Treatment of lichen planus with acitretin. A double-blind, placebo-controlled study in 65 patients. Treatment of lichen planus: An evidence-based medicine analysis of efficacy.

Disseminated hypertrophic lichen planus: Relevant response to acitretin. An Bras Deramatol ; Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine. Efficiency of acitretin in the treatment of cutaneous lupus erythematosus.

Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: A double-blind, placebo-controlled study. An appraisal of acitretin therapy in children with inherited disorders of keratinization.

Retinoids in disorders of keratinization: Their use in adults. Dermatologica ; Suppl 1:S Oral retinoid therapy for disorders of keratinization: Single-centre retrospective 25 years' experience on 23 patients.