Acitretin Vitamin

Acid yellow (Aquashade), herbicide/algicide for aquaculture in U.S., 3 214t Acitretin, 25 790 a-c Josephson effect, 15 750 Aclame, 24 232 ac losses, 23 845-846 Acne, vitamin A treatments for, 25 789 cis-Aconitic acid, in citric acid cycle, 6 633 Aconitine, 2 103... 

Medicines related to vitamin D are also effective but an unwanted side effect of the early ones was to cause the body to retain too much calcium, which is detrimental. More than 1500 different compounds have been synthesised to try and find one that would act on the psoriasis without raising the level of calcium in the blood. Calcipotriol cream was the one that performed best and is now widely used. Another chemical, etretinate, was introduced in 1975 and found to be just as effective. It was eventually superseded by acitretin when it was discovered that the body converted etretinate to acitretin and it was the latter which was the active agent. Acitretin is now the prescribed drug and it is very effective with three quarters of those treated reporting noticeable improvement and for about a third of patients their psoriasis cleared up completely. Psoriasis can also be treated with successive oral doses of methoxsalen followed by UV irradiation of the affected area. 

Vitamin A (retinols) plays a role in epithelial function and the retinoic acid derivative, acitretin (Neotigason, orally), inhibits psoriatic hyperkeratosis over 4-6 weeks. Acitretin should be used in courses (6-9 months) with intervals (3-4 months). It is teratogenic, like the other vitamin A derivatives. Rigorous precautions for use in women of childbearing potential are laid down by the manufacturer and must be followed, including contraception for 2 years after cessation, because the drug is stored in the liver and in fat and released over many months. The plasma t) is 3 months. It can cause other serious toxicity (see Vitamin A, p. 739). Tazarotene, a topical retinoid, is of some benefit in mild psoriasis, but is irritant. 

Clinically important, potentially hazardous interactions with acitretin, beta-carotene, dexamethasone, gemfibrozil, isotretinoin, tretinoin, vitamin A... 

Clinically important, potentially hazardous interactions with acetaminophen, acitretin, aspirin, chloroquine, digoxin, doxepin, fat-soluble vitamins A, D, E, K, hydroxychloroquine, isotretinoin, lovastatin, mycophenolate, raloxifene, sulfasalazine, sulfonylureas, tetracycline, tricyclic antidepressants, ursodeoxycholic acid, valproic acid... 

Clinically important, potentially hazardous interactions with acitretin, aluminum salts, amoxicillin, ampicillin, antacids, bacampicillin, bismuth, calcium, carbenicillin, cloxacillin, digoxin, iron salts, isotretinoin, magnesium salts, methotrexate, methoxyflurane, mezlocillin, nafcillin, oxacillin, penicillins, piperacillin, ticarcillin, vitamin A, zinc, zinc salts... 

Topical treatments of first choice for mild to moderate psoriasis include keratolytics, corticosteroids, vitamin D analogues (calcipotriene, calcitriol, and tacalcitol), and tazarotene. The systemic treatment of first choice for moderate to severe psoriasis is acitretin. See Tables 96-2 and 96-3 for topical and systemic psoriasis treatment guidelines. 

Bryan, P.D. Honigberg, I.L. Meltzer, N.M. Electrochemical detection of retinoids using normal phase HPLC. J.Liq.Chromatogr., 1991, 14, 2287-2295 [LOD 1 ng also acitretin, isotretinoin, tretinoin, vitamin A palmitate]... 

Retinoids include natural compounds and synthetic derivatives of retinol that exhibit vitamin A activity. First-generation retinoids include retinol, tretinoin (aU-ironi-retinoic acid), isotretinoin (13-cu-retinoic acid), and alitretinoin (9-cw-retinoic acid). Second-generation retinoids, also known as aromatic retinoids, were created by alteration of the cyclic end group and include acitretin. Third-generation retinoids contain further modifications and are called arotinoids. Members of this generation include tazarotene and bexarotene. Adapalene, a derivative of naphthoic acid with retinoid-like properties, does not fit precisely into any of the three generations. 

A condition similar to vitamin A (retinol) overdosage may occur if acitretin or isotretinoin are given with vitamin A. 

The manufacturers of acitretin say that the concurrent use of vitamin A should be avoided. In the UK they advise no more than 4000 to 5000 units daily, which is the recommended daily allowance, and in the US they advise doses of no more than the minimum recommended daily allowance. Similarly, the manufacturers of isotretinoin say that vitamin A should be avoided. ... 

Leithead JA, Simpson KJ, MacGilchrist AJ. Fulminant hepatic failure following overdose of the vitamin A metabolite acitretin. Eur J Gastroenterol Hepatol 2009 21(2) 230-2. 

EG Larsen, C Vahlquist, E Andersson, H Torma, K KragbaUe, A Vahlquist. Oral acitretin in psoriasis drug and vitamin A concentrations in plasma, skin and adipose tissue. Acta Derm Venereol (Stockh) 72 84-88, 1992. 

The parent compound in the vitamin A group is called sdl-trans retinol (Fig. lA) [4]. Its aldehyde and acid forms are retinal (Fig. IB) and retinoic acid (Fig. 1C). The active form of vitamin A in vision is ll-cis retinal (Fig. ID), and a therapeutically useful form (accutane, isotretinoin) is l3-cis retinoic acid (Fig. IE). Retinyl palmitate (Fig. IF) is a major storage form, and retinoyl p-glucuronide is a biologically active, relatively non-toxic water-soluble metabolite (Fig. IG). A synthetic aromatic analog (etretin, acitretin), shows therapeutic usefulness (Fig. IH). Finally, p-carotene, a major provitamin A carotenoid, is shown in Figure II. 

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