Acitretin
Dermatological retinoids
Dermatological retinoidsPregnancy: contraindicated
Contraindicated. Pregnancy must be avoided during treatment and for at least three years after stopping, because etretinate formed with alcohol can remain in the body for years.
An oral retinoid for severe psoriasis. With alcohol it forms etretinate, which lingers for years, so pregnancy is avoided for three years after stopping.
Quick facts
- Group
- Dermatological retinoids
- Target
- Retinoic acid receptors RAR-α, -β and -γ (exact mechanism in psoriasis not established)
- Used for
- Severe psoriasis in adults
- Key effects
- Dry · Hair loss and fragile nails
- Monitor
- Pregnancy tests before starting · Visual problems
- ATC
- D05BB02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Acitretin is an aromatic retinoid, the active metabolite of the older drug etretinate and a relative of retinoic acid and vitamin A. Its exact mechanism is not known; like other systemic retinoids it acts through nuclear retinoid receptors to normalise the fast turnover and abnormal differentiation of psoriatic keratinocytes. Benefit begins within weeks and is full after a few months. Alcohol converts it back into etretinate, which is stored in fat and eliminated extremely slowly, which drives the long pregnancy-prevention period.
- Acitretin acts through nuclear retinoid receptors in keratinocytes
- Fast, abnormal keratinocyte turnover slows and normalises
- Psoriatic scale and thickness fall over weeks to months
- With alcohol it becomes etretinate, stored in fat for years
Indications
- Severe psoriasis in adults, especially pustular forms Psoriasis →
Adverse effects
Common
- Dry, peeling, itchy skin; chapped lips; nosebleeds
- Hair loss and fragile nails
- Dry eyes and loss of eyebrows or lashes
- Raised triglycerides and cholesterol, lower HDL
- Raised liver enzymes
- Joint pain and muscle tightness; sun sensitivity
Contraindications
- Pregnancy, or intending pregnancy during treatment or within three years after stopping
- Severe liver or kidney impairment
- Chronically raised blood lipids
- Combination with methotrexate or with tetracyclines
- Breastfeeding
- Hypersensitivity to acitretin or other retinoids
Key interactions
- Alcohol (drinks, foods and medicines that contain it)
- Forms etretinate, with a much longer half-life and teratogenic risk; avoided during treatment and for two months after.
- Methotrexate
- More hepatitis; the combination is contraindicated.
- Tetracyclines
- Both raise intracranial pressure; contraindicated together.
- Progestin-only 'minipill'
- Acitretin interferes with its contraceptive effect.
What is monitored
- Pregnancy tests before starting, every month during treatment and regularly for three years after
- Liver tests and fasting lipids before starting and at short intervals until the response is known
- Visual problems, headache, abdominal pain
- Bone and joint symptoms during long treatment
Administration and safety
- Oral capsule taken with food.
- Prescribed with signed informed consent and a pregnancy-prevention programme for people who can become pregnant.
- No blood donation during treatment and for three years after.
Pregnancy and breastfeeding
Contraindicated. Pregnancy must be avoided during treatment and for at least three years after stopping, because etretinate formed with alcohol can remain in the body for years.
Nursing care
- Check the pregnancy test and two contraceptive methods before each prescription in people who can become pregnant.
- Teach to avoid alcohol in drinks, food and medicines (mouthwash, syrups) during treatment and for two months after.
- Teach to report yellow skin, dark urine, upper abdominal pain, headache or visual change.
- Teach sun protection and care when driving at night.
Pharmacokinetics
- Absorption
- Oral; absorption is best when taken with food.
- Distribution
- Almost entirely bound to plasma albumin; etretinate formed with alcohol accumulates in fat.
- Metabolism
- Isomerised to cis-acitretin, then broken into chain-shortened products and conjugates; ethanol converts it to etretinate.
- Elimination
- Metabolites in faeces and urine.
- Half-life
- About two days for acitretin; etretinate stays for months, and has been found years after stopping.
Test yourself
Think of the answer, then tap the question to see it.
Why must pregnancy be avoided for three years after acitretin?
Alcohol converts acitretin into etretinate, which is stored in fat and eliminated over months to years and is highly teratogenic.
Which two drugs are contraindicated with acitretin?
Methotrexate (hepatitis) and tetracyclines (intracranial hypertension).
Which laboratory tests are followed during acitretin treatment?
Liver tests and fasting lipids, plus regular pregnancy tests in people who can become pregnant.
Connections
← Back to the class: Dermatological retinoids
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Acitretin: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - ACITRETIN capsule (DailyMed (U.S. National Library of Medicine), 2022); Retinoid-containing medicinal products - referral (European Medicines Agency (EMA), 2018).
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Representative model, for educational purposes only.