[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Dermatological retinoids](https://durgical.com/en/pharmacology/classes/dermatological-retinoids/) › Acitretin

# Acitretin

## Dermatological retinoids?

Dermatological retinoids

## Pregnancy: 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Dermatological retinoids](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Severe birth defects (malformations of the spine, skull, face and limbs, among others)
- Hepatotoxicity, including fatal hepatitis
- Pancreatitis with very high triglycerides
- Intracranial hypertension (pseudotumor cerebri)
- Skeletal changes (spurs, hyperostosis, ligament calcification) with long use
- Capillary leak syndrome; exfoliative dermatitis; decreased night vision

## 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.

## Memory aid

ACITRETIN = Alcohol Creates etretInate: Three years of contraception, no blood donation, no teTRAcycline, no meThotrexate.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/acitretin/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**Pregnancy: 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.

## Connections

## Related drugs 2

- [Isotretinoin](https://durgical.com/en/pharmacology/isotretinoin/)
- [Calcipotriol](https://durgical.com/en/pharmacology/calcipotriol/)

## Related conditions 1

- [Psoriasis](https://durgical.com/en/conditions/psoriasis/)

[← Back to the class: Dermatological retinoids](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a601010.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - ACITRETIN capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=993a5325-cd10-4450-b5ea-1c0a90510df6) (DailyMed (U.S. National Library of Medicine), 2022); [Retinoid-containing medicinal products - referral](https://www.ema.europa.eu/en/medicines/human/referrals/retinoid-containing-medicinal-products) (European Medicines Agency (EMA), 2018).

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