Severe psoriasis (in female patients of reproductive potential, use only if unresponsive to or cannot take other agents).
25–50mg once daily with main meal; may discontinue when lesions resolve. May repeat if relapse occurs. Prescribe limited supply. Decrease phototherapy dose.
Alcohol. Concomitant methotrexate, tetracyclines. Severe hepatic or renal dysfunction. Dyslipidemias. Pregnancy (Cat.X). Nursing mothers.
Be fully familiar with toxicity and teratogenicity before use. Transient worsening of symptoms may occur. Females of reproductive potential (including history of infertility): obtain 2 reliable (–) pregnancy tests (when decision is made to start and within 1 week of start) and repeat periodically (eg, monthly); use at least 2 reliable methods of contraception or abstain for at least 1 month before, during, and for 3 years after therapy (if etretinate had been used previously, continue to follow contraception recommendations for that product). Discontinue if hepatotoxicity is suspected, if papilledema (refer to neurologist), visual difficulties (refer to ophthalmologist), or CNS disturbances (eg, depression) occur. Do pretreatment blood lipid evaluation and repeat at 1–2 week intervals until lipid response established; control significant triglyceride elevations with diet, drugs, or dose reduction. Hypertriglyceridemia risk. Avoid sun and UV light. Monitor diabetics. Do not donate blood during and for 3 years after therapy. Get written informed consent. Elderly.
See Contraindications (methotrexate increases risk of hepatitis; tetracycline increases intracranial pressure). Females must not ingest ethanol during or for 2 months after therapy (prolongs teratogenic potential). Interferes with efficacy of low-dose progestin-only contraceptives and possibly other progestin-only contraceptives (eg, injectables, implants); avoid St. John's wort, others that may decrease efficacy of contraceptives. Avoid phenytoin, vitamin A, other oral retinoids. May potentiate phenytoin, sulfonylureas.
Lipid elevations, abnormal liver function and other lab tests, cardiovascular effects, depression or other psychiatric symptoms, chelitis, alopecia, skin peeling, dry or sticky skin, nail disorder, pruritus, dry mouth, rhinitis, hypervitaminosis A syndrome, epistaxis, rash, hyperesthesia, paresthesia, xerophthalmia, dry or irritated eye, loss of eye brow or lashes, decreased night vision, intolerance to contact lenses, arthralgia, spinal hyperostosis, rigors; rare: pseudotumor cerebri, pancreatitis, hepatitis.