Tretinoin Topical Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Acne

Initial dose: Apply a small amount lightly to the entire affected area once a day at bedtime.
Maintenance dose: An apparent exacerbation of the acne may also occur during the initial phase of therapy (3 to 4 weeks) as a result of tretinoin's action on subclinical comedones, but should subside with prolonged use. Improvement is gradual and often not evident for 6 to 12 weeks or more. Therapy should be continued until the patient is free of new lesions for several months, although less frequent applications or a switch to a less potent formulation may be adequate for maintenance once a satisfactory therapeutic response is obtained.

Tretinoin lacks antibacterial activity and may therefore be combined with an antibiotic in the treatment of inflammatory acne. In severe cystic acne, the addition of benzoyl peroxide may be beneficial if the patient has tolerated tretinoin without significant inflammation. The benzoyl peroxide should be applied in the morning and the tretinoin at bedtime. Initially, the two agents may be applied on alternate days of each other.

Usual Adult Dose for Dermatoheliosis

Initial dose: Apply a small amount lightly to the entire affected area once a day at bedtime.
Maintenance dose: The duration of active treatment will depend on the extent of the photodamage. Often it will take 3 to 4 months before significant improvement is seen. When maximal clinical benefits have been obtained (usually after 8 months to 1 year of therapy), the patient may be maintained on a schedule of 2 to 4 applications per week. Perpetual maintenance therapy is essential in order to sustain the clinical improvements, although safety has not been established for use beyond 48 weeks for the 0.05% cream and 52 weeks for the 0.02% cream.

Greater than 50 years: Safety and efficacy have not been established for the 0.05% emollient cream

Usual Geriatric Dose for Dermatoheliosis

Greater than 71 years: Safety and efficacy have not been established for the 0.02% emollient cream

Usual Pediatric Dose for Acne

Less than 12 years: Safety and efficacy have not been established.
12 to 18 years:
Initial dose: Apply a small amount lightly to the entire affected area once a day at bedtime.
Maintenance dose: An apparent exacerbation of the acne may also occur during the initial phase of therapy (3 to 4 weeks) as a result of tretinoin's action on subclinical comedones, but should subside with prolonged use. Improvement is gradual and often not evident for 6 to 12 weeks or more. Therapy should be continued until the patient is free of new lesions for several months, although less frequent applications or a switch to a less potent formulation may be adequate for maintenance once a satisfactory therapeutic response is obtained.

Tretinoin lacks antibacterial activity and may therefore be combined with an antibiotic in the treatment of inflammatory acne. In severe cystic acne, the addition of benzoyl peroxide may be beneficial if the patient has tolerated tretinoin without significant inflammation. The benzoyl peroxide should be applied in the morning and the tretinoin at bedtime. Initially, the two agents may be applied on alternate days of each other.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Tretinoin may induce photosensitivity in some individuals. Patients on tretinoin therapy should minimize exposure to sunlight, including sun lamps, and use sunscreens and other protection whenever prolonged exposure is unavoidable. Therapy should be discontinued if sunburn develops, and not resumed until the skin fully recovers. The concomitant use of photosensitizing drugs should be avoided. Patients may also have a heightened susceptibility to irritation due to weather extremes while under tretinoin treatment.

When used to mitigate the signs of aging, tretinoin should be used as an adjunct to a comprehensive skin care and sun avoidance program.

Tretinoin frequently causes erythema and scaling at the treated areas, particularly during the early weeks of therapy. Patients who develop excessive irritation should use the medication less frequently, interrupt treatment briefly, or discontinue use totally. In addition, tretinoin may cause severe irritation on eczematous skin and should be used with caution in patients with this condition.

Tretinoin can cause skin fragility and enhance percutaneous penetration. Patients may be more vulnerable to the irritating effects of astringents, abrasive soaps, skin cleansers, and other facial chemicals and cosmetics that contain alcohol or have a strong drying effect. Hot wax epilation has been reported to cause erosions at tretinoin treated areas.

Tretinoin is relatively unstable and subject to inactivation by other chemicals. Therefore, it should not be applied concurrently with other topical products. Tretinoin is also readily oxidized by sunlight and should be applied in the evening.

Tretinoin should not be used on the sensitive areas around the eyes, the mouth, the angles of the nose, and mucous membranes.

The safety and effectiveness of chronic use (greater than 48 weeks) or in patients with moderately or heavily pigmented skin have not been established.

Dialysis

Data not available

Other Comments

The affected area should be washed gently with a mild soap and dried 20 to 30 minutes before application to avoid undue irritation. No other topical products should be applied concomitantly because of potential chemical or pH incompatibilities that may inactivate the tretinoin. Cosmetics, moisturizers, and/or sunscreen may be used daily in the morning; however, the area should be cleansed before applying tretinoin.

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