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Adapalene

Medically reviewed by Drugs.com. Last updated on Sep 29, 2019.

Pronunciation

(a DAP a leen)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Differin: 0.1% (45 g)

Generic: 0.1% (45 g)

Gel, External:

Differin: 0.1% (15 g, 45 g); 0.3% (45 g) [contains edetate disodium, methylparaben, propylene glycol]

Differin: 0.1% (15 g, 45 g) [fragrance free, oil free; contains edetate disodium, methylparaben, propylene glycol]

Generic: 0.1% (45 g); 0.3% (45 g)

Lotion, External:

Differin: 0.1% (59 mL) [contains methylparaben, propylene glycol, propylparaben]

Generic: 0.1% (59 mL)

Pad, External:

Generic: 0.1% (14 ea)

Solution, External:

Generic: 0.1% (60 mL)

Brand Names: U.S.

  • Differin
  • Differin [OTC]

Pharmacologic Category

  • Acne Products
  • Retinoic Acid Derivative
  • Topical Skin Product, Acne

Pharmacology

Retinoid-like compound which is a modulator of cellular differentiation, keratinization, and inflammatory processes, all of which represent important features in the pathology of acne vulgaris

Absorption

Topical: Minimal; only trace amounts have been measured in serum after chronic application

Excretion

Bile

Onset of Action

8 to 12 weeks

Half-Life Elimination

Terminal: 7 to 51 hours (gel)

Use: Labeled Indications

Acne vulgaris: Treatment of acne vulgaris.

Off Label Uses

Rosacea

Topical adapalene for the management of rosacea has been studied in a limited number of patients, with data suggesting it may be a useful alternative to topical metronidazole in patients with papulopustular rosacea [Altinyazar 2005].

Contraindications

Hypersensitivity to adapalene or any component of the formulation.

Lotion: There are no contraindications listed in the manufacturer's labeling.

OTC labeling: When used for self-medication, do not use on damaged skin (cuts, abrasions, eczema, sunburn).

Documentation of allergenic cross-reactivity for retinoids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Canadian labeling: Additional contraindications (not in US labeling): Patients with eczema or seborrheic dermatitis; women who are pregnant or planning to become pregnant.

Dosing: Adult

Acne vulgaris: Topical: Apply once daily in the evening before bedtime. If irritation occurs, may reduce the frequency of application.

Rosacea (off-label use): Topical: 0.1% Gel: Apply to affected area once daily in the evening for up to 12 weeks (Altinyazar 2005)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Acne vulgaris, treatment: Children ≥7 years and Adolescents: Limited data available in ages <12 years (Eichenfield 2013): Topical: Apply once daily; cream, gel, or solution should be applied in the evening (at bedtime). Note: During the initial 2 weeks of therapy, it may appear that acne worsens; full effect may take up to 8 to 12 weeks of therapy.

Administration

For topical use only; not for oral, ophthalmic, or intravaginal use. Avoid contact with abraded, broken, eczematous, or sunburned skin, mucous membranes, eyes, lips, and angles of the nose. Moisturizers may be used if necessary; avoid alpha hydroxy or glycolic acid-containing products. A mild transitory sensation of warmth or slight stinging may occur shortly after application.

Cream/gel: Apply a thin film to clean/dry skin in the evening before bedtime; apply enough to cover entire affected area.

External pad: Remove pad from foil just prior to use. Before bedtime, wash and dry area to be treated, then apply pad containing topical solution to affected areas. Discard pad after single use.

Lotion: Apply after washing gently with a mild or soapless cleanser and then pat dry; dispense a nickel size amount (3 to 4 pump actuations) to cover entire face.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F); do not freeze. Protect from light.

Lotion: Protect from light and heat; do not refrigerate.

Drug Interactions

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Avoid combination

Multivitamins/Minerals (with AE, No Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Avoid combination

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Monitor therapy

Adverse Reactions

>10%: Dermatologic: Xeroderma (≤45%), exfoliation of skin (≤44%), erythema (≤38%), burning sensation of skin (≤29%), stinging of the skin (≤29%)

1% to 10%: Dermatologic: Skin abnormalities (1% to 6%; discomfort), desquamation (2%), pruritus (≤2%), skin irritation (1% to 2%), sunburn (1% to 2%)

≤1%, postmarketing, and/or case reports: Acne flare, angioedema (gel), application site pain (gel), conjunctivitis, contact dermatitis, dermatitis, eczema, eyelid edema, facial edema (gel), skin discoloration, skin rash (cream/gel), swelling of lips (gel)

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Reactions such as pruritus, face edema, eyelid edema, and swelling have been reported. Discontinue use immediately if allergic or anaphylactoid/anaphylactic reactions occur.

• Photosensitivity: Use is associated with increased susceptibility/sensitivity to UV light; avoid sunlamps or excessive sunlight exposure. Daily sunscreen use and other protective measures are recommended. Patients with sunburn should discontinue use until sunburn has healed.

• Skin irritation: Certain cutaneous signs and symptoms such as erythema, dryness, scaling, stinging/burning, or pruritus may occur during treatment; these are most likely to occur during the first 2 to 4 weeks and will usually lessen with continued use. Treatment can increase skin sensitivity to weather extremes of wind or cold. Concomitant topical medications (eg, medicated or abrasive soaps and cleansers, or cosmetics with a strong drying effect, products with high concentrations of alcohol, astringents, spices or limes) should be avoided due to increased skin irritation. Depending on the severity of irritation, use moisturizer, reduce the frequency of application, or discontinue use.

Other warnings/precautions:

• Appropriate use: For external use only; avoid contact with abraded, broken, eczematous, or sunburned skin, mucous membranes, eyes, lips, and angles of the nose. Wax depilation is not recommended.

Pregnancy Risk Factor

C

Pregnancy Considerations

Inadvertent exposure to a limited number of pregnant women occurred during premarketing studies. Published information related to adapalene exposure in pregnancy is limited (Autret 1997).

In general, topical products are recommended for the treatment of acne in pregnancy due to lower systemic exposure. However, because adapalene may share the characteristic of teratogenicity with other retinoids, agents other than adapalene are preferred. Avoid applying large amounts over prolonged periods of time to decrease the potential for systemic absorption (Akhavan 2003; Kong 2013; Leechman 2006).

In clinical trials, women of childbearing potential were required to have a negative pregnancy test prior to therapy.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience redness, dry skin, scaling, or burning. Have patient report immediately to prescriber severe skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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