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Acitretin Side Effects

Medically reviewed by Drugs.com. Last updated on Oct 4, 2023.

Applies to acitretin: oral capsule.

Warning

Oral route (Capsule)

Acitretin, the active metabolite of etretinate, is teratogenic and major fetal abnormalities have been reported during and after treatment completion. Use in women should be reserved for non-pregnant patients with severe psoriasis that did not respond to alternative treatments or when alternative treatments are contraindicated. Acitretin is contraindicated in women of childbearing potential unless all of the following criteria are met: 1) two negative urine or serum pregnancy tests (sensitivity at least 25 milli-international units/mL) prior to initiation; the first test is a screen test, the second test is a confirmation test done during first 5 days of menstrual period before therapy initiation or done at least 11 days after unprotected sex in amenorrhea patients; initiate treatment within 7 days of second negative pregnancy test; prescription for acitretin is limited to a 1 month supply; 2) pregnancy test must be repeated every month during treatment with a sensitivity of at least 25 milli-international units/mL and test result must be negative before receiving a prescription for the month; after discontinuing therapy, a pregnancy test must be repeated every 3 months for at least 3 years; 3) commitment to use 2 effective forms of contraception (except the minipill) simultaneously for at least 1 month prior to initiation, during, and for at least 3 years following cessation of therapy unless reproductive status is posthysterectomy or postmenopausal; 4) monthly counseling by the prescriber during therapy and every 3 months for at least 3 years following therapy discontinuation about contraception and behaviors associated with an increased risk of pregnancy. Avoidance of St. John's wort during hormonal contraception and signed patient agreement/informed consent form, which includes warning to refrain from consumption of ethanol or ethanol-containing beverages during and for 2 months after treatment discontinuation and avoidance of pregnancy at start of treatment, during, and for at least 3 years after treatment discontinuation. The Pregnancy Prevention Actively Required During and After Treatment (Do Your PART) program requirements are available at www.soriatane.com/doyour-part-Program.html or 1-888-784-3335. Men and women must avoid donation of blood during and for at least 3 years following acitretin therapy. All patients must receive the medication guide each time acitretin is dispensed. Acitretin has also been associated with severe hepatotoxicity. Mild and reversible, severe, and fatal cases of hepatoxicity have been reported .

Serious side effects of Acitretin

Along with its needed effects, acitretin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking acitretin:

More common

Less common

Rare

Incidence not known

Get emergency help immediately if any of the following symptoms of overdose occur while taking acitretin:

Symptoms of overdose

Other side effects of Acitretin

Some side effects of acitretin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Less common

Incidence not known

For Healthcare Professionals

Applies to acitretin: oral capsule, oral and topical kit.

General

The most commonly reported side effects were hypervitaminosis A, skin peeling, alopecia, dry mucous membranes of mouth and nose, chelitis, increased triglycerides, and rhinitis.[Ref]

Hepatic

Very common (10% or more): Increased SGOT (up to 50%), increased SGPT (up to 50%), increased alkaline phosphatase (up to 25%), increased direct bilirubin (up to 25%), increased GGTP (up to 25%)

Common (1% to 10%): Increased globulin, increased total bilirubin, increased total protein, increased and decreased serum albumin

Uncommon (0.1% to 1%): Abnormal hepatic function, hepatitis, jaundice[Ref]

Metabolic

Very common (10% or more): Increased/decreased LDH (up to 50%), increased/decreased cholesterol (up to 50%), increased fasting blood sugar (up to 50%), decreased fasting blood sugar (up to 25%)

Common (1% to 10%): Increased appetite, anorexia, thirst

Uncommon (0.1% to 1%): Alcohol intolerance, weight increase[Ref]

Hypersensitivity

Postmarketing reports: Hypersensitivity, including angioedema and urticaria[Ref]

Cardiovascular

Common (1% to 10%): Hot flashes, flushing

Uncommon (0.1% to 1%): Chest pain, cyanosis, intermittent claudication, peripheral ischemia

Postmarketing reports: Acute myocardial infarction, thromboembolism, capillary leak syndrome, stroke[Ref]

Dermatologic

Very common (10% or more): Hypervitaminosis A (over 80%), skin peeling (up to 80%), alopecia (up to 75%), dry skin ( up to 50%), nail disorder (up to 50%), pruritus (up to 50%), scaling and thinning of healthy skin with increased sensitivity (up to 40%), erythema (up to 40%), sensation of "burning skin" (up to 40%), sensation of "sticky skin" (up to 40%), dermatitis (up to 40%), hair loss (up to 40%), inflammation of the nail wall (up to 40%), nail fragility (up to 40%), erythematous rash (up to 25%), paronychia (up to 25%), skin atrophy (up to 25%), skin fragility

Common (1% to 10%): Abnormal skin odor, abnormal hair texture, bullous eruption, cold/clammy skin, increased sweating, psoriasiform rash, purpura, pyogenic granuloma, rash, seborrhea, skin fissures, skin ulceration, sunburn, rhagades, blistering of the skin, change in pigmentation of the skin and hair, change in growth rate of hair, change in hair structure

Uncommon (0.1% to 1%): Acne, cyst, eczema, furunculosis, hyperkeratosis, hypertrichosis, hypoesthesia, otitis media, otitis externa, photosensitivity reactions, aggravated psoriasis, skin nodule, skin hypertrophy, skin disorder, skin irritation, sweat gland disorder, urticaria, verrucae

Rare (less than 0.1%): Retinoid dermatitis (occasionally provoking psoriatic lesion)

Postmarketing reports: Madarosis, exfoliative dermatitis/erythroderma[Ref]

Gastrointestinal

Very common (10% or more): Dry mucous membranes of mouth and nose (up to 80%), chelitis (more than 75%), high occult blood (up to 25%),

Common (1% to 10%): Abdominal pain, diarrhea, nausea, tongue disorder, gingival bleeding, gingivitis, increased saliva, stomatitis, ulcerative stomatitis, inflammation of oral mucosa and gingiva

Uncommon (0.1% to 1%): Constipation, dyspepsia, esophagitis, gastritis, gastroenteritis, glossitis, hemorrhoids, melena, tenesmus, tongue ulceration, altered saliva, anal disorder, gum hyperplasia, hemorrhage, pharyngitis, heartburn, inflammatory bowel disorders

Rare (less than 0.1%): Pancreatitis, icterus

Frequency not reported: Rectal hemorrhage[Ref]

Genitourinary

Very common (10% or more): WBC in urine (up to 50%), acetonuria, hematuria, RBC in urine

Common (1% to 10%): Glycosuria, proteinuria

Uncommon (0.1% to 1%): Atrophic vaginitis, abnormal urine, dysuria. penis disorder, leukorrhea, breast pain

Rare (less than 0.1%): Metrorrhagia

Postmarketing reports: Vulvo-vaginitis due to Candida albicans.[Ref]

Musculoskeletal

Very common (10% or more): Arthralgia (up to 25%), spinal hyperostosis

Common (1% to 10%): Arthritis, arthrosis, back pain, hypertonia, myalgia, osteodynia, peripheral joint hyperostosis (progression of existing lesions), demineralization and rarefaction of bone, cortical hyperostosis, periosteal calcification, premature epiphyseal closure, calcification of spinal ligaments resulting in spinal cord compression

Uncommon (0.1% to 1%): Muscle weakness, bone disorder, olecranon bursitis, tendonitis, scleroderma[Ref]

Nervous system

Very common (10% or more): Hyperesthesia (up to 25%), paresthesia (up to 25%)

Common (1% to 10%): Headache, taste perversion

Uncommon (0.1% to 1%): Dizziness, abnormal gait, migraine, neuritis, pseudotumor cerebri (intracranial hypertension), taste loss, dysgeusia, lassitude, disturbance of consciousness

Rare (less than 0.1%): Lightheadedness, visual disturbance

Postmarketing reports: Myopathy with peripheral neuropathy[Ref]

Ocular

Very common (10% or more): Conjunctivitis (up to 40%), xerophthalmia (up to 25%), dry eyes, eye irritation, intolerance of contact lenses

Common (1% to 10%): Abnormal/ blurred vision,

blepharitis, irritation, corneal epithelial abnormality, decreased night vision/night blindness, eye abnormality, eye pain, photophobia

Uncommon (0.1% to 1%): Abnormal lacrimation, chalazion, conjunctival hemorrhage, corneal ulceration, diplopia, ectropion, itchy eyes and lids,

papilledema, recurrent sties, subepithelial corneal lesions

Rare (less than 0.1%): Keratitis, abrasion and irregularities leading to corneal opacities[Ref]

Other

Very common (10% or more): Increased triglycerides (up to 75%), increased creatinine phosphokinase (up to 50%), feeling of cold (up to 40%), rigors (up to 25%), increased phosphorus (up to 25%), increased potassium (up to 25%), increased sodium (up to 25%), increased and decreased magnesium (up to 25%)

Common (1% to 10%): Edema, fatigue, pain, earache, tinnitus, decreased phosphorus, decreased potassium, decreased sodium, increased and decreased calcium, increased and decreased chloride, increased and decreased iron

Uncommon (0.1% to 1%): Fever, influenza-like symptoms, malaise, impaired healing, ceruminosis, deafness. peripheral edema, sensation of heat

Frequency not reported: Elevation in lactate dehydrogenase[Ref]

Respiratory

Very common (10% or more): Rhinitis (up 80%), epistaxis (up to 40%)

Common (1% to 10%): Sinusitis

Uncommon (0.1% to 1%): Coughing, increased sputum, laryngitis, dysphonia[Ref]

Endocrine

Rare (less than 0.1%): Gynecomastia[Ref]

Hematologic

Very common (10% or more): Increased reticulocytes (up to 50%), decreased hematocrit (up to 25%), decreased hemoglobin (up to 25%), decreased WBC (up to 25%), increased haptoglobin (up to 25%), increased neutrophils (up to 25%), increased WBC (up to 25%)

Common (1% to 10%): Increased bands, increased basophils, increased eosinophils, increased hematocrit, increased hemoglobin, increased lymphocytes, increased monocytes, decreased haptoglobin, decreased lymphocytes , decreased neutrophils, decreased reticulocytes, increased or decreased platelets, increased or decreased RBC

Uncommon (0.1% to 1%): Increased bleeding time[Ref]

Immunologic

Uncommon (0.1% to 1%): Moniliasis, fungal infection, herpes simplex[Ref]

Oncologic

Frequency not reported: Pyogenic granuloma[Ref]

Psychiatric

Common (1% to 10%): Depression, insomnia, somnolence

Uncommon (0.1% to 1%): Anxiety, decreased libido, nervousness, abnormal thinking, emotional lability, aggressive feelings

Postmarketing reports: Suicidal thoughts[Ref]

Renal

Very common (10% or more): Increased uric acid (up to 25%)

Common (1% to 10%): Increased BUN, increased creatinine[Ref]

References

1. Product Information. Soriatane (acitretin). Roche Laboratories. 2001;PROD.

2. Cerner Multum, Inc. UK Summary of Product Characteristics.

3. Cerner Multum, Inc. Australian Product Information.

Further information

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

Some side effects may not be reported. You may report them to the FDA.

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