Acitretin

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 during first 5 days of menstrual period prior to treatment initiation) 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), psychiatric symptoms (eg, depression), capillary leak syndrome, or exfoliative dermatitis/erythroderma occurs. Monitor for ossification abnormalities. 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; consider discontinuing if hypertriglyceridemia and low HDL levels persist. Perform LFTs prior to initiation, at 1–2 week intervals until stable, and thereafter as clinically indicated. Avoid sun and UV light. Monitor diabetics. Do not donate blood during and for 3 years after therapy. Get written informed consent. Elderly. Nursing mothers: not recommended.