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Acitretin, a member of the retinoid drug class, is the sole FDA-approved systemic retinoid for treating psoriasis, exhibiting efficacy as a standalone therapeutic agent. Retinoids encompass natural and synthetic compounds, similar to vitamin A, and influence various physiological processes. Vitamin A, a vital regulator of the immune system, contributes to cellular growth, differentiation, and proliferation and plays a crucial role in embryonic development. Noteworthy effects of retinoids extend to immunologic anti-inflammatory actions, apoptosis induction, and inhibition of tumor promotion. Beyond its sanctioned use in psoriasis, acitretin finds application in dermatology for off-label purposes. This activity examines the indications, contraindications, and potential adverse events linked to acitretin, empowering interprofessional healthcare team members to manage patients collaboratively and ensure optimal medication utilization in clinical settings. Objectives: Identify the approved and off-label indications for acitretin. Assess the potential adverse effects and toxicity associated with acitretin use. Implement the monitoring necessary for patients on acitretin therapy. Determine strategies with the rest of the interprofessional to improve care coordination for patients undergoing acitretin therapy to improve patient outcomes. Access free multiple choice questions on this topic.

Acitretin must be withdrawn at once in overdose cases. Overdose symptoms are similar to acute hypervitaminosis A (headache and vertigo). In mice and rats, the acute oral toxicity (LD50) of acitretin was only observed at greater than 4,000 mg/kg dose. In one reported overdose, a 32-year-old man with Darier disease took a 525 mg single dose. Later, he vomited for several hours but did not experience any other ill effects. One case of fulminant hepatic failure following an intentional overdose of 600 mg of acitretin was reported, where the patient demonstrated a rapid recovery and did not require liver transplantation.[18] If any female patient of childbearing age takes an excessive dose of acitretin, a pregnancy test is recommended immediately, and the patient must be counseled as per box contraindications and warnings related to congenital disabilities. Also, patients must be encouraged to use contraceptives for at least 3 years after the overdose.

Acitretin is frequently used to treat several skin disorders, including acne, psoriasis, lichen planus, and discoid lupus. While the drug is effective, it is crucial for interprofessional healthcare team members, including pharmacists, nurse practitioners, PAs, and primary care clinicians, to know its potential adverse effects. Acitretin should be prescribed only by clinicians with special competence in diagnosing and treating severe psoriasis, who have experience using systemic retinoids and understand the risk of teratogenicity. Clinicians should never prescribe the drug to a pregnant patient because of the risk of teratogenicity. The FDA has issued several boxed warnings about the risk of hepatitis when combining the agent with alcohol or methotrexate. When prescribing acitretin, the patient must understand the potential adverse effects and the importance of avoiding alcohol.[19][20] Given the warnings, it is apparent that an interprofessional team approach with coordinated activity and open communication is the best means to manage acitretin therapy. Once the prescriber has decided to give the patient the drug, nursing can counsel on the patient's dosing, administration, and potential teratogenicity for female patients. The pharmacist will verify dosing and perform medication reconciliation, alerting the prescriber of any issues. Nurses can also chart the therapeutic progress of the condition, monitor the patient, and report to the prescriber regarding their findings and possible recommendations so the prescriber can adjust therapy as needed. Through this interprofessional team paradigm, acitretin can deliver maximal benefit with minimal downside, resulting in better patient outcomes.