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Concerns related to adverse effects: • Photosensitivity: Use is associated with increased susceptibility/sensitivity to UV light; avoid sunlamps or excessive sunlight exposure. Daily sunscreen use and other protective measures recommended. • Skin irritation: Certain cutaneous signs and symptoms such as erythema, dryness, scaling, burning, or pruritus may occur during treatment; these are most likely to occur during the first 2-4 weeks and will usually lessen with continued use. Depending on the severity of irritation, reduce the frequency or discontinue use.

Other warnings/precautions: • Appropriate use: For external use only; avoid contact with abraded, eczematous, or sunburned skin, mucous membranes, eyes, mouth, and angles of the nose. Wax depilation is not recommended. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Contraceptives (Progestins): Retinoic Acid Derivatives may diminish the therapeutic effect of Contraceptives (Progestins). Retinoic Acid Derivatives may decrease the serum concentration of Contraceptives (Progestins). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Particularly, microdosed progesterone-only preparations may be inadequately effective. Risk D: Consider therapy modification Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoid-like Compounds. Risk X: Avoid combination Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy Vitamin A: May enhance the adverse/toxic effect of Retinoid-like Compounds. Risk D: Consider therapy modification Pregnancy Risk Factor C ( show table ) Pregnancy Implications Adverse effects were observed in animal reproduction studies. Retinoids may cause harm when administered during pregnancy. A case report described maternal use of adapalene 1 month prior to pregnancy and through 13 weeks gestation; cerebral and ocular malformations were reported in the exposed fetus which resulted in termination of pregnancy (Autret, 1997). In clinical trials, women of childbearing potential were required to have a negative pregnancy test prior to therapy. Lactation Excretion in breast milk unknown/use caution Pricing: U.S. (Medi-Span®)

Lotion (Differin External) 0.1% (59 mL): $301.98 International Brand Names Aclear (HK); Aclene (KP); Acnelene (PK); Acure (TW); Adaferin (CR, DO, GR, GT, HN, IN, MX, NI, PA, SV); Adaferin Gel (IL); Beautyface (TW); Butipalen (KP); Differin (AR, AU, BR, CL, CN, CO, EE, FI, HK, MY, NL, NO, NZ, PE, PH, PL, PT, PY, RU, SG, TH, TR, TW, UY, VE, ZA); Differin Gel (AT, BE, CH, DE, GB, IE, IL, IT, SE); Differine (CZ, ES, FR); Doulishu (TW); Easy Acne (TW); Evalen (ID); Klenzit (PH); Klenzit-MS (PH); Panalene (AR); Redap (DK); Rozac (IN); T3ADA (MY); Tifforly Gel (HK); Zudenina (CO); Zudenina F (CO) Mechanism of Action 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 Pharmacodynamics/Kinetics Onset: 8-12 weeks Absorption: Topical: Minimal Excretion: Bile Use of UpToDate is subject to the Subscription and License Agreement . Topic 9352 Version 35.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [1104-58.240.98.179-5450C57513-S244013.14]