Acitretin Soriatane
Nursing Considerations
WARNING Don’t give acitretin to a pregnant
woman, a woman contemplating pregnancy,
or a woman who may not use reliable
contraception during drug therapy and for
at least 3 years afterward because acitretin
causes major fetal abnormalities.
•Make sure patient has had two negative
urine or serum pregnancy tests with a sensitivity
of at least 25 mIU/ml before
receiving acitretin. First test should be
obtained when decision is made to use
acitretin and second test during first
5 days of the menstrual period just before
acitretin therapy starts. For patients with
amenorrhea, second test should be done at
least 11 days after the last act of unprotected
sexual intercourse (which means
without using two effective forms of contraception
simultaneously).
• Check to make sure female patient of
childbearing age has signed the patient
agreement and informed consent form
before starting acitretin therapy.
•Obtain a lipid profile, as ordered, before
acitretin therapy starts and every 1 to
2 weeks for up to 8 weeks or until lipid
effects are known. In high-risk patients,
such as those with diabetes, obesity, or a
history of alcohol abuse and those taking
acitretin long-term, check lipid profile
periodically throughout therapy.
•Monitor liver function test results, as
ordered. If hepatotoxicity is suspected,
expect to stop drug and investigate cause.
• If patient takes acitretin long-term or she
develops a skeletal disorder, prepare her
for periodic bone radiography because
ossification abnormalities can occur, especially
of the vertebral column, knees, and
ankles.
•Monitor patient’s eyes for abnormalities
throughout therapy. Expect patient to stop
drug and have an ophthalmologic examination
if eye abnormalities occur.
•Monitor patient for evidence of increased
intracranial pressure, such as papilledema,
headache, nausea, vomiting, and visual
disturbances. If papilledema occurs, stop
drug therapy immediately and obtain a
neurologic evaluation, as ordered. Patient
should never receive a tetracycline while
taking acitretin because combined use can
increase intracranial pressure.
• Assess patient for suidical ideation because
depression and other psychiatric symptoms,
including thoughts of self-harm,
may occur with acitretin use. Expect drug
to be discontinued if psychiatric symptoms
develop.
• Significantly lower doses of phototherapy
are needed during acitretin therapy
because drug increases the risk of erythema.
PATIENT TEACHING
WARNING Warn women of childbearing age
that acitretin causes major fetal abnormalities.
• Inform woman of childbearing age that
she must have a pregnancy test before
acitretin therapy starts, every month during
acitretin therapy, and every 3 months
for 3 years after therapy stops.
• Stress to woman of childbearing age that
she must use two effective forms of contraception
simultaneously unless she has
chosen absolute abstinence or has had a
hysterectomy. This must begin at least 1
month before acitretin therapy starts and
continue throughout therapy and for at
least 3 years after therapy ends.
• Caution women taking oral contraceptives
that some prescribed and OTC drugs,
including herbal supplements such as St.
John’s wort, may interfere with oral contraceptives.
Urge her to tell prescriber
about all drugs she takes.
• Caution patient not to consume alcohol or
products that contain alcohol during
acitretin therapy and for 2 months after
therapy ends.
•Warn patient, male or female of any age,
not to donate blood during acitretin therapy
and for at least 3 years after it ends.
• Review acitretin medication guide with
patient, and answer the patient’s questions.
• Inform patient that psoriasis may worsen
during initial treatment and that full
effects of drug may not be seen for up to
3 months.
• Caution patient to avoid hazardous activities
until drug’s CNS and ophthalmic
effects are known.
• Inform patient that tolerance to contact
lenses may decrease during acitretin therapy
and for a period of time after treatment
ends.
• Advise patient not to take more than the
minimum recommended daily allowance
of vitamin A during acitretin therapy
because of the risk of vitamin A toxicity.
• Caution patient not to use sun lamps and
to avoid excessive exposure to sunlight
because the effects of UV light are
enhanced by retinoids such as acitretin.
