WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Neotigason contains acitretin, a medicine related to vitamin A. It works
by regulating the growth and shedding of skin cells, correcting the rapid,
abnormal cell turnover that causes the thick, scaly plaques of psoriasis.
Your doctor may prescribe it for: severe psoriasis that has not responded
to other treatments — including widespread plaque psoriasis, erythrodermic
psoriasis (where most of the body skin is affected and inflamed), and pustular
psoriasis (a rare form with pus-filled blisters); severe disorders of skin
keratinisation — rare inherited or acquired conditions where the skin thickens
and hardens abnormally.
Acitretin is a specialist treatment, usually prescribed only when
psoriasis is severe enough to significantly affect your quality of life and
when other options have been tried or are not suitable.
3. HOW TO TAKE THIS MEDICINE
The dose is tailored to each individual and adjusted over time based on
how well your skin responds and how well you tolerate the medicine. A typical
starting dose is 25 to 30mg once daily (two to three 10mg capsules), taken with
the main meal or with milk.
Higher doses of up to 75mg per day may be used in severe cases. Your
dermatologist will review and adjust your dose regularly. Always take
Neotigason with food — taking it with fat helps it absorb properly.
Acitretin can take 2 to 3 months to show its full benefit — do not be
discouraged if results are not immediate. Your dermatologist will assess your
response at regular intervals. Liver function tests and blood fat levels
(triglycerides and cholesterol) will be checked before starting and regularly
during treatment.
⚠ PATIENT TIP: Dry lips are almost universal on
acitretin — this is one of the earliest and most reliable signs that the
medicine is reaching your body. Keep a good lip balm with you at all times. Dry
eyes, dry nasal passages, and dry skin elsewhere are also very common. Stay
well moisturised and use lubricating eye drops if needed.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Very Common (affects
most people) |
Dry, cracked, or sore
lips (cheilitis), dry skin, dry eyes, dry nose (sometimes with nosebleeds),
hair thinning, peeling skin on palms and soles, increased sensitivity to
sunlight (photosensitivity), raised blood fat levels (triglycerides and
cholesterol) |
|
Common |
Headache, joint or
muscle aches, raised liver enzyme levels on blood tests, sticky or fragile
skin |
|
Serious — Tell Your
Doctor |
Severe headache with
visual disturbances or vomiting (signs of raised pressure around the brain —
called pseudotumour cerebri or benign intracranial hypertension). Severe
liver problems: jaundice (yellowing of skin or eyes), dark urine, right-sided
tummy pain. Very high triglyceride levels (increasing the risk of
pancreatitis — a serious, painful inflammation of the pancreas). Mood changes
or depression. |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Acitretin must NEVER be taken during pregnancy — it causes severe,
life-threatening birth defects affecting the brain, heart, face, and limbs.
Women of childbearing potential face the most critical restriction: they
must not be pregnant, must not become pregnant, must use two forms of effective
contraception (usually at least one highly effective method), and must continue
contraception for a full 3 years after stopping acitretin.
This is because acitretin converts back into a related compound
(etretinate) in the body when alcohol is consumed, which has an even longer
half-life and remains detectable for years. Acitretin should also not be used
in patients with severe liver or kidney disease, or significantly raised blood
fat levels.
⚠ PREGNANCY PREVENTION — 3-YEAR RULE: This is
one of the most stringent pregnancy prevention requirements of any medicine.
Women must use two effective methods of contraception for 3 years after
stopping acitretin — not 4 weeks, not 3 months, but 3 YEARS. This is because of
the conversion to etretinate (especially with alcohol). Do not become pregnant
during this time under any circumstances.
⚠ ALCOHOL — ABSOLUTE PROHIBITION FOR WOMEN:
Women taking acitretin must not consume alcohol during treatment or for 2
months after stopping. Alcohol converts acitretin into etretinate in the body,
which stays in the body for much longer and further extends the teratogenic
risk. Men may drink alcohol but should be aware of other liver risks.
⚠ BLOOD FAT AND LIVER MONITORING: Regular blood
tests for liver function and blood fats are essential. High triglycerides can
cause pancreatitis — an extremely painful and serious condition.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Acitretin must not be combined with other retinoids (isotretinoin,
tretinoin, vitamin A supplements in high doses) — vitamin A toxicity
(hypervitaminosis A) can occur. It reduces the effectiveness of the mini-pill
(progestogen-only contraceptive pill) — use alternative or additional
contraception.
Tetracycline antibiotics combined with acitretin may increase the risk of
raised intracranial pressure — avoid this combination. Methotrexate combined
with acitretin significantly increases the risk of liver damage — this
combination is generally avoided. Always tell your dermatologist and pharmacist
about all medicines, vitamins, and supplements you take.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Keep in the original blister pack and protect from
light and moisture. Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (dermatology) prescription required. Pregnancy
Prevention Programme monitoring required for women of childbearing potential. |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Take your capsules once a day with your main meal or with milk — food
helps the medicine absorb properly. Keep your lips well moisturised — dry lips
are almost universal and a lip balm will become your best friend.
Protect your skin from the sun carefully — wear SPF 50 sunscreen, cover
up, and avoid peak sun hours, as acitretin makes you much more sensitive to
sunburn. Attend all blood test appointments.
If you are female and of childbearing age, use two forms of contraception
throughout treatment and for 3 years after stopping — absolutely do not become
pregnant during this time. Do not drink alcohol if you are female. Do not take
vitamin A supplements or high-dose multivitamins. Report severe headaches with
visual changes, yellowing of the skin, or very severe tummy pain to your doctor
immediately.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Pregnancy Prevention
Programme (PPP) compliance mandatory for all females of childbearing
potential — verify at every dispensing. Two effective contraceptive methods
required throughout treatment and for 3 years post-cessation. The mini-pill
(POP) is not considered sufficient — additional barrier method required.
Alcohol prohibition in females during treatment and 2 months after
(etretinate conversion). Baseline and monthly LFTs and fasting lipids
(triglycerides, cholesterol) — high TG risk is significant (pancreatitis). No
concurrent retinoids or vitamin A supplements. Avoid tetracyclines
(intracranial hypertension risk). Avoid concomitant methotrexate
(hepatotoxicity). Photosensitivity counselling — SPF50, protective clothing,
avoid peak sun. Dispense with patient information leaflet and PPP
documentation. |
11. FREQUENTLY ASKED QUESTIONS
Q: Why are the pregnancy rules so strict — stricter than most other
medicines?
Acitretin is converted in the body — especially when alcohol is involved
— into a compound called etretinate, which causes very severe birth defects and
stays in the body for years. This is why the 3-year contraception requirement
exists after stopping, and why alcohol is completely prohibited for women
taking it. The risk to an unborn baby is extremely serious.
Q: My lips are very dry and cracked — is this normal?
Yes — dry lips (cheilitis) are one of the most common and expected side
effects, affecting almost everyone on acitretin. It is actually used as a sign
that the medicine is working. A good quality lip balm applied frequently
throughout the day will help enormously.
Q: Why do I need regular blood tests?
Acitretin can raise blood fat levels (particularly triglycerides) which —
if very high — can cause pancreatitis (a serious, painful inflammation of the
pancreas). It can also occasionally affect the liver. Blood tests check these
levels regularly so your dose can be adjusted if needed.
Q: Can I go out in the sun?
With caution. Acitretin makes your skin much more sensitive to sunburn
(photosensitivity). Use a high-factor sunscreen (SPF 50), wear protective
clothing, and avoid the midday sun — even on overcast days. Do not use sunbeds.