Phenytoin, St.Johns Wart

Severe extensive refractory psoriasis

Darlers Disease

Prescription by experienced skin specialists only

Dry skin, sticky skin,

Dermatitis erosion of mucosa, erythema,

Pruritus rhinitis,

Nail frigility conjuntivitis

Concomittant tetracyclines, Methotrexate, vitamin A or other retinods,

Alcohol, Renal or hepatic impairment

Chronic hyperlipidemia

Warn patients against risks of pregnancy

Exclude pregnancy before initiating therapy

Contraceptives measures must be taken before , using and at least 2 years after withdrawal of treatment

Lactation

Special Precautions-

Transient worsening of symptoms may occur

Avoid blood donations for 2 years after the course

Monitor liver functions, serum lipids, blood glucose and bone changes

Discontinue if hepatoxicity occurs

Diabetes

Avoid excessive UV exposure

Elderly

Indication-

Severe extensive refractory

Psoriasis

Darlers Darlers disease

Prescription by experienced skin specialists only

Dosage-

Take with main meal or with a glass of milk

Initially 25-30mg daily for 3-4 weeks

Titrate against response up to max. 75mg daily

Maintenance - -upto 25- 50mg daily

Darlers disease - Initially - 10mg , increase cautiously

Maximum treatment - 6 mths

Children - not recommended

Females of reproductive potential-                                                             Acitretin  can cause severe birth defects.

Female patients must not be pregnant when acitrein therapy is initiated,they must not become pregnant while taking acitrein, and for at least 3 years after stoppng acetrein, so that the drug can be eliminated to below ablood concentration that would be assoiciated with increased incidence of defects.

Because this threshold has not been established for acitrein in humans and becuase the elimination rates vary among patients, the duration of post therapy contraception to acheive adequate elimination cannot be calculated            

Female of reproductive potential should be adviced that they must not ingest beverages or products containing ethanol while taking acitretin

Female patients should be adviced that any method of birth control can fail, including tubal ligation, and that microdosed progestin - Minipril- preparations are not recommended for use with acitretin

All patients-                                                                                                           Depression or other psychiatric symptoms such as aggressive feelings or thought of self harm have been reported. Patients are advised to report these feeings or symptoms to their doctor   

Patients should be advised that a worsening of psoriasis is sometimes seen during the initial treatment period. Patients should be advised that they may may to wait for 2 to 3 months before they get the full benefit                                                                                      

Take with main meal or with a glass of milk

Use contraindicated

Warn patients against risks of pregnancy

Exclude pregnancy before initiating therapyy

Contraceptives measures must be taken before , using and at least 2 years after withdrawal of treatment