Using Novatretin

How Do I Use Novatretin ?

It is very important to follow the instructions given to you by your doctor. These instructions will help to make sure you are getting the right dose of Novatretin. In determining the exact dosage you need, your doctor will have considered the severity of your condition, your weight, and other factors.

It is important not to miss any of your Novatretin capsules, or to take too many Novatretin capsules. If you do miss a dose you should not take a double dose to make up for it, you should wait until it is time for your next dose and take your Novatretin as normal, then continue taking your Novatretin in the usual way.

Your doctor has prescribed a particular dose of Novatretin for you for a specific reason. It is important that you do not change the amount of Novatretin you are taking, if you think it is too strong or too weak speak to your doctor. Your doctor may vary your dose of Novatretin, depending on how your body responds to the treatment. You should continue taking your Novatretin for as long as your doctor instructs you to.

What MUST I Do While Taking Novatretin?

While taking Novatretin you MUST :

  • Take your Novatretin capsules with meals to help absorption.
  • NOT chew or suck the capsules.
  • Swallow the capsules whole with water or another non-alcoholic drink.
  • Take each dose of Novatretin when it is due.
  • Follow your doctor’s instructions.

If you follow the above instructions as closely as possible your Novatretin will work better.

What Should I Expect From Novatretin?

When you first start taking Novatretin you may find that your condition starts to get worse. If you have any worries or concerns about this, contact your doctor. This does not mean that the medication is not working. If this happens to you, do not be discouraged; keep taking your Novatretin, as prescribed by your doctor. The worsening of your condition nearly always stops within the first few weeks, and then your condition will start to clear. Within the first four weeks of starting Novatretin you may notice that your skin is much drier than before. You may also find that you need to wash your hair less often. Most improvement in your condition will occur in the first 3 months of treatment and is maintained while treatment continues.

When I Have Finished My Novatretin

If you have any Novatretin capsules left when you have finished your treatment, it is very important that you return them to your doctor or pharmacist.

Never give your Novatretin to anyone else, even if they have similar looking condition.

At the conclusion of your Novatretin treatment your condition may continue clearing, possibly for one or two months, but it may also or later recur or worsen after the Novatretin treatment has ceased. Your doctor may recommend taking Novatretin again. The side effects associated with Novatretin treatment will begin to clear at the conclusion of the treatment.

Acitretin

Acitretin is an oral retinoid (vitamin-A derivative) used to treat severe psoriasis, usually at a dose of between 25 and 50mg per day. It is best taken after a meal because fat helps it to be absorbed through the gut wall.

Acitretin is particularly effective for pustular psoriasis, erythrodermic psoriasis and psoriasis affecting hands and feet. It is not effective for psoriatic arthritis.

It is occasionally used to treat other skin conditions including:

  • Palmoplantar pustulosis
  • Hand dermatitis (when very thick and scaly)
  • Darier disease
  • Lichen planus
  • Lupus erythematosus
  • Cutaneous T-cell lymphoma
  • Extensive granuloma annulare
  • Severe ichthyosis
  • Extensive solar keratoses and skin cancers
  • Extensive warts

Acitretin MUST NOT be taken in pregnancy; it can damage an unborn child and cause birth defects. Strict birth control measures must be used during treatment and for two years after stopping acitretin. Therefore, acitretin is rarely prescribed to females of child-bearing potential.
If it is, they will be asked to have a blood pregnancy test before treatment and regularly during treatment. People on acitretin should not donate blood during treatment or for two years afterwards.

Also, acitretin should not be taken while breast-feeding. It has no effect on male sexual function or offspring.

Mechanism of action

Acitretin is thought to work in psoriasis by slowing down the proliferation of skin cells. A response is noted in more than half of treated patients. Improvement begins about two weeks after starting treatment, and is maximum after about twelve weeks. The affected skin either peels off or gradually clears. Some patients are treated for a few months, repeated from time to time, whilst others remain on the acitretin long term.

It is not known how it works in other skin disorders, but it may relate to some effect on immune cells.

In resistant cases, acitretin can be combined with other anti-psoriatic drugs and/or phototherapy.

Side effects

Acitretin has side effects that may limit the dose that can be used.

Dryness of lips: apply lip salve frequently especially when outdoors.

Dry nostrils that may crust and/or bleed: petroleum jelly can help.

Dry eyes: use artificial tear eye drops.

Dry reddened skin: apply moisturizers frequently.

Peeling skin, especially hands and feet; apply moisturisers frequently.

Fragile soft skin: protect it from injury, especially where skin can rub.

Increased susceptibility to sunburn: protect your skin from the sun. Use broad spectrum sunscreen and cover up well. If you are receiving phototherapy, advise your therapist that you are taking acitretin. A reduction in dose may be necessary.

Skin infections, especially with Staphylococcus aureus (impetigo, boils or nail fold paronychia).

Aggravation of your skin complaint: this is often temporary and followed by improvement but if a severe flare occurs you should tell your dermatologist and stop taking the acitretin.

Headaches: if these are severe or accompanied by visual problems, inform your dermatologist and stop the acitretin; the symptoms could be caused by an increase in pressure on the brain. Muscle, joint or bone aches, especially with exercise; reduce exercise if needed.

Generalised hair shedding and thinning may occur; this is usually temporary although permanent thinning has been reported.

Hyperlipidaemia (raised blood fats i.e. cholesterol and triglyceride), detected by blood tests, which are best taken when fasting (on an empty stomach). The level of the blood fats is compared with a pre-treatment test. High blood fats are more likely in diabetics and in those who drink a lot of alcohol. If the blood fats are too high, a special low fat and low sugar diet may be recommended, a lipid-lowering medication may be prescribed or the dose of acitretin may be reduced or stopped.

Rarely, acitretin may result in disturbed liver function (hepatitis). It should be discontinued if this occurs, and it would be unwise to take it again.

Mood changes; high dose retinoids can cause mood change including irritability, aggression and depression.

Interactions

Acitretin should not normally be taken at the same time as the following medications (there may be rare exceptions):

  • Vitamin A or any other retinoid (e.g. isotretinoin).
  • Tetracycline or one of its derivatives.
  • Methotrexate.
  • Phenytoin.

It is best to avoid alcohol, during treatment and for two months after treatment with Novatretin is completed.