Acitrok 2 mg
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Acitrok 2 mg is a brand of Acitretin 2 mg, a retinoid used primarily in dermatology for severe psoriasis and other keratinization disorders.
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Acitrok 2mg acitretin uses dose indications
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Here is a complete drug profile for Acitrok 2 mg (Acitretin 2 mg):
Acitrok 2 mg - Acitretin
What It Is
Acitrok 2 mg is a brand formulation of Acitretin 2 mg, a second-generation aromatic retinoid (vitamin A derivative) used in dermatology. It is the active metabolite of the older drug etretinate. The 2 mg strength is a low-dose option used for maintenance therapy or in patients who are dose-sensitive.
Drug Class & Mechanism
- Class: Second-generation systemic retinoid
- Mechanism: Activates all three retinoic acid receptor (RAR) subtypes, leading to:
- Normalization of epidermal differentiation and proliferation
- Modification of inflammatory responses
- Reduction in neutrophil function
- Half-life: ~2 days (much shorter than etretinate's 120 days), so it does not accumulate in adipose tissue - Dermatology 2-Volume Set 5e
Indications
| Indication | Notes |
|---|---|
| Psoriasis (pustular - von Zumbusch) | First-line; clears rapidly |
| Erythrodermic psoriasis | Highly effective as monotherapy |
| Chronic plaque psoriasis | Best combined with PUVA/NB-UVB or vitamin D analogues |
| Palmoplantar keratodermas | Listed indication |
| Pityriasis rubra pilaris | Listed indication |
| Darier disease | Listed indication |
| Lamellar ichthyosis | Listed indication |
| Congenital ichthyosiform erythroderma | Listed indication |
| Cutaneous T-cell lymphoma (mycosis fungoides) | Used in combination with PUVA or interferon |
| Lichen planus | Off-label use |
| Other keratinization disorders | Subcorneal pustular dermatosis, verruca vulgaris, condyloma (off-label) |
- Dermatology 2-Volume Set 5e, Katzung's Basic and Clinical Pharmacology 16e
Dosing
| Form | Standard Adult Dose |
|---|---|
| Oral (tablets) | 25-50 mg/day (standard) |
| Low-dose / maintenance | 2 mg/day (Acitrok 2 mg) or titrated up |
- Maximal therapeutic efficacy is reached after 2-3 months
- The 2 mg formulation allows flexible dose titration and maintenance dosing
Adverse Effects
These resemble hypervitaminosis A:
Mucocutaneous (very common):
- Cheilitis (lip dryness) - most common
- Xerosis (dry skin), xerophthalmia (dry eyes)
- Skin fragility, peeling, hair loss
- Paronychia
Metabolic:
- Elevated triglycerides and cholesterol (common)
- Elevated liver enzymes (up to one-third of patients) - can require drug discontinuation
- Hepatotoxicity (rare, but fatal hepatitis reported)
Musculoskeletal (with long-term use):
- Hyperostosis, enthesopathy
- Premature epiphyseal closure in children
Other:
- Pseudotumor cerebri (rare, risk increased if combined with tetracyclines)
- Photosensitivity
Contraindications
Absolute:
- Pregnancy or lactation
- Women of childbearing potential who cannot guarantee contraception for 3 years after stopping (FDA recommendation)
- Severe liver or kidney dysfunction
- Uncontrolled hypertriglyceridemia
- Excessive alcohol intake
Relative / Caution:
-
Poorly controlled diabetes mellitus
-
History of pancreatitis
-
Atherosclerosis
-
Concomitant methotrexate (hepatotoxicity risk - reserved for treatment-resistant cases only)
-
Phenytoin co-administration (competes for plasma protein binding)
-
Dermatology 2-Volume Set 5e, Table 8.13
Critical Drug Interactions
| Interaction | Risk |
|---|---|
| Alcohol | Converts acitretin back to etretinate - extends teratogenic risk for years. Alcohol must be strictly avoided during therapy and for 2 months after stopping |
| Methotrexate | Additive hepatotoxicity |
| Tetracyclines | Risk of benign intracranial hypertension (pseudotumor cerebri) |
| Phenytoin | Protein-binding competition; dose adjustment needed |
| Vitamin A supplements | Additive hypervitaminosis A toxicity |
Monitoring
Before starting:
- Pregnancy test
- LFTs (AST, ALT, GGT, ALP, bilirubin)
- Fasting lipid profile (triglycerides, cholesterol, HDL)
- Blood glucose
- Serum creatinine
- CBC
- Consider baseline spinal X-ray if long-term therapy is planned
During therapy:
- Repeat LFTs and lipid panel every 4-8 weeks initially, then every 3 months
- Monitor for mucocutaneous side effects
Key Safety Points
- Teratogenicity - Acitretin is a potent teratogen. Contraception must be used for at least 3 years after stopping (FDA), or 2 years (manufacturer) if alcohol has been strictly avoided.
- Blood donation - Prohibited during treatment and for 3 years after stopping.
- Alcohol avoidance - Alcohol causes re-esterification of acitretin back to etretinate (much longer half-life), extending the period of teratogenic risk.
- Contact lens wearers - May need lubricants or switch to glasses due to dry eyes.
Combination Use
- Acitretin + PUVA (Re-PUVA): Highly effective for plaque psoriasis - reduces the UVA dose required
- Acitretin + NB-UVB: Effective and commonly used
- Acitretin + Vitamin D3 analogues (calcipotriol): Additive benefit in plaque psoriasis
Combination therapy is indicated for chronic plaque psoriasis where monotherapy efficacy is limited (~70% achieve moderate or better response as monotherapy; only 23% achieve PASI 75 at 50 mg/day for 8 weeks).
Sources: Dermatology 2-Volume Set 5e; Fitzpatrick's Dermatology Vol. 1 & 2; Katzung's Basic and Clinical Pharmacology, 16th Ed.
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