|Trade names||Panretin, Toctino, other|
|Other names||9-cis-retinoic acid|
|Main uses||Kaposi’s sarcoma, eczema|
|Side effects||Topical: Itchiness, skin peeling, rash|
By mouth: Hair loss, low red blood cells, tiredness, high blood pressure, high cholesterol, ringing in the ears
|Topical, by mouth|
|Protein binding||Highly bound, no exact figure available|
|Metabolism||Liver (CYP3A4-mediated oxidation, also isomerised to tretinoin)|
|Elimination half-life||2-10 hours|
|Excretion||Urine (64%), faeces (30%)|
|Chemical and physical data|
|Molar mass||300.442 g·mol−1|
|3D model (JSmol)|
Alitretinoin, sold under the brand name Panretin among others, is a medication used to treat Kaposi’s sarcoma due to AIDS and eczema of the hands. It is only used to treat disease involving the skin. It is applied to the skin or take by mouth.
Common side effects include when applied to the skin include itchiness, skin peeling, and rash. Common side effects when taken by mouth include hair loss, low red blood cells, tiredness, high blood pressure, high cholesterol, and ringing in the ears. Other side effects may include sunburns. Use in pregnancy may harm the baby. It is a retinoid.
Alitretinoin was approved for medical use in the United States in 1999. While it was approved for use in Europe in 2000, this has subsequently been withdrawn. It is available as a generic medication. In the United Kingdom a month of pills costs the NHS about £500 as of 2021. In the United States a 60 gram tube costs about 5,600 USD as of 2022.
In the United States, topical alitretinoin is indicated for the treatment of skin lesions in AIDS-related Kaposi's sarcoma. Alitretinoin is not indicated when systemic therapy against Kaposi's sarcoma is required. It has received EMA (11 October 2000) and FDA (2 March 1999) approval for this indication.
Chronic hand eczema
Alitretinoin has been granted prescription rights in the UK (08/09/2008) for in chronic hand eczema as used by mouth. In May 2009 the National Institute for Health and Clinical Excellence (NICE) issued preliminary guidance on the use of alitretinoin for the treatment of severe chronic hand eczema in adults. The recommendation stated that only patients with severe chronic hand eczema who are unresponsive to potent topical corticosteroids, oral immunosuppressants or phototherapy should receive the drug. Final NICE guidance is expected in August 2009.
By mouth it is taken at a dose of 30 mg once per day.
Very common (>10% frequency):
Common (1-10% frequency):
- Increased iron binding capacity
- Monocytes decreased
- Thrombocytes increased
- TSH decreased
- Free T4 decreased
- Dry eye
- Eye irritation
- Transaminase increased
- Dry skin
- Dry lips
- Hair loss
- Joint pain
- Muscle pains
- Blood creatine phosphokinase increased
Uncommon (0.1-1% frequency):
Rare (<0.1% frequency):
- Benign intracranial hypertension
- Anaphylactic reactions
- Mood changes
- Suicidal ideation
- Decreased night vision
Very common (>10% frequency):
- Rash (77%)
- Pain (34%)
- Itchiness (11%)
Common (1-10% frequency):
Pregnancy is an absolute contraindication as with most other vitamin A products, it should also be avoided when it comes to systemic use in any women that is of childbearing potential and not taking precautions to prevent pregnancy. Toctino (the oral capsule formulation of alitretinoin) contains soya oil and sorbitol. Patients who are allergic to peanut, soya or with rare hereditary fructose intolerance should not take this medicine. It is also contraindicated in nursing mothers. The oral formulation of alitretinoin is contraindicated in patients with:
It is a CYP3A4 substrate and hence any inhibitor or inducer of this enzyme may alter plasma levels of alitretinoin. It should not be given to patients with excess vitamin A in their system as there is a potential for its actions on the retinoid X receptor to be exacerbated. It may also interact with tetracyclines to cause benign intracranial hypertension.
Alitretinoin is a form of vitamin A. Alitretinoin has been administered in oncological clinical studies at dosages of more than 10-times of the therapeutic dosage given for chronic hand eczema. The adverse effects observed were consistent with retinoid toxicity, and included severe headache, diarrhoea, facial flushing and hypertriglyceridemia. These effects were reversible.
Mechanism of action
Alitretinoin is believed to be the endogenous ligand (a substance that naturally occurs in the body that activates this receptor) for retinoid X receptor, but it also activates the retinoic acid receptor.
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