9-cis-Tretinoin
9-cis-Tretinoin Uses, Dosage, Side Effects, Mechanism of Action, How Long Does it Take to Work? 9-cis-Tretinoin is a brand name. Its generic name is Alitretinoin.
9-cis-Tretinoin Introduction
9-cis-Tretinoin is an oral synthetically-derived retinoid that is used for the treatment of severe chronic hand eczema related to atopic dermatitis that has not responded (or has only partially responded) to other treatments, as well as scarring from Kaposi’s disease. 9-cis-Tretinoin has been approved by the US Food and Drug Administration (FDA) in 2014 for these indications and is sold under the trade name Panretin.
Uses for 9-cis-Tretinoin
9-cis-Tretinoin has been approved for the treatment of severe chronic hand eczema related to atopic dermatitis that has not responded (or has only partially responded) to other treatments, as well as scarring from Kaposi’s disease. The drug should be used only when other treatments have failed and the patient is unresponsive to safer topical medications. It should be used as part of a complete hand eczema treatment plan.
Mechanism of Action
9-cis-Tretinoin works by regulating the activity of cells responsible for causing inflammation and interactions between these cells. In addition, it can help decrease the production of natural substances in the body that can cause inflammation and can help reduce itching and swelling.
How Long Does it Take to Work?
It typically takes 4-8 weeks for alitretinoin to start working on chronic hand eczema. Treatment should be continued until the hand eczema is cleared or if there is a lack of improvement after 8 weeks.
Absorption
9-cis-Tretinoin is rapidly absorbed and undergoes extensive hepatic metabolism. It is excreted mainly as metabolites in the feces and less than 0.1% is excreted unchanged in the urine.
Route of Elimination
9-cis-Tretinoin is eliminated mainly through the feces as metabolites. Less than 0.1% is excreted unchanged in the urine.
Dosage
The recommended dose of alitretinoin is 9 mg per day (administered as two 45 mg capsules). It should be taken with food and should not be taken with mineral oil or other lipid-containing supplements.
Administration
9-cis-Tretinoin should be taken orally with food once daily, preferably in the evening. The capsules should be swallowed whole.
Side Effect
Common side effects of alitretinoin use include dry skin, redness, itching, peeling, or swelling of the skin, rash, flatulence, diarrhea, constipation, and increased sensitivity to sunlight. Other more serious side effects may include fever, chills, difficulty breathing, seizures, inflammation of the pancreas or liver, dizziness, confusion, headaches, depression, and suicidal thoughts. Patients should contact a healthcare professional if they experience any of these side effects.
Toxicity
9-cis-Tretinoin is relatively safe when used as prescribed. However, due to its potential toxicity, caution should be taken when using the drug. The risk of toxicity is increased if the drug is taken at higher than recommended doses and concomitantly with other drugs.
Precautions
It is important to only take alitretinoin as prescribed. Patients should inform their doctor about all medications they are taking, including vitamins, herbal supplements, and over the counter drugs. Patients should also speak to their doctor before beginning any new medications. Patients should also consult their doctor immediately if they experience any symptoms they believe to be due to alitretinoin.
Interactions
9-cis-Tretinoin may interact with other medications, which may increase the risk of serious side effects. Patients should tell their doctor about all prescription and non-prescription medications they are taking prior to taking alitretinoin.
Disease Interactions
Patients with preexisting conditions such as liver or kidney disease, depression, or abnormal lipid levels, should talk to their doctor before using alitretinoin as it may worsen these conditions.
Drug Interactions
9-cis-Tretinoin may interact with other medications, which can increase the risk of serious side effects. It should not be taken with other retinoid products as this may cause serious adverse reactions. It may also interact with certain antibiotics, anticonvulsants, antifungals, sedatives, tranquilizers, muscle relaxants, and non-steroidal anti-inflammatory drugs (NSAIDs). It is important to talk to your doctor before taking any other medication concomitantly with alitretinoin.
Food Interactions
9-cis-Tretinoin should be taken with food. Patients should not take it with mineral oil or other lipid-containing supplements.
Pregnancy Use
There is no safe and effective use of alitretinoin in pregnant women. Use is contraindicated in women who are pregnant or are planning to become pregnant. Patients should discuss effective methods of contraception with their doctor before starting alitretinoin.
Lactation Use
It is best to avoid alitretinoin use while breastfeeding as it can be transferred to the baby through breastmilk. Patients should discuss the risks and benefits of breastfeeding with their doctor.
Acute Overdose
Signs and symptoms of an acute overdose may include nausea, vomiting, and diarrhea. In more severe cases there may also be confusion, dizziness, increased heart rate, and seizures. If an overdose is suspected, the patient should seek immediate medical attention.
Contraindications
9-cis-Tretinoin should not be used in pregnant women or those who plan to become pregnant, as well as women who are breastfeeding or those with severe hepatic impairment.
Use Directions
9-cis-Tretinoin should be taken orally with food once daily, preferably in the evening. The capsules should be swallowed whole.
Storage Conditions
9-cis-Tretinoin should be stored at room temperature, away from heat, light, and moisture.
Volume of Distribution
The volume of distribution of alitretinoin is approximately 68 L/m2.
Half Life
9-cis-Tretinoin has a half life of approximately 1.2 hours.
Clearance
9-cis-Tretinoin
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