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Alitretinoin belongs to the group of skin diseases, is available in the form of soft capsules and gel for topical use. It is indicated for the treatment of adults with chronic eczema unresponsive to topical corticosteroid therapy. However, Alitretinoin can cause some unwanted side effects such as headache, anemia, conjunctivitis... Therefore, before using the drug, it is necessary to learn carefully and consult a doctor. treatment.
1. Mechanism of action of the drug
Alitretinoin's pharmacological effects of retinoids can be explained by its effects on cell proliferation, cell differentiation, apoptosis, keratinization, angiogenesis, sebum secretion, and regulation. immunity. However, the drug, unlike other steroids, is primarily a specific agonist of two generations of the RAR or RXR receptors. Alitretinoin binds to subunits of both receptor families. And the mechanism of action of Alitretinoin in chronic hand eczema has yet to be further investigated. However, Alitretinoin has been shown to have both immunomodulatory and anti-inflammatory effects associated with inflammatory skin conditions. Alitretinoin also suppresses the production of chemokines involved in the chemotaxis of leukocytes to sites of skin inflammation and reduces the activation of T lymphocytes and antigen-presenting cells. In addition, the drug can inhibit the effect of cell differentiation. The CXCR3 ligands and the chemokines CCl20 expressed in urticaria-associated skin lesions are upregulated by Alitretinoin in cytokine-stimulated concurrent keratinocytes and subcutaneous endothelial cells.
Alitretinoin is not completely absorbed from the gastrointestinal tract when the patient is fasting. But absorption can be significantly increased by about 2 times or more when the drug is taken with a high-fat meal. When Alitretinoin enters the body, it will be bound to plasma proteins at a rate of up to 99.1%. The volume of distribution of Alitretinoin in the body is estimated to be greater than the extracellular volume but less than the total body water.
Metabolism of Alitretinoin is carried out by the isoenzymes CYP2C9, CYP2C8 and CYP3A4 to form the compound 4-oxo Alitretinoin. Both compounds undergo isomerization to form tretinoin and its metabolite 4-oxo.
Elimination of Alitretinoin is possible via urine and glucuronidated 4-oxo Alitretinoin. The mean half-life of Alitretinoin is 9 hours and that of 4-oxo Alitretinoin is 10 hours.
2. Indications and contraindications for drug use
What does Alitretinoin do? Alitretinoin is indicated for use in adults with chronic eczema that has not responded to topical corticosteroid treatment. Patients with eczema characterized primarily by hyperkeratosis are more likely to respond to treatment than patients with eczema whose predominant expression is pompholyx.
However, Alitretinoin is also contraindicated in cases of hypersensitivity to the drug's ingredients, or subjects who are pregnant, lactating women, or women of childbearing potential unless the response is met. with conditions of contraception, or those with liver failure, uncontrolled hypercholesterolemia, uncontrolled hypertriglyceridemia, uncontrolled hypothyroidism, or people with hypervitaminosis A syndrome, or patients with are being treated with tetracyclines.
3. Dosage and how to use Alitretinoin
Alitretinoin is used for adults and the recommended dosage can be 10mg or 30mg once a day. The starting dose for Alitretinoin may be 30mg once daily. When using Alitretinoin, consideration should be given to reducing the dose to 10mg once daily in those with serious adverse reactions to the 30mg dose. Application of Alitretinoin treatment can be done from 12 to 24 weeks depending on the response of the patient. Alitretinoin should be taken with the main meal.
In case the patient accidentally takes an overdose of Alitretinoin than prescribed and has some signs of unwanted side effects, it is necessary to take the patient to the nearest emergency medical facility to be able to timely medical support to help patients overcome dangerous conditions.
If the patient misses a dose of Alitretinoin while taking Alitretinoin, the missed dose can be used as soon as he remembers. However, if the interval between the missed dose of Alitretinoin and the next dose is close, the patient can skip the missed dose and take the next dose. Patients should also be careful not to double the dose of Alitretinoin because it can cause drug overdose and unwanted side effects that affect the patient's current health.
4. Unwanted side effects when using the drug Alitretinoin
Alitretinoin medicine can cause some unwanted side effects for patients during treatment.
Common side effects include headache, hypertriglyceridemia, decreased HDL and increased LDL. Side effects are uncommon with symptoms such as: anemia due to increased iron-binding with decreased monocytes and thrombocythemia, conjunctivitis with dry eyes and eye irritation, dizziness, tinnitus, sadness vomiting, dermatitis, hair loss... Rare side effects include depressive symptoms, tendency to anxiety, mood swings, abnormal behavior, benign increase in intracranial pressure, vasculitis, reflexes protection, reduced night vision...
5. Some notes on the use of Alitretinoin
Alitretinoin is strictly contraindicated for pregnant and lactating women. For women of childbearing age, the duration of use of the drug should be limited to less than 30 days along with regular monitoring of the patient's health. Severe depression or increased aggression, renal dysfunction symptoms may occur in patients treated with Alitretinoin. The effects of UV are enhanced with retinoid therapy. Therefore, patients using Alitretinoin should avoid exposure to sunlight and it is necessary to use sunscreen and use sunscreen to protect the skin. For patients treated with Alitretinoin who have symptoms of dry skin and lips, their doctor may recommend the use of additional moisturizers or ointments to prevent this. Treatment with Alitretinoin may increase myalgia, arthralgia and increase serum creatinine phophokinase values. Signs and symptoms of benign intracranial hypertension such as nausea, headache, visual disturbances... need to be discontinued. use Alitretinoin medicine immediately and tell your doctor for prompt medical assistance. Alitretinoin Drug Interactions:
Concomitant use with inhibitors such as ketoconazole will increase plasma concentrations of Alitretinoin and in that case a dose reduction to 10mg should be considered. Or Alitretinoin is not recommended for concurrent use with Amiodarone because it can be metabolized by CYP2C8 with a narrow half-life and therapeutic index. Or patients should not use Alitretinoin with vitamin A or other retinoids because it can increase the risk of vitamin A levels in the body. Alitretinoin drug interactions can change how the medicine works or increase the effects of side effects. Therefore, when using the drug, the patient needs to learn and must be prescribed by the doctor to use it. At the same time, adhere to the therapeutic dose, do not change the dose or stop using the drug without the permission of the doctor.
drug alitretinoin
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