Issues for surgery
Risk of perioperative flare of severe psoriasis if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Consider checking liver function tests (LFTs) if not checked in previous 3 months – discuss clinically significant increases in transaminases with patient’s dermatologist.
Patients with diabetes
Retinoids can alter glucose tolerance; monitor blood glucose closely, especially at the beginning of the retinoid treatment period.
Patients taking oestrogen-containing contraceptive
If pre-operative cessation of oestrogen-containing contraceptive is being considered see Further Information.
Post-operative advice
Restart when enteral intake resumed.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Tetracyclines
Acitretin can cause an increase in intracranial pressure which may be additive with the increase in intracranial pressure seen with tetracyclines; cases of benign intracranial hypertension (pseudotumor cerebri) have been reported with concurrent use. Tetracyclines (e.g. doxycycline, tigecycline) must be avoided.
Hepatotoxicity
Concomitant use of acitretin with the following medications may increase the risk of hepatotoxicity:
- Doxycycline – AVOID (also see Tetracyclines)
- Low molecular weight heparin (LMWH), if high dose
- Paracetamol
- Tigecycline – AVOID (also see Tetracylines)
- Unfractionated heparin (UFH)
Whilst single doses of LWMH and paracetamol should not pose a problem, continued post-operative treatment may require close monitoring of LFTs.
Further information
Pregnancy Prevention Programme
Retinoids are highly teratogenic; therefore, it is essential that females of childbearing potential use effective contraception for a least 1 month before starting treatment, during treatment, and for 3 years after stopping acitretin. Females must use at least one highly effective method of contraception (i.e. a user-independent form), or two complementary user-dependent forms of contraception. Do not discontinue oestrogen-containing contraceptive pre-operatively without discussing with patient’s dermatologist.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19th June 2024]
Summary of Product Characteristics – Acitretin 10mg Capsules. Genus Pharmaceuticals. Accessed via www.medicines.org.uk 19/06/2024 [date of revision of the text April 2024]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19th June 2024]