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It is recommended that Acitretin be given only by, or under supervision of, a dermatological specialist. Acitretin capsules are for oral administration. The capsules should be taken once daily with meals or with milk. There is a wide variation in the absorption and rate of metabolism of Acitretin. This necessitates individual adjustment of dosage. For this reason the following dosage recommendations can serve only as a guide.
Adult: Initial daily dose should be 25 mg or 30 mg for 2 to 4 weeks. After this initial treatment period the involved areas of the skin should show a marked response and/or side-effects should be apparent. Following assessment of the initial treatment period, titration of the dose upwards or downwards may be necessary to achieve the desired therapeutic response with the minimum of side-effects. In general, a daily dosage of 25–50 mg taken for a further 6–8 weeks achieves optimal therapeutic results. However, it may be necessary in some cases to a maximum of 75 mg/day. Therapy can be discontinued in patients with psoriasis whose lesions have improved sufficiently.
In patients with Darier’s disease a starting dose of 10 mg may be appropriate. The dose should be increased cautiously as isomorphic reactions may occur. Patients with severe congenital ichthyosis and severe Darier's disease may require therapy beyond 3 months. The lowest effective dosage, not exceeding 50 mg/day, should be given.
Continuous use beyond 6 months is contraindicated as only limited clinical data are available on patients treated beyond this length of time.
Children: Acitretin is contra-indicated in children unless the benefits significantly outweigh the risks, in view of possible severe side-effects associated with long-term treatment. The dosage should be established according to bodyweight. The daily dosage is about 0.5 mg/kg. Higher doses (up to 1 mg/kg daily) may be necessary in some cases for limited periods, but only up to a maximum of 35 mg/day. The maintenance dose should be kept as low as possible in view of possible long-term side-effects.
Elderly: Dosage recommendations are the same as for other adults.
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