alitretinoin

Therapeutic Classification: antineoplastics

Pharmacologic Classification: retinoids

Indications ⬆ ⬇

High Alert

Topical treatment of cutaneous lesions from AIDS-related Kaposi’s sarcoma.

Action ⬆ ⬇

Binds to and activates retinoid receptors, resulting in inhibition of Kaposi's sarcoma cells.

Therapeutic effects:

Decreased cutaneous lesions of Kaposi's sarcoma.

Pharmacokinetics ⬆ ⬇

Absorption: Small amounts are absorbed.

Distribution: Unknown.

Metabolism/Excretion: Some metabolism occurs.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(response of Kaposi's sarcoma lesions)

ROUTE	ONSET	PEAK	DURATION
topical	2 wk	4–14 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to retinoids;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Local: pain, pruritus, rash, dermatitis, edema, paresthesia

Interactions ⬆ ⬇

Drug-drug:

May ↑ absorption of insect repellent products containing N,N-diethyl-m-toluamide (DEET); avoid concurrent use.

Route/Dosage ⬆ ⬇

(Adults ): Apply generous coating twice daily to Kaposi's sarcoma lesions initially; may ↑ frequency, if needed, to 3–4 times daily.

Availability ⬆ ⬇

Topical gel: 0.1%

Assessment ⬆ ⬇

Assess skin lesions before and periodically throughout therapy to determine effectiveness.
Assess patient for dermal toxicities throughout therapy. Dermal toxicity may begin with erythema, which may increase, and edema may develop with continued application. Severe toxicity (as evidenced by erythema, edema, or vesiculation) may limit treatment. If toxicity occurs, decrease frequency of application. If extreme irritation occurs, discontinue for a few days until symptoms subside.

Implementation ⬆ ⬇

Apply sufficient gel to cover lesion with a generous coating twice daily initially. May increase to 3–4 times daily if tolerated. Allow gel to dry for 3–5 minutes before covering with clothing. Avoid application of gel to healthy skin surrounding lesions or on or near mucosal surfaces; skin may become irritated. Do not cover with occlusive dressing.

Patient/Family Teaching ⬆ ⬇

Instruct patient in correct method for application of gel. Emphasize the importance of continuing treatment, even if results are not visible. Prolonged therapy may be required.
Advise patient to notify health care professional if signs of dermal toxicity occur.
Caution patient to minimize exposure of treated areas to sunlight or sunlamps to prevent photosensitivity reactions.
Advise patient to avoid use of products, such as insect repellents, which contain DEET during treatment. Alitretinoin may increase DEET toxicity.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in cutaneous lesions of Kaposi's sarcoma. Effects may be seen as early as 2 wk, but most patients require 4–8 wk for response. Some patients require more than 14 wk for significant improvement. Gel application should be continued as long as patient is deriving benefit from it.

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Pronunciation ⬇

Classifications ⬆ ⬇