Alitretinoin

Sounds like 'AL-i-TRET-i-noyn'

Alitretinoin is used to treat severe ongoing eczema of the hands. Alitretinoin is also called Zematane®.

What is alitretinoin?

Alitretinoin is used in adults to treat severe hand eczema that hasn't improved with other treatments such as potent corticosteroids applied to the skin. 

Alitretinoin belongs to a group of medicines known as retinoids, which are related to vitamin A. It works by decreasing the production of certain substances that cause skin inflammation. Read more about eczema. 

Alitretinoin isn't a cure, but most people will see a gradual improvement in their skin within a few weeks of starting the treatment. This improvement should continue while you are taking the medication and can continue after it's been stopped. 

A course of treatment is usually 12 to 24 weeks. Treatment may be stopped early if your hands are clear before 24 weeks. After 12 weeks, if there is no improvement, it should be stopped.

Alitretinoin is only available on prescription and isn't subsidised. This mean you will need to pay for the full cost of the medicine.

Dose

In New Zealand alitretinoin comes as capsules (10mg and 30mg).

  • The usual starting dose is 30 mg once daily.
  • Some people may need a lower dose of 10 mg daily, if they can't tolerate the higher dose. 
  • Always take alitretinoin exactly as recommended. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

How to take alitretinoin

  • Take alitretinoin once a day, at about the same time each day.
  • Alitretinoin is best taken with or just after food.
  • Swallow the capsules whole – don't split or chew them.
  • Keep taking alitretinoin until the prescribed course is completed. It usually takes a few weeks before you begin to notice a difference to your symptoms.
  • If you forget to take your dose, take it as soon as you remember. But if it is nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Things to consider before you start alitretinoin

Risk of birth defects

Alitretinoin can cause birth defects and is harmful to unborn babies.

Don't use alitretinoin if you are pregnant or planning a pregnancy.

If you are sexually active, ask your doctor about reliable contraceptive options.

Don't take alitretinoin if you are pregnant, or if there is a chance you could become pregnant.

  • Before you start treatment, your doctor may arrange a pregnancy test to ensure that you're not pregnant.
  • If you're sexually active, ask your doctor about reliable contraceptive options. You must use reliable birth control for at least 1 month before you start alitretinoin, the whole time you are taking alitretinoin and for at least 1 month after you finish taking it. Read more about methods of contraception.
  • You may be asked to sign a consent form to make sure you have understood the seriousness of this. 
  • If you do become pregnant while taking, or within 1 month of stopping alitretinoin, let your doctor know immediately.
  • Note: no contraceptive precautions are required for males who are taking alitretinoin; birth defects have not been identified in children fathered by men who have taken alitretinoin.

Things to consider while you are taking alitretinoin

Dry skin, lips, nostrils and eyes

Alitretinoin reduces oil production in the skin, and can cause dry skin, dry mouth, chapped lips, dry nostrils and dry eyes. These effects can be uncomfortable. Here are some tips to manage them, but if you have any questions, ask your doctor or pharmacist for advice.

  • Lips: from the start of treatment, use an emollient lip balm that has a sunscreen. It's important to apply the lip balm often during the day such as in the morning as soon as you awake, after any food, snack or drink, last thing at night and any other time in between that your lips become dry. 
  • Skin: from the start of treatment, use a non-perfumed moisturizing cream. Use non-soap cleansers, as these are less likely to irritate the skin than soap cleansers. Avoid beauty treatments such as chemical peels, dermabrasion and waxing during treatment, and for at least 6 months after stopping.
  • Eyes: your eyes may become dry and itchy, especially if you wear contact lenses. Ask your pharmacist to recommend a suitable eye lubricant (also called artificial tears). Read more about eye lubricants. While you are taking alitretinoin, you may need to wear glasses instead of contact lenses.
  • Nostrils: the inside of the nostrils may become dry and crusted and lead to mild nose bleeds. Applying a thin layer of petroleum jelly gently to the inside of the nose may help.

Increased sensitivity to the sun

Alitretinoin can make you more sensitive to the sun and your skin is more likely to burn.

  • Avoid unnecessary sun exposure.
  • When outside, protect your skin by using an oil-free sunscreen (SPF50+). Apply the sunscreen to all areas especially the face, neck and ears. Read more about using sunscreen.  
  • Wear clothing that protects you from the sun.
  • Wear sunglasses when outdoors.

Other precautions

  • Breastfeeding: Do not take alitretinoin if you are breastfeeding.
  • Donating blood: Donating blood by males and females on alitretinoin is not allowed during treatment, and for 1 month after treatment has finished. This is in case the blood is used for a pregnant woman.

Possible side effects

Side effects What should I do?
  • Headache
  • This is common and will probably go away with time.
  • Try taking your dose with your evening meal, so you may 'sleep over' any discomfort. 
  • Tell your doctor if it bothers you. 
  • Mood changes, anxiety, depression, or worsening depression, low mood, aggressive tendencies, thoughts or talk of suicide and self-harm.
  • If you experience any of these symptoms, tell your doctor immediately or ring Healthline on 0800 611 116.
  • Severe headache with blurred vision.
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Severe diarrhoea (runny poo), especially if it contains blood.
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

References

  1. Zematane Medsafe Datasheet
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 29 Aug 2022