Acitretin: severe psoriasis treatment, dosing, and side effects
Last updated September 6, 2026.
**Acitretin is an oral retinoid, a vitamin A derivative sold under the brand name Soriatane, used to treat severe psoriasis in adults.** It works inside skin cells to slow the overgrowth and abnormal maturation of keratinocytes that build up as thick plaques and pustules, so the skin turns over closer to a normal rate. Results are gradual and often take 2 to 3 months to show fully. The single most important point: acitretin causes severe birth defects, so it must not be used by anyone who is pregnant or who could become pregnant during treatment or for 3 years after the last dose.
What does it treat?
Acitretin is approved for severe psoriasis in adults, meaning psoriasis that has not responded well to topical steroids, vitamin D creams, or phototherapy. It is used most often for the harder subtypes: generalized pustular psoriasis, where crops of sterile pustules appear on red skin; erythrodermic psoriasis, where redness and scaling cover most of the body; and extensive plaque psoriasis with thick, scaly patches on the elbows, knees, scalp, and trunk. It is also used for palmoplantar psoriasis of the hands and feet, where cracking and fissures limit walking and gripping. Dermatologists frequently pair acitretin with narrowband UVB or PUVA phototherapy, which lets both the light dose and the acitretin dose stay lower. It is not a cure, and psoriasis usually returns after the drug is stopped. Acitretin is not sold as a combination pill, and it is not used for acne.
How do you take it?
Acitretin comes as 10 mg, 17.5 mg, and 25 mg capsules taken by mouth. The label starts adults at 25 mg or 50 mg once a day, given as a single dose with the main meal, then adjusts maintenance to 25 mg to 50 mg a day based on how your skin responds and what side effects you get. Doses above 50 mg a day are not usual and raise side effects sharply. Food matters: take it with your largest meal every day, since taking it on an empty stomach cuts absorption substantially and changing your routine changes your blood levels. If you miss a dose, take it with your next meal on the same day, but skip it entirely if it is almost time for the next one, and never double up. Your clinician will check a pregnancy test, liver enzymes, and fasting cholesterol and triglycerides before you start, then repeat them every 1 to 2 weeks until levels are stable and periodically after that. Stop the drug and call your clinician for yellowing of the eyes or skin, dark urine, persistent nausea, severe or new headache, blurred or doubled vision, worsening night vision, severe belly pain, or new depression or thoughts of self-harm.
Side effects to know
- Common: Almost everyone gets dry, chapped, cracking lips, along with dry mouth, dry eyes, dry or peeling skin, sticky or fragile skin, thinning hair, nail changes, nosebleeds, and easy sunburn.
- Serious: Get medical help and stop taking acitretin for signs of liver injury (yellow eyes or skin, dark urine, right upper belly pain, ongoing nausea), pancreatitis from very high triglycerides (severe upper belly pain boring through to the back with vomiting), or raised pressure around the brain called pseudotumor cerebri (severe headache with nausea, vomiting, or vision changes). Also call right away for new or worsening depression, mood changes, or thoughts of hurting yourself, and for a sudden loss of night vision while driving.
Who should not take it?
Do not take acitretin if you are pregnant, planning a pregnancy, or could become pregnant and are unwilling to use two effective forms of birth control at the same time, starting 1 month before, continuing throughout treatment, and for 3 years after your last dose; two negative pregnancy tests are required before the first capsule. Progestin-only "minipill" contraceptives may not be reliable with acitretin, so they do not count as one of the two methods. Do not breastfeed while taking it, and do not donate blood during treatment or for 3 years after, since donated blood could reach a pregnant recipient. If you can become pregnant, do not drink alcohol during treatment or for 2 months after your last dose, because alcohol converts acitretin into etretinate, a compound that lingers in the body far longer. Acitretin is contraindicated with methotrexate (liver injury risk) and with tetracycline antibiotics such as doxycycline and minocycline (pressure around the brain). Talk with your clinician before starting if you have liver or kidney disease, high cholesterol or triglycerides, diabetes, a history of pancreatitis, depression, or heavy alcohol use, and tell them about vitamin A supplements, glyburide, and phenytoin. Men taking acitretin do not need to stop fathering children; the drug in semen has not been shown to cause birth defects.
When is it an emergency?
Call 911 if you collapse, have trouble breathing, have swelling of the face, lips, or throat, or break out in hives with dizziness, which can signal a severe allergic reaction. Call Poison Control at 1-800-222-1222 right away for any overdose or accidental swallowing, including a child getting into your capsules; acute acitretin overdose looks like vitamin A poisoning, with severe headache, dizziness, nausea, vomiting, drowsiness, flushing, and unsteadiness. Go to an emergency room for severe upper belly pain that spreads to your back with vomiting, which can mean pancreatitis, and for a severe headache with vomiting or vision loss. If someone who could become pregnant takes acitretin, or a pregnancy occurs during treatment or within 3 years of the last dose, stop the drug and contact your clinician the same day.
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Common questions
What is the maximum dose of acitretin?
The label uses 25 mg or 50 mg once a day to start, and maintenance stays in that same 25 mg to 50 mg daily range. Fifty milligrams a day is the usual practical ceiling for most adults. Higher doses do not reliably clear psoriasis faster, but they do sharply increase lip cracking, hair loss, and abnormal lipid and liver results. Your clinician will often move the other direction and lower your dose if side effects build up, especially when acitretin is combined with phototherapy. Never adjust the dose on your own.
Can I drink alcohol on acitretin?
If you can become pregnant, no. Alcohol converts acitretin into etretinate, a related compound that stays in body fat for far longer, which extends the window in which a pregnancy could be harmed. The label requires no alcohol during treatment and for 2 months after your last dose for anyone of reproductive potential, and this includes beer, wine, liquor, and alcohol-containing foods and medicines like some cough syrups. For men and for people who cannot become pregnant, alcohol is not banned outright, but heavy drinking still adds to the liver and triglyceride strain acitretin already causes, so keep intake low and tell your clinician what you actually drink.
What are the pregnancy rules with acitretin?
Acitretin is contraindicated in pregnancy because it causes severe birth defects, including problems with the skull, face, heart, and nervous system. If you can become pregnant, you need two negative pregnancy tests before starting, two effective forms of birth control used at the same time beginning 1 month before your first dose, and continued contraception throughout treatment and for 3 full years after your last capsule. Progestin-only minipills do not count as one of the two methods because acitretin can make them less reliable. Do not breastfeed while taking acitretin. If you become pregnant at any point in that window, stop the drug and contact your clinician immediately.
Do I have to take acitretin with food?
Yes. Take it with your main meal of the day, every day, at roughly the same time. Acitretin absorption drops substantially on an empty stomach, so skipping the meal means less drug reaching your skin and a weaker response. A meal with some fat in it works best. Being consistent matters as much as the meal itself, because switching between fed and fasted dosing makes your blood levels swing and makes side effects harder to interpret.
What happens if I take too much acitretin?
Call Poison Control at 1-800-222-1222 right away, even if you feel fine. Acute overdose produces vitamin A toxicity: severe headache, dizziness, nausea, vomiting, flushing, drowsiness, and unsteady walking. These usually settle after the drug is stopped, but the exposure still matters for pregnancy planning. Call 911 instead if the person collapses, cannot breathe, or is not fully awake. Keep the bottle with you so the exact strength and count can be reported.
What medicines interact with acitretin?
Methotrexate is contraindicated because the combination raises the risk of hepatitis. Tetracycline antibiotics, including doxycycline and minocycline, are contraindicated because both they and acitretin can raise pressure around the brain. Vitamin A supplements and other retinoids stack on top of acitretin and cause vitamin A toxicity, so stop any high-dose vitamin A products. Acitretin can interfere with glyburide blood sugar control and may increase phenytoin levels, and progestin-only contraceptives can become less effective. Give your clinician a full list of your prescriptions, over-the-counter drugs, and supplements before your first dose.