Acitretin Dosage: How Much to Take and What to Watch For

Acitretin is a powerful oral retinoid used mainly for severe psoriasis and some keratinization disorders. Want to know how much to take, how fast it works, and what labs you’ll need? Here’s a straight, practical guide—no fluff.

Common dosing and adjustments

Typical adult dosing is in the 10–50 mg per day range. Many doctors start with 25 or 50 mg daily for moderate to severe cases. If you’re older, have liver issues, or are sensitive to side effects, starting lower (10–25 mg) or using alternate-day dosing is common.

For stubborn pustular or erythrodermic psoriasis doctors may use higher daily doses briefly, but long-term high doses raise side effect risk. Some people find maintenance works well at 10–25 mg daily or even every other day after skin clears.

Expect to wait: noticeable improvement often shows by 4–8 weeks, and the strongest benefit usually takes 3–6 months. If you don’t see progress by a few months, your clinician will reassess dose or treatment choice.

Safety, monitoring, and practical tips

Key labs before starting: liver function tests and fasting lipid panel. Repeat them during treatment—usually at 1 month and then every 1–3 months, depending on results. Pregnancy testing is mandatory for women of childbearing potential before starting and monthly while on treatment.

Important pregnancy rule: acitretin is highly teratogenic. Women must use effective contraception during treatment and follow their doctor’s guidance about avoiding pregnancy for a long time after stopping. Discuss exact timing with your prescriber—this is not negotiable.

Avoid alcohol while taking acitretin. Alcohol can convert acitretin into a long-lived metabolite, increasing the time the drug stays in the body and raising pregnancy risk. Also avoid vitamin A supplements and be careful with other drugs that affect the liver.

Common side effects you’ll likely notice: dry lips and skin, brittle nails, and mild hair thinning. More serious issues include raised triglycerides and elevated liver enzymes. If you get severe headaches, mood changes, or visual problems, contact your doctor right away.

Simple tips to make treatment easier: take acitretin with a meal that has some fat to improve absorption, use heavy moisturizers and lip balm daily, and check blood tests on schedule. Keep a written record of side effects and blood results to share at follow-up visits.

Want to change dose or stop treatment? Talk to your prescriber first. Stopping suddenly is sometimes fine, but because of the drug’s effects and pregnancy risk, a clear follow-up plan is essential.

If you have questions about how acitretin fits with other meds or about pregnancy safety, bring them up with your dermatologist or pharmacist. They’ll help tailor the dose and monitoring to your situation so the treatment works with the least risk.