Drug General Information (ID: DDIXW3ZI95)
Drug Name			Acitretin		Drug Info		Methotrexate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Keratolytic Agents				Antimetabolites
Structure

Mechanism of Acitretin-Methotrexate Interaction (Severity Level: Major)
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Acitretin				Methotrexate
Mechanism		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 1
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Acitretin and Methotrexate

Recommended Action
Management		The use of acitretin in combination with methotrexate is considered contraindicated.

References
1	Canadian Pharmacists Association.
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Larsen FG, Nielsen-Kudsk F, Jakobsen P, Schroder H, Kragballe K "Interaction of etretinate with methotrexate pharmacokinetics in psoriatic patients." J Clin Pharmacol 30 (1990): 802-7. [PMID: 2277127]
5	Product Information. Soriatane (acitretin). Roche Laboratories, Nutley, NJ.
6	Zachariae H "Dangers of methotrexate/etretinate combination therapy." Lancet 1 (1988): 422. [PMID: 2893228]
7	Zachariae H "Methotrexate and etretinate as concurrent therapies in the treatment of psoriasis." Arch Dermatol 120 (1984): 155. [PMID: 6696467]