Psoriasis - Other Medications

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Highlights	Diagnosis	Managing Psoriasis
Introduction	Treatment	Outlook
Types of Psoriasis	Topical Medications	Resources
Causes	Systemic Medications	References
Risk Factors	Phototherapy

Despite methotrexate's side effects, some experts view it as the best therapy for widespread plaque psoriasis. It may also be effective for some patients with generalized erythrodermic and pustular psoriasis.

Methotrexate appears to be effective in children, but more safety research is needed.

Drug Interactions. Many drugs interact with methotrexate, occasionally with harmful results. For example, the antibiotic trimethoprim-sulfamethoxazole increases the toxicity of methotrexate.

Taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen at the same time as methotrexate may change the blood levels of methotrexate. Always talk with your doctor before taking these or any other medications in combinations.

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People Who Should Avoid Methotrexate. Pregnant and nursing mothers should never take methotrexate because it increases the risk for severe, even fatal, birth defects and miscarriage. The drug should be discontinued several months before the actual pregnancy. Methotrexate may also cause temporary impairment of fertility in men.

People with the following conditions are unlikely to be given methotrexate:

Alcoholism
Anemia or other blood abnormalities
Kidney problems
Liver problems (including hepatitis)
Peptic ulcers
Suppressed immune system

Oral Retinoids

Oral retinoids are vitamin A-related medications taken by mouth. This group of medicines is also a first-line treatment for adults with severe psoriasis. Oral retinoids used for psoriasis include acitretin (Soriatane) and isotretinoin (Accutane).

Acitretin is the retinoid of choice and may be dramatically effective for severe psoriasis, particularly pustular or erythrodermic types. It is also effective in a low-dose formulation for symptoms of nail psoriasis. When used alone, it is much less effective against more common forms of psoriasis, such as plaque or guttate psoriasis. However, when combined with PUVA phototherapy it can markedly improve the response, even in patients with these forms of psoriasis.