Psoriasis - Other Medications

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Maintenance doses should be as low as possible and should be taken every second or third day.

Oral Retinoids and Pregnancy

Taking retinoids during pregnancy significantly increases the risk for severe birth defects in the unborn child. Pregnant or nursing women, or those planning to become pregnant, should not use these drugs. Women of childbearing age who take retinoids should have regular pregnancy tests.

• Acitretin should not be given to any woman who may become pregnant within 3 years of taking it. Drinking alcohol changes acitretin to a retinoid that is stored in fat cells for 3 years. It may have the potential to cause birth defects during that time. Be cautious about cooking products and over-the-counter preparations, such as cough syrup, which may contain alcohol.
• Women who are pregnant or who plan to become pregnant should not use isotretinoin. Everyone who takes, prescribes, or dispenses the drug must enroll in a national registry called iPLEDGE, which ensures that no woman starts retinoid therapy while pregnant or trying to get pregnant.

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Cyclosporine

Cyclosporine (Neoral, Sandimmune, SangCya) blocks certain immune factors and may be effective for all forms of psoriasis. It is also a first-line, or primary, systemic drug used to treat adults with severe psoriasis. Neoral is the preparation used most often for psoriasis, and it clears psoriasis in many patients within 8 - 12 weeks.

Side Effects. Cyclosporine has significant side effects if used for a long time, notably kidney problems and non-melanoma skin cancers. It should be reserved for patients who do not respond to phototherapy or less potent systemic medications (for example, methotrexate or acitretin).

Common and temporary side effects include:

• Fatigue
• Gingivitis
• Gout
• Hair growth
• Headaches
• Joint pain
• Tremor

More serious complications may include:

• Kidney damage
• High blood pressure (Some doctors advise treating high blood pressure with calcium channel blockers, because other standard blood pressure drugs may worsen psoriasis. Calcium channel blockers also help prevent kidney problems.)
• High cholesterol and lipid levels
• High levels of calcium and low levels of magnesium
• Increased risk for infections
• Liver problems
• Lymphomas
• Skin cancers (Patients who take cyclosporine after PUVA therapy have a higher incidence of squamous cell skin cancer. The risks are greatest with long-term and previous use of PUVA, methotrexate, or other immunosuppressants.)