Kaposi sarcoma: Topical: Initial: Apply gel twice daily to cutaneous lesions; may gradually increase application frequency to 3 or 4 times daily based on lesion tolerance. Continue as long as deriving clinical benefit; response may be observed within 2 weeks of initiation, but typically a longer period is required (>14 weeks); in clinical trials, therapy lasted up to 96 weeks.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; however, systemic absorption is not extensive making the need for a dose adjustment appear unlikely.
There are no dosage adjustments provided in the manufacturer's labeling; however, systemic absorption is not extensive making the need for a dose adjustment appear unlikely.
Application site irritation: May reduce the frequency of administration if application site toxicity occurs.
Grades 0, 1, or 2 dermal irritation: No dosage adjustment necessary (Walmsley 1999).
Grade 3 dermal irritation: Reduce dosing frequency to once daily (Bodsworth 2001) or reduce frequency or withhold treatment for up to 2 weeks and restart when irritation improves to grade 1 or lower (Walmsley 1999).
Grade 4 dermal irritation: Discontinue treatment until irritation improves to grade 1 or lower within 2 weeks and then restart at less than once daily for 2 weeks before increasing application frequency. If grade 4 irritation occurs less than once daily, do not restart treatment (Walmsley 1999).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Gel, External:
Panretin: 0.1% (60 g)
Panretin: 0.1% (60 g) [contains alcohol, usp]
No
Topical: Apply sufficient gel to cover lesion(s) with a generous coating; allow gel to dry 3 to 5 minutes after application before covering with clothing. Do not cover alitretinoin application site with occlusive dressings. Avoid applying gel to normal skin surrounding lesions. Do not apply to any lesions on or near mucosal surfaces.
Hazardous agent (NIOSH 2016 [group 3]).
Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage.
NIOSH recommends double gloving, a protective gown, and (if liquid that could splash) eye/face protection for administration of a topical product; if there is potential for inhalation, respiratory protection is recommended (NIOSH 2016). Assess risk to determine appropriate containment strategy (USP-NF 2017).
Kaposi sarcoma: Topical treatment of cutaneous lesions in AIDS-related Kaposi sarcoma.
Limitations of use: Alitretinoin is not indicated when systemic therapy is necessary (eg, >10 new Kaposi sarcoma lesions in previous month, symptomatic visceral involvement, symptomatic pulmonary Kaposi sarcoma, symptomatic lymphedema). There is no experience in using alitretinoin (topical) in combination with systemic treatment for Kaposi sarcoma.
Alitretinoin (topical) may be confused with tretinoin (topical)
Panretin may be confused with pancreatin
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Pain (≤34%), paresthesia (3% to 22%)
Dermatologic: Skin rash (25% to 77%), pruritus (8% to 11%)
1% to 10%:
Cardiovascular: Edema (3% to 8%)
Dermatologic: Exfoliative dermatitis (3% to 9%), dermatological disease (≤8%)
Known hypersensitivity to alitretinoin, other retinoids, or any component of the formulation
Concerns related to adverse effects:
• Dermal irritation: Application site irritation and pain have been reported, including grade 3 dermal irritation; may require dosage reduction.
• Photosensitivity: Alitretinoin may be photosensitizing (based on experience with other retinoids); minimize sun or other UV exposure of treated areas.
Other warnings/precautions:
• Products containing DEET: Do not use concurrently with topical products containing DEET (eg, insect repellant); an increase in DEET toxicity has been observed.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination
Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy
Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy
Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination
Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination
Multivitamins/Minerals (with AE, No Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination
Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy
Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy
Females of reproductive potential should avoid becoming pregnant during treatment with topical alitretinoin.
Alitretinoin may cause fetal harm if significant absorption occurs in a female who is pregnant.
It is not known if alitretinoin is present in breast milk.
Due to the potential for adverse reactions in the breastfed infant, the manufacturer recommends discontinuing breastfeeding during alitretinoin (topical) treatment.
Alitretinoin is a naturally occurring endogenous retinoid that binds to and activates intracellular retinoid receptors (RAR and RXR subtypes); this results in altered expression of the genes controlling cellular differentiation and proliferation in normal and neoplastic cells, inhibiting the growth of Kaposi sarcoma
Absorption: Not extensive
Gel (Panretin External)
0.1% (per gram): $115.96
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