Novatretin (Acitretin generic) - anyone else used it? My experience so far...

[Kat]

I think you have answered your own question that the lower dose has not worked in the past, what makes your dermatologist think it will work now.

As I said above: "In the last couple of years my rash had become a little nasty with spots and patches all over which I was managing with Daivonex and a low dose steroid for the scalp. I didn't have a flare-up but decided to get Acitretin from my derm who thought it was a good idea to try a lower dose regime."

It was my suggestion to my derm that since I wasn't involved in a flare-up that it might be worthwhile to try a lower dose to see if it would be as effective and which would soften the side effects of a higher dose. He thought it a good idea and indicated 20mg as appropriate.

Naturally I expected it to take longer to show results as it's almost half my usual starter dose. What's disconcerting is the renewed activity after the initial settling period and the eruption on my palms and soles. That said, I'm fairly philosophical about it knowing it was somewhat of an experiment. The positive outcome will be a better understanding of how starting on a low dose differs from starting high then going lower (35mg/25mg).

My current supply gives me 38 (from 90) remaining days at 20mg which I doubt is long enough to effect the clearance I was expecting. But if my derm suggests I continue to see what happens I'm open to that since unexpected things can happen. The drug may finally reach a critical point and really kick in. However I will be suggesting stepping up to 30mg for the next month.

The one great benefit of the lower dose is the low level of side effects. But there's no point to that if the outcome is a partial suppression at best. I'd rather experience the normal side effects (which aren't actually too bad) knowing it would be well worth it in the end.

Im reading this as a sufferer who has never used acetretin, but I know with my drug my body reacts badly if I reduce the dose to low
I'm assuming from what I've read from others who are on acetretin who have reduced their dose that the psoriasis comes back and increasing the dose stops the flare see this thread  Flare up on Acitretin it looks to me as if the body needs a certain level of the drug to block the disease, and then reduce the dose, rather than start low
It's just my opinion, your dermatologist will know for sure. I can understand wanting to minimise the side effects,

I can only speak for myself but I started with Acitretin 25mg per day, also with UV light therapy. After it started working, I did what I'm bad about doing and started missing some doses but thankfully didn't suffer any consequences and so I went down to about every other day. Then my dermatologist suggested trying to go without the Acitretin and use topicals to maintain and so far it's been going fairly well (I had a stubborn spot ears and hairline that has never totally cleared that has gone a bit back and forth but as of now even that has much improved.) So as Jim mentions for me it was lowering the dose after it started working.

[rasherman]

Update 26/11/2015

Emailed derm with some pics and my experiences with the low dosage regime which through all of November has been a roller coaster ride. Most disturbing has been the flare and sustained activity on my soles which for the past two years (and more) had been quite clear.

Dosage increased to 35mg/day as of today.


My derm has no opinion about the use of the generic Novatretin and thinks my recent experience is dose-related. So at least upping to 35mg is going to answer that question definitively. If in another month I'm not showing widespread improvement as per usual I'll know my reaction to Acitretin has changed from what it's consistently been for 30 years. In fact, I expect the increase in dosage to take effect quicker as I've been on 20mg/day for 10 weeks now.

As I said to my derm, the lower dose appears to have been therapeutic in some areas and antagonistic in others mainly my soles. And I've no doubt whatsoever that my soles flared due to the Acitretin since they had been perfectly clear for so long previously. If not for that I'd have accepted the inconsistent fading to be a sign of the lower dose expecting that continuation would have resulted in an ongoing improvement.


Side effects on 20mg have been minimal with sun sensitivity being the most obvious. Dry mouth and lips have been at a low level and easily remedied: drink water, use a chap stick. I expect the side effects to worsen due to the dose increase but it's not like I'm jumping from 0 to 35mg all at once so I may be pleasantly surprised.

Mentally-speaking I've found it very disconcerting that a drug that's been a miracle for me every time before has given me such a bad ride. I have to put this down to experience.

If the higher dose doesn't prove effective I'll be requesting something like methotrexate when I see my derm in a couple of months.

I hope this update helps others. I'll report back.

[rasherman]

It's been two months since I went up to 35mg and the results have been identical. That is, a cyclical therapeutic effect and then a slight reassertion of the rash. Soles and palms in particular have remained as described.

The drug simply has not been effective.

I consulted with my derm today and he suggested my response had changed and suggested methotrexate as the next step.

Now, I accept the proposition that response changes over time and that a drug that works in one context may not work in others. Yet I feel some disquiet considering that for 30 years my response to Acitretin has always been nothing short of miraculous. I posited to my derm that the generic (Novatretin versus Neotigason) was the problem. He dismissed this. He may be right. But again, having used Acitretin on eight previous occasions with the same wonderful effect, this seems hard to believe.

Since it's summer here I'm going to try sun therapy along with a reduced dose of Novatretin (20mg). Then I will try methotrexate.

But I'm still wondering if there are any others who have used Novatrein versus Neotigason (or any other Acitrein product) and found their response to have been different.

[mataribot]

Not all generics are considered equal. They often use different binders and with time sensitive medication the results may be different. I am sorry to hear this happen.

[Caroline]

To my idea, if you are in a certain specific situation and you change one parameter, and than the situation changes, there is causal connection between them.
So it's my feeling that your derm is not thinking logically nor scientifically.

If I were you I would challenge the derm to go back to Neotigason, and if that will not work again, that you can go on to other treatments. Make a bargain.
Yes, certainly at a certain point medications may stop working. That is not because the medication is not good enough anymore, but that is because your body found a way to resist it. A medication is also "strange" for your body, so it will try to get rid of it and try to find a way to resist it.
Therefore it makes sense to take medication intermittently, to give your body a bit of rest so it will not get used to the medication.

Remember. Methotrexate is a cancer treatment, I recently saw it again on tv where it mentioned as a chemotherapy. Sure it may help, but there are other better and safer treatments.
Also remember, it is you who should be in control, this is about your person and your body.

I hope you can come to the right decision/approach.
Caroline

P.s. What Mati says may be very correct, there may be a slight difference because if which it does not work anymore.

[Bill]

What is the dosage error of the generic? I believe that for some the amount of medication can vary by as much as 20%. You should be able to get this information from the manufacturer.

[mataribot]

Bill you are close, it's (75, 125). Most generics are > than 100. However, they don't typically use the same binder. This causes problems when a medication needs be slowly released or released all once. I have no idea if this is the case with the drug in question, but what is the harm of trying the old version? It's not like we are talking biologics here, the medication is not overly expensive.

[Caroline]

Bill you are close, it's (75, 125). Most generics are > than 100. However, they don't typically use the same binder. This causes problems when a medication needs be slowly released or released all once. I have no idea if this is the case with the drug in question, but what is the harm of trying the old version? It's not like we are talking biologics here, the medication is not overly expensive.

I totally agree with you Mati !

[Fred]

If you are looking for new posts here I have moved them to a split. This thread is about Novatretin but it had moved on to Acitretin so I think it's best separated to save any confusion.

New thread here: [split] Novatretin (Acitretin generic) - anyone else used it? My experience so far...