Psoriasis (Oral & Topical agents)

Intro	acitretin - Soriatane ®
alefacept - Amevive ®	Anthralin - Drithocreme ®
Calcipotriene - Dovonex ®	efalizumab - Raptiva ®
Tazarotene - Tazorac ®

Intro

Approximately one percent of the population is affected by psoriasis. The typical clinical findings of erythema and scaling are the result of hyperproliferation and abnormal differentiation of the epidermis, plus inflammatory cell infiltrates and vascular changes.

acitretin - Soriatane ®

Drug Category: Retinoid-Like Compound. Individualization of dosage is required to achieve maximum therapeutic response while minimizing side effects.
Dosing (Adults) : ( treatment of severe psoriasis) Therapy should be initiated at 25 or 50 mg per day, given as a single dose with the main meal. Maintenance doses of 25 to 50 mg per day may be given after initial response to treatment. In general, therapy should be terminated when lesions have resolved sufficiently. Relapses may be treated as outlined for initial therapy.

[Supplied: 10, 25mg capsule]

alefacept - Amevive ®

(Monoclonal antibody). Recombinant leukocyte function-associated antigen-3 (LFA-3)-immunoglobulin G1 (IgG1) fusion protein. Net result: reduction in the activation of T-lymphocytes in psoriasis (inflammatory mediators reduced in etc).
Dosing (adults): 7.5 mg IV weekly or 15 mg IM have been effective in plaque psoriasis. Optimal doses/schedules remain to be established. Usual duration of treatment is 12 weeks. Second course: A second course of treatment may be initiated at least 12 weeks after completion of the initial course of treatment, provided CD4+ T-lymphocyte counts are within the normal range.

Monitoring: CD4+ T-lymphocyte counts should be monitored before initiation of treatment and weekly during therapy. Dosing should be withheld if CD4+ counts are <250 cells/µL, and dosing should be permanently discontinued if CD4+ lymphocyte counts remain at <250 cell/µL for longer than 1 month.

[Supplied: Injection (powder for reconstitution): 7.5mg, 15 mg. ]

Anthralin - Drithocreme ®

Synthetic tar derivative.
Dosing: Apply once daily at bedtime, covered with dressing, and removed after 8 to 24 hours. Therapy is usually initiated with 0.1% topical cream, ointment, or paste, gradually increasing concentrations to an optimal response level within acceptable patient skin irritation limits. Alternatively, a short-contact regimen that uses higher initial concentrations of anthralin (1% to 3%) may be applied for 5 to 60 minutes. Anthralin concentrations are increased every 3 to 4 days until patient intolerance occurs. Therapy continues until psoriatic plaques clear. Maintenance therapy is infrequently used.

Supplied: [ointment, cream: 0.1, 0.25, 0.5, 1%].

Calcipotriene - Dovonex ®

Synthetic vitamin D3 derivative.
Indicated for the treatment of plaque psoriasis.
Dosing: Apply twice daily.

Supplied: 0.005% ointment /cream/ solution.

efalizumab - Raptiva ®

Monoclonal antibody. Immunosuppressant (blocks multiple T-cell mediated responses involved in the pathogenesis of psoriatic plaques.)
Dosing (adults): Tx of psoriasis: 0.7 mg/kg SQ initially, followed by weekly dose of 1 mg/kg (maximum: 200 mg/dose).

Supplied: Injection (powder for reconstitution): provides 125 mg/1.25 ml after dilution.

Tazarotene - Tazorac ®

Retinoid.
Indicated for the topical treatment of patients with stable plaque psoriasis of up to 20% body surface area involvement.

Psoriasis: Apply a thin film to lesions at bedtime (no more than 20% of body surface area). Avoid application to unaffected skin. ACNE: apply a thin film to dry skin once a day in the evening.

Supplied: gel: 0.05, 0.1%

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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