Agent

Dosage

Adverse effects

Special considerations

Acitretin (oral retinoid)

10-25 mg/d PO

– Dry skin and mucous membranes

– Retinoid dermatitis

– Elevated liver enzymes

– Hyperlipidemia

– Teratogenicity

Requires regular monitoring of liver function and lipids

Methotrexate (folate antagonist)

7.5-25 mg/wk PO or SC

– Nausea, vomiting, and GI upset

– Fatigue

– Cytopenia

– Mucositis

– Hair loss

– Hepatotoxicity

– Increased risk of infections

– Requires regular monitoring of blood count and liver and kidney function

– Possible drug–drug interaction

– Supplementation with folic acid may reduce certain adverse effects

Cyclosporine (calcineurin inhibitor)

3-5 mg/kg/d PO

– Electrolyte imbalance (eg, hyperkalemia and hypomagnesemia)

– Hyperuricemia

– Dyslipidemia

– Hypertension

– Neurotoxicity (eg, headache, tremor, and peripheral neuropathy)

– Nephrotoxicity

– Hypertrichosis

– Gingival hyperplasia

– Increased risk of infection

– Increased risk of malignancy

– Requires regular blood count monitoring

– Possible drug–drug interaction