Monitoring and Prevention of Side Effects

Laboratory examinations of liver function (transaminases and y-glutamyl transferase), alkaline phosphatase, serum lipids, and renal function tests (creatinine) should be performed before treatment is started, 3-4 weeks thereafter, and then at 3-month intervals. Patients with diabetes mellitus, obese patients, and alcoholic patients are at increased risk for hepatotoxicity and require more frequent liver function testing during therapy with retinoids. Concomitant use of other drugs (0-blockers, hormonal corticosteroid contraceptives, and thiazide diuretics) with an additive effect on lipid levels should be performed carefully. Other therapeutic agents that may interact with retinoids, such as antidiabetics (alterations in blood glucose), corticosteroids and tetracyclines (hyperlipidemia and pseudotumor cerebri), and methotrexate (hepatotoxicity), should be monitored cautiously or avoided. Supplementary therapy with vitamin A should be avoided while taking retinoids. To minimize skeletal toxicity, the lowest possible dosage in patients receiving long-term retinoid therapy should be used. Baseline radiography may be useful to document pretreatment bone status in addition to control x-rays once a year for individuals requiring prolonged treatment (Brecher and Orlow 2003, Katz et al. 1999, Orfanos et al. 1987).

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