Alvox (tazarotene/niacinamide)
Acne Products Topical Cream (Gram)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Tazarotene is a synthetic acetylenic retinoid.
Tazarotene is a synthetic acetylenic retinoid. Tazarotene is a prodrug and exhibits no pharmacologic activity until hydrolyzed to its active metabolite tazarotenic acid. Tazarotenic acid has pharmacologic actions similar to those of other retinoids (e.g., tretinoin, isotretinoin).
However, unlike these drugs, tazarotenic acid has been shown to have relatively selective affinity for specific nuclear retinoic acid receptor (RAR) proteins (e.g., RARbeta, RARgamma) that appear to enhance gene transcription. RARgamma is the predominant RAR species expressed in human epidermis and therefore may be the primary molecular target of retinoid action in adult human skin. Tazarotenic acid does not bind to retinoid X receptors (RXRs), which work in conjunction with RARs but appear to affect a variety of hormonal pathways and therefore may be involved in producing adverse effects of retinoid therapy.
The exact mechanism(s) of action of tazarotene in the treatment of psoriasis has not been determined. Once hydrolyzed to tazarotenic acid, the drug appears to affect expression of genes that modulate cell (e.g., epidermal) differentiation, proliferation, and inflammation, leading to normalization of keratinocyte differentiation and a reduction in cellular hyperproliferation and inflammation. Although the exact mechanism(s) of action of tazarotene in the treatment of acne is not fully understood, apparent modulation of follicular keratinization, cell proliferation, and inflammation by tazarotenic acid results in inhibition of corneocyte accumulation and cohesion and a reduction in inflammatory and noninflammatory acne lesions.
The exact mechanism(s) of action of tazarotene in the palliative management of dermatologic changes (e.g., fine wrinkling, mottled hypopigmentation or hyperpigmentation, and benign lentigines) associated with photodamage has not been established. However, data from a histologic study in patients with fine wrinkling and mottled hyperpigmentation indicate that therapy with tazarotene 0.1% cream for 24 weeks may be associated with an increase in the number of granular cell layers and an increased incidence of epidermal edema; the clinical relevance of these changes is unknown.
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information.
The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Generic name: tazarotene/niacinamide
Drug class: Acne Products
Therapeutic class: Dermatological
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
No indications are available for this drug.
Dosing
Application of tazarotene cream or gel may cause a transient feeling of pruritus, burning, or stinging. (See Cautions: Precautions and Contraindications.) If irritation is excessive, tazarotene should be discontinued temporarily until the integrity of the skin is restored, or dosing of the drug should be reduced to a lower concentration (in patients with psoriasis) or to an interval the patient can tolerate; tazarotene therapy may be resumed, or the drug concentration or frequency of application increased, as therapy with the drug becomes more tolerable. Frequency of dosing, therapeutic response, and skin tolerance should be monitored carefully during tazarotene therapy. The efficacy of reduced dosing frequencies (i.e., less than once daily) has not been established.
Safe use of tazarotene gel over more than 20% of body surface area has not been established.
Tazarotene is applied topically to the skin as a 0.05 or 0.1% cream or gel. Patients should be instructed carefully regarding proper use of the drug. (See Cautions: Precautions and Contraindications.)
Occlusive dressings or wrappings should not be used with tazarotene cream or gel, and hands should be washed after applying the drug (unless the hands are being treated for psoriasis). Patients should be advised not to use tazarotene cream or gel in amounts larger than instructed or more often than instructed, since such use of the drug will not lead to more rapid or better results but may result in marked redness, peeling, or discomfort.
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Drug interactions
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There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
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- Pregnancy
- Sunburn
- Skin photosensitivity
- No disease contraindications
Adverse reactions
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More Frequent
- Severe erythema
- Severe pruritus
- Skin fissure
Rare or Very Rare
- Blistering skin
- Dyschromia
- Skin photosensitivity
More Frequent
- Abnormal desquamation
- Dry skin
- Erythema
- Localized edema
- Pruritus of skin
- Skin irritation
- Stinging of skin
Less Frequent
- Cheilitis
- Contact dermatitis
Rare or Very Rare
- Exfoliative dermatitis
- Pain
- Skin rash
Precautions
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Retinoids (e.g., isotretinoin) have been reported to cause serious fetal harm when administered orally to pregnant women. (See Cautions: Pregnancy, Fertility, and Lactation, in Isotretinoin 84:28.) Single instances of known retinoid malformations (e.g., spina bifida, hydrocephaly, heart anomalies) have been reported in some species of animals (e.g., rabbits) followingtopical administration of tazarotene during gestation. Abnormal early embryonic development (e.g., decreased litter size, decreased number of live fetuses, decreased fetal body weights) was observed in animals receiving oral tazarotene in dosages 3.4 times the systemic exposure (AUC0-24 h) in human psoriasis patients treated topically with tazarotene 0.1% cream over 35% of body surface area, 11 times the systemic exposure in human acne patients treated topically with tazarotene 0.1% cream over 15% of body surface area, or 6.7 times the systemic exposure in human photoaging patients treated topically with tazarotene 0.1% cream over 15% of body surface area. Developmental delays, teratogenic effects, and postimplantation fetal loss also have been reported in animals receiving oral tazarotene in dosages 1.1-26 or 0.7-13 times the systemic exposure in human psoriasis patients treated topically with tazarotene 0.1% cream (over 35% of body surface area) or gel (over 20% of body surface area), respectively, 3.5-85 times the systemic exposure in human acne patients treated topically with tazarotene 0.1% cream (over 15% of body surface area), or 2.1-52 times the systemic exposure in human photoaging patients treated topically with tazarotene 0.1% cream (over 15% of body surface area).
Systemic exposure to tazarotene depends on the extent of body surface area treated. In patients treated topically over sufficient body surface area (over 35 or 20% of body surface area when used as a cream or gel, respectively, in psoriasis patients), systemic exposure to tazarotene could be of the same magnitude as in these orally treated animals. Although systemic exposure anticipated in the treatment of the face alone may be less as a result of the more limited area of application of the drug, it is not known what level of exposure produces teratogenic effects in humans.
There are no adequate and controlled studies to date using tazarotene topical cream or gel in pregnant women. The manufacturer states that the 8 women in clinical trials who were inadvertently exposed to tazarotene during pregnancy subsequently delivered healthy infants. The importance of these findings is unknown because the exact timing and extent of exposure to the drug in relation to gestation are uncertain. However, tazarotene is contraindicated in women who are or may become pregnant or who intend to become pregnant during treatment. Women of childbearing potential should be warned of the potential risk and should use adequate birth-control measures during treatment with tazarotene. If the drug is inadvertently administered during pregnancy or if the patient becomes pregnant while receiving the drug, the drug should be discontinued and the patient informed of the potential risks to the fetus. A negative result on a reliable blood pregnancy test (i.e., having a sensitivity of at least 50 mIU/mL for human chorionic gonadotropin (hCG)) should be obtained within 2 weeks prior to beginning tazarotene therapy and therapy should begin during the next normal menstrual period.
It is not known if topically applied tazarotene is distributed into human milk, but the drug appears to distribute into milk following topical application in lactating animals. The manufacturer states that caution should be exercised when tazarotene is administered to a nursing woman.
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ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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