tazarotene

General

Pronunciation:
taz-ar-oh-teen

Trade Name(s)

• Avage
• Fabior
• Tazorac

Ther. Class.
antiacne agents
antipsoriatics
cosmetic agents

Pharm. Class.
retinoids

Indications

•  0.1% foam, gel– Topical treatment of acne vulgaris in patients > 12 yr.
•  0.05% and 0.1% cream– Treatment of plaque psoriasis.
•  Avage 0.1% cream only– As an adjunctive agent to decrease facial fine wrinkling, facial mottled hyper- and hypopigmentation, and benign facial lentigines in patients who already use comprehensive skin care and sunlight avoidance programs.

Action

Has anti-hyperproliferative, and anti-inflammatory effects; also normalizes differentiation.

Therapeutic Effect(s):

• Decreased severity of acne vulgaris or plaque psoriasis.
• Improvement in appearance of fine lines (Avage).

Pharmacokinetics

Absorption: A prodrug that is rapidy converted to its active form, tazarotenic acid. Minimal systemic absorption.

Distribution: Unknown.

Protein Binding: >99%.

Metabolism and Excretion: Highly metabolized and excreted via urine and feces.

Half-life: 8.1 hr.

TIME/ACTION PROFILE (improvement in lesions)

Contraindication/Precautions

Contraindicated in:

• OB:  Pregnancy;
• Lactation: Breastfeeding should be avoided.

Use Cautiously in:

• Females of childbearing age (negative pregnancy test within 2 wk of initiating therapy and effective contraception during treatment required);
• History of local irritation/sensitivity;
• Personal/family history of skin cancer;
• History of eczema;
• Weather extremes;
• Concurrent use of photosensitizers
• Pedi:  Safe and effective use in children <12 yr has not been established.

Adverse Reactions/Side Effects

Local: burning/stinging, dry skin, itching, peeling, photosensitivity, red skin, skin pain (psoriasis), worsening of psoriasis

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Concurrent use of other irritant/drying topical medications  may risk of irritant/drying reactions.
• Concurrent use of  oxidizing agents  including  benzoyl peroxide  may decrease effectiveness by inactivating tazarotene.
• risk of photosensitivity reactions with other  photosensitizing drugs  including fluroquinolones, phenothiazines, sulfonamides, tetracyclines, and  thiazides .

Route/Dosage

Topical  (Adults and Children)  12 yr) Apply once daily (not recommended for use longer than 12 wk for acne).

Availability (generic available)

Topical cream (Avage): 0.1%

Topical cream (Tazorac): 0.05%, 0.1%

Topical foam (Fabior ): 0.1%

Topical gel (Tazorac): 0.05%, 0.1%

Assessment

• Assess skin lesions before and periodically during therapy.

Lab Test Considerations:

Obtain a negative serum or urine pregnancy test having a sensitivity down to at least 25 mIU/mL for human chorionic gonadotropin (hCG) within 2 wk prior to tazatotene therapy. Begin therapy during a normal menstrual period, for females of childbearing potential.

Potential Diagnoses

• Risk for impaired skin integrity (Indications) 

Implementation

• Topical   Acne:  Wash with a mild cleanser and fully dry affected area in the evening, then apply once daily. Shake can before use. Dispense a small amount of foam into palm of hand. Use fingertips to apply only enough foam to lightly cover the entire affected areas of the face and/or upper trunk with a thin layer. Massage foam gently into skin until the foam disappears. Avoid the eyes, lips, and mucous membranes. Wash hands after application. Store can upright; do not freeze.
  • May use moisturizer as needed.
  • If undue irritation (redness, peeling, or discomfort) occurs, reduce frequency of application or temporarily interrupt treatment. Treatment may be resumed once irritation subsides. Discontinue treatment if irritation persists.
• Topical   Psoriasis:  Apply a thin film of tazarotene cream once per day in the evening, to cover only lesions. If a bath or shower is taken prior to application, dry skin before applying cream. If emollients used, apply at least an hour before application of tazarotene cream. Unaffected skin may be more susceptible to irritation, avoid application to unaffected areas.
•  Facial wrinkles: Apply a pea-sized amount of cream to lightly cover entire face once daily at bedtime.

Patient/Family Teaching

• Instruct patient on correct technique for application.
• Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions. Avoid tanning beds and sun lamps. Wind and cold weather may also irritate skin.
• Inform patient foam is flammable. Avoid fire, flame, or smoking during and immediately following application.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise female patients to use an effective form of contraception during therapy and notify health care professional if pregnancy is planned or suspected or if breastfeeding. Tazarotene may be harmful to fetus.

Evaluation/Desired Outcomes

• Decreased severity of acne vulgaris or plaque psoriasis.
• Improvement in appearance of fine facial lines.