isotretinoin and Vitamin-A-Deficiency

Topics: Adolescent; Adult; Aged; Child; Drug Administration Schedule; Etretinate; Female; Humans; Isotretinoin; Retinoids; Skin Diseases; Tretinoin; Vitamin A; Vitamin A Deficiency

The aim of this study was to estimate the concentration of cholecalciferol and 13-cis-retinoic acid (RA) in the plasma and pleural fluid of patients with tuberculosis (TB) against controls.. Plasma levels of cholecalciferol and 13-cis-RA were measured in 22 patients with TB and healthy controls and their pleural fluids levels were measured in 6 TB patients and diseased controls by established high-performance liquid chromatography-based procedure.. Cholecalciferol levels in plasma and pleural fluid of patients with TB and healthy controls were 67.45 (10.71) nmol/L and 21.40 (8.58) nmol/L compared with 117.43 (18.40) nmol/L (P < 0.001) and 94.73 (33.34) nmol/L (P = 0.0049), respectively. 13-cis-RA level in the plasma of patients with TB and healthy controls were 1.51 (0.72) nmol/L and 6.67 (0.81) nmol/L (P < 0.001), respectively. 13-cis-RA was not detectable in pleural fluid. The levels of both the agents were lower in patients with TB than in controls.. It was observed that in patients with TB there is a combined deficiency of cholecalciferol and 13-cis-RA compared with healthy volunteers. Because cholecalciferol and 13-cis-RA are in equilibrium with active ingredients of vitamins A and D, we feel that there is a combined deficiency of these vitamins in patients with TB. There is an evidence that concomitant vitamin A and D supplementation can kill intracellular Mycobacterium tuberculosis in vitro. Therefore, the observations made in this study can pave the path for a trial of combined supplementation of available formulations of vitamin A and D (cholecalciferol and 13-cis-RA) for novel anti-tubercular drug therapy. Because such an approach is host-based it has potential to treat even multidrug-resistant and extensively drug-resistant forms of TB.

Topics: Adolescent; Adult; Aged; Case-Control Studies; Cholecalciferol; Dietary Supplements; Drug Resistance, Multiple, Bacterial; Female; Humans; Isotretinoin; Male; Middle Aged; Mycobacterium tuberculosis; Tuberculosis; Vitamin A Deficiency; Vitamin D Deficiency; Young Adult

Topics: Depression; Dermatologic Agents; Humans; Isotretinoin; Peripheral Nervous System Diseases; Vitamin A Deficiency

Topics: Administration, Oral; Adolescent; Adult; Depression; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Vitamin A Deficiency

Topics: Adolescent; Animals; Child; Dietary Supplements; Drug Labeling; Humans; Isotretinoin; Meat; Mental Disorders; Mice; Night Blindness; Rats; Retinal Rod Photoreceptor Cells; Vegetables; Vitamin A; Vitamin A Deficiency

A 16-year-old male developed night blindness 2 weeks after starting isotretinoin at a dose of 20 mg per day for cystic acne. He also had cystic fibrosis, complicated by hepatic cirrhosis. Despite long-term oral vitamin A supplementation, serum vitamin A levels were found to be 0.3 mumol/L (normal range 0.9-2.5 mumol/L). Oral vitamin A replacement was instituted with resolution of his visual symptoms in 6 months. Isotretinoin therapy was successfully continued with no deterioration in liver function. Isotretinoin has been reported to cause deterioration in night vision. In vitro evidence suggests isotretinoin may interfere with the processing of endogenous vitamin A in the retina. This case highlights the need for careful monitoring of serum vitamin A status in patients with malabsorptive states on isotretinoin therapy.

Topics: Acne Vulgaris; Adolescent; Cystic Fibrosis; Dermatologic Agents; Humans; Isotretinoin; Liver Cirrhosis; Male; Night Blindness; Risk Factors; Vitamin A Deficiency

Topics: Animals; Female; Immunoenzyme Techniques; Isotretinoin; Kidney; Plasminogen Activator Inhibitor 1; Rats; Rats, Inbred BN; Time Factors; Tissue Plasminogen Activator; Tretinoin; Urokinase-Type Plasminogen Activator; Vitamin A; Vitamin A Deficiency

Vitamin A is essential for growth and development, reproduction and vision in humans. Chemical modification of vitamin A has yielded compounds showing therapeutic promise in skin and neoplastic diseases. The medicinal use of retinoids (vitamin A and its derivatives) is limited by the toxicity associated with this group of compounds. One retinoid, 13-cis-retinoic acid, has proved to be quite effective in the treatment of severe recalcitrant cystic acne under conditions in which toxicity is manageable.

Topics: Acne Vulgaris; Adolescent; Humans; Hypervitaminosis A; Isotretinoin; Male; Retinoids; Tretinoin; Vitamin A Deficiency

Topics: Chemical Phenomena; Chemistry; Humans; Isotretinoin; Neoplasms; Precancerous Conditions; Retinaldehyde; Skin Diseases; Tretinoin; Vitamin A; Vitamin A Deficiency

The metabolites of all-trans-[3H]retinoic acid appearing in the intestines of bile duct-cannulated rats were compared to those of similarly treated intact rats. 2.4% of administered radioactivity was found in the small intestines of bile duct-cannulated rats 2 H after dose, while a much larger proportion of the dose (7.2%) was found in the intestines of the intact rats. All-trans- and 3-cis-retinoic acids predominate in the intestinal mucosa of bile duct-cannulated rats shortly after dosing. Retinoyl glucuronide was the major metabolite occurring as a mixture of the all-trans and 13-cis forms. Highly polar metabolites of retinoic acid appear in mucosa at all times in both intact and bile duct-cannulated rats demonstrating rapid metabolism of retinoic acid in intestine. The finding of a similar proportion of the 13-cis isomers in retinoic acids and retinoyl glucuronides suggests that injected all-trans-retinoic acid is isomerized in vivo probably prior to conjugated with glucuronic acid.

Topics: Animals; Bile; Glucuronates; Intestinal Mucosa; Intestine, Small; Isotretinoin; Kinetics; Male; Rats; Tretinoin; Tritium; Vitamin A Deficiency