How does one manage the side effects of bexarotene?

Hypothyroidism caused by bexarotene (Targretin) results in a low thyroid-stimulating hormone level because the drug stops RNA transcription. Central hypothyroidism is managed with levothyroxine replacement. It is recommended that one start and stop levothyroxine and bexarotene together. Measure free T4 at baseline, at 2 weeks, then monthly. Normalizing free T4 helps clear plasma lipids.

Hyperlipidemia caused by bexarotene (Targretin) can be managed with lipid-lowering agents. The preferred lipidlowering agents include atorvastatin (Lipitor), an HMG CoA reductase inhibitor (statin), and fenofibrate (Tricor), which acts by increasing lipolysis through activation of lipoprotein lipase. Other statins include simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), lovastatin (Mevacor), and rosuvastatin (Crestor). It is recommended that one start the preferred statin 1 week before starting bexarotene.