Drug	Dosage	Monitoring	FDA pregnancy category	Comments	Estimated cost*
Topical therapies
Corticosteroids	Once or twice daily to affected areas	—	C	Use with caution in children; limit duration of potent steroid use	—
Tacrolimus (Protopic) and pimecrolimus (Elidel)	Twice daily to affected areas	—	C	Less effective for plaque psoriasis than facial or intertriginous psoriasis; approved for use in children older than two years; boxed warning about risk of malignancy with long-term use	$170 per 30-g tube
Tazarotene (Tazorac)	Once daily to affected areas	—	X	Perilesional adverse effects are common; approved for treatment of psoriasis in persons older than 18 years and for treatment of acne in persons older than 12 years	$225 per 30-g tube
Vitamin D analogs	Twice daily to affected areas	—	C	Appears safe for use in children; additional benefit if combined with topical corticosteroids; inactivated by ultraviolet A light	—
Systemic therapies
Acitretin (Soriatane)	10 to 50 mg orally per day	Renal function tests, LFTs, lipid panel, and CBC every one to two weeks until levels stabilize (typically four to eight weeks)	X	Often used at reduced doses with phototherapy	$770 to $1,900 per month, depending on dosage
Adalimumab (Humira)†	80 mg subcutaneously on day 1, 40 mg one week later, then 40 mg every other week	LFTs, CBC‡	B	Order baseline PPD tuberculin test; moderately painful injection site reactions may occur; live vaccines are contraindicated	$2,300 for two 40-mg/0.8-mL syringes
Cyclosporine (Sandimmune)†	2.5 to 5.0 mg per kg per day, in two divided oral doses	Blood pressure; CBC; LFTs; lipid panel; and magnesium, uric acid, blood urea nitrogen, creatinine, and potassium levels every two weeks for the first three months of therapy, then monthly if stable	C	May be used continuously for one year; optimal use is intermittent (12 weeks for flare-up suppression); no data for treatment of psoriasis in children	$200 to 400 per month, depending on dosage
Etanercept (Enbrel)†	50 mg subcutaneously twice per week for three months, then 50 mg once per week	LFTs, CBC‡	B	Order baseline PPD tuberculin test; pruritic injection site reactions may occur; live vaccines are contraindicated; evaluated in children older than four years, but not approved by the FDA	$2,300 for four 50-mg syringes
Infliximab (Remicade)†	5 mg per kg per dose infusion at weeks 0, 2, and 6, then every six to eight weeks	LFTs, CBC‡	B	Order baseline PPD tuberculin test; live vaccines are contraindicated; infusion reactions are common and may be minimized with azathioprine (Imuran) or methotrexate	$3,200 for four 100-mg vials
Methotrexate†	7.5 to 25 mg orally per week	LFTs, renal function tests, CBC, and platelet count every one to two months	X	Can be used long-term if patient has no signs of toxicity; supplement with folate	$8 to $30 per month, depending on dosage
Ustekinumab (Stelara)†	45 mg in patients < 100 kg (222 lb) and 90 mg in patients 100 kg or more, given subcutaneously at weeks 0 and 4, then every 12 weeks	—	B	Order baseline PPD tuberculin test; generally well tolerated	$6,300 for one 45-mg/0.5-mL syringe