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Arsenic Trioxide Coupon - Arsenic Trioxide 10ml of 10mg/10ml vial

arsenic trioxide

Generic Trisenox
Used for Leukemia
Used for Leukemia

Arsenic trioxide (Trisenox) is an anticancer medication used to treat a rare type of cancer of the blood cells called acute promyelocytic leukemia (APL). It’s given as a slow injection into the vein (intravenous, IV) at an infusion center or clinic once a day for several months of treatment. Arsenic trioxide (Trisenox) is sometimes given along with tretinoin (all-trans retinoic acid (ATRA)) to treat certain types of APL. The medication can cause side effects such as nausea, heart rhythm changes, and a serious condition called differentiation syndrome. Both the brand-name medication Trisenox and the generic are available.

Reviewed by:
reviewer
Allison Baxley, PharmD, BCOP
reviewer
Daisy Chau, PharmD
Last reviewed on July 15, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesImagesReferencesPricesMedicare
basics-icon

What is Arsenic trioxide (Trisenox)?

What is Arsenic trioxide (Trisenox) used for?

  • Refractory or relapsed acute promyelocytic leukemia (APL) in children and adults who have previously been treated with a retinoid and anthracycline chemotherapy

  • Newly diagnosed, low-risk acute promyelocytic leukemia (APL) in adults, given together with tretinoin (all-trans retinoic acid (ATRA))

How Arsenic trioxide (Trisenox) works

Acute promyelocytic leukemia (APL) is caused by a genetic change which signals young white blood cells to divide and grow before they’re fully mature. With too many immature blood cells in your body. This leads to lower amounts of healthy blood cells and platelets in your body.

Arsenic trioxide (Trisenox) damages the abnormal protein created by the genetic change that causes APL. This results in young white blood cells growing and maturing into healthy cells.

Arsenic trioxide (Trisenox) also helps by causing cancer cells to die faster.

Drug Facts

Common BrandsTrisenox
Drug ClassArsenical
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Arsenic trioxide (Trisenox)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea (75%)
  • Cough (65%)
  • Tiredness (63%)
  • Fever (63%)
  • Headache (60%)
  • Stomach pain (58%)
  • Vomiting (58%)
  • Faster heart rate (55%)
  • Diarrhea (53%)
  • Trouble breathing (53%)
  • Electrolyte changes in blood (up to 50%)
  • Higher white blood cells (50%)
  • Trouble sleeping (43%)
  • Rash (43%)
  • Swelling (40%)
  • Heart rhythm changes (40%)
  • Shivering (38%)
  • Sore throat (35%)
  • Itching (33%)
  • Joint aches (33%)
  • Numbness (33%)

Other Side Effects

  • Anxiety
  • Constipation
  • Nosebleeds
  • Muscle aches
  • Low blood pressure
  • Chest pain
  • Dizziness
  • Bone pain
  • Neck pain
  • Lower appetite
  • Depression
  • Vaginal bleeding
  • Blurred vision
  • Eye irritation
  • Dry eye
  • Earache
  • Ringing in the ears

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Differentiation syndrome: fever, fluid build-up and swelling in the lower legs, weight gain, trouble breathing, low blood pressure, kidney problems
  • Changes in heart rhythm: lightheadedness, irregular heartbeat, blurry vision, fainting, loss of consciousness, seizures
  • Brain damage: confusion, loss of consciousness, muscle coordination problems, seizures

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Chills

cough

decreased urine output

dry mouth

eye pain

general feeling of illness

headache

increased thirst

irregular heartbeat

loss of appetite

mood changes

muscle pain or cramps

nausea

numbness or tingling in hands, feet, or lips

seizures

sore throat

trouble breathing

unusual tiredness or weakness

vomiting

Less common

Black, tarry stools

bluish lips or skin

blurred vision

chest pain

dizziness or lightheadedness

fever

flushed, dry skin

fruit-like breath odor

increased hunger

increased urine output

irregular or pounding heartbeat or pulse

painful or difficult urination

sores, ulcers, or white spots on the lips or in the mouth

stomach ache or cramps

sweating

swollen glands

unexplained weight loss

unusual bleeding or bruising

unusual weight gain

Incidence not known

Agitation

anxiety

back pain

behavior changes similar to drunkenness

bleeding

blistering, peeling, or loosening of the skin

bloating

blood in the urine or stools

bluish fingernails, palms, or nailbeds

bruising

change in size, shape, or color of existing mole

cloudy urine

cold sweats

cool, pale skin

confusion

constipation

coughing that sometimes produces a pink frothy sputum

coughing or spitting up blood

dark urine

diarrhea

difficult, fast, noisy breathing

dilated neck veins

drowsiness

extreme tiredness or weakness

fainting

fast heartbeat

high fever

indigestion

irregular heartbeat, recurrent

irritability

joint pain

large hives, itching, or skin rash

loss of consciousness

mole that leaks fluid or bleeds new mole

painful blisters on the trunk of the body

pains in the stomach, side, or abdomen, possibly radiating to the back

pale skin

persistent bleeding or oozing from puncture sites, mouth, or nose

rapid, shallow breathing

red skin lesions, often with a purple center

red, irritated eyes

seeing, hearing, or feeling things that are not there

severe nausea

shakiness

stiff neck

sudden weight gain

tightness in the chest

swelling of the eyelids, lips, face, fingers, or lower legs

unsteadiness or awkwardness

vomiting of blood or material that looks like coffee grounds

yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Confusion

muscle weakness, severe

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Belching

bone pain

feeling of warmth

heartburn

heavy non-menstrual vaginal bleeding

injection site pain, redness, or swelling

limb pain

mental depression

neck pain

nosebleeds

redness of the face, neck, arms, and occasionally, upper chest

trouble sleeping or getting to sleep

Incidence not known

Deafness

difficulty moving

earache

eye dryness, redness, or pain

loss of bowel or bladder control

night sweats

ringing in the ears

small red or purple spots on the skin

swelling of the abdominal or stomach area

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Arsenic trioxide (Trisenox)

thumbs-up

Pros

Recommended first-choice treatment of APL in combination with tretinoin (ATRA)

Works in a more targeted way in people with APL

Typically doesn’t cause hair loss

thumbs-down

Cons

Requires daily infusions for several months, so less convenient

Requires regular electrocardiograms (EKGs) to monitor for heart rhythm changes

Might cause a serious side effect called differentiation syndrome

pharmacist-tips

Pharmacist tips for Arsenic trioxide (Trisenox)

pharmacist

  • Arsenic trioxide (Trisenox) is given slowly, typically over 2 hours. In some instances, it might even take up to 4 hours. So plan accordingly for this time. Make sure you dress comfortably, bring water and food, and have something to help you pass the time, such as a book or music.

    • Arsenic trioxide (Trisenox) might cause nausea, and your oncologist could recommend antiemetic medications to help prevent and treat it. But they might advise against certain ones like ondansetron (Zofran), which can cause QT prolongation. Because arsenic trioxide (Trisenox) can also cause QT prolongation, taking both medications could raise this risk. Talk to your oncologist about which medications are safe for you to take.

      • You might experience some diarrhea while taking arsenic trioxide (Trisenox). Your oncologist might suggest an over-the-counter medication like loperamide (Imodium A-D) to help manage diarrhea. Contact your oncologist right away if you have signs of dehydration such as dry skin and urinating less often, as dehydration can lower your blood electrolyte levels. And reduced electrolytes can raise your risk of heart problems with arsenic trioxide (Trisenox).

        • Taking arsenic trioxide (Trisenox) can sometimes irritate your liver, sometimes without noticeable symptoms. Regular blood tests, sometimes done multiple times a week, are important to check your liver health while on this medication. If you experience stomach pain or yellowing of the skin or whites of your eyes, contact your oncologist right away.

          • People taking arsenic trioxide (Trisenox) and who have low levels of a vitamin called thiamine might be at higher risk for a nervous system problem called Wernicke’s encephalopathy. Symptoms include confusion, fatigue, and muscle coordination problems. If you’re at risk for this side effect, your oncologist will likely check your thiamine levels.

            • If you’re a male, arsenic trioxide (Trisenox) might affect your ability to have children. Talk with your oncologist if you have questions about this potential risk.

              faqs

              Frequently asked questions about Arsenic trioxide (Trisenox)

              Is [EDITOR|DRUG_DISPLAY_NAME]] chemotherapy?
              No. Arsenic trioxide (Trisenox) isn’t considered traditional chemotherapy. Instead, it’s a targeted therapy. Chemotherapy works by killing cells that divide quickly in the body, which includes cancer cells. But chemotherapy ends up killing some healthy cells as well. Arsenic trioxide (Trisenox) works differently because it doesn’t kill all fast-growing cells. Instead, this medication works by damaging an abnormal protein caused by the genetic change from the condition.
              Is arsenic trioxide (Trisenox) poisonous?
              Arsenic trioxide (Trisenox) is found in nature and it can be toxic to humans when taken at certain doses. But it’s also been used in Chinese medicine for centuries. Research shows that arsenic trioxide (Trisenox) works well to treat APL, a rare type of leukemia. Clinical studies helped determine the best dose of arsenic trioxide (Trisenox) to treat APL while keeping people taking it as safe as possible. Just like with any medication, there are possible side effects your oncologist will look closely for, such as heart rhythm changes and differentiation syndrome.
              Why do I need my heart checked while taking arsenic trioxide (Trisenox)?
              Arsenic trioxide (Trisenox) can cause a dangerous change in heart rhythm known as QT prolongation. Some symptoms include lightheadedness, irregular heartbeat, blurry vision, and fainting. But because it doesn’t always cause symptoms, the best way to check for this side effect is through a test called an electrocardiogram (ECG or EKG). You’ll need an EKG before you start taking arsenic trioxide (Trisenox) and once a week during treatment. If you develop heart rhythm changes, you might need to pause arsenic trioxide (Trisenox) while your oncologist looks into it.
              What medications should I avoid taking while taking arsenic trioxide (Trisenox)?
              Because arsenic trioxide (Trisenox) can cause heart rhythm problems, your risk could be higher if you take other medications that also cause this problem. Other medications that can cause QT prolongation include antibiotics such as levofloxacin (Levaquin), heart medications like amiodarone (Pacerone), and antiemetics such as ondansetron (Zofran). The risk is also higher if you take medications that lower the levels of potassium and magnesium in your body, such as loop diuretics. But if the benefits outweigh the risks, your prescriber might have you take these medications with arsenic trioxide (Trisenox). They will watch you closely or adjust your doses to keep you safe. Before you start arsenic trioxide (Trisenox), your oncologist or pharmacist will check all your medications to avoid any harmful interactions.
              Is arsenic trioxide (Trisenox) safe in pregnancy?
              There haven’t been studies of arsenic trioxide (Trisenox) in human pregnancy, but based on animal studies and the way the medication works, it could cause harm to an unborn baby. If you’re able to have children, use effective birth control while taking arsenic trioxide (Trisenox) and for 6 months after the last dose. If you’re male and have a partner who can become pregnant, use birth control throughout treatment and for 3 months after your last dose.
              Is arsenic trioxide (Trisenox) safe in breastfeeding?
              People taking arsenic trioxide (Trisenox) should avoid breastfeeding during treatment and for 2 weeks after the last dose. We don’t know whether the medication is found in breast milk and whether it affects breastfed babies. But there’s a possible risk of harm to a baby, it’s recommended that you don’t breastfeed
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              What are the risks and warnings for Arsenic trioxide (Trisenox)?

              Arsenic trioxide (Trisenox) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Differentiation syndrome

              Differentiation syndrome is a serious complication that can happen with APL treatments like arsenic trioxide (Trisenox). It’s an immune response that leads to small proteins called cytokines becoming active and causing problems in the body. Symptoms include fever, fluid build-up and swelling in the lower legs, sudden weight gain, and trouble breathing.

              It can happen as early as the first day of the induction phase or as late as the second month of the induction phase. Treatment usually includes corticosteroids such as dexamethasone, and you might also need medications to help keep your blood pressure in a normal range. If your symptoms are severe, you might need to stop treatment with arsenic trioxide (Trisenox). Once differentiation syndrome improves, you can typically restart the medication.

              risk-warning

              Serious heart problems

              • Risk factors: Heart failure | Heart rhythm problems | Taking Arsenic trioxide (Trisenox) with other medications that can change heart rhythm | Low magnesium or potassium levels in the blood

                Some people taking arsenic trioxide (Trisenox) have changes in their heart rhythm. QT prolongation is the most common and was seen in studies to happen between 1 and 5 weeks after starting the medication. Some symptoms include lightheadedness, irregular heartbeat, blurry vision, and fainting.

                Because it doesn’t always cause symptoms, the best way for your oncologist to monitor this side effect is through a test called an electrocardiogram (ECG or EKG). You’ll need an EKG before you start taking arsenic trioxide (Trisenox) and once a week during treatment. Low levels of potassium and magnesium in your blood can raise your risk of QT prolongation, so your oncologist will also monitor these closely with lab tests. If you develop long QT, you might need to pause arsenic trioxide (Trisenox) while your oncologist looks into it.

                risk-warning

                Brain damage

                • Risk factors: Low thiamine levels | Long-term alcohol use | Gut absorption problems | Nutritional deficiency | Taking arsenic trioxide (Trisenox) with furosemide (Lasix)

                  Some people taking Arsenic trioxide (Trisenox) have developed nervous system problems called encephalopathy. Symptoms include confusion, trouble staying awake, seizures, trouble speaking, and vision changes. It’s important for family members and caregivers to be aware of this possible side effect, because someone experiencing these symptoms might not be able to describe what’s wrong.

                  A specific type of encephalopathy called Wernicke’s encephalopathy has also occurred with arsenic trioxide (Trisenox) treatment, and this can be treated with a vitamin called thiamine. If you have low thiamine, which can happen if you have gut absorption problems or drink alcohol often, talk to your oncologist before you start taking this medication. Your oncologist can test your thiamine level with a lab test.

                  risk-warning

                  Serious liver problems

                  Sometimes, arsenic trioxide (Trisenox) treatment can cause liver problems. Most of the time, when your liver is irritated you won't feel any noticeable symptoms. But your oncologist can see signs of this through blood tests. Make sure you get regular blood tests while you're taking arsenic trioxide (Trisenox) so your oncologist can check your liver health and make sure it's still safe for you to take. If you have stomach pain, yellowish skin, or yellow around the whites of your eyes, call your oncologist right away. If your lab tests show liver irritation, you might need to pause arsenic trioxide (Trisenox) or take a lower dose.

                  risk-warning

                  New cancers

                  Arsenic trioxide (Trisenox) is a known carcinogen, which means it can cause cancer. Your oncologist will regularly check you for signs and symptoms of new cancers even after your treatment with arsenic trioxide (Trisenox) is complete.

                  risk-warning

                  Harm to unborn baby

                  There haven’t been studies of arsenic trioxide (Trisenox) in human pregnancy, but based on animal studies and the way the medication works, it could cause harm to an unborn baby. If you’re able to have children, you use effective birth control while taking arsenic trioxide (Trisenox) and for 6 months after the last dose. If you’re a male who is sexually active with a partner who can have children, use birth control such as condoms while taking arsenic trioxide (Trisenox) and for 3 months after the last dose. Contact your oncologist right away if you become pregnant while taking arsenic trioxide (Trisenox).

                  dosage

                  Arsenic trioxide (Trisenox) dosage forms

                  Typical dosing for Arsenic trioxide (Trisenox)

                  The recommended dose depends on the treatment phase (induction or consolidation).

                  • Refractory or relapsed APL

                    • Induction: The typical dose is 0.15 mg/kg of bodyweight, injected into a vein once a day until bone marrow remission or for up to 60 days.

                    • Consolidation: The typical dose is 0.15 mg/kg of bodyweight, injected into a vein once a day for 25 doses over 5 weeks

                  Consolidation begins 3-6 weeks after completing induction

                  • Newly diagnosed, low-risk APL

                    • Induction: The typical dose is 0.15 mg/kg of bodyweight, injected into a vein once a day with tretinoin (ATRA) until bone marrow remission or for up to 60 days.

                    • Consolidation: The typical dose is 0.15 mg/kg of bodyweight, injected into a vein once a day with tretinoin (ATRA) for 5 days during weeks 1-4. After that, there is a 4-week break with no medication.

                      • This dosing schedule is repeated for a total of 4 cycles.

                      • You won’t receive any tretinoin (ATRA) during weeks 5-6 of the last cycle.

                  interactions

                  Interactions between Arsenic trioxide (Trisenox) and other drugs

                  Arsenic trioxide (Trisenox) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Arsenic trioxide (Trisenox). Please note that only the generic name of each medication is listed below.

                  Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                  Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                  Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                  alternatives

                  What are alternatives to Arsenic trioxide (Trisenox)?

                  There are a number of medications that your doctor can prescribe in place of Arsenic trioxide (Trisenox). Compare a few possible alternatives below.
                  Arsenic trioxide (Trisenox)
                  Used for:

                  • Refractory or relapsed acute promyelocytic leukemia (APL) in children and adults who have previously been treated with a retinoid and anthracycline chemotherapy

                  • Newly diagnosed, low-risk acute promyelocytic leukemia (APL) in adults, given together with tretinoin (all-trans retinoic acid (ATRA))

                  View Prices
                  Tretinoin (ATRA)
                  Used for:

                  • Acute promyelocytic leukemia (APL) with specific gene changes

                  $35.00 Lowest GoodRx priceView Prices
                  images

                  Arsenic trioxide (Trisenox) images

                  colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  This medicine is Colorless Vial.colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  This medicine is Colorless Vial.colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  This medicine is Colorless Vial.colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  This medicine is Colorless Vial.colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection
                  This medicine is Colorless Vial.colorless - Arsenic Trioxide 10mg / 10mL Solution for Injection

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                  References

                  Best studies we found

                  Alimoghaddam, K. (2014). A review of arsenic trioxide and acute promyelocytic leukemia. International Journal of Hematology-Oncology and Stem Cell Research.

                  American Cancer Society. (2018). Acute myeloid leukemia (AML) subtypes and prognostic factors.

                  Farzam, K., et al. (2023). QT prolonging drugs. StatPearls.

                  View All References (16)

                  Lång, E., et al. (2012). The arsenic-based cure of acute promyelocytic leukemia promotes cytoplasmic sequestration of PML and PML/RARA through inhibition of PML body recycling. Blood.

                  Leukemia & Lymphoma Society. (n.d.). Treatment of acute promyelocytic leukemia.

                  National Cancer Institute. (n.d.). Differentiation syndrome.

                  National Cancer Institute. (n.d.). Encephalopathy.

                  National Cancer Institute. (n.d.). Refractory cancer.

                  National Cancer Institute. (n.d.). Relapse.

                  National Comprehensive Cancer Network. (2024). Acute myeloid leukemia.

                  National Institutes of Health. (2021). Thiamin: Fact sheet for consumers.

                  Reyhanoglu, G., et al. (2020). Differentiation syndrome, a side effect from the therapy of acute promyelocytic leukemia. Cureus.

                  Roboz, G. J., et al. (2014). Prevalence, management, and clinical consequences of QT interval prolongation during treatment with arsenic trioxide. Journal of Clinical Oncology.

                  Saeed, S., et al. (2011). Genome-wide functions of PML-RARα in acute promyelocytic leukaemia. British Journal of Cancer.

                  Sanz, M. A., et al. (2014). How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. Blood.

                  Vasan, S., et al. (2023). Wernicke encephalopathy. StatPearls.

                  Wang, H. Y., et al. (2022). An effective and chemotherapy-free strategy of all-trans retinoic acid and arsenic trioxide for acute promyelocytic leukemia in all risk groups (APL15 trial). Blood Cancer Journal.

                  Zhang, P. (2017). On arsenic trioxide in the clinical treatment of acute promyelocytic leukemia. Leukemia Research Reports.

                  Zydus Pharmaceuticals USA Inc. (2024). Arsenic trioxide injection, solution [package insert]. DailyMed.

                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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