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Tretinoin Coupon - Tretinoin 10mg capsule

tretinoin

Generic Vesanoid
Used for Leukemia, Acne
Used for Leukemia, Acne

Tretinoin oral capsules, also known as all-trans retinoic acid (ATRA), is used to treat a rare, but aggressive type of blood cancer, called acute promyelocytic leukemia (APL). It's generally used to start the process of remission (induction of remission) and work towards the goal of being cancer-free. Tretinoin (ATRA) is taken by mouth twice daily. Some of the more common side effects of tretinoin (ATRA) include severe headaches, dizziness, and a risk of blood clots. Brand name Vesanoid is no longer available and tretinoin (ATRA) is now only generic.

Reviewed by:
reviewer
Connie Zheng, PharmD
reviewer
Sonja Jacobsen, PharmD, BCPS, BCOP
Last reviewed on August 2, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesLatest newsImagesReferencesPricesMedicare
basics-icon

What is Tretinoin (ATRA)?

What is Tretinoin (ATRA) used for?

  • Acute promyelocytic leukemia (APL) with specific gene changes

How Tretinoin (ATRA) works

In APL, there are too many immature blood cells in your body. This leads to lower amounts of healthy blood cells and platelets in your body, which can cause weakness and a risk of developing infections.

Tretinoin (ATRA) is a retinoid, which is a chemical formed from vitamin A. While the exact way it works to treat APL isn’t known, it's thought that tretinoin (ATRA) helps immature blood cells grow and mature normally. This then leads to higher levels of healthy red blood cells, white blood cells, and platelets in your body.

Are you looking for information on tretinoin (Retin-A) cream for acne or isotretinoin (Absorica) for acne instead?

Drug Facts

Common BrandsVesanoid (brand no longer available)
Drug ClassRetinoid
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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What are the side effects of Tretinoin (ATRA)?

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

  • Headache (86%)
  • Fever (83%)
  • Dry skin (77%)
  • Bone pain (77%)
  • Feeling unwell or very tired (66%)
  • Shivering (63%)
  • Infections (up to 63%)
  • Bleeding (60%)
  • Trouble breathing (60%)
  • Nausea or vomiting (57%)
  • Rash (54%)
  • Swelling in the hands, legs, or feet (52%)

Other Side Effects

  • Dizziness
  • Pain
  • Chest discomfort
  • General swelling
  • Mouth sores
  • Flushing
  • Stomach pain
  • Diarrhea
  • Itching
  • Hair loss
  • Ear pain
  • Blood clots

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Differentiation syndrome: fever, trouble breathing, fast breathing, weight gain, swelling, low blood pressure
  • High white blood cell count: fever, weight loss, easy bleeding or bruising, weakness or tiredness, night sweats, difficulty breathing
  • Blood clot in veins or arteries: leg pain or cramps, leg swelling or redness, trouble breathing, chest pain, cough, weakness or numbness on one side of the body
  • Stroke: weakness or numbness of arms, legs, or face on one side of the body, slurred speech, blurred vision, severe headache, loss of balance, trouble walking, confusion
  • Heart attack: chest pain or discomfort, chest tightness, trouble breathing, nausea, vomiting, dizziness, sweating, fast heartbeat
  • High pressure in the brain: severe headache, dizziness, vision changes, vision loss
  • Serious bleeding: black or tarry stool, bloody vomit, vomit that looks like coffee grounds, stomach cramps, dizziness, tiredness or weakness, paleness, shortness of breath, severe headache

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 immediately if any of the following side effects occur:

More common

Burning, stinging, peeling, redness, or unusual dryness of the skin (severe)

Less common

Dryness, pain, redness, irritation, or peeling at the application site

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:

More common

Burning, itching, stinging, scaling, or redness of the skin

chapping or slight peeling of the skin (mild)

darkening of the skin

lightening of normal skin color

lightening of treated areas of dark skin

redness of skin (mild)

unusual dryness of skin (mild)

unusually warm skin (mild)

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 Tretinoin (ATRA)

thumbs-up

Pros

Non-chemotherapy treatment option for APL

A first-choice option for initial treatment of APL

Taken by mouth

Available as a generic

thumbs-down

Cons

Taken twice daily

Has a risk of blood clots, breathing problems, and severe headaches

Must use two forms of birth control during treatment, because of the risk of birth defects, miscarriage, and serious harm to unborn babies

Can cause dry skin, headaches, and bone pain as side effects

pharmacist-tips

Pharmacist tips for Tretinoin (ATRA)

pharmacist

  • Take tretinoin (ATRA) by mouth with water. Don’t chew, dissolve, or open the capsules. This medication needs to be taken whole.

    • If you miss a dose of tretinoin (ATRA) by more than 10 hours, then just skip the missed dose and take your medication at the next scheduled time.

      • If you vomit after taking tretinoin (ATRA), don’t take any additional capsules to make up for it. Just continue taking this medication at the next schedule time.

        • Tretinoin (ATRA) can cause severe headaches and dizziness. Be careful while driving or using machinery until you know how the medication affects you and your body.

          • Tretinoin (ATRA) can raise your chances of having a miscarriage or cause birth defects in your unborn baby, so it's important to avoid becoming pregnant while taking the medication. If you’re able to become pregnant, you should use 2 forms of birth control while you’re receiving treatment. Your provider will also regularly perform blood or urine pregnancy tests to make sure it's safe for you to keep taking tretinoin (ATRA).

            • Don't take tretinoin (ATRA) in combination with other forms of vitamin A. Retinoids, like tretinoin (ATRA), comes from vitamin A, and too much vitamin A can lead to serious side effects, like nausea, headache, or dizziness, let your healthcare provider know so you can be treated appropriately.

              • If you want to start a topical retinoid product for acne, talk to your provider first. Because both tretinoin (ATRA) and topical retinoid products come from vitamin A, taking both together can worsen your risk for side effects like dry skin, bone pain, and headache.

                • Store tretinoin (ATRA) at room temperature and away from excessive heat or sunlight, as this can cause damage to the capsules. Keep the medication out of reach from children to prevent accidental ingestion.

                  • If you or anyone around you accidentally overdoses on tretinoin (ATRA), get emergency medical help or call your local poison control center at 1-800-222-1222 right away. Signs of an overdose include, headache, nausea, vomiting, facial flushing, swelling of the mouth or lips, stomach pain, dizziness, and loss of coordination or balance.

                    faqs

                    Frequently asked questions about Tretinoin (ATRA)

                    Is tretinoin (ATRA) a retinol?
                    Yes, tretinoin (ATRA) is a retinol because it's a form of vitamin A. Unlike topical tretinoin, which is prescribed to treat acne, tretinoin (ATRA) treats a specific type of blood cancer called promyelocytic leukemia (APL). As with all retinols, tretinoin (ATRA) can cause side effects related to too much vitamin A, including dry skin, headaches, and bone pain.
                    How long does it take for tretinoin (ATRA) to work?
                    If tretinoin (ATRA) works for you, you’ll typically see results within the first 3 months of treatment. For people with APL, tretinoin (ATRA) is only prescribed at the beginning of treatment to start remission. Your provider will ask you to take tretinoin (ATRA) until you’ve reached complete remission (all signs of cancer cells gone) and for a month after that. Or, if tretinoin (ATRA) doesn’t seem to work well for you, your provider will ask you to stop treatment after 3 months. About 80% of people who receive treatment with tretinoin (ATRA) will experience short-term remission, after which their provider will prescribe other medications to keep the cancer from coming back. Ask your healthcare provider if you need long-term treatment and what options are available for you.
                    What does complete remission with tretinoin (ATRA) mean?
                    Complete remission means all signs and symptoms of your cancer are gone. For tretinoin (ATRA), this means all signs and symptoms of APL are gone. Tretinoin (ATRA) is used to start the process of remission and work towards the goal of complete remission. Your provider will regularly monitor your progress towards complete remission.
                    Is it safe to use tretinoin (ATRA) during pregnancy?
                    No. Tretinoin (ATRA) can cause miscarriages and birth defects if taken by mothers during pregnancy. If you’re able to become pregnant, your provider will ask you to take a pregnancy test before you start treatment. And once you begin tretinoin (ATRA), you need to use 2 different forms of effective birth control until a month after treatment ends. If you’re male and have a partner who can become pregnant, you also need to use birth control (e.g., condoms) during tretinoin (ATRA) treatment and for a month after you stop this medication. Let your provider know right away if you become pregnant during treatment with tretinoin (ATRA).
                    Is it safe to use tretinoin (ATRA) while breastfeeding?
                    There aren't any safety studies looking at tretinoin (ATRA) while breastfeeding, so it's unknown if the medication passes into breast milk. But if it does, there’s a chance that your baby can experience serious side effects. For your baby's safety, avoid breastfeeding while taking tretinoin (ATRA) and for a week after your last dose.
                    What's differentiation syndrome and why might tretinoin (ATRA) cause it?
                    Differentiation syndrome is one of the most serious side effects of tretinoin (ATRA). Up to 27% of people who take tretinoin (ATRA) can experience differentiation syndrome within weeks of starting treatment. Researchers aren’t sure why it happens, but a possible reason is that taking tretinoin (ATRA) activates a series of reactions in the body, leading to inflammation in different parts of the body. If not treated in time, differentiation syndrome can lead to swelling in the body and multi-organ failure. Your provider might order blood draws regularly to monitor for differentiation syndrome because having high white blood cell count can be a sign that you might experience this side effect. Let your provider know if you experience symptoms of differentiation syndrome, such as fever, breathing problems, weight gain, and swelling. If so, you’ll need to get treated right away with steroid injections until your condition is stable.
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                    What are the risks and warnings for Tretinoin (ATRA)?

                    Tretinoin (ATRA) 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

                    • Risk factors: First month of taking tretinoin (ATRA)

                      Tretinoin (ATRA) can cause a serious side effect called differentiation syndrome. This side effect can happen during the first month of treatment, sometimes as early as after the first dose. It's important to treat this side effect as soon as possible, since it can be life-threatening and lead to liver, kidney, and multiple organ failure. If you have differentiation syndrome, you’ll likely need to go to the hospital for treatment with intravenous steroid and for monitoring. Your provider will likely pause your treatment of tretinoin (ATRA) until you’ve recovered. Call for emergency medical help right away if you experience symptoms such as unexplained fever, trouble breathing, weight gain, swelling, and low blood pressure.

                      risk-warning

                      Serious harm to unborn baby if taken during pregnancy

                      • Risk factors: Taking tretinoin (ATRA) during pregnancy | Becoming pregnant while taking tretinoin (ATRA) | Birth control not working well

                        Don’t take tretinoin (ATRA) if you’re pregnant or thinking of becoming pregnant. Taking tretinoin (ATRA) during pregnancy can lead to birth defects and miscarriage. If you’re able to become pregnant, your provider will ask you to do a pregnancy test before you start treatment. In addition, you need to use 2 forms of effective birth control during tretinoin (ATRA) treatment and for 1 month after your last dose. If you’re male and have a partner who’s able to become pregnant, you need to use birth control (e.g., condoms) during tretinoin (ATRA) treatment and for 1 week after your last dose.

                        risk-warning

                        Blood clots

                        • Risk factors: First month of taking tretinoin (ATRA) | Taking medications that can raise the risk of blood clots

                          Taking tretinoin (ATRA) can put you at risk for serious, life-threatening risk of blood clots in the veins or arteries. This can happen within the first month of starting tretinoin (ATRA). Before starting treatment, tell your provider if you take any medications that can raise your chances of developing blood clots, such as tranexamic acid (Cyklokapron or Lysteda), aminocaproic acid (Amicar), or aprotinin. During treatment with tretinoin (ATRA), look out for symptoms of blood clots, such as leg pain or cramping, leg swelling or redness, trouble breathing, chest pain, cough, and weakness or numbness on one side of the body. If you experience any of these symptoms, get medical help as soon as possible.

                          risk-warning

                          High white blood cell count

                          People who take tretinoin (ATRA) sometimes experience high white blood cell (WBC) count. You might not experience any physical symptoms when this happens. But high WBC counts can be a sign of a more serious health condition and can lead to dangerous complications. Your provider will likely order blood tests regularly to check your blood cell counts.

                          risk-warning

                          High pressure in the brain

                          • Risk factors: Children | Taking tetracyclines or other medications that raise pressure in the brain

                            Retinoids, such as tretinoin (ATRA), have been linked to the development of high pressure in the brain (pseudotumor cerebri). The chances are higher in children using this medication. There's also a higher risk if you take other medications that can raise pressure in your brain, such as tetracycline antibiotics. Let your healthcare provider know if you have symptoms of high pressure in the brain, such as a severe headache, dizziness, and vision changes or vision loss. They’ll examine you and depending on your symptoms, might lower your dose of tretinoin (ATRA), stop your treatment temporarily, or change you to a different medication.

                            risk-warning

                            High cholesterol or fat in your body

                            • Risk factors: History of high cholesterol or high triglycerides

                              Tretinoin (ATRA) can lead to high cholesterol and high triglycerides (type of fat) levels in your body. Though more research is needed to learn about the complications that can result from this side effect, some people have reported blood clots and heart attacks. Because of this risk, your provider will check your cholesterol levels regularly while you’re receiving treatment. If you're worried about your cholesterol or triglyceride levels, discuss how to manage these conditions with your healthcare provider. Usually, your cholesterol levels will go back to what it was before tretinoin (ATRA) after you stop treatment. If you have signs of a heart attack, such as chest pain or discomfort, chest tightness, or trouble breathing, call for emergency medical help right away.

                              risk-warning

                              Liver problems

                              Tretinoin (ATRA) can raise your liver enzyme levels, which suggest liver irritation. Most of the time, the liver enzyme levels return to normal on its own or after the end of tretinoin (ATRA) treatment. To prevent serious problems, your provider will check your liver health regularly through blood draws. If your lab values are much higher than than the normal range, you might need to temporarily stop taking tretinoin (ATRA). Let your provider know if you experience symptoms of liver problems, such as nausea, vomiting, stomach pain, weakness, and yellowing of the whites of the eyes or the skin.

                              dosage

                              Tretinoin (ATRA) dosage forms

                              The average cost for 98 capsules of 10mg of Tretinoin (ATRA) is $809.60 with a free GoodRx coupon. This is 81.64% off the average retail price of $4409.27.
                              capsule
                              Capsule
                              DosageQuantityPrice as low asPrice per unit
                              10mg98 capsules$809.60$8.26

                              Typical dosing for Tretinoin (ATRA)

                              Your provider will calculate your dose based on your body surface area (BSA) in units of m2, takes into account your height and weight.

                              • People ages 1 years and older: The typical dose of tretinoin (ATRA) is 22.5 mg/m2 by mouth twice daily for 3 months, or for 1 month if you’ve reached complete remission, whichever comes first.

                              interactions

                              Interactions between Tretinoin (ATRA) and other drugs

                              Tretinoin (ATRA) 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 Tretinoin (ATRA). 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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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                              alternatives

                              What are alternatives to Tretinoin (ATRA)?

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

                              • Acute promyelocytic leukemia (APL) with specific gene changes

                              $809.60 Lowest GoodRx priceView Prices
                              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
                              latest news

                              What is the latest news about Tretinoin (ATRA)?

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                              Adapalene (Differin) and tretinoin (Retin-A) are retinoids that can reduce the appearance of wrinkles. Adapalene may be less irritating than tretinoin according to some studies.

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                              References

                              Best studies we found

                              American Cancer Society. (2018). Non-chemo drugs for acute promyeloctic leukemia (APL).

                              American Cancer Society. (2018). Treatment of acute promyeloctic leukemia (APL).

                              American Cancer Society. (2021). Can cancer be cured?

                              Gilbert, C. (2013). What is vitamin A and why do we need it? Community Eye Health Journal.

                              View All References (11)

                              Glenmark Pharmaceuticals Inc., USA. (2023). Tretinoin capsule [package insert]. DailyMed.

                              Leukemia and Lymphoma Society. (n.d.). Treatment of acute promyeloctic leukemia.

                              Mank, V., et al. (2023). Leukocytosis. StatPearls.

                              Montesinos, P., et al. (2009). Differentiation syndrome in patients with acute promyeloctic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: Characteristics, outcome, and prognosis factors. Blood.

                              National Cancer Institute. (2019). Understanding cancer prognosis.

                              National Center for Advancing Translational Sciences, Genetic and Rare Diseases Information Center. (2023). Acute promyelocytic leukemia.

                              National Comprehensive Cancer Network. (2023). Acute myeloid leukemia.

                              National Institutes of Health, Office of Dietary Supplements. (2022). Vitamin A and carotenoids.

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

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

                              Yoham, A. L., et al. (2023). Tretinoin. StatPearls.

                              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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