tretinoin
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.
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.
Drug facts
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%)
Less Common Side Effects
- Dizziness
- Pain
- Chest discomfort
- General swelling
- Mouth sores
- Flushing
- Stomach pain
- Diarrhea
- Itching
- Hair loss
- Ear pain
- Blood clots
Tretinoin (ATRA) 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
The following Tretinoin (ATRA) 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.
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Pros and cons of Tretinoin (ATRA)
Pros
- Non-chemotherapy treatment option for APL
- A first-choice option for initial treatment of APL
- Taken by mouth
- Available as a generic
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 for Tretinoin (ATRA)
- 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.
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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.
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.
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.
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.
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.
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.
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.
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.
Tretinoin (ATRA) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mg | 30 capsules | $250.96 | $8.37 |
Typical dosage 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 between Tretinoin (ATRA) and other drugs
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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