Drug reference
Induction of remission in acute promyelocytic leukaemia (used in previously untreated patients as well as in those who have relapsed after standard chemotherapy or who are refractory to it) ▶BY MOUTH ▶Adult: 45 mg/m2 daily in 2 divided doses maximum duration of treatment is 90 days, consult product literature for details of concomitant chemotherapy
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History of depression (risk of neuropsychiatric reactions). increased risk of thromboembolism during first month of treatment
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Tretinoin is the acid form of vitamin A.
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MHRA/CHM ADVICE: ORAL RETINOID MEDICINES: REVISED AND SIMPLIFIED PREGNANCY PREVENTION EDUCATIONAL MATERIALS FOR HEALTHCARE PROFESSIONALS AND WOMEN (JUNE 2019) Materials to support the Pregnancy Prevention Programme in women and girls of childbearing potential taking oral acitretin, alitretinoin, or isotretinoin have been updated. Oral tretinoin and bexarotene do not have a Pregnancy Prevention Programme in light of their oncology indication and specialist care setting. However, healthcare professionals are advised that these medicines are extremely teratogenic and product information should be consulted for contraceptive and pregnancy testing requirements when used in females of childbearing potential. Neuropsychiatric reactions have been reported in patients taking oral retinoids. Healthcare professionals are advised to monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment, if necessary; particular care is needed in those with a history of depression. Patients should be advised to speak to their doctor if they experience any changes in mood or behaviour, and encouraged to ask family and friends to look out for any change in mood.
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→Appendix 1: retinoids
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▶Common or very common Abdominal pain. alopecia. anxiety. appetite decreased. arrhythmia. asthma. bone pain. cheilitis. chest pain. chills. confusion. constipation . depression. diarrhoea. dizziness. dry mouth. flushing. headache. hearing impairment. hyperhidrosis. insomnia. intracranial pressure increased. malaise. nasal dryness. nausea. pancreatitis. paraesthesia. respiratory disorders. skin reactions. visual impairment. vomiting ▶Frequency not known Embolism and thrombosis. erythema nodosum. genital ulceration. hepatotoxicity. hypercalcaemia. increased leucocytes. myocardial infarction. myositis. necrotising fasciitis. QT interval prolongation. stroke. thrombocytosis. vasculitis SIDE-EFFECTS, FURTHER INFORMATION Retinoic acid syndrome Fever, dyspnoea, acute respiratory distress, pulmonary infiltrates, pleural effusion, hyperleucocytosis, hypotension, oedema, weight gain, hepatic, renal and multi-organ failure requires immediate treatment— consult product literature.
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Effective contraception must be used for at least 1 month before oral treatment, during treatment and for at least 1 month after stopping (oral progestogen-only contraceptives not considered effective).
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Teratogenic. See Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid (discontinue breast-feeding).
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Manufacturer advises caution. Dose adjustments Manufacturer advises dose reduction to 25 mg/m2.
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Dose adjustments Reduce dose to 25 mg/m2.
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Monitor haematological and coagulation profile, liver function, serum calcium and plasma lipids before and during treatment.
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There can be variation in the licensing of different medicines containing the same drug. Capsule CAUTIONARY AND ADVISORY LABELS 21, 25 ▶Tretinoin (Non-proprietary) Tretinoin 10 mg Tretinoin 10mg capsules | 100 capsule P £300.00–£315.00 DT = £300.00 3.1 Cytotoxic drug-induced side effects ANTIDOTES AND CHELATORS › IRON CHELATORS
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Risk of neuropsychiatric reactions The MHRA advises patients and carers to seek medical attention if changes in mood or behaviour occur.
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45 mg/m2 daily in 2 divided doses maximum
First-line fragment. Read the complete Indications and Dose section above.
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