Names and pronunciation
(tret′i-noyn) Altreno, Atralin, Avita, Refissa, Renova, Renova Pump, Retin-A, Retin-A Micro, Retin-A Micro , Vesanoid , Pump, StieVA-A Vitamin A Acid
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Drug reference
(tret′i-noyn) Altreno, Atralin, Avita, Refissa, Renova, Renova Pump, Retin-A, Retin-A Micro, Retin-A Micro , Vesanoid , Pump, StieVA-A Vitamin A Acid
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Func. class.: Vit A acid, acne product; antineoplastic (miscellaneous)
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Chem. class.: Tretinoin derivative
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ACTION: (Topical) Decreases cohe siveness of follicular epithelium, decreases microcomedone formation; (PO) induces maturation of acute promyelocytic leukemia, exact action is unknown
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USES: (Topical) Acne vulgaris (grades 1-3); (PO) facial wrinkles, photoaging
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CONTRAINDICATIONS: Hyper- sensitivity to retinoids or sensitivity to parabens
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Black Box Warning: Pregnancy (PO) Precautions: Pregnancy (topical), breastfeeding, eczema, sunburn, sun exposure Black Box Warning: Rapid-evolving leu- kocytosis, respiratory compromise, acute promyelocytic leukemia differentiation syndrome, requires a specialized care setting, experienced clinician Black Box Warning: To notify prescriber if pregnancy is planned or suspected See Appendix B See Appendix B
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SIDE EFFECTS PO route CNS: Headache, fever, sweating, fatigue CV: Cardiac dysrhythmias, pericardial effusion GI: Nausea, vomiting, hemorrhage, abdominal pain, diarrhea, constipa- tion, dyspepsia, distention, hepatitis Topical route INTEG: Rash, stinging, warmth, redness, erythema, blistering, crusting, peeling, contact dermatitis, hypo/hyperpigmenta- tion, dry skin, pruritus, scaly skin, reti- noic acid syndrome (RAS) META: Hypercholesterolemia, hypertri- glyceridemia RESP: Pneumonia, upper respiratory tract disease
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INTERACTIONS • Use with caution: medicated, abrasive soaps; cleansers that have a drying effect; products with high concentration of alco- hol astringents (topical) Increase: peeling—medication con- taining agents such as sulfur, benzoyl peroxide, resorcinol, salicylic acid (topical) Increase: plasma concentrations of tretinoin—ketoconazole (PO) Increase: ICP, risk of pseudotumor cere bri—tetracyclines; do not use together (PO) Increase: photosensitivity—retinoids, qui- nolones, phenothiazines, sulfonamides, sulfonylureas, thiazide diuretics Increase: thrombotic complications— aminocaproic acid, aprotinin, tranexamic acid Drug/Lab Test Increase: AST, ALT
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DOSAGE AND ROUTES • Adult/child: TOP cleanse area, apply 0.025%-0.1% cream or 0.05% liquid gel at bedtime, cover lightly
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Available forms: Cream 0.01%, 0.02%, 0.025%, 0.05%, 0.1%; gel 0.01%, 0.025%, 0.04%, 0.05%, 0.1%; liquid 0.05%; caps 10 mg
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Administer: Topical route • Once daily before bedtime; cover area lightly using gauze; use gloves to apply • Store at room temperature • Handwashing after application
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Assess: Topical route • Area of body involved, what helps or aggravates condition; cysts, dryness, itch- ing; lesions may worsen at beginning of treatment PO route • Hepatic function, coagulation, hema- tologic parameters; also cholesterol, tri- glycerides • Pregnancy/breastfeeding: do not use PO in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: decrease in size, number of lesions
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: Topical route • To avoid application on normal skin; to avoid getting cream in eyes, nose, other mucous membranes; not to use product on areas with cuts, scrapes • To use cream/gel by applying a thin layer to affected skin; to rub gently; to use liquid by applying with fingertip or cotton swab • To avoid sunlight, sunlamps; to use protective clothing, sunscreen • That treatment may cause warmth, stinging; that dryness, peeling will occur • That cosmetics may be used over product; not to use shaving lotions • That rash may occur during first 1-3 wk of therapy • That product does not cure condition, only relieves symptoms • That therapeutic results may be seen in 2-3 wk but may not be optimal until after 6 wk PO route
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PHARMACOKINETICS PO: Terminal half-life 0.5-2 hr TOPICAL: Poor systemic absorption
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• Adult/child: TOP cleanse area, apply 0.025%-0.1% cream or 0.05% liquid gel at bedtime, cover lightly
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