Posted on April 28th, 2009 by
Generic Name: tretinoin (TRE-ti-noyn), all-trans retinoic acid, ATRA
Trade Name: Vesanoid®
How is this drug used? Tretinoin is indicated for the induction of remission of promyelocytic leukemia that is characterized by a certain gene and has not responded to other standard treatments. Tretinoin is for the induction of remission only.
What is the mechanism of action? Tretinoin belongs to a class of agents referred to as retinoids. Retinoids are related to vitamin A and play a part in controlling growth, maturation, and death of a cell. Tretinoin binds to specific retinoid receptors in a cancer cell and affects cellular growth and maturation.
How is tretinoin given (administered)? Tretinoin is given in capsule form orally and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. It may also be in lotion form that is placed on the skin for treatment of acne or certain rashes.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with tretinoin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. In addition, blood levels of fat and cholesterol will also be evaluated prior to and during treatment for all patients treated with tretinoin.
Patients treated with tretinoin will be monitored closely for a serious side effect that may occur referred to as APL differentiation syndrome. The syndrome causes high fever, difficulty breathing, lung and heart problems, organ dysfunction and sudden weight gain. APL differentiation syndrome often occurs within the first month of treatment, and may occur following the first dose. It can be treated with high-dose steroids and treatment with tretinoin often continues. It is extremely important that patients contact their healthcare provider immediately if they experience fever, difficulty breathing, chest pain, a noticeable change in heart rate or rhythm, dizziness or sudden weight gain.
Women treated with tretinoin will also be tested for pregnancy prior to treatment and regularly during treatment as this drug is known to cause birth defects.
What are the common (occur in 30% or more of patients) side effects of treatment with tretinoin?
What are the less common (occur in 10% to 29% of patients) side effects of treatment with tretinoin?
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
Are there any special precautions patients should be aware of before starting treatment?
When should patients notify their physician?
What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Last updated on 09/16.
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