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Tretinoin (Vesanoid, ATRA)

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This page tells you about a retinoid drug called tretinoin and its possible side effects. There is information about


What tretinoin is

Tretinoin is one of a group of drugs called retinoids that are similar to vitamin A. It is not a chemotherapy drug, but you may have it along with chemotherapy to treat a type of acute myeloid leukaemia called promyelocytic leukaemia. Tretinoin is also called all trans retinoic acid (ATRA) and its brand name is Vesanoid.

Tretinoin treats promyelocytic leukaemia by encouraging the promyelocytic cells to develop normally. The growth of other normal cells can be affected by tretinoin.


How you have tretinoin

Tretinoin comes as 10mg orange yellow and reddish brown soft capsules. Your doctor will tell you what dose you need and when to take this drug. You usually take it twice a day. You must take the capsules with food or shortly after a meal, as this helps your body to absorb the drug. Do not chew the capsules. Swallow them whole with plenty of water. You usually take tretinoin until there is no sign of your leukaemia (remission) or for a maximum of 90 days.

It is very important that you take the capsules according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.


Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with tretinoin below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section. Or you can use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

The side effects may be different if you are having tretinoin with other drugs.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of these effects.

  • Headaches, dry or itchy skin, a rash, swelling (oedema), a high temperature, chills, a sore mouth, and sore eyes in the first days or weeks of treatment
  • Feeling and being sick – this is usually well controlled with anti sickness medicines
  • Tiredness and weakness (fatigue) during and after treatment
  • Changes in levels of fats in your blood – this drug raises the amount of cholesterol and triglycerides in your blood in about 6 out of 10 people (60%) and you will have regular blood tests to check this
  • Ear problems happen in about 1 in 4 people – you may have an earache, loss of hearing, or a feeling of fullness in your ear
  • Retinoic acid syndrome happens in about 1 in 4 people within a month of starting treatment causing difficulty breathing, heart problems, weight gain, a high temperature, fluid around the heart or lungs, and a raised white blood cell count – if you have any difficulty breathing or sudden weight gain, contact your doctor or nurse straight away
  • Risk of blood clots during the first month of treatment – let your doctor or nurse know if you have any chest pain, dizziness, or redness, swelling or pain in your legs
  • Dizziness may reduce your ability to drive or use machinery
  • Difficulty sleeping (insomnia)
  • Loss of appetite
  • Confusion, anxiety, or depression
  • Eyesight changes – your eyes may become more sensitive to light
  • A dry mouth
  • An irregular heartbeat
  • Aching bones or muscles
  • Lung changes causing breathlessness and wheezing – if you have this, contact your doctor or nurse straight away
  • Diarrhoea – drink plenty of fluids and let your doctor or nurse know
  • Constipation – drink plenty of fluids and let your doctor or nurse know
  • Inflammation of the pancreas – tell your doctor or nurse if you have a sudden, sharp abdominal pain
  • Bone pain

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.


Rare side effects

Fewer than 1 in 100 people have these.

  • Problems with the nervous system, including agitation, slow speech, fits (seizures), facial numbness, sleepiness or hallucinations (hearing or seeing things which are not there)
  • Difficulty passing urine
  • Liver inflammation – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • Heart damage, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

There is a very high risk that this drug will harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for a month afterwards. Talk to your doctor or nurse about effective contraception before starting treatment. If you are taking the progesterone only pill, your doctor will ask you to stop and they will prescribe a different type of contraceptive for you.


Do not breastfeed during this treatment because the drug may come through in the breast milk.

Peanut and soya allergy

Do not take tretinoin if you are allergic to peanuts or soya because tretinoin contains soya bean oil.

Sorbitol and tretinoin

Tretinoin contains a type of sugar called sorbitol. If you have an intolerance to some sugars, ask your doctor if tretinoin is safe for you to take.


Related information

On this website you can read about 

Acute myeloid leukaemia 

Promyelocytic leukaemia


More information about tretinoin

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 24 January 2014