Tretinoin (Vesanoid, ATRA)

Tretinoin is one of a group of drugs made from vitamin A, called retinoids. Doctors use tretinoin to treat a number of illnesses, including skin conditions such as acne. 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).

Tretinoin treats promyelocytic leukaemia by encouraging the promyelocytic cells to develop normally. The growth of other normal cells can be affected by 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 take it with food or shortly after a meal, as this helps your body to absorb the drug. You usually take it until there is no sign of your leukaemia (remission) or for a maximum of 90 days.

It is very important that you take tablets 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.

Tretinoin side effects are listed below. You can click on the links to find out more about the side effects. As you usually have tretinoin with a chemotherapy drug, you will also have side effects from the chemotherapy. There is information about general drug side effects in this section. Or you can look up the specific side effects if you know the name of the drug you are having.

All drugs cause side effects. Some are more serious than others, but you must report any side effects to your doctor. More than 10 in every 100 people have one or more of these.

• 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
• Fatigue (tiredness) during and after treatment
• Tretinoin may harm a developing baby so it is not advisable to become pregnant while you are taking this drug, or for a few months afterwards – talk about contraception with your doctor or nurse before having the 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%) but 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
• It is not advisable to breastfeed while having tretinoin treatment because the drug may come through in the breast milk
• Dizziness may reduce your ability to drive or use machinery
• Difficulty sleeping (insomnia)
• Loss of appetite
• Confusion, anxiety, or depression
• Eyesight changes
• A dry mouth
• Feeling and being sick – this is usually well controlled with anti sickness medicines
• An irregular heartbeat
• Aching bones or muscles

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

• Abdominal pain or swelling
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if this is severe or lasts longer than 3 days
• Constipation – drink plenty of fluids and let your doctor or nurse know
• Pins and needles in hands and feet (peripheral neuropathy)
• Skin changes – skin can become red, dry and itchy

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

The side effects above 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

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

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