Tretinoin (Vesanoid, ATRA)

Tretinoin is also called all trans retinoic acid (ATRA) and its brand name is Vesanoid. It belongs to a group of drugs called retinoids, these are similar to vitamin A. 

It is not a chemotherapy drug, but you may have it with chemotherapy drugs to treat a type of acute myeloid leukaemia called acute promyelocytic leukaemia (APL or APML).

How tretinoin works

Tretinoin treats promyelocytic leukaemia by encouraging the abnormal leukaemic cells to develop normally.

How you have tretinoin

Tretinoin comes as 10mg orange-yellow and reddish-brown soft capsules.

Taking your tablets or capsules

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.

Talk to your specialist or advice line before you stop taking a cancer drug.

You must take the capsules with food or shortly after a meal, as this helps your body to absorb the drug. Don't chew the capsules. Swallow them whole with plenty of water.

When you have tretinoin

You take the capsules twice a day. You usually take tretinoin until there is no sign of your leukaemia (remission) or for a maximum of 90 days.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 
• your side effects aren’t getting any better
• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Confusion, anxiety or depression

You might have some mood changes while having this drug. Let your doctor or nurse know if you feel anxious or depressed.

Difficulty sleeping (insomnia) 

It can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Increased pressure in the head 

Possible signs of having increased pressure in your head include double vision, feeling dizzy, feeling or being sick, ringing in your ears and a headache.

You must contact your doctor straight away.

Flushing

Your skin may appear flushed.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Eye problems

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

Changes to the heart beat

Your heart beat might become irregular.

Breathing problems

You may have difficulty breathing with wheezing and coughing. Let your doctor or nurse know straight away if this happens. 

If you have asthma or a similar breathing problem this might get worse. 

Dry mouth and nose

A dry mouth is also called xerostomia (pronounced zero-stow-mee-a). Talk to your nurse or doctor if you have this. They can give you artificial saliva to help with a dry mouth. It can also help to drink plenty of fluids.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Inflammation of the pancreas

This drug can cause inflammation of the pancreas (pancreatitis). Tell your doctor straight away if you have sudden and severe pain in your tummy (abdomen).

Inflammation of the lips

Your lips and the skin around your mouth can become red and swollen. 

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Increased sweating

You might sweat more than usual especially under the arms and your hands and feet. Tell your doctor or nurse they may be able to help. 

Bone pain

You might experience pain in your bones. Speak to your doctor as they can prescribe medicine to help. 

Chest pain

You might have chest pain.

Chills

You might have chills. Let your doctor know if you have this. They may be able to prescribe medicines to help. 

Lack of energy

This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.

Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.

Change to the way the liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Other side effects

There isn't enough information to work out in how many people these side effects might happen. You might have one or more of them. They include:

• infections
• an increase in blood cells such as platelets and white blood cells
• an increase in the amount of calcium in the blood
• an increased risk of blood clots - this can cause an increase in the risk of a stroke, heart problems and kidney problems
• inflammation of the blood vessels
• skin changes such as bumps or painful sores
• inflammation of the muscles
• genital ulcers
• a mild allergic reaction caused by an increased level of histamines

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Vitamin A

You shouldn't take vitamin A while taking tretinoin. 

Sorbitol

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.

Peanut and soya allergy

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

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This drug may 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 at least a month afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.