Dangerous Drug: Tretinoin (Retinoic Acid)(tret’ i noyn)
Atralin, Avita, Refissa, Renova, Retin-A, Retin-A Micro, Stieva-A (CAN), Tretin-X
PREGNANCY CATEGORY D
(ORAL)
PREGNANCY CATEGORY C
(TOPICAL)
Drug Classes
Antineoplastic
Retinoid (topical form)
Therapeutic Actions
Induces cell differentiation and decreases proliferation of acute promyelocytic leukemia cells, leading to an initial maturation of the primitive promyelocytes, followed by a repopulation of the bone marrow and peripheral blood by normal hematopoietic cells in patients achieving complete remission; exact mechanism of action is not understood. Acne: decreased cohesiveness and increased turnover of follicular epithelial cells, decreasing comedones.
Indications
-
Induction of remission in acute promyelocytic leukemia (APL)
-
Topical treatment of acne vulgaris
-
Adjunctive agent for use in mitigation of fine wrinkles, mottled hyperpigmentation, and tactile roughness in select patients (topical)
-
Unlabeled uses: Hyperpigmentation of photoaged skin, postinflammatory hyperpigmentation, facial actinic keratoses (topical), acute promyelocytic leukemia (oral), emphysema (oral)
Contraindications and Cautions
-
Contraindicated with allergy to retinoids or parabens, suicidal tendencies, pregnancy, lactation.
-
Use cautiously with liver disease, hypercholesterolemia, hypertriglyceridemia.
Available Forms
CapsuleDNC—10 mg; cream—0.02%, 0.025%, 0.0375% 0.05%, 0.1%; gel—0.01%, 0.025%, 0.04%, 0.05%, 0.1%
Dosages
Adults and children 1 yr and older
Oral
45 mg/m2/day PO administered in two or three evenly divided doses until complete remission is documented; discontinue therapy 30 days after complete remission is obtained or after 90 days, whichever comes first.
Dosages
Adults
Topical
Apply once a day before bedtime. Cover entire affected area lightly, avoiding mucous membranes.
Pediatric patients
Not recommended for use in children younger than 1 yr.
Pharmacokinetics
|
Metabolism: Hepatic; T1/2: 0.5–2 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Feces, urine
Adverse Effects
-
CNS: Fever, headache, pseudotumor cerebri (papilledema, headache, nausea, vomiting, visual disturbances), earache, visual disturbances, malaise, sweating, suicidal ideation
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