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
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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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