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Tretinoin

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This is the acid form of vitamin A and is also called all-trans retinoic acid. The exact method of action is unclear but topical tretinoin decreases binding ability of epithelial cells to adjacent cells. Tretinoin also enhances mitotic activity although the exact method still remains to be elucidated.

Uses include

Induction of remission in acute promyelocytic leukaemia.¹^,² It is used in those previously untreated patients, patients that have relapsed and in those resistant to standard therapy.
Acne vulgaris³
Photodamage to skin
Treatment of hair loss (unlicensed use)

Cautions

Monitor FBC, INR, liver function and calcium (can cause hypercalcaemia)
Patients should be advised to monitor for evidence of thrombo-embolism e.g. swollen legs, chest pain
Monitor lipids
Renal impairment - monitor renal function
Liver impairment - monitor liver function
Avoid using topical preparations in or near eyes, mouth and broken skin

Contraindications

Tretinoin is teratogenic, so pregnancy is an absolute contraindication and women of child bearing age should avoid getting pregnant (this extends to up to one month after treatment ends)³
Breast feeding
History of cutaneous epithelioma for topical preparations

Important drug interactions

When used with tetracyclines there is an increased risk of benign intracranial hypertension
Vitamin A - risk of hypervitaminosis A with retinoids
Possible reduction in effectiveness of the progestogen only pill (combined oral contraceptive preparations are not effected)

Administration

Tretinoin is given orally in leukaemia. In the treatment of acne it is usually applied topically and is available in cream and gel formulations. There is also a solution of tretinoin and erythromycin available for acne.

Side effects

Skin irritation - with redness and peeling
Photosensitivity when used topically
Retinoic acid syndrome (may be fatal) - fever, SOB, pulmonary infiltrates, oedema, weight gain and may lead to multi-organ failure
GIT disturbances ranging from nausea to pancreatitis
Arrhythmias
Headaches and benign intracranial hypertension
Hypercalcaemia
Risk of both arterial and venous thrombosis¹

Document references

Summary of Product Characteristics - Vesanoid® 10mg soft capsules, Roche Products Limited (updated 17 Aug 2006) electronic Medicines Compendium.
Sanz MA, Tallman MS, Lo-Coco F; Practice points, consensus, and controversial issues in the management of patients with newly diagnosed acute promyelocytic leukemia.; Oncologist. 2005 Nov-Dec;10(10):806-14. [abstract]
Specific Protect Characteristics - Isotretinoin 20mg capsules, Beacon Pharmaceuticals (Updated 3 Nov 2006) electronic Medicines Compendium.

AcknowledgementsEMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 436
Document Version: 2
DocRef: bgp25232
Last Updated: 19 Oct 2007
Review Date: 18 Oct 2008

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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