Tretinoin (Vesanoid, ATRA)

• What tretinoin is
• Common side effects
• Occasional side effects
• Rare side effects
• Important points to remember

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. It 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 and this can cause side effects, which are listed below.

Tretinoin comes as 10mg orange-yellow and reddish-brown soft capsules. Your doctor will tell you what dose and when to take this drug. Take it with food or shortly after a meal, as this helps your body absorb the drug. You usually take it until your leukaemia has gone into remission, or for a maximum of 90 days.

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 more information about general drug side effects in this section of CancerHelp UK or you can look up the specific side effects if you know the name of the drug.

All drugs cause side effects. Some are more serious than others, but you must report any side effects to your doctor. Many people have one or more of the following side effects

• Fatigue during and after treatment 
• Vitamin A can cause effects in nearly everyone in the first days or weeks of treatment - you may have a headache, dry or itchy skin, a rash, swelling (oedema), a high temperature, a sore mouth, and sore eyes
• 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 before having the treatment
• Changes in blood tests - 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 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, fluid around the heart or lungs, and raised white blood cell count. If you have any difficulty breathing or sudden weight gain, contact your doctor straight away.

Some people may have one or more of the following side effects

• Abdominal pain or swelling
• Aching bones or muscles
• Diarrhoea - drink plenty of fluids and tell your doctor 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)
• Depression
• Skin changes - skin can become red, dry and itchy

A very small number of people may have one or more of these side effects

• Problems with the nervous system, including dizziness, anxiety, confusion, agitation, slow speech, fits, facial numbness, sleepiness or hallucinations
• Difficulty passing urine
• Liver inflammation
• Heart damage

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

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them.

Your chemotherapy nurse, clinic or ward 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.