Arsenic Trioxide

Arsenic Trioxide Brand Name– Trisenox

What is Arsenic Trioxide

Arsenic trioxide is a cytotoxic agent that promotes myeloid differentiation by degrading the promyelocytic leukemia alpha retinoic acid receptor-alpha fusion protein.

It is indicated for the treatment of newly-diagnosed, low-risk acute promyelocytic leukemia (APL) in combination with tretinoin.

Arsenic trioxide is also indicated as a single-agent for the treatment of relapsed or refractory APL.

Cardiac arrhythmias (e.g., ventricular arrhythmias, AV block) and differentiation syndrome (characterized by fever, dyspnea, respiratory distress, fluid retention or weight gain, hypotension and/or multi-organ dysfunction) have been reported.

Indications

  • acute promyelocytic leukemia

Side Effects

  1. abdominal pain
  2. agitation
  3. anemia
  4. anorexia
  5. anxiety
  6. arthralgia
  7. atrial fibrillation
  8. atrial flutter
  9. AV block
  10. back pain
  11. bleeding
  12. blurred vision
  13. bone pain
  14. candidiasis
  15. chest pain (unspecified)
  16. chills
  17. coma
  18. confusion
  19. constipation
  20. cough
  21. depression
  22. diarrhea
  23. differentiation syndrome
  24. disseminated intravascular coagulation (DIC)
  25. dizziness
  26. drowsiness
  27. dyspepsia
  28. dyspnea
  29. ecchymosis
  30. edema
  31. elevated hepatic enzymes
  32. encephalopathy
  33. epistaxis
  34. erythema
  35. fatigue
  36. fecal incontinence
  37. fever
  38. flushing
  39. GI bleeding
  40. headache
  41. hearing loss
  42. heart failure
  43. hemoptysis
  44. hypercholesterolemia
  45. hyperglycemia
  46. hyperhidrosis
  47. hyperkalemia
  48. hypertension
  49. hypertriglyceridemia
  50. hypocalcemia
  51. hypoglycemia
  52. hypokalemia
  53. hypomagnesemia
  54. hypotension
  55. hypoxia
  56. infection
  57. injection site reaction
  58. insomnia
  59. leukocytosis
  60. lymphadenopathy
  61. metabolic acidosis
  62. myalgia
  63. nausea
  64. nephrotoxicity
  65. neurotoxicity
  66. neutropenia
  67. new primary malignancy
  68. night sweats
  69. ocular irritation
  70. oliguria
  71. otalgia
  72. pallor
  73. palpitations
  74. pancytopenia
  75. paresis
  76. paresthesias
  77. pericardial effusion
  78. peripheral edema
  79. peripheral neuropathy
  80. petechiae
  81. pharyngitis
  82. pleural effusion
  83. pruritus
  84. QT prolongation
  85. renal failure (unspecified)
  86. rhabdomyolysis
  87. seizures
  88. sinus tachycardia
  89. sinusitis
  90. skin hyperpigmentation
  91. tachypnea
  92. thrombocytopenia
  93. tinnitus
  94. torsade de pointes
  95. toxic epidermal necrolysis
  96. tremor
  97. urinary incontinence
  98. urticaria
  99. vaginal bleeding
  100. ventricular tachycardia
  101. vomiting
  102. weakness
  103. weight gain
  104. weight loss
  105. wheezing
  106. xerophthalmia
  107. xerosis
  108. xerostomia

Monitoring Parameters

  • blood glucose
  • CBC with differential
  • D-dimer
  • ECG
  • fibrin degradation products (FDPs)
  • LFTs
  • neurologic function
  • partial thromboplastin time (PTT)
  • prothrombin time (PT)
  • serum creatinine/BUN
  • serum electrolytes
  • weight

Contraindications

  • alcoholism
  • AV block
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • contraception requirements
  • diabetes mellitus
  • differentiation syndrome
  • disseminated intravascular coagulation (DIC)
  • electrolyte imbalance
  • encephalopathy
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hyperglycemia
  • hypokalemia
  • hypomagnesemia
  • infants
  • infertility
  • leukocytosis
  • long QT syndrome
  • male-mediated teratogenicity
  • malnutrition
  • neonates
  • neutropenia
  • new primary malignancy
  • pregnancy
  • pregnancy testing
  • QT prolongation
  • renal failure
  • renal impairment
  • reproductive risk
  • thiamine deficiency
  • thrombocytopenia
  • thyroid disease
  • torsade de pointes
  • ventricular arrhythmias

Interactions

  • Abarelix
  • Abciximab
  • Acetazolamide
  • Aclidinium; Formoterol
  • Albuterol
  • Albuterol; Ipratropium
  • Alfuzosin
  • Alpha interferons
  • Alteplase
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphotericin B
  • Anagrelide
  • Anticoagulants
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Apomorphine
  • Arformoterol
  • Argatroban
  • Aripiprazole
  • Artemether; Lumefantrine
  • Asenapine
  • Aspirin, ASA; Dipyridamole
  • Atomoxetine
  • Azelastine; Fluticasone
  • Azithromycin
  • Beclomethasone
  • Bedaquiline
  • Bepridil
  • Betamethasone
  • Betrixaban
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bivalirudin
  • Budesonide
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Carbamazepine
  • Celecoxib
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Ciclesonide
  • Cilostazol
  • Ciprofloxacin
  • Cisapride
  • Cisplatin
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clopidogrel
  • Clozapine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Crizotinib
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Dasatinib
  • Deflazacort
  • Degarelix
  • Desflurane
  • Desipramine
  • Desirudin
  • Deutetrabenazine
  • Dexamethasone
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Digoxin
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dipyridamole
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxepin
  • Dronedarone
  • Droperidol
  • Edoxaban
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Eliglustat
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Enflurane
  • Enoxaparin
  • Entrectinib
  • Eptifibatide
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esomeprazole; Naproxen
  • Etodolac
  • Ezogabine
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Fondaparinux
  • Formoterol
  • Formoterol; Mometasone
  • Foscarnet
  • Gallium Ga 68 Dotatate
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Glasdegib
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Halofantrine
  • Halogenated Anesthetics
  • Haloperidol
  • Halothane
  • Heparin
  • Histrelin
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indapamide
  • Indomethacin
  • Inotuzumab Ozogamicin
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Isoflurane
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lapatinib
  • Lefamulin
  • Lenvatinib
  • Lepirudin
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levofloxacin
  • Levomethadyl
  • Lithium
  • Lofexidine
  • Lomefloxacin
  • Long-acting beta-agonists
  • Loop diuretics
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Macimorelin
  • Mannitol
  • Maprotiline
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Meperidine; Promethazine
  • Mesoridazine
  • Metaproterenol
  • Methadone
  • Methazolamide
  • Methylprednisolone
  • Metronidazole
  • Midostaurin
  • Mifepristone
  • Mirtazapine
  • Mometasone
  • Moxifloxacin
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Olodaterol
  • Ondansetron
  • Osilodrostat
  • Osimertinib
  • Oxaliplatin
  • Oxaprozin
  • Palifermin
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Pentamidine
  • Pentosan
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenylephrine; Promethazine
  • Pimavanserin
  • Pimozide
  • Pirbuterol
  • Piroxicam
  • Pitolisant
  • Posaconazole
  • Potassium-sparing diuretics
  • Prednisolone
  • Prednisone
  • Primaquine
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Reteplase, r-PA
  • Ribociclib
  • Ribociclib; Letrozole
  • Rilpivirine
  • Risperidone
  • Rivaroxaban
  • Romidepsin
  • Salmeterol
  • Saquinavir
  • Sertraline
  • Sevoflurane
  • Short-acting beta-agonists
  • Siponimod
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sparfloxacin
  • Streptokinase
  • Sulindac
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telavancin
  • Telithromycin
  • Tenecteplase
  • Terbutaline
  • Tetrabenazine
  • Thiazide diuretics
  • Thioridazine
  • Thrombolytic Agents
  • Ticlopidine
  • Tinzaparin
  • Tiotropium; Olodaterol
  • Tolmetin
  • Tolterodine
  • Toremifene
  • Trazodone
  • Triamcinolone
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Tuberculin Purified Protein Derivative, PPD
  • Umeclidinium; Vilanterol
  • Urokinase
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Ziprasidone
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