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What is Tretinoin (all trans retinoic acid ATRA)
Tretinoin, also known as all-trans-retinoic acid (ATRA), is a naturally occurring derivative of vitamin A.
As vitamin A (retinol) derivatives, retinoids are important regulators of cell reproduction, and cell proliferation and differentiation; however, unlike vitamin A, retinoids are not converted into rhodopsin, which is needed for night vision.
Topical tretinoin is indicated in the treatment of mild to moderate acne (e.g., grades I-III) and photodamaged skin.
Topical tretinoin has also been used in the symptomatic management of keratinization disorders such as ichthyosis and keratosis follicularis. Tretinoin represents a new class of anticancer drugs, differentiating agents.
Oral tretinoin is used in the treatment of acute promyelocytic leukemia (APL) and is undergoing phase III investigation in the treatment of Kaposi’s sarcoma.
In the treatment of APL, tretinoin offers a less toxic means to induce complete remission than conventional chemotherapy; however, approximately 25% of patients who receive tretinoin for the treatment of APL have experienced acute promyelocytic leukemia differentiation syndrome.
Indications
- acne rosacea
- acne vulgaris
- actinic keratosis
- acute promyelocytic leukemia
- facial wrinkles
- ichthyosis
- Kaposi’s sarcoma
- keloids
- keratosis follicularis
- melasma
- photoaging
Side Effects
- abdominal pain
- agitation
- agnosia
- alopecia
- anorexia
- anxiety
- aphasia
- arrhythmia exacerbation
- ascites
- asterixis
- ataxia
- bleeding
- bone pain
- cardiac arrest
- cardiomyopathy
- coma
- confusion
- constipation
- depression
- diaphoresis
- diarrhea
- differentiation syndrome
- disseminated intravascular coagulation (DIC)
- dizziness
- drowsiness
- dysarthria
- dyspepsia
- dyspnea
- dysuria
- edema
- elevated hepatic enzymes
- encephalopathy
- erythema
- erythema nodosum
- fatigue
- fever
- flank pain
- fluid retention
- flushing
- GI bleeding
- hallucinations
- headache
- hearing loss
- heart failure
- hepatitis
- hepatomegaly
- hypercalcemia
- hypercholesterolemia
- hyperlipidemia
- hypertension
- hypertriglyceridemia
- hypervitaminosis A
- hyporeflexia
- hypotension
- hypothermia
- hypoxia
- impaired cognition
- increased intracranial pressure
- increased urinary frequency
- insomnia
- intracranial bleeding
- laryngeal edema
- leukocytosis
- malaise
- myalgia
- myocardial infarction
- myocarditis
- nausea
- otalgia
- pallor
- pancreatitis
- papilledema
- paresthesias
- peptic ulcer
- pericardial effusion
- pericarditis
- peripheral edema
- phlebitis
- photosensitivity
- pleural effusion
- pruritus
- pseudotumor cerebri
- pulmonary edema
- pulmonary hypertension
- rash
- renal failure (unspecified)
- renal tubular necrosis
- respiratory depression
- seizures
- shivering
- skin hyperpigmentation
- skin hypopigmentation
- skin irritation
- splenomegaly
- spontaneous fetal abortion
- stomatitis
- stroke
- teratogenesis
- thrombocytosis
- thrombosis
- tremor
- vesicular rash
- visual impairment
- vomiting
- weakness
- weight gain
- weight loss
- wheezing
- xerosis
Monitoring Parameters
- CBC with differential
- LFTs
- pregnancy testing
- serum cholesterol profile
- serum lipid profile
Contraindications
- accidental exposure
- breast-feeding
- children
- contraception requirements
- differentiation syndrome
- eczema
- fish hypersensitivity
- hepatic disease
- hypercholesterolemia
- hyperlipidemia
- hypertriglyceridemia
- infants
- leukocytosis
- neonates
- ocular exposure
- paraben hypersensitivity
- pregnancy
- pregnancy testing
- reproductive risk
- requires a specialized care setting
- requires an experienced clinician
- respiratory insufficiency
- retinoid hypersensitivity
- skin photosensitivity disorder
- sunburn
- sunlight (UV) exposure
Interactions
- Abciximab
- Acetohexamide
- Adapalene; Benzoyl Peroxide
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Alpha interferons
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminocaproic Acid
- Aminolevulinic Acid
- Amiodarone
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Anagrelide
- Anticoagulants
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Aprotinin
- Argatroban
- Aspirin, ASA; Dipyridamole
- Atenolol; Chlorthalidone
- Azelastine; Fluticasone
- Azilsartan; Chlorthalidone
- Barbiturates
- Beclomethasone
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzoyl Peroxide
- Benzoyl Peroxide; Clindamycin
- Benzoyl Peroxide; Erythromycin
- Benzoyl Peroxide; Sulfur
- Betamethasone
- Betrixaban
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bivalirudin
- Budesonide
- Budesonide; Formoterol
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril; Hydrochlorothiazide, HCTZ
- Carbamazepine
- Chlorothiazide
- Chlorpromazine
- Chlorpropamide
- Chlorthalidone
- Chlorthalidone; Clonidine
- Cholestyramine
- Ciclesonide
- Cilostazol
- Cimetidine
- Ciprofloxacin
- Clopidogrel
- Clozapine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colestipol
- Corticosteroids
- Corticotropin, ACTH
- Cortisone
- Cyclosporine
- Dabigatran
- Dalteparin
- Danaparoid
- Danazol
- Deflazacort
- Desirudin
- Dexamethasone
- Dextromethorphan; Promethazine
- Diclofenac
- Diclofenac; Misoprostol
- Digoxin
- Diltiazem
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Dipyridamole
- Echinacea
- Edoxaban
- Enalapril; Hydrochlorothiazide, HCTZ
- Enoxaparin
- Eprosartan; Hydrochlorothiazide, HCTZ
- Eptifibatide
- Eravacycline
- Erythromycin
- Erythromycin; Sulfisoxazole
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Felbamate
- Fenoprofen
- Filgrastim, G-CSF
- Fludrocortisone
- Flunisolide
- Fluphenazine
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fondaparinux
- Formoterol; Mometasone
- Fosinopril; Hydrochlorothiazide, HCTZ
- Gemifloxacin
- Gentamicin
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Griseofulvin
- Heparin
- Hydantoins
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indapamide
- Indomethacin
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Ketoconazole
- Ketorolac
- Lansoprazole; Naproxen
- Lepirudin
- Levofloxacin
- Lithium
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Meperidine; Promethazine
- Mesoridazine
- Methotrexate
- Methoxsalen
- Methyclothiazide
- Methylprednisolone
- Metolazone
- Mometasone
- Moxifloxacin
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Norfloxacin
- Ofloxacin
- Omeprazole; Amoxicillin; Rifabutin
- Orlistat
- Oxaprozin
- Palifermin
- Pegfilgrastim
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Penicillamine
- Pentosan
- Perphenazine
- Perphenazine; Amitriptyline
- Phenothiazines
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Photosensitizing agents (topical)
- Piroxicam
- Platelet Inhibitors
- Porfimer
- Prasugrel
- Prednisolone
- Prednisone
- Prochlorperazine
- Promethazine
- Rifabutin
- Rifampin
- Rifapentine
- Rivaroxaban
- Salicylic Acid
- Sodium Thiosulfate; Salicylic Acid
- St. John’s Wort, Hypericum perforatum
- Sulfonylureas
- Sulindac
- Tbo-Filgrastim
- Tetracyclines
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Thrombolytic Agents
- Thyroid hormones
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolazamide
- Tolbutamide
- Tolmetin
- Topiramate
- Trandolapril; Verapamil
- Tranexamic Acid
- Triamcinolone
- Trifluoperazine
- Tuberculin Purified Protein Derivative, PPD
- Verapamil
- Verteporfin
- Vorapaxar
- Voriconazole
- Warfarin
