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Tretinoin (Vesanoid®, All-Trans-Retinoic Acid, ATRA)

Last Modified: September 13, 2012

Pronounced: TREH-tih-NO-in
Classification: Retinoid

About Tretinoin

Tretinoin belongs to a class of drugs known as retinoids. Retinoids are drugs that are relatives of vitamin A. Retinoids control normal cell growth, cell differentiation (the normal process of making cells different from each other), and cell death. This occurs during embryonic development and, in certain tissues, later in life. In APML, the cells are "stuck" in an immature form, making thousands of copies of this immature cell that cannot function. Tretinoin causes the cells to get "unstuck" and mature. This can slow or stop the growth of cancer cells.

How to Take Tretinoin

Tretinoin comes as a capsule to take orally (by mouth). It is typically taken twice a day for up to 90 days. The dose is based on your body size.

Possible Side Effects of Tretinoin

There are a number of things you can do to manage the side effects of Tretinoin. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Retinoic Acid Syndrome

This is a syndrome resulting from the changes tretinoin causes to blood cell production in patients with leukemia. Symptoms of the syndrome include: fever (temperature >100.5), sudden weight gain and/or swelling, low blood pressure, bone pain, and fluid build up around the heart, lungs, and chest, causing shortness of breath or difficulty breathing. The symptoms typically occur after 7-12 days on the medication. This syndrome is treated with high doses of IV steroids (like dexamethasone). Your healthcare providers will monitor for these signs or symptoms, but it is also important for you to tell your doctor or nurse promptly if you experience any of these symptoms.

Increased White Blood Cell Count

This is also called hyperleukocytosis. Generally, it does not cause any problems, nor does it require stopping the treatment. Your healthcare provider will monitor your white blood count during treatment.

Headache and Muscle or Joint Pain/Ache

Headache is the most common side effect associated with tretinoin. It most commonly occurs several hours after the dose. Your doctor or nurse can recommend over-the- counter medications to treat the headache. These headaches tend to occur around the time of the medication and resolve before the next dose. If your headache is persistent or severe, notify your healthcare provider right away. There is a very rare side effect of tretinoin that is associated with severe, persistent headache.

Nausea and/or Vomiting

There are things you can do to help nausea and vomiting. There are many effective drugs that will prevent, eliminate, or lessen the severity of nausea and vomiting, just ask your doctor which is best for you. In addition, dietary adjustments may help. Avoid things that worsen the symptoms, try antacids (milk of magnesia and calcium tablets, like Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Flu-Like Symptoms

These include muscle aches, fever, chills, and feeling tired.

Skin Changes

These include dryness, itching, rash and cracking, dry lips. You should use a moisturizer on your skin and lips, but avoid moisturizers with perfumes or scents. Your doctor or nurse can recommend medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. For more suggestions, read the Nail and Skin Care Tip Sheet.


While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink’s section on fatigue for helpful tips on dealing with this side effect.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected.


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