Medication Information Leaflet

What is this medication for?

Tretinoin, also known as All-Trans-Retinoic acid (ATRA), is used in the treatment of acute promyelocytic leukaemia, a type of white blood cell that starts from the bone marrow. It works by promoting the abnormal leukemic cells to develop normally.

How should I take/use this medication?

This medicine should be taken after food. Swallow the capsules whole. Do not crush, chew, or open the capsules.

Do not stop taking your medication without checking with your healthcare professional.

If possible, handle the medication yourself. If a family member or caregiver needs to give the medication, do wash their hands before and after handling the medication.

What should I do if I forget to take/use this medication?

If you forget to take a dose, take it as soon as you remember. If it is too close to the next dose, skip the missed dose and take your next dose at the usual time. Do not take two doses to make up for the missed dose.

What precautions should I take?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You or your partner is pregnant or planning to become pregnant
  • Tretinoin may cause serious harm to the baby if used during pregnancy
    • Use two forms of reliable birth control during and for at least one month after treatment
  • Tell your doctor immediately if you or your partner becomes pregnant
• You are breastfeeding
• You have a history of mental health issues
• You are taking any other medications, including supplements, traditional medications and herbal remedies.

What are some common side-effects of this medication?

• Temporary decrease in blood cell counts
  • This may put you at higher risk of infections, bleeding or bruising and feeling tired
  • Reduce your risk of getting an infection by:
    • Maintaining good hand hygiene. Wash your hands often during the day especially before you eat or after using the toilet
    • Avoid crowded spaces and wear a mask to protect yourself
    • Eating freshly cooked food. Avoid raw meats, vegetables, eggs, half-cooked or uncooked food
  • Brush teeth gently with a soft bristle toothbrush to prevent gum bleeding
  • Be careful when handling sharp objects such as scissors or knives
• Nausea and vomiting
  • Take small and frequent meals, rather than 3 large meals
  • Consume food that are cold or at room temperature to avoid becoming nauseated from the smell
• Dry skin, lips, and mouth
  • Apply a moisturiser routinely on your skin i.e. in the morning, after showering and in the night before sleep
  • Do use lip balm to manage dryness
• Increased risk of sunburn
  • Avoid staying directly under sunlight for a long period of time.
  • Use a broad-spectrum sunscreen with sunscreen protection factor (SPF) of at least 30
  • Wear protective clothing if you are exposed to direct sunlight
• Headache, bone or muscle pain
  • Avoid strenuous physical exertion to prevent it from worsening
  • You may take painkillers such as paracetamol if needed
• Dizziness and fatigue
  • Avoid activities such as driving or operating heavy machinery if you feel dizzy and/or fatigue.
• Increased cholesterol levels
  • Regular blood tests may be conducted during treatment

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Other serious side effects include:

• Differentiation syndrome
  • This results from the changes tretinoin causes to blood cell production in patients with leukemia
  • Signs of differentiation syndrome include:
    • Fever (temperature over 38°C)
    • Shortness of breath or having difficulty breathing
    • Sudden weight gain and/ or leg swelling
    • Discomfort, pain or tightness in the chest
• Hypervitaminosis A (high vitamin A levels)
  • Signs of high vitamin A level include:
    • Nausea and vomiting
    • Bone pain
    • Headache
    • Dry skin, lip or mouth dryness or swelling
    • Rash
• Blood clots or blockage in your blood vessels
  • Signs of a blood clot include:
    • Calf swelling and tenderness
    • Sudden onset of cough
    • Chest pains
    • Shortness of breath
• Liver problems:
  • Signs of liver problems include:
    • Dark or tea-coloured urine
    • Pale or light-coloured stools
    • Yellowing of skin or eyes
    • Severe loss of appetite
    • Abdominal pain
    • Nausea or vomiting that does not go away
• Severe headache that is not relieved with painkillers or a headache which occurs with nausea and vomiting or changes in eyesight

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take this medication?

Some medications and fruits may interact with tretinoin.

• Do not take Vitamin A supplements while you are on tretinoin as this may increase the risk of side effects of tretinoin. Check with your doctor or pharmacist before you start taking any new vitamin supplements, including multivitamins.
• Do not take this medication if you are currently taking any tetracycline class of antibiotics such as doxycycline and minocycline. This can increase the risk of pressure build up in the head which may lead to headaches, nausea and vomiting and in severe cases, loss of eyesight.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How should I throw away this medication safely?

Pack the medication into a bag and bring it back to the pharmacy where you received the medication from.
 

Disclaimers

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on Aug 2023