Tretinoin (Oral)

INTRODUCTION

Indications

Oral: Induction of remission in acute promyelocytic leukemia in patients who cannot receive anthracyclines due to lack of response, intolerance, or the presence of a contraindication.

Topical: Management of acne vulgaris. Decreased facial dermal effects of photoaging (used with sun avoidance; 0.05% water-in-oil cream formulation only).

Action

Oral: Causes maturation of promyelocytes derived from the leukemic clone. Therapeutic Effects: Repopulation with normal hematopoietic cells in patients who achieve remission.

Topical: ↓ the formation of microcomedones and stimulates turnover of follicular epithelium.

Therapeutic Effects: ↓ acne formation with improved skin appearance. ↓ skin roughness, hyperpigmentation, and wrinkling due to photoaging.

Adverse Reactions/Side Effects (Oral)

CNS: SEIZURES, anxiety, confusion, depression, dizziness, fatigue, headache, insomnia, malaise, pseudotumor cerebri, weakness, agitation, cerebral hemorrhage, hallucinations, intracranial hypertension. EENT: altered visual acuity, ocular disorders, visual disturbances, visual field defects, earache, hearing loss. Resp: asthma, laryngeal edema. CV: CARDIAC FAILURE, MI, STROKE, arrhythmias, chest discomfort, edema, hypertension, hypotension, peripheral edema, phlebitis. GI: GI BLEEDING, abdominal distention, abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia, hepatosplenomegaly, mucositis, nausea, ulcer, vomiting. GU: renal insufficiency, acute renal failure, dysuria, enlarged prostate, renal tubular necrosis, urinary frequency. Derm: alopecia, cellulitis, dry skin, facial edema, flushing, increased sweating, pallor, pruritus, rash, skin changes. F and E: acidosis, fluid imbalance. Hemat: disseminated intravascular coagulation, hemorrhage, leukocytosis. Metab: weight gain, weight loss. MS: bone inflammation, bone pain, flank pain, myalgia. Neuro: paresthesias. Misc: fever, infections, pain, hypothermia, retinoic acid–acute promyelocytic leukemia syndrome, shivering.

Adverse Reactions/Side Effects (Topical)

Derm: photosensitivity, redness, blistering, edema, crusting, hyperpigmentation, hypopigmentation.

PHYSICAL THERAPY IMPLICATIONS^*

^*Implications refer primarily to oral/systemic use for cancer

Evaluation and Examination

• Continually monitor for signs of stroke (sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances) and MI or cardiac failure (sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, loss of consciousness). Seek immediate medical assistance if patient develops these signs.

• Be alert for seizures and other signs of neurotoxicity (anxiety, confusion, hallucinations, dizziness, depression, changes in vision or hearing). Notify physician immediately if these signs occur.

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician ...