Tretinoin (VESANOID)

Acute promyelocytic leukemia

Acute promyelocytic leukemia

• Oral: 45 mg/m2/day in 2 equally divided doses. Duration depends on the protocol being used, and which phase of the protocol (induction, consolidation, maintenance) the patient has reached. Please follow local protocol

• Given in combination with chemotherapy

Available as 10 mg capsules. Capsules should NOT be opened. Store at room temperature and protect from light.

Retinoic Acid Derivative

Take with food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 6 hours of the missed dose. If it is over 6 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Ototoxicity, Fatigue, Fever, Weight gain, Headache, Hypervitaminosis A syndrome, Retinoic acid syndrome.

Less Common: Pseudotumour cerebri, Sweet’s syndrome, Thrombosis.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment:  CBC & differential, platelets, sodium, potassium, calcium, magnesium, phosphate, urea, serum creatinine, alkaline phosphate, ALT, bilirubin, LDH, albumin, uric acid, INR, PTT, fibrinogen, HSV, HBsAg, HBsAB, HbcAb, ECG.  

During treatment: alkaline phosphate, ALT, bilirubin, LDH, calcium, phosphate, uric acid, INR, PTT, fibrinogen. 

If clinically indicated: ECG.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Do not take vitamin A while taking tretinoin.
• Differentiation Syndrome can be life-threatening or fatal, occurred in about 26% of patients with APL who received tretinoin capsules. At first signs or symptoms of this syndrome, immediately initiate high-dose corticosteroid therapy and hemodynamic monitoring until resolution of signs and symptoms. Consider withholding tretinoin capsules for moderate and severe Differentiation Syndrome until resolution.

BC Cancer. BC Cancer Drug Manual. Tretinoin.  Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Tretinoin_monograph_1Feb2014.pdf. Updated February 1, 2014. Accessed February 2, 2024.

Lexicomp. Tretinoin Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7806?cesid=03fBEycKdeV&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dtretinoin%26t%3Dname%26acs%3Dtrue%26acq%3Dtretuno. December 5, 2023. Accessed February 2, 2024.

Cancer Care Ontario. Tretinoin Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43981. Updated June 2019. Accessed January 22, 2024.

Hoffmann La Roche Ltd. VESANOID® Product Monograph. Mississauga, Ontario. Updated October 3, 2013.