II. Indications

  1. See Topical Tretinoin and Isotretinoin (Accutane) for Acne Vulgaris related uses
  2. Acute Promyelocytic Leukemia (APL)
  3. Neuroblastoma

III. Contraindications

  1. Paraben Sensitivity

IV. Mechanism

  1. Tretinoin is a Retinoic Acid (Vitamin A) analog
    1. Most commonly used for acne: Topical Tretinoin (Retin-A), and systemically as Isotretinoin (Accutane)
    2. However, Tretinoin is also used as an antineoplastic drug
      1. Induces maturation of APL cells, as well as Neuroblastoma cells

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Alopecia
  2. Leukocytosis (rapid increase in 40% of patients)
  3. Hepatotoxicity (increased Liver Function Tests)
  4. APL Differentiation Syndrome
    1. Presents with fever and Dyspnea
    2. Signs include Pulmonary Infiltrates, Pleural Effusions, Pericardial Effusions, weight gain, Cardiomyopathy, Hypotension
  5. Lipid abnormalities (reversible)
    1. Hypercholesterolemia
    2. Hypertriglyceridemia

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception (two concurrent forms, similar to Isotretinoin)
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Coagulation tests
    4. Lipid profile with Cholesterol levels and Serum Triglycerides

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