Tretinoin Capsules are a retinoid medication used for the treatment of acute promyelocytic leukemia (APL). Although it has a significant therapeutic effect, it may cause severe side effects, so strict adherence to medication precautions is required.
What Are the Side Effects of Tretinoin Capsules?
Common Side Effects
Systemic symptoms: Fever (83%), fatigue (66%), chills (63%), peripheral edema (52%).
Nervous system: Headache (86%), dizziness (20%), insomnia (14%).
Skin and mucous membranes: Dry skin/mucous membranes (77%), rash (54%), pruritus (20%).
Digestive system: Nausea/vomiting (57%), abdominal pain (31%), diarrhea (23%).
Respiratory system: Upper respiratory tract infection (63%), dyspnea (60%).
Hematological system: Leukocytosis (49%), bleeding (60%).
Other common reactions (10%-30%) include visual disturbances, muscle pain, hypotension, etc.
Severe Side Effects of Tretinoin Capsules That Require Vigilance
Embryo-Fetal Toxicity
Tretinoin Capsules can cause fetal malformation, miscarriage, or fetal death. The pregnancy status of female patients must be confirmed before medication administration.
Women of childbearing age should complete a pregnancy test (sensitivity ≥50mIU/mL) within 1 week before treatment.
During treatment and within 1 month (for females)/1 week (for males) after drug discontinuation, two effective contraceptive measures must be taken.
Differentiation Syndrome (DS)
Incidence rate: Approximately 26%, which may be life-threatening.
Symptoms: Fever, dyspnea, weight gain, hypotension, multiple organ failure, etc., usually occurring within the first month of treatment.
Management: High-dose glucocorticoids (e.g., 10mg dexamethasone via intravenous injection every 12 hours) should be used immediately; if necessary, tretinoin treatment should be suspended.
Intracranial Hypertension
High-risk population: Pediatric patients are more prone to this condition.
Symptoms: Headache, nausea, vomiting, blurred vision, papilledema.
Measures: Avoid concurrent use of drugs that may increase intracranial pressure (such as tetracyclines); if necessary, reduce the dosage or discontinue the drug.
Thromboembolic Events
These include venous/arterial thrombosis, myocardial infarction, renal infarction, etc., mostly occurring within the first month of treatment.
Avoid concurrent use of antifibrinolytic drugs (e.g., tranexamic acid).
Other Severe Reactions
Dyslipidemia: 60% of patients develop hypercholesterolemia or hypertriglyceridemia, so fasting blood lipids need to be monitored.
Hepatotoxicity: 50%-60% of patients experience abnormal liver function, so regular liver enzyme tests are required.
Leukocytosis: Occurring in 40% of patients, which may require combined cytoreductive chemotherapy.
Precautions for Taking Tretinoin Capsules
Drug Interactions
CYP3A inhibitors/inducers: Potent inhibitors (e.g., ketoconazole) may increase toxicity, while potent inducers (e.g., rifampicin) may reduce efficacy.
Vitamin A: Concurrent use may exacerbate adverse reactions.
Antifibrinolytic drugs: Concurrent use increases the risk of thrombosis and is strictly prohibited.
Special Populations
Children: Tretinoin can be used in children over 1 year old, but vigilance is needed for headache and intracranial hypertension; dosage reduction is necessary if required.
Lactating women: Breastfeeding is prohibited during treatment and within 1 week after drug discontinuation.
Monitoring Requirements
Baseline examinations: Pregnancy test, blood lipid test, liver function test, and complete blood count.
Monitoring during treatment: Evaluate symptoms of differentiation syndrome weekly, and recheck liver enzymes and blood lipids regularly.
