Tretinoin Capsules are a key medication for the treatment of acute promyelocytic leukemia (APL), and their efficacy and effectiveness rely on strict medication management.
What Are the Side Effects of Tretinoin Capsules?
Common Side Effects
Systemic Reactions: Fever (83%), dry skin/mucous membranes (77%), fatigue (66%), chills (63%), peripheral edema (52%).
Neurological Symptoms: Headache (86%), dizziness (20%), paresthesia (17%), anxiety (17%).
Gastrointestinal Reactions: Nausea/vomiting (57%), abdominal pain (31%), diarrhea (23%), constipation (17%).
Respiratory Symptoms: Upper respiratory tract infection (63%), dyspnea (60%), pleural effusion (20%).
Others: Bone pain (77%), rash (54%), bleeding (60%), leukocytosis (49%).
Severe Side Effects of Tretinoin Capsules Requiring Vigilance
Differentiation Syndrome (DS)
Risk: May occur in approximately 26% of APL patients, presenting with symptoms such as fever, dyspnea, weight gain, hypotension, and multiple organ failure; it can be fatal in severe cases.
Management: Once symptoms appear, intravenous injection of dexamethasone (10mg every 12 hours) is required immediately, and Tretinoin Capsules should be suspended until symptoms resolve.
Embryo-Fetal Toxicity
Risk: Use during pregnancy can cause miscarriage and fetal malformations (e.g., central nervous system abnormalities, facial malformations).
Measures: Before medication, the pregnancy status of female patients must be confirmed (negative); double contraceptive measures should be adopted during treatment and within 1 month after drug discontinuation.
Intracranial Hypertension
High-Risk Population: Pediatric patients are more prone to this condition, which presents with headache, papilledema, nausea, and vomiting.
Management: Symptoms need to be monitored; dose reduction or drug discontinuation may be necessary if needed. Concurrent use of tetracyclines and other drugs that may increase intracranial pressure should be avoided.
Leukocytosis and Thromboembolic Risk
Leukocytosis: May occur in 40% of patients; concurrent use of cytoreductive chemotherapy (e.g., hydroxyurea) is required.
Thromboembolic Events: Include venous/arterial thrombosis (e.g., myocardial infarction, stroke); concurrent use of antifibrinolytic drugs (e.g., tranexamic acid) should be avoided.
Hepatotoxicity and Dyslipidemia
Liver Injury: Abnormal liver function occurs in 50%-60% of patients; regular monitoring of transaminases is required.
Hyperlipidemia: Hypercholesterolemia/hypertriglyceridemia occurs in 60% of patients; fasting lipid monitoring is required.
Precautions for Tretinoin Capsules Administration
Medication in Special Populations
Lactation: Breastfeeding is prohibited during treatment and within 1 week after drug discontinuation.
Pediatric Patients: Efficacy in patients under 1 year of age has not been established; vigilance against intracranial hypertension is required.
Geriatric Patients: No dose adjustment is needed, but enhanced cardiovascular monitoring is required.
Drug Interactions
CYP3A Inhibitors/Inducers: Concurrent use of potent CYP3A inhibitors (e.g., ketoconazole) or inducers (e.g., rifampicin) should be avoided.
Vitamin A: Concurrent use may increase tretinoin toxicity and should be avoided.
Patient Monitoring Plan
Baseline Examinations: Pregnancy test, electrocardiogram (QT interval), liver function, blood lipids, APL genetic markers (t(15;17) translocation or PML/RARα fusion gene).
During Treatment: Monitor complete blood count and liver function weekly; regularly assess symptoms of differentiation syndrome.
