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.