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tretinoin (ATRA)

( TRET-i-noyn )
Exceptional Access Program
  • tretinoin (ATRA)
Other Name(s): Vesanoid®
Appearance: capsule

Medication Information Sheet
tretinoin (ATRA) (TRET-i-noyn)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Vesanoid®, All-trans retinoin acid (ATRA)


What is this medication for?
  • For treating acute promyelocytic leukemia
What should I do before I have this medication?
  • Tell  your doctor if you have/had significant medical condition(s), such as heart, liver or kidney problems, high cholesterol or fats in the blood, or if you have any allergies.
  • People who have cancer or leukemia are at a higher risk of developing other cancers/leukemias or blood clots. Also, some cancer medications, such as tretinoin, may increase these risks. You should discuss these with your doctor.
How will this medication affect sex, pregnancy and breastfeeding?
  • Tretinoin can harm the unborn baby and must never be used in pregnant women.
  • Do not use tretinoin if you are pregnant.  If there is ANY chance that you or your partner may become pregnant, you and your partner together must:  ►Use 2 effective forms of birth control at the same time at least 4 weeks before starting treatment and while taking this drug: Keep using birth control until at least 1 month after the last dose. You must follow birth control measures carefully as directed by your doctor. Discuss with your health care team.
  • Tell your doctor right away if you or your partner becomes pregnant.
  • Do not breastfeed while on tretinoin treatment.
  • Effects on Fertility: Yes
  • Effects on Fertility: Yes
How is this medication given?
  • Tretinoin is usually taken twice a day, for a specific timeframe as directed by your doctor.  Make sure you understand the instructions.
  • Swallow whole with a glass of water, with food.
  • Take the dose at about the same times each day.
  • If you miss a dose, take it as soon as possible.  If it is close to your next dose, do not double the dose. Discuss with your doctor or pharmacist.


What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain:

    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding.
    • Talk to your health care team before you start or stop these medications.
    • If you feel unwell, take your temperature before taking any of these medications. They may hide a fever. 
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Do not take any vitamins and supplements containing vitamin A as this can increase the chance of getting severe side effects. Check with your doctor or pharmacist before starting any supplements.
How should I safely store this medication?
  • Keep this medication in the original packaging at room temperature in a dry place, away from heat and light. Keep out of sight and reach of children and pets.

  • Do not throw out any unused medications at home. Bring them to your pharmacy to be thrown away safely.

What are the side effects of this medication?

The following side effects are common or severe. You may not have all of the side effects. Other side effects may occur. If you have any unusual or bothersome symptoms, discuss with your doctor.

Side effects and what to do When to contact doctor?
More Common Side Effects

Dry lips, mouth or skin

  • Sip water regularly. Use lip balm and skin moisturizer several times a day.
  • For dry mouth, try artificial saliva or suck on hard candy/ice chips.
Contact your health care team if no improvement or if severe

Rash; sensitivity to sunlight

  • Stay out of the sun; wear sunblock, a hat and cover exposed skin.
  • Use daily moisturizer.
Contact your health care team if no improvement or if severe

Headache; mild joint, muscle pain or cramps 

  • Headache and muscle/bone pain may slowly go away as your body gets used to the drug.
  • Contact your doctor immediately if headache is severe (not controlled with acetaminophen (Tylenol®)), or happens with nausea/vomiting or changes in your eye sight.
Contact your health care team if no improvement or if severe

Rapid increase of white blood cells

  • Your doctor may monitor your blood counts regularly.
Get emergency medical help right away


  • Rest often; take naps if needed. Move slowly when getting up.
  • Eat well-balanced meals and drink plenty of fluids. Light exercise may help.
  • If you are feeling tired, avoid driving or operating machinery
Contact your health care team if no improvement or if severe

Abnormal liver lab tests

  • Your doctor will monitor these regularly.  Call your doctor if you have yellowish skin or eyes, or unusual dark urine.
Contact your health care team if no improvement or if severe

Unusual bleeding or bruising
(black stools, coughing up blood, purple or red dots on skin, bleeding that will not stop) 

  • May occur in days to weeks after treatment starts.
  • Use a soft toothbrush. Be careful not to cut or bruise yourself.
  • Check with your doctor before any surgery or dental work.
  • Also see Low Platelets pamphlet.*
Get emergency medical help right away

Increased cholesterol or fat levels in the blood

  • Your doctor may monitor these regularly.
Contact your health care team if no improvement or if severe

Fever, chills, infection

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries or visiting your dentist.

If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Nausea and vomiting

  • May occur in hours to days after treatment starts.
  • Drink clear fluids and avoid large meals. Get fresh air and rest.
  • Limit spicy, fried foods or foods with a strong smell.
  • Take anti-nausea drug(s) exactly as directed by your doctor. It is easier to prevent nausea than to treat it.
  • Contact your doctor if nausea lasts more than 48 hours or vomiting for more than 24 hours.
  • Also see Nausea & Vomiting pamphlet.*


Contact your health care team if no improvement or if severe

Bleeding/clotting disorder (may include bleeding from more than 1 site, bruising, signs of blood clots, kidney/liver/lung problems, fever, confusion)




Get emergency medical help right away

Mild swelling in arms and legs; puffiness

  • Keep your feet up when sitting. Eat a low-salt diet.
  • Avoid tight fitting clothing.


Contact your health care team if no improvement or if severe

Retinoic acid syndrome (group of signs and symptoms that may include fever, fluid buildup around the heart and lungs, lower ability of the lung in absorbing oxygen)

  • If you have any of these symptoms, contact your doctor right away.
    • fever
    • shortness of breath, difficulty breathing, wheezing
    • unusual weight gain
    • unusual or severe swelling of arms, hands, legs, ankles, feet
    • pain or tightness in chest
    • bone pain
    • yellowing of the skin or eyes
    • trouble with passing urine
Get emergency medical help right away

Side effects and what to do When to contact doctor?
Less Common Side Effects, but may be Severe

Kidney problems
(lower back pain, body swelling, passing little or no urine, or recent unusual weight gain)

Get emergency medical help right away

Increased pressure in the brain (may include headaches with pain behind the eye/with eye movement, changes or loss in eye sight)

Get emergency medical help right away

Heart problems
(irregular heartbeat, chest pain, fainting, swelling in legs/ankles/belly, shortness of breath)

Get emergency medical help right away

Fullness/pain in the ear; hearing loss



Contact your health care team as soon as possible (office hours)

Lung problems
(increased cough, breathing problems, chest pain, coughing blood)

Get emergency medical help right away
Blockage of an artery (blood vessel) in your heart, brain, chest, belly, or limbs; this may result in stroke (sudden loss of vision, speech, or the use of your limb(s)) or heart attack (chest pain, shortness of breath), or pain in chest, belly or limb Get emergency medical help right away

Increased calcium levels in the blood
(confusion, severe muscle weakness, seizures, irregular heartbeat)

Get emergency medical help right away

Rapid killing of cancer cells when you start treatment may lead to build up of cell waste products

  • If mild, this may cause gout, with joint pains, but if severe, may cause fevers, kidney failure, confusion and be life-threatening.
  • You MUST take the preventive medicines given by your doctor AND
  • Drink plenty of fluids (6-8 glasses per day) and void (urinate) frequently.


Get emergency medical help right away

Sweets syndrome

  • Severe rash with other symptoms, such as fever.
  • May include effects on other organs.
Get emergency medical help right away

Pancreas problems
(increased pain in centre of belly and may extend to the back, appetite or weight loss)

Get emergency medical help right away
Blood clot (limb pain or swelling, hardened vein in limb), may occur in lungs (sudden start of coughing, breathing problems, chest pain, coughing blood) Get emergency medical help right away

For more links on how to manage your symptoms go to

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.