You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

arsenic trioxide

( AR-se-nik tri-OX-ide )
Funding:
New Drug Funding Program
  • Arsenic Trioxide - First Line Consolidation of Acute Promyelocytic Leukemia (APL)
  • Arsenic Trioxide - First Line Induction of Acute Promyelocytic Leukemia (APL)
  • Arsenic Trioxide - Relapsed_Refractory Induction of Acute Promyelocytic Leukemia (APL)
  • Arsenic Trioxide - Relapsed_Refractory Consolidation of Acute Promyelocytic Leukemia (APL)
Other Name(s): Trisenox® (Lundbeck)
Appearance: clear, colourless solution mixed into larger bags of fluids

Medication Information Sheet
arsenic trioxide (AR-se-nik tri-OX-ide)
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: Trisenox®

 

Appearance:
clear, colourless solution mixed into larger bags of fluids

 

What is this medication for?
  • For treating a type of leukemia called acute promyelocytic leukemia (APL)

     

What should I do before I have this medication?
  • Tell your doctor and pharmacist if you have/had significant medical condition(s), especially if you have / had heart (including irregular heartbeat), liver or kidney problems, diabetes or any allergies.
  • People who have cancer or leukemia are at a higher risk of developing other cancers/leukemias (usually some years later) or blood clots. Some cancer medications may increase these risks, especially if used for a prolonged period of time. You should discuss any concerns with your doctor.
How will this medication affect sex, pregnancy and breastfeeding?
  • Arsenic trioxide can harm the unborn baby and should not be used by pregnant women.
  • 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 while receiving this drug: Keep using birth control until 3 months after the last dose. Discuss with your healthcare team.
  • Tell your doctor right away if you or your partner becomes pregnant.
  • Do not breastfeed while taking this drug and for 3 months after treatment ends.
  • Effects on Fertility: Probable
  • Effects on Fertility: Probable
How is this medication given?
  • This drug is given by injection into a vein.

  • The infusion is usually given over 1 to 2 hours, but may last longer if side effects like flushing and dizziness occur.
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.
What are the side effects of this medication?

Common side effects usually occur in more than 1 out of every 10 patients. Other side effects are less common, but may be severe. You may not have all of the side effects below. You may have side effects that are not listed. Discuss with your health care team if you have any unusual or bothersome symptoms.

Side effects and what to doWhen to contact doctor?
More Common Side Effects

Nausea and vomiting

  • 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

Tiredness

  • Rest often; take naps if needed. Move slowly when getting up.
  • Eat well-balanced meals and drink plenty of fluids. Light exercise may help.
  • Do not drive a motor vehicle or operate machinery when feeling tired.
Contact your health care team if no improvement or if severe

APL differentiation syndrome (can be severe)

  • Watch for any unusual symptoms such as sudden weight gain, fever, chest pain, cough, shortness of breath or difficulty breathing. 
  • You may be asked to weigh yourself everyday during your treatment.

 

Get emergency medical help right away

Diarrhea

  • Drink plenty of clear fluids. Limit hot, spicy, fried foods, foods/drinks with caffeine, orange or prune juice. Try a low-fiber BRAT diet (Bananas, white Rice, Apple sauce, Toast made with white bread).
  • Take anti-diarrhea drug(s) if given to you by your doctor.
  • Also see Diarrhea pamphlet.*

 

Contact your health care team if no improvement or if severe

Pains or cramps in the belly

  • Treat constipation or diarrhea.
  • May be due to other causes; check with your doctor or nurse if pain is severe, does not go away or worsens.
Contact your health care team if no improvement or if severe

Irregular heartbeat, fainting; Persistent fast heartbeat, pounding sensation

  • Your doctor will monitor your heartbeat regularly during your treatment.
Get emergency medical help right away

High white blood cell count

  • Your doctor will monitor your blood counts regularly.
Contact your health care team if no improvement or if severe

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

High blood sugar (increased thirst, urinates frequently)

  • Check your blood sugar if you have diabetes.
Contact your health care team if no improvement or if severe

Rash; dry, itchy skin

  • Stay out of the sun; wear sunblock, a hat and cover exposed skin.
  • Use daily moisturizer.
  • May be severe, including skin peeling; get emergency medical help right away if this occurs.
Contact your health care team if no improvement or if severe

Headache; mild joint, muscle pain or cramps 

  • Take painkiller(s) as directed, if given to you by your doctor.
  • Otherwise, take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Rest often, but may try light exercise.

 

Contact your health care team if no improvement or if severe

Tingling, numb fingers and toes

  • May slowly return to normal after treatment ends.
  • Contact your doctor or nurse if you have trouble doing up buttons, writing, picking up small objects, have pain or trouble with movement.
Contact your health care team if no improvement or if severe

Salt imbalances
(muscle twitching, severe weakness or cramping, confusion, irregular heartbeat)

Get emergency medical help right away

Low blood pressure; dizziness

  • It may happen when the drug is being given. Let your healthcare team know right away if it occurs.
  • Try to get up and move slowly.
  • Do not drive a motor vehicle or operate machinery if dizzy.
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

Poor Appetite; don't feel like eating; weight loss

  • Eat foods that you like and try to eat regular small meals.
  • Use meal supplements if possible.  See a dietitian.
Contact your health care team if no improvement or if severe

Unusual bleeding or bruising

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

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 (or 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
 
Side effects and what to doWhen to contact doctor?
Less Common Side Effects, but may be 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

Seizures, confusion or muscle weakness
These symptoms may be due to high blood levels of arsenic.

Get emergency medical help right away

Inflammation of blood vessels in the skin or in the body

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

Allergic reaction (severe rash, itchiness, flushing, dizziness, swollen face, lip or tongue, chest or throat tightness)

  • May occur during or shortly after the drug is given
Get emergency medical help right away

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

Get emergency medical help right away

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

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

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

For more links on how to manage your symptoms go to www.cancercare.on.ca/symptoms.

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.