arsenic trioxide
Other Name: Trisenox®
mixed into larger bags of fluids
- For treating a type of leukemia called acute promyelocytic leukemia (APL)
Tell your health care team if you have or had significant medical condition(s), especially if you have / had:
- heart problems (including irregular heartbeat),
- liver or kidney problems,
- diabetes, or
- any allergies.
Remember to:
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Tell your health care team about all of the other medications you are taking.
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Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
Talk to your health care team about:
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How this medication may affect your sexual health.
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How this medication may affect your ability to have a baby, if this applies to you.
This medication may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance you may become pregnant, you and your partner together must use 2 effective forms of birth control at the same time until at least 6 months after your last dose. Talk to your health care team about which birth control options are best for you.
- If you are a patient that can get somebody pregnant, you and your partner together must use 2 effective forms of birth control at the same time until at least 3 months after your last dose. Talk to your health care team about which birth control options are best for you.
- Do not breastfeed while on this medication and for 3 months after the last dose.
- Arsenic trioxide is given through an IV (injected into a vein). Talk to your health care team about your treatment schedule.
- If you missed your treatment appointment, talk to your health care team to find out what to do.
- Each dose is usually given over 1 to 2 hours, but may last longer if reactions like flushing or dizziness happen.
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Will this medication interact with other medications or natural health products?
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This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
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Tell your health care team about all of your:
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prescription and over-the-counter (non-prescription) medications and all other drugs, such as cannabis/marijuana (medical or recreational)
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natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
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Check with your health care team before starting or stopping any of them.
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What should I do if I feel unwell, have pain, a headache or a fever?
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Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
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Fever can be a sign of infection that may need treatment right away.
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If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
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How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
- 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.
- 38.3°C (100.9°F) or higher at any time
If you do have a fever:- Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
- Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
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Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
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Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
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Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
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What to DO while on this medication:
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DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
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DO tell your health care team about any serious infections that you have now or have had in the past.
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DO tell your health care team if you have or have had low Vitamin B1 (thiamine) levels.
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DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
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DO talk to your health care team about your risk of getting other cancers or heart problems from this treatment.
What NOT to DO while on this medication:
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DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
The following table lists side effects that you may have when getting arsenic trioxide. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on arsenic trioxide.
Very Common Side Effects (50 or more out of 100 people) | |
Side effects and what to do | When to contact health care team |
Nausea and vomiting What to look for?
To help prevent nausea:
If you have nausea or vomiting:
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Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe. |
Fatigue What to look for?
What to do?
Ask your health care team for the Fatigue pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe. |
Cough and feeling short of breath (May be severe) What to look for?
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Talk to your health care team. If you are not able to talk to your health care team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away. |
Diarrhea What to look for?
What to do? If you have diarrhea:
Ask your health care team for the Diarrhea pamphlet for more information. |
Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day). |
Headache; Mild joint, muscle pain or cramps (May be severe) What to look for?
What to do?
Ask your health care team for the Pain pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe. |
Fast or irregular heartbeat (May be severe)
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Get emergency medical help right away. |
Too much or too little salt in your body (May be severe) What to look for?
Get emergency medical help right away for severe symptoms. |
Get emergency medical help right away for severe symptoms. |
Common Side Effects (25 to 49 out of 100 people) | |
Side effects and what to do | When to contact health care team |
Higher than normal white blood cells (lymphocytes) in the blood You may have higher white blood cell levels in the blood. This can happen in the first few weeks of treatment and may last for a few weeks or months.
Get emergency medical help right away for severe symptoms. |
Get emergency medical help right away for severe symptoms. |
Swelling in your arms or legs (May be severe) What to look for?
What to do?
If you have swelling:
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Talk to your health care team if it does not improve or if it is severe. |
High blood sugar (May be severe) What to look for?
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Talk to your health care team as soon as possible. |
Rash; dry, itchy skin (may be severe) Darkening of the skin (rare) What to look for?
What to do? To prevent and treat dry skin:
Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away. |
Talk to your health care team if it does not improve or if it is severe. |
Trouble Sleeping Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends. What to look for?
What to do? Talk to your health care team if it does not improve or if it is severe. |
Talk to your health care team if it does not improve or if it is severe. |
Pains or cramps in the belly What to look for?
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Talk to your health care team if it does not improve or if it is severe. |
Low appetite What to look for?
Ask your health care team for the Loss of Appetite pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe. |
Mood changes What to look for?
Talk to your health care team if your mood changes do not improve or if they are severe. |
Talk to your health care team if it does not improve or if it is severe. |
Neuropathy (Tingling, numb toes or fingers) (May be severe) What to look for?
In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice. |
Talk to your health care team, especially if you have trouble doing tasks like doing up buttons, writing, moving, or if you have severe pain or numbness. |
Constipation What to look for?
What to do? To help prevent constipation:
To help treat constipation:
Ask your health care team for the Constipation Pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe. |
Dizziness, low blood pressure What to look for?
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Talk to your health care team if it does not improve or if it is severe. |
Less Common Side Effects (10 to 24 out of 100 people) | |
Side effects and what to do | When to contact health care team |
Differentiation syndrome (May be severe) Differentiation syndrome is caused by a large, fast release of proteins (called cytokines) that help control your body’s immune system and fight disease. This is a serious side effect that usually happens within 1 to 2 weeks after starting your arsenic trioxide treatment, but it can also happen later into your treatment. If you have differentiation syndrome, it must be treated right away. What to look for?
If you have symptoms of differentiation syndrome, especially if they are new or severe, get emergency medical help right away. |
Get emergency medical help right away. |
Liver problems (May be severe) Your health care team may check your liver function with a blood test. The liver changes do not usually cause any symptoms.
If you have any symptoms of liver problems, get emergency medical help right away. |
Get emergency medical help right away. |
Reactions at the injection site What to look for?
What to do?
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Talk to your health care team if this bothers you. |
Low neutrophils (white blood cells) in the blood (neutropenia) (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for?
What to do? If your health care team has told you that you have low neutrophils:
If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away. |
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away. |
Low platelets in the blood (May be severe) When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for?
If your health care team has told you that you have low platelets:
If you have signs of bleeding:
If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away. |
Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away. |
Eye problems What to look for?
What to do?
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Talk to your health care team as soon as possible. |
Heartburn; stomach upset; bloating What to look for?
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Talk to your health care team if it does not improve or if it is severe. |
Flushing What to look for?
Talk to your health care team if no improvement or if severe. |
Talk to your health care team if it does not improve or if it is severe. |
High blood pressure What to look for?
What to do?
If you have a severe headache get emergency help right away as it may be a sign your blood pressure is too high. |
Talk to your health care team if it does not improve or if it is severe. |
Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:
- chest pain, unusual tiredness, shortness of breath and new pain in your belly or arms
- trouble seeing, speaking, or using your arms and legs
- confusion, memory loss, personality changes, seizures
- passing very little or no pee, or new unusual weight gain
- signs of an allergic reaction: fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness, especially during or shortly after the medication is given
- foamy, frothy, or bubbly-looking pee
- unusual red or purple patches on your skin
- muscle twitches and cramps or itchiness that won’t go away
Who do I contact if I have questions or need help?My cancer health care provider is: ______________________________________________ During the day I should contact:________________________________________________ Evenings, weekends and holidays:______________________________________________
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Other Notes:
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October 2023 Updated "How will this medication affect sex, pregnancy and breastfeeding" section
For more links on how to manage your symptoms go to www.cancercareontario.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.