Tretinoin Side Effects

Brand Names: Vesanoid

Please note - some side effects for Tretinoin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Tretinoin - for the Consumer

Tretinoin

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tretinoin:

Bone pain; dry skin and mouth; fever; hair loss; headache; increased sweating; itching; nausea; rash; tiredness; vomiting; weakness.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dizziness; hearing loss; heart attack; severe headache; shortness of breath; unusual bruising or bleeding; vision changes; weight gain.

Tretinoin Cream

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tretinoin Cream:

Redness, peeling, or feeling of warmth; sensitivity to sunlight; skin irritation; stinging at application site.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe redness, swelling, blistering, or crusting of the skin.

Tretinoin Emollient Cream

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tretinoin Emollient Cream:

Burning; dry skin; itching; peeling; redness; stinging or warmth at application site; unusual sensitivity to wind and cold.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blistering, crusting, swelling, or excessive redness of the skin; changes in skin color.

Tretinoin Gel

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tretinoin Gel:

Redness, peeling at application site; sensitivity to sunlight; skin irritation; warmth or stinging at application site.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe redness, peeling, swelling, blistering, or crusting of the skin.

Tretinoin Liquid

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tretinoin Liquid:

Redness, peeling at application site; sensitivity to sunlight; skin irritation; warmth or stinging at application site.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); change in skin color; severe redness, peeling, swelling, blistering, or crusting of the skin.

Tretinoin Side Effects - for the Professional

Tretinoin

The skin of certain sensitive individuals may become excessively red, edematous, blistered, or crusted. If these effects occur, the medication should either be discontinued until the integrity of the skin is restored, or the medication should be adjusted to a level the patient can tolerate. True contact allergy to topical Tretinoin is rarely encountered. Temporary hyper- or hypopigmentation has been reported with repeated application of a Tretinoin preparation. Some individuals have been reported to have heightened susceptibility to sunlight while under treatment with Tretinoin. To date, all adverse effects of Tretinoin have been reversible upon discontinuance of therapy.

Side Effects by Body System

General

Headache, fever, weakness, and fatigue are seldom permanent and will not usually require any interruption in therapy.

In general, almost all patients experience some tretinoin related toxicity including headache (86%), fever (83%), weakness, and fatigue. General effects related to either tretinoin or to the disease condition acute promyelocytic leukemia (APL) have been reported to include malaise (66%), shivering (63%), hemorrhage (60%), infections (58%), peripheral edema (52%), pain (37%), chest discomfort (32%), edema (29%), weight increase (23%), weight decrease (17%), flank pain (9%), cellulitis (8%), facial edema (6%), fluid imbalance (6%), pallor (6%), lymph disorders (6%), acidosis (3%), hypothermia (3%), and ascites (3%).

Other

Other side effects include a retinoic-acid-APL (RA-APL) syndrome characterized by fever, dyspnea, weight gain, radiographic pulmonary infiltrates and pleural or pericardial effusions, which has been reported in approximately 25% of patients treated with tretinoin. Impaired myocardial contractility and episodic hypotension have been reported occasionally with this syndrome. Several fatalities have been reported due to multiorgan failure.

Pseudotumor cerebri has also been reported. Side effects including isolated cases of erythema nodosum, basophilia and hyperhistaminemia, Sweet's syndrome, organomegaly, and hypercalcemia have been reported rarely.

Due to progressive hypoxia which can occur with RA-APL syndrome, endotracheal intubation and mechanical ventilation have been required in some cases.

High dose steroids (dexamethasone 10 mg intravenously administered every twelve hours for three days or until the resolution of symptoms) given at the first signs suggestive of the RA-APL syndrome (unexplained fever, dyspnea, and/or weight gain, abnormal chest auscultatory findings or radiographic abnormalities) have been reported to appear to reduce morbidity and mortality. High dose steroids should be initiated immediately regardless of the leukocyte count. However, most patients do not require discontinuation of tretinoin therapy during treatment of the RA-APL syndrome.

Approximately 40% of patients develop a rapidly evolving leukocytosis. Rapidly evolving leukocytosis has been associated with a higher risk of life-threatening complications.

Early signs of pseudotumor cerebri have been reported to include papilledema, headache, nausea, vomiting, and visual disturbances.

Hematologic

Rapidly evolving leukocytosis has been associated with a higher risk of life-threatening complications.

Although hypercholesterolemia and/or hypertriglyceridemia have been reversible upon the completion of treatment, venous thrombosis and myocardial infarction have been reported in patients who ordinarily are at low risk for these complications.

Hematologic side effects including a reversible hypercholesterolemia and/or hypertriglyceridemia (up to 60%), rapidly evolving leukocytosis (40%), and disseminated intravascular coagulation (26%) have been reported. Several cases of thrombocytosis have also been reported.

Hepatic

Liver function tests should be monitored closely during treatment. Temporary discontinuation of therapy may be appropriate if liver test results reach greater than five times the upper limit of normal values.

Hepatic side effects including elevated liver function tests (50% to 60%), hepatosplenomegaly (9%), hepatitis (3%), and unspecified liver disorder (3%) have been reported.

Dermatologic

Dermatologic side effects including skin/mucous membrane dryness (77%), rash (54%), pruritus (20%), increased sweating (20%), alopecia (14%), and skin changes (14%) have been reported.

Musculoskeletal

Musculoskeletal side effects including bone pain (77%) and bone inflammation (3%) have been reported. Isolated cases of myositis have also been reported.

Gastrointestinal

Gastrointestinal side effects including nausea/vomiting (57%), GI hemorrhage (34%), abdominal pain (31%), mucositis (26%), other gastrointestinal disorders (26%), diarrhea (23%), constipation (17%), dyspepsia (14%), anorexia (17%), abdominal distention (11%), and ulcer (3%) have been reported. Isolated cases of pancreatitis (including one case of fatal acute pancreatitis) have also been reported.

Ocular

Ocular side effects including visual disturbances (17%), ocular disorders (17%), changed visual acuity (6%), and visual field defects (3%) have been reported.

Local

Local side effects including injection site reactions (17%) have been reported.

Respiratory

The majority of respiratory side effects with the use of tretinoin are symptoms of the retinoic-acid-APL (RA-APL) syndrome (25%). This syndrome is charactered by radiographic pulmonary infiltrates and pleural or pericardial effusions among other things. Respiratory system effects including upper respiratory tract disorders (63%), dyspnea (60%), respiratory insufficiency (26%), pleural effusion (20%), pneumonia (14%), rales (14%), expiratory wheezing (14%), lower respiratory tract disorders (9%), pulmonary infiltration (6%), bronchial asthma (3%), pulmonary edema (3%), larynx edema (3%), and unspecified pulmonary disease (3%) have been reported.

Due to progressive hypoxia related to RA-APL, endotracheal intubation and mechanical ventilation have been required in some cases.

Other

Otic side effects (23%) have been reported. Hearing loss and other unspecified auricular disorders (6%) including irreversible hearing loss (less than 1%) have also been reported.

Cardiovascular

Cardiovascular side effects including arrhythmias (23%), flushing (23%), hypotension (14%), hypertension (11%), phlebitis (11%), cardiac failure (6%), cardiac arrest (3%), myocardial infarction (3%), enlarged heart (3%), heart murmur (3%), ischemia (3%), stroke (3%), myocarditis (3%), pericarditis (3%), pulmonary hypertension (3%), and secondary cardiomyopathy (3%) have been reported. Cases of thrombosis (both venous and arterial) involving various sites have been reported rarely. Several cases of vasculitis have also been reported.

Nervous system

Nervous system side effects including dizziness (20%), paresthesias (17%), anxiety (17%), insomnia (14%), depression (14%), confusion (11%), cerebral hemorrhage (9%), intracranial hypertension (9%), agitation (9%), hallucination (6%), abnormal gait (3%), agnosia (3%), aphasia (3%), asterixis (3%), cerebellar edema (3%), cerebellar disorders (3%), convulsions (3%), coma (3%), CNS depression (3%), dysarthria (3%), encephalopathy (3%), facial paralysis (3%), hemiplegia (3%), hyporeflexia (3%), hypotaxia (3%), no light reflux (3%), neurologic reaction (3%), spinal cord disorder (3%), tremor (3%), leg weakness (3%), unconsciousness (3%), dementia (3%), forgetfulness (3%), somnolence (3%), and slow speech (3%) have been reported.

Genitourinary

Genitourinary side effects including renal insufficiency (11%), dysuria (9%), acute renal failure (3%), micturition frequency (3%), renal tubular necrosis (3%), enlarged prostate (3%), and genital ulceration have been reported.

Oncologic

Oncologic side effects have been reported in animals. Animal studies have reported that tretinoin increased the rate of diethylnitrosamine-induced liver adenomas and carcinomas.

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