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Retinoid (ATRA)

Tretinoin (Specialist drug)

Brand names: Vesanoid

Tretinoin (all-trans retinoic acid) is an oral retinoid used under specialist supervision to induce remission in acute promyelocytic leukaemia.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It promotes terminal differentiation of the abnormal promyelocytes driven by the PML-RARA fusion, allowing leukaemic cells to mature rather than proliferate.

Prescribing in practice

  • Differentiation syndrome (retinoic acid syndrome) with fever, fluid overload and respiratory distress can be life-threatening and needs prompt recognition and corticosteroid treatment.
  • It is highly teratogenic, so pregnancy must be excluded and effective contraception ensured.
  • Treatment is given by haematology specialists, commonly alongside arsenic trioxide or chemotherapy per the SPC.

Monitoring

Monitor full blood count, coagulation, liver function and for features of differentiation syndrome during induction.

Counselling the patient

  • Report breathlessness, fever, weight gain or swelling urgently as these may signal differentiation syndrome.
  • Pregnancy must be avoided; use reliable contraception as directed.
  • Headache, dry skin and lips are common and should be mentioned if troublesome.

Evidence & guidelines

Combined ATRA-based therapy is established by landmark APL trials (e.g. APL0406) and supported by haematology guidelines.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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