tretinoin 45gm Carbamazepine: (Moderate) Concurrent use of hepatic cytochrome P450 inducers, such as carbamazepine, with oral tretinoin therapy may result in significant decreases in serum tretinoin levels. differin galderma gel acne counter fda approval announces use Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. No specific studies have been done with oral tretinoin and rifabutin, however, patients should be closely monitored for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. Most improvement is noted during the first 24 weeks of treatment. It is not intended to be a substitute for the exercise of professional judgment. In 13 patients who had received oral tretinoin daily for 4 consecutive weeks, a 72% increase in mean tretinoin plasma AUC was observed when ketoconazole (400 mg to 1200 mg PO) was given 1 hour before the tretinoin dose. No specific studies have been done with oral tretinoin and other inhibitors of CYP450 isoenzymes (such as cimetidine, cyclosporine, diltiazem, erythromycin, and verapamil), however, patients should be closely monitored for tretinoin toxicity while receiving concomitant therapy.

Levoketoconazole: (Major) Concurrent oral tretinoin therapy with drugs that inhibit the hepatic cytochrome (CYP) P450 enzyme system can result in significant increases in serum tretinoin levels. Tranexamic Acid: (Major) Rare cases of fatal thrombotic complications have been reported in patients treated with systemic all-trans retinoic acid (ATRA) or tretinoin and the use of antifibrinolytic agents, like tranexamic acid. Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. kn[cUb>ayL1h There is a high risk of birth defects if oral tretinoin is administered during pregnancy. Approximately 25% of patients who receive tretinoin for the treatment of acute promyelocytic leukemia have experienced acute promyelocytic leukemia differentiation syndrome. Methotrexate: (Moderate) Concomitant use of systemic retinoids, such as tretinoin, and methotrexate could increase risk of liver-related side effects of methotrexate and such patients should be monitored closely during methotrexate therapy. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Interferon Alfa-n3: (Moderate) Use of alpha interferons are associated with myelosuppression; additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives. Platelet Inhibitors: (Moderate) An additive risk of bleeding may occur when platelet inhibitors are used with agents that cause clinically significant thrombocytopenia including antineoplastic agents, such as tretinoin. Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. Acetohexamide: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as sulfonylureas, as concomitant use may augment phototoxicity. Trifluoperazine: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as phenothiazines, as concomitant use may augment phototoxicity.

The reduction in digoxin tablet absorption has resulted in plasma concentrations that are 50% of pretreatment levels and has been clinically significant in some patients. [48167] [55916]. Simultaneous use of retinoids and topical drying agents, such as salicylic acid, can potentiate the drying effects of retinoids on the skin. Filgrastim, G-CSF: (Major) Filgrastim induces the proliferation of neutrophil-progenitor cells, and, because antineoplastic agents exert toxic effects against rapidly growing cells, filgrastim is contraindicated for use during the 24 hours before or after cytotoxic chemotherapy. Patients who achieved a hematologic CR received 3 multi-agent chemotherapy consolidation courses containing anthracyclines and cytarabine.

Gentamicin: (Moderate) The concomitant use of systemic tretinoin, ATRA and systemic gentamicin should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). Patients with high-risk APL received: idarubicin 5 mg/m2/dose IV on days 1, 2, 3, 4, and 4 and cytarabine 1,000 mg/m2/day IV on days 1, 2, 3, and 4 (course 1); mitoxantrone 10 mg/m2/dose IV on days 1, 2, 3, 4, and 5 and etoposide 100 mg/m2/dose IV on days 1, 2, 3, 4, and 5 (course 2); and idarubicin 12 mg/m2/dose IV on day 1, cytarabine 150 mg/m2 subcutaneously every 8 hours on days 1, 2, 3, 4, and 5, and 6-thioguanine 70 mg/m2 PO every 8 hours on days 1, 2, 3, 4, and 5 (course 3). hbbd``b`$v H 1K:Rr "$@m .H?Y@BHLH?c`bd`Y8JK?SB ` The distribution of tretinoin has not been determined. hYn8`E( N Nwm[3|Vtv!S$yJR0, '"&R >#:|NZ BN|pp During the early weeks of treatment, an apparent exacerbation of inflammatory lesions may occur.

Cortisone: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. GI bleeding / Delayed / 34.0-34.0disseminated intravascular coagulation (DIC) / Delayed / 26.0-26.0arrhythmia exacerbation / Early / 23.0-23.0pleural effusion / Delayed / 20.0-20.0visual impairment / Early / 17.0-17.0increased intracranial pressure / Early / 9.0-9.0intracranial bleeding / Delayed / 9.0-9.0heart failure / Delayed / 6.0-6.0hearing loss / Delayed / 6.0-6.0pulmonary edema / Early / 3.0-3.0laryngeal edema / Rapid / 3.0-3.0peptic ulcer / Delayed / 3.0-3.0cardiomyopathy / Delayed / 3.0-3.0pericarditis / Delayed / 3.0-3.0pulmonary hypertension / Delayed / 3.0-3.0myocarditis / Delayed / 3.0-3.0myocardial infarction / Delayed / 3.0-3.0cardiac arrest / Early / 3.0-3.0stroke / Early / 3.0-3.0agnosia / Delayed / 3.0-3.0seizures / Delayed / 3.0-3.0coma / Early / 3.0-3.0renal failure (unspecified) / Delayed / 3.0-3.0renal tubular necrosis / Delayed / 3.0-3.0erythema nodosum / Delayed / Incidence not knowndifferentiation syndrome / Delayed / Incidence not knownpericardial effusion / Delayed / Incidence not knownhypervitaminosis A / Delayed / Incidence not knownpancreatitis / Delayed / Incidence not knownthrombosis / Delayed / Incidence not knownpapilledema / Delayed / Incidence not knownspontaneous fetal abortion / Delayed / Incidence not knownteratogenesis / Delayed / Incidence not known, bone pain / Delayed / 77.0-77.0dyspnea / Early / 60.0-60.0elevated hepatic enzymes / Delayed / 50.0-60.0hyperlipidemia / Delayed / 0-60.0bleeding / Early / 60.0-60.0fluid retention / Delayed / 29.0-52.0peripheral edema / Delayed / 52.0-52.0stomatitis / Delayed / 26.0-26.0constipation / Delayed / 17.0-17.0wheezing / Rapid / 14.0-14.0hypotension / Rapid / 14.0-14.0depression / Delayed / 14.0-14.0phlebitis / Rapid / 11.0-11.0hypertension / Early / 11.0-11.0confusion / Early / 11.0-11.0flank pain / Delayed / 9.0-9.0hepatomegaly / Delayed / 9.0-9.0splenomegaly / Delayed / 9.0-9.0dysuria / Early / 9.0-9.0edema / Delayed / 6.0-6.0hallucinations / Early / 6.0-6.0ascites / Delayed / 3.0-3.0hepatitis / Delayed / 3.0-3.0impaired cognition / Early / 3.0-3.0ataxia / Delayed / 3.0-3.0dysarthria / Delayed / 3.0-3.0aphasia / Delayed / 3.0-3.0encephalopathy / Delayed / 3.0-3.0thrombocytosis / Delayed / 0-1.0erythema / Early / 10.0hypoxia / Early / Incidence not knownrespiratory depression / Rapid / Incidence not knownpseudotumor cerebri / Delayed / Incidence not knownhypertriglyceridemia / Delayed / Incidence not knownhypercholesterolemia / Delayed / Incidence not knownhypercalcemia / Delayed / Incidence not known, headache / Early / 86.0-86.0fever / Early / 83.0-83.0fatigue / Early / 66.0-66.0malaise / Early / 66.0-66.0shivering / Rapid / 63.0-63.0vomiting / Early / 57.0-57.0nausea / Early / 57.0-57.0rash / Early / 54.0-54.0leukocytosis / Delayed / 40.0-40.0abdominal pain / Early / 31.0-31.0weight gain / Delayed / 23.0-23.0diarrhea / Early / 23.0-23.0flushing / Rapid / 23.0-23.0otalgia / Early / 23.0-23.0dizziness / Early / 20.0-20.0diaphoresis / Early / 20.0-20.0anorexia / Delayed / 17.0-17.0weight loss / Delayed / 17.0-17.0anxiety / Delayed / 17.0-17.0paresthesias / Delayed / 17.0-17.0alopecia / Delayed / 14.0-14.0myalgia / Early / 14.0-14.0dyspepsia / Early / 14.0-14.0insomnia / Early / 14.0-14.0agitation / Early / 9.0-9.0pallor / Early / 6.0-6.0asterixis / Delayed / 3.0-3.0weakness / Early / 3.0-3.0tremor / Early / 3.0-3.0hyporeflexia / Delayed / 3.0-3.0drowsiness / Early / 3.0-3.0hypothermia / Delayed / 3.0-3.0increased urinary frequency / Early / 3.0-3.0skin hyperpigmentation / Delayed / 2.0-2.0skin hypopigmentation / Delayed / 2.0-2.0skin irritation / Early / 10.0pruritus / Rapid / 20.0xerosis / Delayed / 10.0photosensitivity / Delayed / Incidence not knownvesicular rash / Delayed / Incidence not known. Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity.

Resistance to tretinoin may develop due to pharmacokinetic reasons (decreased bioavailability) and/or changes in proteins involved in the cellular activity of tretinoin. Concurrent application of these agents on areas treated with tretinoin should be avoided. No specific studies have been done with oral tretinoin and cyclosporine, however, patients should be closely monitored for tretinoin toxicity while receiving concomitant therapy. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Responding patients continued tretinoin therapy beyond 12 weeks (mean duration, 27 +/- 7 weeks; range, 16 to 36 weeks) and the median time to response and time to disease progression in these patients were 56 and 332 days, respectively. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Altinac:- Do not freeze- Store at controlled room temperature (between 68 and 77 degrees F)Altreno:- Protect from freezing- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees FAtralin:- Protect from freezing- Store at controlled room temperature (between 68 and 77 degrees F)AVITA:- Store below 86 degrees FRefissa:- Do not freeze- Store at controlled room temperature (between 68 and 77 degrees F)Renova:- Store at 77 degrees F; excursions permitted to 59-86 degrees FRetin-A:- Store below 86 degrees FRetin-A Micro:- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F- Store uprightTretin-X:- Store below 86 degrees FVesanoid:- Protect from light- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F. Tretinoin is contraindicated in patients who experience retinoid hypersensitivity reactions to vitamin A or other retinoids because cross-sensitivity between agents is possible. /0WF3g=GP4v,H62dj e0YPz2)[P4\AE4'9LY!ML0 Interferon Alfa-2b; Ribavirin: (Moderate) Use of alpha interferons are associated with myelosuppression; additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives. Chlorthalidone; Clonidine: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. Budesonide; Formoterol: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. The etiology of this syndrome is unknown, but may be due to decreases in leukocyte adhesion protein activity. St. John's Wort, Hypericum perforatum: (Moderate) In theory it is possible that additive photosensitizing effects may result from the concomitant use of St. John's wort with other photosensitizing drugs such as retinoids.

Colestipol: (Moderate) The bile-acid sequesterant colestipol is well-known to cause drug interactions by binding and decreasing the oral administration of many drugs, which may include interaction with oral tretinoin; to minimize drug interactions, administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of cholestyramine or colestipol. This may be followed by a reduced dosage schedule. Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. endstream endobj 401 0 obj <. Apply a thin layer to the affected area(s) once daily. Consolidation therapy is repeated every 8 weeks for 4 cycles.

The fusion protein that is formed, PML-RAR-alpha, inhibits apoptotic pathways and blocks myeloid differentiation when present in levels greater than those of the normal RAR-alpha protein. US-based MDs, DOs, NPs and PAs in full-time patient practice can register for free on PDR.net. In one 4-arm trial, the 12-year disease-free survival (DFS) rates were not significantly different in patients who received 2 years of chemotherapy compared with no chemotherapy (68.9% vs. 69%) or in patients who received 2 years of tretinoin compared with no tretinoin (68.3% vs. 69.7%) in 318 patients who were (PCR)-negative for the PML-RARA fusion gene following induction therapy with tretinoin and idarubicin and 3 cycles of intensive consolidation therapy.The 10-year cumulative incidence of relapse was significantly decreased with 2 years of chemotherapy- and tretinoin-containing maintenance therapy in patients with a hematologic complete remission (CR) following either tretinoin or chemotherapy induction therapy and 2 cycles of consolidation therapy in another 4-arm trial; however, the 10-year overall survival rate was significantly improved with chemotherapy compared with no chemotherapy maintenance therapy (85.2% vs. 79.2%) but not with tretinoin compared with no tretinoin maintenance therapy (82.7% vs. 79.4%). Wash hands immediately after applying.Gel: Apply lightly to the affected area. Flunisolide: (Minor) Because systemically administered corticosteroids exhibit immunosuppressive effects when given in high doses and/or for extended periods, additive effects may be seen with other immunosuppressives or antineoplastic agents. )L^6 g,qm"[Z[Z~Q7%" Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances.

The microsphere gel may be applied immediately after washing the face. 22.5 mg/m2 orally twice daily (dose rounded to the nearest 10-mg increment) in combination with arsenic 0.15 mg/kg IV over 2 hours once daily until bone marrow remission or for up to a maximum of 60 days as induction therapy followed by consolidation therapy with tretinoin 22.5 mg/m2 orally twice daily (dose rounded to the nearest 10-mg increment) as continuous therapy during weeks 1 and 2 (on all 4 cycles) and during weeks 5 and 6 (on cycles 1, 2, and 3 only) in combination with arsenic trioxide 0.15 mg/kg IV daily given 5 days per week for 4 consecutive weeks (total of 20 doses/cycle). endobj Topical tretinoin 0.025% to 0.1% applied once daily to affected areas has been used in the treatment of various diseases of keratinization, often in combination with other agents. If eye contact occurs, rinse thoroughly with large amounts of water. Glimepiride: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as sulfonylureas, as concomitant use may augment phototoxicity. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Excessive application results in caking of the gel. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Cholera Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the live cholera vaccine. )p^5ij8$/%GB !Txj 62=s3/ =V-2$,QO*d)2l|R E]gdBQr&%TsL)k2I1Lz [dS<6L Ippq)I Q2G !84L8Z3]H29=!,' Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Peginterferon Alfa-2b: (Moderate) Use of alpha interferons are associated with myelosuppression; additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives.

An increased risk of bleeding may occur when thrombolytic agents are used following agents that cause clinically significant thrombocytopenia including antineoplastic agents. Captopril; Hydrochlorothiazide, HCTZ: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as thiazide diuretics, as concomitant use may augment phototoxicity. True contact allergy to tretinoin is rare. Up to 7 weeks of therapy may be required before improvement is evident. Concomitant use with other photosensitizing agents may increase the risk of a photosensitivity reaction. Systemic tretinoin is greater than 95% bound to plasma proteins, primarily albumin. Elevated hepatic enzymes has been reported in patients receiving oral tretinoin.

Tretinoin appears to prevent horny cell cohesion and to increase epidermal cell turnover and mitotic activity. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. %PDF-1.5 % Application of excessive amounts may result in 'caking' or 'pilling' and will not provide incremental efficacy. Lithium: (Moderate) The concomitant use of systemic tretinoin, ATRA and lithium should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri. Retinoid receptors are divided into retinoid X receptors (RXRs) and retinoic acid receptors (RARs); both types can be further divided into 3 subtypes: Alpha, beta, and gamma.

Barbiturates: (Moderate) Barbiturates may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. The metabolites include 13-cis retinoic acid, 4-oxo trans retinoic acid, 4-oxo cis retinoic acid, and 4-oxo trans retinoic acid glucuronide.

The significance of these spontaneous reports in terms of risk to the fetus is not known. Administration of tretinoin with another strong CYP3A4 inhibitor resulted in a 72% increase in the mean tretinoin plasma AUC. You should confirm the information on the PDR.net site through independent sources and seek other professional guidance in all treatment and diagnosis decisions. Temporary discontinuation or reduction in application frequency may be necessary until the patient is able to tolerate the treatment. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. 8nA9 p; C"_ #mG>'^#^ P$uCV">rOG}eWS;cx6g!pId=cGR[ X2=^pL] Additionally, patients who achieved a molecular CR after consolidation received up to 2 years of tretinoin-containing maintenance therapy. Thrombolytic Agents: (Moderate) Patients with thrombocytopenia are at increased risk of bleeding complications. Cream: Rub cream gently into the affected area. Rifampin: (Moderate) Rifampin may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. Chlorpromazine: (Moderate) A manufacturer of topical tretinoin states that tretinoin, ATRA should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as phenothiazines, as concomitant use may augment phototoxicity.



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