Retinoic acid (for cancer therapy)

Article Translations: (Spanish)

Generic name	Brand name
___ isotretinoin	Accutane®
___ tretinoin	Vesanoid®

How does this medicine work?

Retinoic (ret-tin-o-ick) acid interferes with the growth and development of cells. It is related to vitamin A.

How is it given?

Retinoic acid is given by mouth. It comes in capsule form and should be swallowed whole with food or milk. It should be given at regular times to keep a steady level in the bloodstream. Your child should be awake and alert when taking any medicine.

___ For children who cannot swallow capsules, put on gloves and:

• Soften the capsule in warm water. Then your child can bite or chew it.
  or
• Open the capsule in a clear plastic bag. Mix the medicine with a small amount of higher-fat food such as ice cream or peanut butter. Give it immediately, and make sure your child takes all of the mixture.
  or
• If using a feeding tube, soften the capsule in warm whole milk. Puncture or cut open the capsule and squeeze the liquid into the milk. Draw the mixture into an oral syringe and give the mixture through the feeding tube. Flush the feeding tube well with a minimum of 30ml of milk or tube feed.

Note: The medicine breaks down quickly if exposed to light and air, so it must be given right away after preparing it.

Are there any precautions about food or other medicines?

Give it with food or milk, especially higher-fat foods, to increase absorption.

Do not take vitamin supplements that contain vitamin A, because they may increase the side effects of retinoic acid.

Tell your doctor if your child is on tetracycline. Check with the doctor, nurse practitioner, or pharmacist before giving any other prescription or non-prescription medicines, herbs, or vitamins.

What should I do if a dose is missed?

If a dose is missed, please call the clinic.

What are the side effects?

Common

• dry skin
• dry mouth and nose
• swollen and sore lips
• skin sensitivity to sunlight
• skin rash, redness, flushing, or peeling
• muscle and bone aches and weakness
• blood pressure changes

Occasional

• nausea and vomiting
• changes in vision
• mood changes
• headache
• eye irritation, soreness
• high levels of fat in the blood
• high levels of liver enzymes in the blood
• muscle pains
• feeling tired

Rare

• changes in skin color
• upset stomach
• mood changes
• fluid buildup in the brain, causing headaches
• low red and white blood cell counts
• abnormality of the eyes
• retinoic acid sy­ndrome:
  
  • abnormal increase in white blood cells
  • fever
  • low blood pressure
  • trouble breathing

When should I call the doctor?

• headaches
• fever or chills
• signs of allergic reaction:
  
  • rash or hives
  • wheezing
  • trouble breathing - call 911

What else do I need to know?

This medicine can cause birth defects. Because of this, there are special safeguards. No refills are allowed, so you will need a new prescription every month. You must pick up the prescription within 7 days after it was filled.

For females of childbearing age, your provider will register you in the iPledge program.

1. Each month you will have a pregnancy test at the clinic. If it is negative, your provider will call the iPledge number, and will give you a new prescription.
2. Before you can get your prescription filled, you will need to call iPledge and:
   
   • answer some questions.
   • confirm that you have been counseled about the medicine.
   • confirm that you are using 2 forms of birth control.
   • confirm that you have had a monthly pregnancy test.
3. Before filling the prescription, the pharmacy will call iPledge to get approval.

All caregivers, especially women who are or could become pregnant, should wear gloves when handling retinoic acid. Also wear gloves when handling urine, stool, and vomit during chemotherapy and for 48 hours afterward. Urine, stool, and vomit can be safely disposed of in septic tanks and the sewer system.

Any clothing or bed linens that are contaminated with urine, stool, or vomit should be washed separately from other laundry in hot water and detergent. Anyone handling the contaminated laundry should wear gloves.

To prevent sunburn, wear sunscreen and protective clothing when outdoors. Do not use sun lamps and tanning beds.

Use moisturizers for dry skin and lips.

You and your child should know the names of all the medicines he or she is taking. Share this information with anyone involved in your child's care.

Check the label for the expiration date. Outdated medicines should be returned to your pharmacy or the clinic for disposal. Do not flush them down the toilet or throw them in the garbage.

Store all medicines in their original container and protected from heat and light. Do not store in humid places such as the bathroom. Keep them out of children's reach, locked up if possible.

If too much or the wrong kind of chemotherapy medicine is taken, call the oncology clinic right away. If your child is unconscious or has a seizure, call 911.

Questions?

This is not specific to your child but provides general information. If you have any questions, please call the oncology clinic or pharmacy.

Children's Hospitals and Clinics of Minnesota
Last reviewed 8/2015

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