|Pronunciation||See pronunciation note|
|Trade names||Avita, Renova, Retin-a|
|Topical, by mouth|
|ATC code||D10AD01 (WHO) L01XX14 (WHO)|
|Protein binding||> 95%|
|Biological half-life||0.5-2 hours|
|Chemical and physical data|
|Molar mass||300.4412 g/mol|
|3D model (Jmol)||Interactive image|
|Melting point||180 °C (356 °F)|
Tretinoin is the pharmaceutical form of retinoic acid. One of several retinoids, it is the carboxylic acid form of vitamin A and is also known as all-trans retinoic acid (ATRA). It is a first generation topical retinoid commonly used topically to treat acne vulgaris. It is also used orally to treat acute promyelocytic leukemia (APL). Its isomer, isotretinoin, is also an acne drug.
It is on the World Health Organization's List of Essential Medicines, a list of the most important medications needed in a basic health system.
In topical form, this drug is pregnancy category C and should not be used by pregnant women.
People using the topical form should not also use any cream or lotion that has a strong drying effect, contains alcohol, astringents, spices, lime, sulfur, resorcinol, or aspirin, as these may interact with tretinoin or exacerbate its side effects.
Tretinoin is used to induce remission in people with acute promyelocytic leukemia who have a mutation (the t(15;17) translocation 160 and/or the presence of the PML/RARα gene) and who don't respond to anthracyclines or can't take that class of drug. It is not used for maintenance therapy.
In oral form, this drug is pregnancy category D and should not be used by pregnant women as it may harm the fetus.
Skin disease use
Topical tretinoin is only for use on skin and it should not be applied to eyes or mucosal tissues. Common side effects include skin irritation, redness, swelling, and blistering. Skin is more susceptible to sunburn.
There are many significant side effects from this drug that include malaise (66%), shivering (63%), hemorrhage (60%), infections (58%), peripheral edema (52%), pain (37%), chest discomfort (32%), edema (29%), disseminated intravascular coagulation (26%), weight increase (23%), injection site reactions (17%), anorexia (17%), weight decrease (17%), and myalgia (14%).
Respiratory side effects usually signify retinoic acid syndrome, and include upper respiratory tract disorders (63%), dyspnea (60%), respiratory insufficiency (26%), pleural effusion (20%), pneumonia (14%), rales (14%), and expiratory wheezing (14%), and many others at less than 10%.
Around 23% of people taking the drug have reported eararche or a feeling of fullness in their ears.
Gastrointestinal disorders include bleeding (34%), abdominal pain (31%), diarrhea (23%), constipation (17%), dyspepsia (14%), and swollen belly (11%) and many others at less than 10%.
In the cardiovascular system, side effects include arrhythmias (23%), flushing (23%), hypotension (14%), hypertension (11%), phlebitis (11%), and cardiac failure (6%) and for 3% of patients: cardiac arrest, myocardial infarction, enlarged heart, heart murmur, ischemia, stroke, myocarditis, pericarditis, pulmonary hypertension, secondary cardiomyopathy.
In the urinary system, side effects include renal insufficiency (11%) and several others at less than 10% frequency.
Mechanism of action
For its use in cancer, its mechanism of action is unknown, but on a cellular level, laboratory test show that tretinoin forces APL cells to differentiate and stops them from proliferating; in people there is evidence that it forces the primary cancerous promyelocytes to differentiate into their final form, allowing normal cells to take over the bone marrow.
For its use in acne, the mechanism is unknown, but again on a cellular level there is evidence that it decreases the ability of epithelial cells in hair follicles to stick together, leading to fewer blackheads; it also seems to make the epithelial cells divide faster, causing the blackheads to be pushed out.
Tretinoin was co-developed for its use in acne by James Fulton and Albert Kligman when they were at University of Pennsylvania in the late 1960s. The University of Pennsylvania held the patent for Retin-A, which it licensed to pharmaceutical companies.
The origin of the name tretinoin is uncertain, although several sources agree (one with probability, one with asserted certainty) that it probably comes from trans- + retinoic [acid] + -in, which is plausible given that tretinoin is the all-trans isomer of retinoic acid. The name isotretinoin is the same root tretinoin plus the prefix iso-. Regarding pronunciation, the following variants apply equally to both tretinoin and isotretinoin. Given that retinoic is pronounced //, it is natural that // is a commonly heard pronunciation. Dictionary transcriptions also include // (trə-TIN-oh-in) and //.
- Baldness treatments
- Hypervitaminosis A syndrome
- Talarozole, an experimental drug potentiating the effects of tretinoin
- Erythromycin/tretinoin, a combionation of tretinoin and the antibiotic erythromycin
- "www.who.int" (PDF).
- Topical Cream Gel Liquid Label
- Arthur W. Perry (2007). Straight talk about cosmetic surgery. Yale University Press. p. 63. ISBN 978-0-300-12104-9.
- Oral Label
- Huang M, Ye Y, Chen S, Chai J, Lu J, Zhoa L, Gu L, Wang Z (1988). "Use of all-trans retinoic acid in the treatment of acute promyelocytic leukemia" (PDF). Blood. 72 (2): 567–72. PMID 3165295.
- Castaigne S, Chomienne C, Daniel M, Ballerini P, Berger R, Fenaux P, Degos L (1990). "All-trans retinoic acid as a differentiation therapy for acute promyelocytic leukemia. I. Clinical results" (PDF). Blood. 76 (9): 1704–9. PMID 2224119.
- Vivant Pharmaceuticals, LLC Press Release. July 10, 2013, Vivant Skin Care Co-founder James E. Fulton, MD, Loses Colon Cancer Battle
- Denis Gellene for the New York Times. Feb 22, 2010. Dr. Albert M. Kligman, Dermatologist, Dies at 93
- Merriam-Webster, Merriam-Webster's Unabridged Dictionary, Merriam-Webster.
- Oxford Dictionaries, Oxford Dictionaries Online, Oxford University Press.
- Houghton Mifflin Harcourt, The American Heritage Dictionary of the English Language, Houghton Mifflin Harcourt.
- Merriam-Webster, Merriam-Webster's Medical Dictionary, Merriam-Webster.
- Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
- Ralph M. Trüeb. The Difficult Hair Loss Patient: Guide to Successful Management of Alopecia and Related Conditions. Springer, 2015. ISBN 9783319197012 Pg. 95
- Rogers, N; Avram, M (October 2008). "Medical treatments for male and female pattern hair loss.". Journal of the American Academy of Dermatology. 59 (4): 547–566. doi:10.1016/j.jaad.2008.07.001. PMID 18793935.
- Tretinoin AHFS Consumer Medication Information at PubMed Health