All Trans-Retinoic Acid (Generic Name)
Other Names: Vesanoid®

About This Drug

All trans-retinoic acid is used to treat cancer. This drug is given by mouth (orally).

Possible Side Effects (More Common)

  • Headache. If the headache is severe, you may also have dizziness, nausea, and throwing up.
  • A serious syndrome may happen with the use of this drug which is known as Differentiation Syndrome. You may get a fever, weight gain, and breathing problems. You will be checked closely for signs of this syndrome.
  • Effects on the heart. High doses of this drug can weaken the heart and decrease heart function. Your heart function will be checked as needed. Symptoms may include:
    • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911
    • Fast heart beat or a feeling that your heart is not beating in a normal way (palpitations
    • Trouble catching your breath
    • Swelling in your feet, ankles, or leg
    • Trouble breathing when lying flat
  • Rash or skin and tissue irritation. You may have redness, peeling, dryness, or itching.
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Dry mouth
  • Flushing of your face, neck and/or chest
  • Some people have loose bowel movements (diarrhea) and some people have constipation (not able to move bowels)
  • Stomach pain
  • Gastrointestinal bleeding
  • Feeling drowsy or tired
  • Weakness
  • Feeling dizzy
  • Trouble sleeping
  • Changes in your feelings (such as feeling depressed or anxious)
  • Changes in blood pressure. In some people, the blood pressure is high and in others it is low.
  • Fever
  • Shivering
  • Sweating
  • Increased total bilirubin in your blood.  This may mean that you have changes in your liver function. Your blood work will be checked by your doctor.
  • Increase in triglyceride and cholesterol in your blood. These will be checked as needed.
  • Hair loss. Hair loss is often complete scalp hair loss and can involve loss of eyebrows, eyelashes, and pubic hair. You may notice this a few days or weeks after treatment has started. Most often hair loss is temporary; your hair should grow back when treatment is done.
  • Ear pain or fullness
  • Blood clots. A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
  • Eye problems may include:
    • Watery eyes
    • Sensitivity to bright light
    • Eye pain
    • Blurred or decreased vision
    • Dryness of the eyes
    • Inflamed eyelids or lining of the eyelids.

Possible Side Effects (Less Common)

  • Sensitivity to light (photosensitivity). Photosensitivity means that you may become more sensitive to the effects of the sun, sun lamps, and tanning beds. Your eyes may water more, most often in bright light.
  • Hearing loss

Allergic Reactions

Serious allergic reactions including anaphylaxis are rare. While you are taking this drug, call 911 right away if you have any of these symptoms of an allergic reaction:

  • trouble catching your breath
  • feeling like your tongue or throat are swelling
  • feeling your heart beat quickly  or in a not normal way (palpitations)
  • feeling dizzy or lightheaded
  • flushing, itching, rash, and/or hives

Treating Side Effects

  • Ask your doctor or nurse about medicine to help stop or lessen headache, nausea, throwing up, dry eyes, dry mouth, stomach pain, loose bowel movements, or if you are unable to have a bowel movement.
  • If you get a rash or irritated skin, do not put anything on it unless your doctor or nurse says you may. Keep the area around the irritated skin clean and dry.
  • Mouth care is very important. Your mouth care should consist of regular, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or 1/2 teaspoon of sodium bicarbonate (baking soda) in 8 ounces of water. This should be done at least after every meal and at bedtime.
  • Avoid mouthwash that contains alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • Cover up when you are out in the sun. Wear wide-brimmed hats, long-sleeved shirts, and pants. Keep your neck, chest, and back covered.
  • Use sunscreen with SPF 30 or higher when you are out in the sun even for a short time.
  • Avoid sun lamps, tanning booths, and tanning beds.
  • Keep lips moist; apply lip balm as needed.
  • Talk with your doctor or nurse about feelings of anxiety, depression and trouble sleeping.

Important Information

  • Take this medicine with food. Swallow the capsule whole.  Do not chew, break or crush the capsule.
  • Missed dose: If you miss a dose of this medication, take it as soon as you remember. If it is close to your next dose, skip the dose and take the medicine at your normal time. Do not take more than one dose at a time.
  • Keep this drug at room temperature in a dry place.

Food and Drug Interactions

There are no known interactions of this medicine with food. This drug may interact with other medicines. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to Call the Doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Fever of 100.5 F (38 C) or above
  • Chills
  • Easy bleeding or bruising
  • Nausea that stops you from eating or drinking
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Trouble breathing, new cough
  • Feeling dizzy or lightheaded
  • Severe headache that is not relieved by prescribed medicines or a headache with nausea and throwing up

Call your doctor or nurse as soon as possible if you have any of these symptoms:

  • Sudden weight gain or weight gain of five pounds or more in one week
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Nausea, throwing up, bone pain or headache that is not relieved by prescribed medication
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or feeling lightheaded
  • Hearing loss
  • Yellowing of the skin or eyes
  • Eye or problems with vision (inflamed or dry)
  • Rash, redness, peeling, dryness, or itchy skin 
  • Shivering and/or sweating episodes
  • Ear pain or fullness
  • Symptoms of a blood clot in your leg: pain, swelling, redness, and/or warmth
  • Extreme weakness or drowsiness that keeps you from doing your daily activities

Reproduction Concerns

  • Pregnancy warning: This drug is known to have harmful effects on the unborn child, so two effective methods of birth control should be used during your cancer treatment and for one month after treatment.
  • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Breast feeding warning: Women should not breast feed during treatment because this drug could enter the breast milk and seriously harm a breast feeding baby.

Revised August 2014

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