Tretinoin

Say it: TRET-i-noyn

Tretinoin is a pill made from vitamin A that helps leukemia cells in acute promyelocytic leukemia grow up into normal cells.

What it is

In acute promyelocytic leukemia (APL), a faulty protein keeps young blood cells stuck at an early stage. Tretinoin, also called all-trans retinoic acid (ATRA), helps these cells mature into normal white blood cells. It is usually given with arsenic trioxide or chemotherapy.

Often used for

• acute promyelocytic leukemia (APL)

How you get it

Tretinoin is a capsule you take by mouth twice a day. It is usually started in the hospital and taken until the leukemia goes into remission, and then on and off for several months. Your schedule may be different.

Common side effects and what helps

• Headache. Ask your team what pain medicine is safe.
• Dry skin, lips and mouth. Use lip balm and a gentle moisturizer.
• Fever. Tell your team, since it can be a sign of infection or differentiation syndrome.
• Bone pain. Ask your team about pain medicine.
• Nausea or vomiting. Eat small meals and ask about anti-nausea medicine.
• Rash, itching or sweating. Use gentle soap and keep cool.
• Earache or a feeling of fullness in the ears. Tell your team.

Call your care team right away if you have

• Fever, trouble breathing, cough, chest pain, fast weight gain, swelling, dizziness, or urinating less, which can be signs of differentiation syndrome
• A bad headache with nausea, vomiting or vision changes, which can be a sign of pressure in the brain
• Bleeding that will not stop, black or bloody stools, vomiting blood, or coughing up blood
• Yellow skin or eyes, or dark urine
• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills

Before you start, tell your team

• If you are pregnant, may become pregnant, or are breastfeeding
• If you take vitamin A supplements
• If you take tetracycline antibiotics (like doxycycline or minocycline)
• If you have high cholesterol or liver problems
• All the medicines you take, including vitamins, herbs and supplements

Good to know

• Tretinoin can cause differentiation syndrome, a serious reaction where leukemia cells mature quickly. It can be life threatening, but it is treatable with steroids if caught early.
• It can cause severe birth defects. People who can become pregnant need pregnancy tests and must use two forms of birth control during treatment and for 1 month after.
• It can raise white blood cell counts, blood fats and liver tests. You will have frequent blood tests.
• It can raise pressure around the brain, especially with tetracycline antibiotics.

At home

• Take the capsules twice a day with food, at about the same times each day.
• Swallow capsules whole. Do not open or chew them.
• Do not take extra vitamin A.
• If you miss a dose, ask your care team what to do. Do not take two doses to make up for it.
• Store at room temperature, away from light, children and pets.

Questions to ask

• How long will I take this medicine?
• What warning signs of differentiation syndrome should I watch for?
• What birth control should I use?
• What other APL treatment will I get with it?

Part of these treatment plans

• ATRA and ATO

Side effect guides

• Nausea and vomiting
• Low white blood cells and infection risk
• Skin rash (including EGFR-inhibitor rash)
• Pain

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.