Approximately 15% of a topically applied dose is excreted in the urine within 24 hours. Apply a thin layer of topical tretinoin to the affected area(s) once daily at bedtime. Monitor for decreased clinical effects while receiving concomitant therapy. The 5-year DFS rate was significantly improved with 1 year of tretinoin maintenance therapy compared with observation only (61% vs. 36%) in patients who achieved a CR following either tretinoin or chemotherapy induction therapy and 2 cycles of consolidation therapy in another randomized study. 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.
Fluticasone: (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. Ketoconazole: (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. In patients receiving orally-administered retinoids along with orlistat, close monitoring is recommended. 
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. There have been 30 case reports of temporally-associated, congenital malformations during 25 years of clinical use of Retin-A. Patients who may have considerable sun exposure due to their occupation and those patients with inherent sensitivity to sunlight should exercise particular caution when using topical tretinoin. Ticlopidine: (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. Up to 7 weeks of therapy may be required before improvement is evident. Send the page ""
After induction therapy with tretinoin, all patients should receive standard consolidation and/or maintenance therapy for APL unless otherwise contraindicated. Pregnancy testing and counseling should occur monthly during oral tretinoin therapy. 45 mg/m2/day PO once daily or divided every 12 hours alone or with regimens containing 6-mercaptopurine and methotrexate for 1 to 2 years following induction and consolidation therapy has been studied in randomized clinical trials. No specific studies have been done with oral tretinoin and rifapentine, however, patients should be closely monitored for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. 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. Perphenazine; Amitriptyline: (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. Metolazone: (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. Weather extremes, such as wind or cold, also may be irritating to patients receiving tretinoin. Rifabutin: (Moderate) Rifabutin may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. Ibuprofen; Oxycodone: (Moderate) The concomitant use of systemic tretinoin, ATRA and ibuprofen should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). Cq_TsSyXJf74ej:Y@fhETBV$8@mv*W#m |%#2?$h%9q A#"!xW+ >B%$ 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. Concomitant use of other photosensitizing agents like retinoids may increase the risk of a photosensitivity reaction. The bacterium involved in acne, Propionibacterium acnes, and sebum production are unaffected. Thrombolytic Agents: (Moderate) Patients with thrombocytopenia are at increased risk of bleeding complications. Formoterol; Mometasone: (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. Tolazamide: (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. 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. Monitor for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. endstream
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Tbo-Filgrastim: (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. Resistance to tretinoin may develop due to pharmacokinetic reasons (decreased bioavailability) and/or changes in proteins involved in the cellular activity of tretinoin. Glimepiride; Rosiglitazone: (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. 7,Eu+W2'b 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. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Tretinoin; Benzoyl Peroxide: (Moderate) Benzoyl peroxide can potentiate the skin irritation caused by topical tretinoin. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. Mean peak plasma concentrations are 347 +/- 266 ng/ml and occur between 1 and 3 hours after dosing. Wash hands immediately after applying. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. sEXFM3
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}W3;)P;vo]:@/wmAO[C4p8\(O,j3Nf}^w;{` Topical retinoid products do not appear to pose this increased risk for liver problems. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. endstream
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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. Aliskiren; 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. Similar interactions may occur with other systemic azole antifungals, such as voriconazole. Patients must be carefully monitored for any signs or symptoms of this syndrome. No specific studies have been done with oral tretinoin and rifampin, however, patients should be closely monitored for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. hZko+`"c54uA([q! If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Felbamate: (Moderate) Felbamate may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. There is a high risk of birth defects if oral tretinoin is administered during pregnancy. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. Patients with hepatic disease could be more prone to developing this condition. Because there is no strong rationale for avoiding clozapine in patients treated with these drugs, consider increased absolute neutrophil count (ANC) monitoring and consult the treating oncologist. hbbd``b`$g > Dy! Tirofiban: (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. 93 0 obj <>stream The metabolites include 13-cis retinoic acid, 4-oxo trans retinoic acid, 4-oxo cis retinoic acid, and 4-oxo trans retinoic acid glucuronide. 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. Systemic tretinoin is greater than 95% bound to plasma proteins, primarily albumin. hwTTwz0z.0. For relief, some patients may require treatment with analgesics or lumbar puncture. Losartan; 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. 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. 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. Mometasone: (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. Verteporfin is a light-activated drug used in photodynamic therapy; all patients treated with verteporfin will be photosensitive. To minimize drug interactions, administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of cholestyramine. Candesartan; 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. This is thought to be due to the persistent procoagulant tendency often associated with systemic tretinoin therapy. Ropeginterferon 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. 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%). Aspirin, ASA; Dipyridamole: (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. This may be followed by a reduced dosage schedule.[55917]. 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. Stored tap water should also not be used for dilution since it may contain microorganisms. /0WF3g=GP4v,H62dj e0YPz2)[P4\AE4'9LY!ML0 Digoxin: (Moderate) Some antineoplastic agents have been reported to decrease the absorption of digoxin tablets due to their adverse effects on the GI mucosa; the effect on digoxin liquid is not known. Glyburide: (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 be closely monitored for decreased clinical effects of tretinoin while receiving concomitant therapy. If tolerated, this should not be considered a reason to discontinue therapy. Clopidogrel: (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. Treatment with tretinoin reverses the bleeding diathesis seen in APL, before any morphologic response is noted. Tretinoin appears to induce its own metabolism. Thyroid hormones: (Moderate) The concomitant use of systemic tretinoin, ATRA and thyroid hormones should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). hbbd``b`@)HpX\q)a bl ~ cH0@\3 "'Xe 1 !b(q{@, rf=&F ;.@ sq Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. Register Now. Dexamethasone: (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. High initial leukocyte counts or rapidly increasing leukocyte counts during treatment may be predictive of retinoic acid-acute promyelocytic leukemia (RA-APL) syndrome (see Adverse Reactions). Tretinoin was administered for a median of 32 days (range, 1 to 56 days) during induction therapy. According to the manufacturers, breast-feeding should be discontinued prior to receiving oral tretinoin and caution should be used with topical tretinoin. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. Codeine; Phenylephrine; Promethazine: (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. Be alert for signs of skin irritation, the offending topical agents may need to be used less often or discontinued during retinoid therapy. The numerous effects of retinoids reflect the complex biology of the nuclear receptors that mediate retinoid activity. 45 mg/m2/day PO in 2 divided doses until complete remission (CR) to a maximum of 45 or 90 days plus idarubicin 12 mg/m2/dose IV on days 2, 4, 6, and 8 has been evaluated in 2 clinical trials (AIDA 0493 study; AIDA 2000 study). Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. Systemic absorption of tretinoin after topical application is low , and therefore it is unlikely that a significant amount of the drug is excreted into breast-milk. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Rifapentine: (Moderate) Rifapentine may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. 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. endstream endobj startxref Following topical application, a minimal amount of drug is absorbed systemically. Bendroflumethiazide; Nadolol: (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. Oral tretinoin therapy requires an experienced clinician and requires a specialized care setting. Oral tretinoin should be used cautiously in patients with hyperlipidemia. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj The manufacturer recommends the immediate initiation of high-dose steroids if signs and symptoms of RA-APL are present together with leukocytosis. Early signs and symptoms include papilledema, headache, nausea, vomiting, and visual disturbances. Temporary discontinuation or reduction in application frequency may be necessary until the patient is able to tolerate the treatment.
Eravacycline: (Major) Avoid the concomitant use of systemic tretinoin and eravacycline due to the potential for increased cranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Wash hands immediately after applying.Gel: Apply lightly to the affected area. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. Approximately 25% of patients who receive tretinoin for the treatment of acute promyelocytic leukemia have experienced acute promyelocytic leukemia differentiation syndrome. Hydrocodone; Ibuprofen: (Moderate) The concomitant use of systemic tretinoin, ATRA and ibuprofen should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine. Phenothiazines: (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. No specific studies have been done with oral tretinoin and rifampin, however, patients should be closely monitored for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. Most patients (74%) in this study had not received prior treatment for AIDS-related Kaposi sarcoma and 89% of patients were receiving concurrent antiretroviral therapy. %%EOF Additionally, most patients who achieved a molecular CR after consolidation received up to 2 years of tretinoin-containing maintenance therapy. <> Concomitant use with other photosensitizing agents may increase the risk of a photosensitivity reaction. Elevated hepatic enzymes has been reported in patients receiving oral tretinoin. At a median follow-up of 5 months (range, 1 to 17 months), the median disease-free survival time was 5 months and the median overall survival time was 27.3 months. Patients should be instructed to contact their health care provider if they develop pruritus or urticaria following application.[63467]. Tretinoin is administered topically and orally; an intravenous formulation is under investigation.
Phentermine; Topiramate: (Moderate) Topiramate may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. Pegfilgrastim: (Major) Pegfilgrastim induces the proliferation of neutrophil-progenitor cells, and because antineoplastic agents exert toxic effects against rapidly growing cells, pegfilgrastim should not be given 14 days before or for 24 hours after cytotoxic chemotherapy. [48167] [55916]. Brown spots begin to fade at around 68 weeks and there is a decrease in fine lines and wrinkles around 3 to 6 months. Monitor for decreased clinical effects of tretinoin, ATRA while receiving concomitant therapy. Retinoids may cause photosensitivity. %PDF-1.5 % Simultaneous use of retinoids and topical drying agents, such as salicylic acid, can potentiate the drying effects of retinoids on the skin. xS*B.C 4T0 \.LcC4.TO+cS#Ss,.@ 3l+ Pseudotumor cerebri has been reported with systemic retinoid use alone and early signs and symptoms include papilledema, headache, nausea, vomiting and visual disturbances. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. 400 0 obj <> endobj Betamethasone: (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. If tolerated, this should not be considered a reason to discontinue therapy. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. 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. %%EOF Patients who achieved a hematologic CR received 3 anthracycline-containing consolidation therapy courses. Adapalene; Benzoyl Peroxide: (Moderate) Benzoyl peroxide can potentiate the skin irritation caused by topical tretinoin. document.write(new Date().getFullYear()) PDR, LLC. Monitor for tretinoin toxicity while receiving concomitant therapy. Prednisolone: (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. $E}kyhyRm333: }=#ve :?,N B] ,s&\D,aK,PC Do}*(c`pm`eRI k,"(CRE|# '3$ $l= E(BrbHhpT.rwj#^8@PS2&{\|D-0CtWi%gci)(6-^|=BSVw/'1SX""?5hRB!oL-8p:0jLn>I]no};nvd_rOC3vQ:PJUR 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. Griseofulvin: (Moderate) Griseofulvin may increase the CYP450 metabolism of tretinoin, ATRA, potentially resulting in decreased plasma concentrations of tretinoin, ATRA. Although this interaction has not been studied, voriconazole may increase tretinoin concentrations and increase the risk of adverse reactions. If tolerated, this should not be considered a reason to discontinue therapy. If eye contact occurs, rinse thoroughly with large amounts of water. The combined actions of these enzymes can fully degrade skin collagen. <>/Metadata 125 0 R/ViewerPreferences 126 0 R>> Application of excessive amounts may result in 'caking' or 'pilling' and will not provide incremental efficacy.
This interaction may be due to inhibition of tretinoin metabolism by the azole antifungal; the precise CYP enzymes involved have not been identified, but CYP3A, 2C8 and 2E have been implicated in preliminary data.
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