Tretinoin (Vesanoid): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD

When most people hear “tretinoin,” they think of acne creams and wrinkle-fighting serums.
But tretinoin (Vesanoid) in capsule form is a very different character.
This version isn’t for breakouts – it’s a powerful cancer medicine used to treat
acute promyelocytic leukemia (APL), a rare but aggressive type of blood cancer.

Because tretinoin capsules can be both life-saving and very strong, people naturally have a lot of questions:
What exactly does it do? How is it taken? What side effects should you expect? And what kinds of big red-flag
warnings should be on your radar?

Think of this guide as a clear, slightly less scary translation of the kind of information you’d see
on sites like WebMD, Mayo Clinic, DailyMed, GoodRx, Cleveland Clinic, Drugs.com, and RxList – but written
in plain English, with a bit of warmth and humor, and absolutely no medical jargon show-off.

Important: This article is for general information only and is not medical advice.
Always follow the specific instructions from your oncologist and care team for tretinoin (Vesanoid) or any cancer medicine.

What Is Tretinoin (Vesanoid)?

Tretinoin (Vesanoid) is an oral cancer medicine in the family of drugs known as
retinoids, which are related to vitamin A. It’s used to treat
acute promyelocytic leukemia (APL), a subtype of acute myeloid leukemia
where immature white blood cells (promyelocytes) build up in the bone marrow and crowd out normal blood cells.

In APL, many patients have a specific genetic change called the PML-RARα fusion,
which essentially “freezes” certain blood cells in an immature, dangerous state. Tretinoin helps “unfreeze” them,
pushing these abnormal cells to mature and die off in a more normal way.

In the United States, the brand name Vesanoid has been discontinued, but
generic tretinoin capsules are still available and used with similar dosing and precautions.

How Tretinoin Works in APL

“Re-training” Leukemia Cells

Instead of killing cancer cells outright like many traditional chemotherapies, tretinoin works more like a
strict but fair coach. It binds to receptors in leukemia cells and effectively tells them:
“You’re going to grow up now, finish maturing, and stop causing trouble.”

As these leukemic promyelocytes mature into more normal blood cells and die off, the bone marrow can
start making healthy blood cells again. This is why tretinoin is often used in the induction phase
of treatment – the goal is to quickly get a patient into remission.

Used With Other Medicines

Tretinoin is rarely a solo act. For most patients, it’s used together with:

• Arsenic trioxide, and/or
• Traditional chemotherapy agents such as anthracyclines.

These combinations have turned APL from one of the most dangerous leukemias into one with very high remission
and cure rates for many people – but only when treatment is started quickly and monitored carefully.

Who Might Receive Tretinoin (Vesanoid)?

Tretinoin capsules are used for adults and children (usually 1 year and older) who have:

• Confirmed acute promyelocytic leukemia (APL) with the typical genetic changes
  (like the PML-RARα fusion), or
• A strong suspicion of APL while genetic testing is still underway, when your doctor feels it’s too risky to wait.

Your oncology team will decide whether tretinoin is right for you based on lab tests, bone marrow studies,
risk features (such as white blood cell count), age, other medical problems, and which other treatment drugs
are available to combine with it.

How to Take Tretinoin (Vesanoid)

Standard Dosing & Schedule

The usual recommended dose for tretinoin capsules in APL is:​

• 22.5 mg per square meter (mg/m²) of body surface area, taken twice a day
• Total daily dose: 45 mg/m² per day, split into two equal doses
• Continue until complete remission is documented, then usually stop either
• 30 days after remission is confirmed, or
  after 90 days of treatment – whichever comes first

Dosing for children and people with other medical conditions is individualized and always calculated and
adjusted by the oncology team.

Never change your dose, skip doses, or stop tretinoin without talking to your cancer specialist first.

Practical Tips for Taking Your Capsules

• Swallow the capsules whole with a full glass of water. Don’t crush, break, or open them.
• Take them with food if your team recommends it – this can help with absorption and stomach comfort.
• Try to take your doses at the same times every day (for example, morning and evening).
• If you miss a dose, call your care team for instructions rather than doubling up on your own.
• Keep the medication away from children and pets; this is not a capsule anyone else should ever take by accident.

Common Side Effects of Tretinoin (Vesanoid)

Tretinoin capsules are powerful, so side effects are common. Some are annoying but manageable; others can be
serious emergencies. Here are some of the more typical day-to-day effects patients often report:​

More Common, “Nuisance” Side Effects

• Headache
• Fever or feeling “flulike”
• Fatigue or weakness
• Dry skin, chapped lips, dry mouth or nose
• Bone pain or muscle aches
• Nausea, vomiting, or decreased appetite
• Temporary swelling or weight changes

Your team may suggest strategies such as hydration, adjusting other medications, gentle moisturizers, or
dose changes to help you cope. Never start over-the-counter pain relievers or supplements without checking first –
some can interact with cancer medicines.

Side Effects That Deserve a Same-Day Call

Call your oncology clinic right away (or seek urgent care) if you notice:

• Sudden weight gain, swelling in the legs, hands, or face
• New or worsening shortness of breath, cough, or trouble breathing
• Chest pain or a feeling of tightness in the chest
• Severe or persistent headache, especially with nausea, vomiting, or vision changes
• Unusual bleeding or bruising, nosebleeds, or blood in urine/stool
• Confusion, fainting, or seizures
• Yellowing of skin or eyes, dark urine, or severe upper-right abdominal pain

Because APL and its treatment already place you at higher risk for bleeding and clotting problems, your team will
often check blood counts, clotting tests, liver function, and electrolytes very frequently while you’re on tretinoin.

Serious Warnings: What You Must Know

The official labeling for tretinoin (Vesanoid) includes several boxed warnings – the FDA’s
strongest type of warning – especially around embryo-fetal toxicity and
differentiation syndrome.

Differentiation Syndrome (Previously Called Retinoic Acid Syndrome)

Differentiation syndrome is a potentially life-threatening complication that can happen when tretinoin
suddenly pushes large numbers of leukemia cells to mature. Symptoms can include:

• Fever
• Rapid weight gain
• Shortness of breath or difficulty breathing
• Low blood pressure
• Fluid around the lungs or heart

This syndrome can progress quickly, which is why your team watches you so closely in the first weeks of treatment.
If suspected, doctors often start high-dose steroids and may temporarily pause tretinoin. Getting help early can be lifesaving.

Blood Clots, Bleeding, and Organ Complications

People with APL are already at risk for serious bleeding due to abnormal clotting, and tretinoin can shift this
balance further. Patients may also have a higher risk of blood clots, lung issues, and respiratory failure as
their disease and treatment interact.

For this reason, tretinoin is usually given in hospitals or specialized centers early on, with fast access to:

• Blood products (platelets, plasma)
• Intensive care support if needed
• Close monitoring by leukemia specialists

Pregnancy, Birth Defects, and Fertility

Like other retinoids, tretinoin is highly teratogenic – meaning it can cause serious birth defects,
pregnancy loss, and premature delivery.

Key safety rules include:

• People who can become pregnant must have a negative pregnancy test before starting treatment.
• Use two reliable forms of contraception during treatment and for at least
  one month after the last dose, unless your oncologist tells you otherwise.
• If you become pregnant (or think you might be), contact your oncology team immediately.

Your doctor may also discuss sperm banking or egg preservation before you start treatment, depending on your age,
life plans, and overall regimen.

Drug Interactions With Tretinoin (Vesanoid)

Tretinoin is processed through the liver and interacts with several other medications and supplements.
Always give your oncology team a complete list of everything you take – prescriptions, over-the-counter drugs,
vitamins, herbal products, and “natural” remedies.

Other Retinoids and Vitamin A Products

Since tretinoin is a retinoid, combining it with:

• High-dose vitamin A supplements
• Other oral or topical retinoids

may increase the risk of side effects such as liver toxicity, bone changes, or severe headache.
Your care team will usually advise you to avoid extra vitamin A while on tretinoin.

Certain Antibiotics, Antifungals, and Seizure Medicines

Some drugs can change how quickly your liver breaks down tretinoin, potentially raising or lowering its levels in
your blood. These may include:

• Azole antifungals (like ketoconazole)
• Macrolide antibiotics
• Some seizure medications
• Other drugs that strongly affect liver enzymes

Your oncologist and pharmacist will check for interactions before you start treatment and any time you add new
medications. Never start or stop prescription drugs on your own when you’re taking tretinoin.

Alcohol and Herbal Supplements

Alcohol can strain the liver, which is already working hard to handle both your disease and your medications.
Many herbal products (for example, some “liver detox” or “immune booster” blends) also affect liver enzymes or
clotting. Ask your team specifically about:

• Alcohol use (many centers recommend avoiding it entirely during treatment)
• Herbal remedies, teas, or supplements marketed for “energy,” “immune support,” or “detox”

What Do Tretinoin (Vesanoid) Capsules Look Like?

Tretinoin capsules are usually small, soft gelatin capsules (softgels), often in shades of
yellow or orange, and commonly labeled as 10 mg. Appearance can vary depending
on the generic manufacturer – shape, imprint codes, and exact color can differ.

If you’re ever unsure whether the capsule in your hand is the correct medication and dose, don’t rely on looks alone.
Double-check with your pharmacist or oncology nurse. They can compare the imprint code and packaging to confirm
that you received the right drug.

Tretinoin Dosing at a Glance (Quick Reference)

• Indication: Acute promyelocytic leukemia (APL)
• Form: Oral soft capsules (usually 10 mg)
• Typical dose: 22.5 mg/m² twice daily (total 45 mg/m²/day), up to 90 days or 30 days after remission,
  whichever comes first
• With other drugs? Often combined with arsenic trioxide and/or chemotherapy based on risk and protocols
• Key monitoring: Blood counts, clotting tests, liver function, kidney function, electrolytes, and
  signs of differentiation syndrome

Again, treat these numbers as background information only. Your actual dose and schedule belong to you and your
medical team – not the internet.

Real-World Experiences With Tretinoin (Vesanoid)

No two APL journeys look exactly the same, but many patients and caregivers describe similar themes when it comes
to tretinoin therapy. Patient-reported reviews and cancer center education resources help paint a picture of what
this drug feels like in real life.

The First Days and Weeks

For many people, the beginning of treatment is a blur: a sudden hospitalization, a scary diagnosis, and then
tretinoin capsules appearing in little paper cups by the bedside. The goal in this phase is clear:
get you into remission safely and quickly.

In the first week or two, you may notice:

• Feeling more tired than usual, even if you’re just sitting in bed
• Headaches that range from mild to “wow, that’s new”
• Flulike symptoms – low-grade fevers, chills, body aches
• Dry, tight skin and lips that demand constant moisturizer and lip balm

Nurses often become your unofficial “side-effect coaches,” offering suggestions like:

• Keeping a water bottle within reach at all times
• Using gentle, fragrance-free moisturizers and lip balms
• Reporting any sudden changes – especially shortness of breath, chest discomfort, or rapid weight gain –
  immediately, not “after a nap”

Living With Side Effects Day to Day

As treatment continues, many people settle into a rhythm of sorts, even though it’s not exactly the routine
they would have chosen. Common real-world experiences include:

• Energy ups and downs: Some days feel surprisingly normal; others feel like walking through mud.
• Body discomfort: Bone pain and muscle aches can show up in waves. Pain management strategies
  are individualized – this is something to talk through regularly with your team.
• Food and appetite changes: Some people crave salty or bland foods; others have very little appetite.
  Oncology dietitians can help you get enough calories and protein even when food doesn’t sound appealing.
• Skin changes: Dryness, sensitivity, and sometimes photosensitivity (getting sunburned more easily)
  may happen. Hats, SPF, and gentle cleansers can become your new fashion and skincare routine.

Many patients say that having a “side-effect diary” helps – jotting down what they felt, what helped, and
what made it worse. That log can be pure gold at clinic visits, where details help your team fine-tune your care.

The Emotional Side of Tretinoin Treatment

APL treatment doesn’t just affect your blood counts and organs; it also shakes up work, school, relationships,
and your sense of “normal.” People describe feelings ranging from gratitude and hope to anxiety and frustration.
It’s completely human to feel all of these, sometimes in the same afternoon.

Helpful coping strategies patients often mention include:

• Leaning on trusted friends or family to help track information and appointments
• Joining support groups (in person or online) for people with leukemia or those in active treatment
• Talking with oncology social workers, psychologists, or counselors who understand cancer-related stress
• Celebrating “small wins” – a better lab result, fewer side effects in a week, or finishing a treatment milestone

Some patients later describe tretinoin as “the medicine that helped me get my life back,” even if the experience
during treatment was hard. That perspective often becomes clearer in hindsight, once remission has settled in and
clinic visits become less frequent.

Questions to Ask Your Care Team

If tretinoin (Vesanoid) is part of your treatment plan, consider asking:

• “What are the top warning signs I should call you about the same day?”
• “What side effects are expected, and which ones are emergencies?”
• “How will we monitor my treatment and know if it’s working?”
• “Are there restrictions on diet, supplements, or other medications while I’m taking tretinoin?”
• “How long do you expect I’ll be on tretinoin, and what happens after that?”

Bringing a written list to appointments – and maybe a friend or family member – can help make sure you get
clear answers when you’re processing a lot of information at once.

Key Takeaways

• Tretinoin (Vesanoid) is an oral retinoid used to treat
  acute promyelocytic leukemia (APL), usually in combination with other drugs.
• It works by maturing abnormal leukemia cells rather than simply destroying them,
  which can rapidly improve blood counts when carefully monitored.
• The usual dose is 22.5 mg/m² twice daily, up to 90 days or 30 days after remission,
  as directed by your oncology team.
• Common side effects include headache, fatigue, bone pain, fever, and dry skin, while serious risks include
  differentiation syndrome, bleeding or clotting problems, liver toxicity, and severe birth defects.
• Because of its complexity and potential risks, tretinoin should only be used under the
  close supervision of an experienced leukemia specialist.

If you or a loved one has been prescribed tretinoin (Vesanoid), you’re not expected to memorize every detail from
the drug label. Your real-life job is to take the medicine as directed, report symptoms early,
and stay in close communication with your care team. They’ll handle the dosing math and monitoring –
you handle listening to your body and speaking up when something doesn’t feel right.