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Pronunciation |
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(TRET
i noyn, TOP i
kal) |
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U.S. Brand
Names |
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Avita®; Retin-A™ Micro Topical;
Retin-A™
Topical |
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Generic
Available |
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No |
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Canadian Brand
Names |
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Retisol-A®; Stieva-A®;
Stieva-A®
Forte |
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Synonyms |
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Retinoic Acid; trans-Retinoic Acid; Vitamin A Acid |
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Pharmacological Index |
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Retinoic Acid Derivative |
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Use |
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Treatment of acne vulgaris, photodamaged skin, and some skin
cancers |
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Pregnancy Risk
Factor |
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C |
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Pregnancy/Breast-Feeding
Implications |
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Clinical effects on the fetus: Oral tretinoin is teratogenic and fetotoxic in
rats at doses 1000 and 500 times the topical human dose, respectively; however,
tretinoin does not appear to be teratogenic when used topically since it is
rapidly metabolized by the skin |
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Contraindications |
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Hypersensitivity to tretinoin or any component; sunburn |
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Warnings/Precautions |
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Use with caution in patients with eczema; avoid excessive exposure to
sunlight and sunlamps; avoid contact with abraded skin, mucous membranes, eyes,
mouth, angles of the nose |
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Adverse
Reactions |
|
1% to 10%:
Dermatologic: Excessive dryness, erythema, scaling of the skin,
hyperpigmentation or hypopigmentation, photosensitivity, initial acne flare-up
Local: Stinging, blistering |
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Overdosage/Toxicology |
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Toxic signs of an overdose commonly respond to drug discontinuation, and
generally return to normal spontaneously within a few days to weeks.
When confronted with signs of increased intracranial pressure, treatment with
mannitol (0.25 g/kg I.V. up to 1 g/kg/dose repeated every 5 minutes as needed),
dexamethasone (1.5 mg/kg I.V. load followed with 0.375 mg/kg every 6 hours for 5
days), and/or hyperventilation should be employed. |
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Drug
Interactions |
|
CYP3A3/4 enzyme substrate |
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Mechanism of
Action |
|
Keratinocytes in the sebaceous follicle become less adherent which allows for
easy removal; inhibits microcomedone formation and eliminates lesions already
present |
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|
Pharmacodynamics/Kinetics |
|
Absorption: Topical: Minimum absorption occurs
Metabolism: Of the small amount absorbed, metabolism occurs in the liver
Elimination: In bile and urine |
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|
Usual Dosage |
|
Children >12 years and Adults: Topical: Begin therapy with a weaker
formulation of tretinoin (0.025% cream or 0.01% gel) and increase the
concentration as tolerated; apply once daily before retiring or on alternate
days; if stinging or irritation develop, decrease frequency of
application |
|
|
Dietary
Considerations |
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Avoid excessive intake of vitamin A |
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Mental Health: Effects
on Mental Status |
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None reported |
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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |
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|
Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
|
For once a day use, do not overuse. Avoid increased intake of vitamin A.
Thoroughly wash hands before applying. Wash area to be treated at least 30
minutes before applying. Do not wash face more frequently than 2-3 times a day.
Avoid using topical preparations that contain alcohol or harsh chemicals during
treatment. You may experience increased sensitivity to sunlight; protect skin
with sunblock, wear protective clothing, or avoid direct sunlight. Stop
treatment and inform prescriber if rash, skin irritation, redness, scaling, or
excessive dryness occurs. Pregnancy precautions: Inform prescriber if
you are pregnant. |
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Nursing
Implications |
|
Observe for signs of hypersensitivity, blistering, excessive dryness; do not
apply to mucous membranes |
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Dosage Forms |
|
Cream:
Retin-A™: 0.025% (20 g, 45 g); 0.05% (20 g, 45 g);
0.1% (20 g, 45 g)
Avita®: 0.025% (20 g, 45 g)
Renova™: 0.05% emollient cream
Gel, topical:
Retin-A™: 0.01% (15 g, 45 g); 0.025% (15 g, 45 g)
Retin-A™ Micro: 0.1% (20 g, 45 g)
Liquid, topical (Retin-A™): 0.05% (28 mL)
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References |
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Winston MH, Shalita AR, "Acne Vulgaris, Pathogenesis and Treatment,"
Pediatr Clin North Am, 1991, 38(4):889-903.
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