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Tretinoin, Topical
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Pregnancy/Breast-Feeding Implications
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(TRET i noyn, TOP i kal)

U.S. Brand Names
Avita®; Retin-A™ Micro Topical; Retin-A™ Topical

Generic Available

No


Canadian Brand Names
Retisol-A®; Stieva-A®; Stieva-A® Forte

Synonyms
Retinoic Acid; trans-Retinoic Acid; Vitamin A Acid

Pharmacological Index

Retinoic Acid Derivative


Use

Treatment of acne vulgaris, photodamaged skin, and some skin cancers


Pregnancy Risk Factor

C


Pregnancy/Breast-Feeding Implications

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


Contraindications

Hypersensitivity to tretinoin or any component; sunburn


Warnings/Precautions

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


Adverse Reactions

1% to 10%:

Dermatologic: Excessive dryness, erythema, scaling of the skin, hyperpigmentation or hypopigmentation, photosensitivity, initial acne flare-up

Local: Stinging, blistering


Overdosage/Toxicology

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.


Drug Interactions

CYP3A3/4 enzyme substrate


Mechanism of Action

Keratinocytes in the sebaceous follicle become less adherent which allows for easy removal; inhibits microcomedone formation and eliminates lesions already present


Pharmacodynamics/Kinetics

Absorption: Topical: Minimum absorption occurs

Metabolism: Of the small amount absorbed, metabolism occurs in the liver

Elimination: In bile and urine


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

Avoid excessive intake of vitamin A


Mental Health: Effects on Mental Status

None reported


Mental Health: Effects on Psychiatric Treatment

None reported


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


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.


Nursing Implications

Observe for signs of hypersensitivity, blistering, excessive dryness; do not apply to mucous membranes


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)


References

Winston MH, Shalita AR, "Acne Vulgaris, Pathogenesis and Treatment," Pediatr Clin North Am, 1991, 38(4):889-903.


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