Your child needs to take the medicine called retinoic acid (say: RET-in-O-ik AS-id). This information sheet explains what retinoic acid does, how to give it, and what side effects or problems your child may have when they take this medicine.
What is retinoic acid?
Retinoic acids, or retinoids, such as isotretinoin and tretinoin are related to Vitamin A. They may be used to treat severe types of acne, and to help treat certain types of cancer such as leukemia or neuroblastoma.
You may hear isotretinoin called cis-retinoic acid or by its brand name, Accutane. You may also hear it called Clarus or Epuris. Isotretinoin comes in a capsule form.
You may hear tretinoin called all-trans retinoic acid or ATRA, or by its brand name, Vesanoid. Tretinoin comes in capsule form and cream forms.
This Family Med-Aid will focus on the use of retinoic acids taken by mouth for the treatment of cancer.
Before giving retinoic acid to your child?
Tell the doctor if your child:
- has ever reacted badly to any medications, food, preservatives or coloring agents
- has infection or recent exposure to infection (e.g. chickenpox)
- has liver or kidney problems
- has high levels of vitamin A in the body
- has high lipid or cholesterol levels
- may be pregnant
- has a peanut or soy allergy (for isotretinoin)
Talk with your child's doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:
- weak bones
- an eating disorder (anorexia or bulimia)
- high triglyceride blood levels (hypertriglyceridemia), or if there is a family history of high triglycerides or cholesterol
- high blood sugars (diabetes)
- any history of depression or psychosis
How should you give your child retinoic acid?
Follow these instructions when you give your child retinoic acid:
- Give your child isotretinoin or tretinoin exactly as your doctor or pharmacist tells you, even if your child seems better. Talk to your child's doctor before you stop giving this medicine for any reason.
- Give your child isotretinoin or tretinoin at the same times every day (exactly as your child's doctor or pharmacist tells you). Pick times that are easy for you so that you do not miss doses.
- Isotretinoin and tretinoin capsules should ideally be swallowed whole with a glass of water after a meal or some food.
- If your child cannot swallow the capsule whole, it is important that you ask your pharmacist to review how to give the medication.
What should you do if your child misses a dose of retinoic acid?
- Give the missed dose as soon as you remember.
- If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
- Do not give your child two doses to make up for one missed dose.
What are the possible side effects of retinoic acid?
Your child may have some of these side effects while they take retinoic acid. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:
- mild headache
- dry or itchy skin
- mild skin rash
- peeling or flaking skin
- dry mouth or lips
- dry eyes and nose
- nausea (stomach upset) or vomiting (throwing up)
- mild stomach cramps or loss of appetite
- stuffy nose
- feeling tired
Call your child's doctor during office hours if your child has any of these side effects:
- swelling of feet or lower legs
- yellow eyes or skin
- dark urine
- urinating more than usual
- excessive thirst
- lower back or side pain
- numbness or tingling in feet or hands
- bone pain or tenderness or aching
- bone fractures
- painful skin rash
- changes in eyesight
- ringing in the ears or hearing problems
- severe stomach cramping or pain
- feeling weak or fainting
- confusion
- changes in mood or personality
Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:
- signs of retinoic acid syndrome such as fever, shortness of breath, difficulty breathing, weight gain, discomfort, pain or tightness in chest, bone pain, or leg swelling.
- tenderness or hardness over a vein.
- calf swelling and tenderness.
- sudden onset of cough, chest pain or shortness of breath.
- severe headache or headache which occurs together with nausea and vomiting or changes in eyesight.
What safety measures should you take when your child is using retinoic acid?
Keep all appointments at the clinic or doctor's office so that the doctor can check your child's response to isotretinoin or tretinoin. Your doctor will order blood tests to check for problems with the liver, lipids, and blood sugars.
Your child may experience thinning of the hair while taking isotretinoin or tretinoin.
While your child is taking isotretinoin or tretinoin, and for several months afterwards, they will be more sensitive to the sun. The skin will burn more easily than normal. To prevent sunburn, your child should wear sunscreen and protective clothing when outdoors.
Your child should not have any cosmetic procedures to smooth the skin, such as waxing, dermabrasion or laser procedures, while taking isotretinoin and for at least 6 months after treatment.
Your child may experience dry skin while being treated with retinoic acids. Using a moisturizing cream or ointment can help with skin dryness. Your doctor or pharmacist can help to recommend a product.
If your child wears contact lenses, they may find them uncomfortable because retinoids can cause dry eyes. Dryness of the eyes may continue up to 2 weeks after treatment has stopped. Talk to your doctor about using eye drops to relieve dry eyes.
To help relieve dryness of the mouth, your child can use sugarless candy or gum, melt bits of ice in the mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your doctor or dentist. Continuing dryness of the mouth may increase the risk of tooth decay, gum disease, and thrush in the mouth.
Isotretinoin/tretinoin may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. Tell the doctor right away if your child may be pregnant.
If your child is of child-bearing age, routine pregnancy tests will be ordered from time to time. Your child's doctor will also discuss the importance of using effective birth control methods while on retinoic acid (at least two effective forms of birth control at the same time) while getting retinoic acid and for one month after finishing treatment.
Your child should not take vitamin A or any vitamin supplements containing vitamin A such as multivitamins while taking this medicine, unless otherwise directed by your child's doctor.
Retinoic acids may interact with other medications. Tetracycline, minocycline, doxycycline, tranexamic acid (Cyklokapron), and aprotinin (Trasylol) should be avoided. Before giving your child any other medication (including non-prescription products, herbal, homeopathic or natural remedies or supplements) or treatments tell your child's doctor, dentist or pharmacist that your child is taking retinoic acid.
What other important information should you know about retinoic acid?
- Use of retinoic acids may cause weakening of the bones (osteoporosis). Your doctor can review this risk with you.
- Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
- Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
- Make sure you always have enough isotretinoin or tretinoin to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
- Retinoic acids are very sensitive to light and air. Keep isotretinoin and tretinoin at room temperature in a cool, dry place away from sunlight. Do NOT store it in the bathroom or kitchen.
- Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
Keep retinoic acid out of your child’s sight and reach and locked up in a safe place. If your child takes too much retinoic acid, call your local Poison Information Centre at one of these numbers. These calls are free.
- Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
- Call 1-800-463-5060 if you live in Quebec.