One could compare the effect of Tretinoin on the skin to chemical peels. Tretinoin, or Vitamin A acid, will stimulate cell division in the epidermis, allowing old skin cells to be removed so that new ones can appear. Tretinoin is used to treat various skin conditions, such as: Acne: one of the most popular skin disorder, characterized by clogged pores, pimples and subcutaneous infections. Rosacea: a skin condition where redness appears on the face, mainly the cheeks. Skin damage due to exposure to UV light: wrinkles, dark, freckle-like patches or rough lesions. Striae: Commonly referred to as stretch marks, can occur due to pregnancy or weight changes. Hyperpigmentation: This can be caused by hormonal changes (pregnancy mask), old age or even medicine use. Hyperpigmentation shows commonly on the face, in the form of uneven brown spots. Tretinoin is quite important as it stimulates the renewal of healthy skin cells, keeping your pores open in order to reduce the probabilities of infections. Tretinoin erases impurities such as scars, patches and other marks on the skin.
An online doctor consultation means filling out a medical questionnaire. A registered EU doctor assesses your medical questionnaire and analize whether Tretinoin (vitamin a acid) is suitable and safe for you to buy. After approval, a prescription is issued and send to the registered EU pharmacy. You will receive your discretely shipped Tretinoin within 3 business days.
Tretinoin will usually present great results. Its effects can be noticed in 8 - 12 months. After this period you can reduce the usage of Tretinoin to 2 or 3 days a week. However, it is possible that your skin does not respond to this treatment. If such happens and you don’t see a change within four months, it is possible that Tretinoin is not suitable for you and you should stop.
The natural metabolite of retinol; binding to nuclear retinoic acid receptors, induces differentiation and inhibits the proliferation of promyelocytes. In acute promyelocytic leukemia, the maturation of promyelocytes from the leukemic clone is induced, as a result of which patients who have achieved complete clinical remission, the cellular composition of the bone marrow and peripheral blood is redistributed mainly towards normal polyclonal hematopoietic cells and mature forms (respectively). It does not have cytolytic properties. The maximum therapeutic effect (complete remission) is achieved on average after 40-50 days (2-120 days) of treatment.
Absorption is high, the dependence on food intake has not been established, although it is known that simultaneous intake with food increases the absorption of other retinoids. Communication with plasma proteins (mainly with albumin) - 95%. TCmax - 1-2 hours. Cmax after a single oral dose of 45 mg / sq. m - 347 +/- 266 ng / ml, after 7-day therapy with the same dose of Cmax, was 1/3 of Cmax after a single dose. It is metabolized in the liver with the participation of cytochrome P450 with the formation of 13-cis retinoic acid and 4-hydroxy metabolites. It is believed that tretinoin induces its own metabolism: Css and AUC after 7-day therapy are significantly lower than after one-day treatment. T1 / 2 - 0.5-2 hours. Metabolites have a longer T1 / 2. It is excreted by the kidneys and through the intestines: after 72 hours, 63% is excreted through the kidneys, after 6 days with feces - 31%.
Acute promyelocytic leukemia (for the induction of remission, including in patients refractory to anthracycline chemotherapy or with contraindications to it).
Hypersensitivity (including parabens), pregnancy, lactation, children under 1-year-old (efficacy and safety of use have not been established).
Carefully. Liver failure, pancreatitis, chronic renal failure, chronic intoxication (including alcohol intoxication), diabetes mellitus, leukocytosis (the number of leukocytes is more than 5 thousand / μl), children's age. Category of action on the fetus.
Inside, for adults and children, the daily dose is 45 mg / sq. m of the surface of the bodies in 2 doses; the duration of treatment is 30-90 days until complete remission is achieved. Then a standard course of chemotherapy with cytostatics is prescribed in order to consolidate the achieved remission.
From the digestive system: in 10% of cases and more often - decreased appetite, flatulence, constipation or diarrhea, dry mouth, nausea; in 3-9% of cases - ulceration of the gastrointestinal mucosa (gastric colic, gastralgia, vomiting, digestive disorders), hepatitis, impaired liver function, scleral electricity.
From the CCC: in 10% of cases and more often - heart rhythm disturbances, a decrease or increase in blood pressure, phlebitis (pain and a feeling of heaviness in the legs and feet); in 3-9% of cases - heart failure, myocardial infarction.
From the respiratory system: in 10% of cases and more often - cough, sneezing, sore throat, difficulty in nasal breathing, rhinitis; in 3-9% of cases - bronchial asthma.
From the nervous system: in 10% of cases and more often - dizziness, increased fatigue, insomnia (difficulty falling asleep), depression, anxiety, paresthesia, tremor; in 3-9% of cases - drowsiness, convulsions, dementia, hallucinations, pseudotumor of the brain (usually in children), stroke, coma, impaired consciousness; less often - ataxia, impaired attention.
From the senses: in 10% of cases and more often - pain in the ears, a feeling of stuffiness in the ears, impaired vision; in 3-9% of cases - hearing loss (up to an irreversible condition)
From the musculoskeletal system: often - myalgia; in 3-9% of cases, pain in the side and lower back; less often - weakness in the legs. From the urinary system: in 10% of cases or more - impaired renal function (decreased urination, swelling of the face, fingers and toes, feet, legs); in 3-9% of cases - difficulty and pain during urination, acute renal failure, tubular necrosis of the kidneys; less often - pollakiuria.
From the skin: in 10% of cases and more often - skin rash, flushing of the skin, itching, xeroderma, cheilitis, exfoliative dermatitis; in 3-9% of cases, fibrous inflammation of the subcutaneous tissue. Allergic reactions: laryngeal edema.
Laboratory indicators: hypertriglyceridemia, hypercholesterolemia, increased activity of "liver" transaminases. Other: in 10% of cases and more often - hyperthermia, asthenia, malaise. Retinoic acid syndrome (bone pain, discomfort, feeling of compression or chest pain, fever, shortness of breath, shortness of breath, wheezing, weight gain, pulmonary infiltrate, pleural and cardiac effusion, acute respiratory distress syndrome, leukocytosis, decreased blood pressure multiple organ failure up to death). Retinoid toxicity (mucositis - the formation of a crust on the surface of the skin, dryness, itching, and hyperemia of the skin, pain or ulceration of the mucous membrane of the oral and/or nasal cavities, cracking of the lips, nausea, vomiting, hair loss, headache), weight loss. Overdose. Symptoms (described with an overdose of other retinoids): abdominal pain, ataxia, cheilosis, dizziness, headache, rash on the skin of the face.
From the musculoskeletal system: myalgia, ossalgia, pain in the chest and back. On the part of the hematopoietic organs and hemostasis system: bleeding, intravenous hemorrhage, violation of the blood coagulation system (including the development of DIC).
Laboratory indicators: hypertriglyceridemia, hypercholesterolemia, increased activity of "liver" transaminases. Other: retinoic acid syndrome (fever, dyspnea, acute respiratory distress syndrome, pulmonary infiltrate, leukocytosis, decreased blood pressure, pleural effusion, liver and/or renal failure); increased sweating, phlegmon, alopecia, peripheral edema, facial swelling, weight loss, infection. With prolonged use - hypervitaminosis A.
Inductors of cytochrome P450 (including GCS, phenobarbital, pentobarbital, rifampicin) can change the pharmacokinetics of tretinoin (there are no data on the effect of this phenomenon on the safety and effectiveness of tretinoin).
The appointment of ketoconazole in a dose of 400-1000 mg for 1 hour before using tretinoin against the background of its previous 29-day intake increases the AUC of tretinoin by 72%. Dr. cytochrome P450 inhibitors (including cimetidine, cyclosporine, diltiazem, verapamil) can also change the pharmacokinetics of tretinoin (data on the effect of this phenomenon on the safety and efficacy of tretinoin have not been established).
Before starting treatment, it is necessary to conduct a mandatory cytogenetic study (in the absence of translocation t (15; 17) and/or the PML / RAR-alpha gene, other drugs are indicated). It is prescribed with caution in case of leukocytosis (the number of leukocytes is more than 5 thousand / μl) - the risk of the retinoic acid syndrome is increased. It occurs more often in the first month of treatment (in exceptional cases after the first dose) in 25% of cases. The risk of its occurrence may reduce the appointment of anthracycline drugs on days 1 and 2 of treatment with tretinoin. In the event of a retinoic acid syndrome, the intravenous administration of dexamethasone in a dose of 10 mg every 12 hours for 3 days or until the disappearance of adverse events is recommended. Women of reproductive age need contraception 1 month before treatment, during therapy, and within 1 month after discontinuation of the drug. Treatment is prescribed for 2-3 days of a normal menstrual cycle. 2 weeks before the start of treatment, the absence of pregnancy should be confirmed by laboratory tests. Further, such tests should be carried out 1 time per month.