Tretinoin (Topical)

Pharmacologic Category

Acne Products; Retinoic Acid Derivative; Topical Skin Product, Acne

Dosing: Adult

Acne vulgaris: Topical: Apply once daily to acne lesions before bedtime or in the evening.

Palliation of fine wrinkles (Refissa/Renova), mottled hyperpigmentation, and tactile roughness of facial skin (Refissa): Topical: Apply a pea-sized amount of cream to entire face once daily in the evening or before bedtime.

Dosing: Geriatric

Refer to adult dosing; safety/efficacy of Retin-A has not been established in patients >65 years of age; safety/efficacy of Refissa has not been established in patients >50 years of age; safety/efficacy of Renova has not been established in patients >71 years of age.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

Acne vulgaris: Children ≥8 years and Adolescents: Topical: Apply to affected areas once daily. Begin therapy with a weaker formulation of tretinoin and increase the concentration as tolerated; if stinging or irritation develop, decrease frequency of application. Approved ages varies by product; see individual product labeling. Guidelines suggest that topical retinoids may be used as part of a therapeutic regimen for all types and severity of acne in children and adolescents; however, specific data for each tretinoin product formulation may not be available (Eichenfield 2013).

Product specific:

Altreno (Lotion 0.05%): Children ≥9 years and Adolescents: Topical: Apply to affected areas once daily.

Atralin (Gel 0.05%): Children ≥10 years and Adolescents: Topical: Apply once daily to acne lesions before bedtime.

Retin-A (Cream 0.025%, 0.05%, or 0.1%; Gel 0.01% or 0.025%), Tretin-X (Cream 0.025%, 0.0375%, 0.05%, 0.075%, or 0.1%): Children ≥12 years and Adolescents: Topical: Apply once daily to acne lesions before bedtime or in the evening.

Retin-A Micro:

Children 8 to <12 years: Limited data available: Gel (0.04%): Topical: Apply once daily to acne lesions before bedtime or in the evening (Eichenfield 2010; Eichenfield 2012).

Children ≥12 years and Adolescents: Gel (0.04%, 0.06%, 0.08%, or 0.1%): Topical: Apply once daily to acne lesions before bedtime or in the evening.

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however dosage adjustment unlikely needed due to low systemic absorption.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however dosage adjustment unlikely needed due to low systemic absorption.

Use: Labeled Indications

Acne vulgaris: Altreno, Atralin, Avita, Retin-A, Retin-A Micro, Stieva-A [Canadian product], Tretin-X, Vitamin-A Acid [Canadian product]: Treatment of acne vulgaris.

Palliation of fine wrinkles: Renova: Adjunctive treatment for mitigation (palliation) of fine wrinkles in patients who use comprehensive skin care and sun avoidance programs.

Palliation of fine wrinkles, mottled hyperpigmentation, and facial skin roughness: Refissa: Adjunctive treatment for mitigation (palliation) of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin in patients who do not achieve such palliation using comprehensive skin care and sun avoidance programs alone.

Clinical Practice Guidelines

American Academy of Dermatology, "Guidelines of care for the management of acne vulgaris," May 2016

Administration: Topical

For topical external use only; not for oral, ophthalmic, or intravaginal use. Prior to application, wash hands; gently wash face with a mild soap; pat dry and wait 20 to 30 minutes. Apply thin layer to affected area in the evening or before bedtime, avoiding eyes, ears, nostrils, and mouth. If stinging or irritation develop, temporarily discontinue or decrease frequency of application. Wash hands immediately after applying. Avoid use of products to the affected area that contain high concentrations of alcohol, astringents, or spices. Do not apply to sunburned skin. If combination topical therapy is required, consider separating applications (eg, one drug in the morning and the other in the evening or before bedtime).

Retin-A Micro: Avoid contact with lime peel and application area.

Administration: Pediatric

Topical: For external use only; not for oral, ophthalmic, or intravaginal use. Prior to application, wash hands; gently wash face with a mild soap; pat dry and wait 20 to 30 minutes. Apply thin layer to affected area in the evening or before bedtime, avoiding eyes, mouth, paranasal creases, and mucous membranes. If stinging or irritation develop, temporarily discontinue or decrease frequency of application. Wash hands immediately after applying. Avoid use of products to the affected area that contain high concentrations of alcohol, astringents, or spices. Do not apply to sunburned skin. If combination topical therapy is required, consider separating applications (eg, one drug in the morning and the other in the evening or before bedtime).

Retin-A Micro: Avoid contact with lime peel and application area.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 3]).

Use appropriate precautions for receiving, handling, administration, and disposal (NIOSH 2016). Gloves (single) should be worn during receiving, unpacking, and placing in storage.

NIOSH recommends double gloving, a protective gown, and (if liquid that could splash) eye/face protection for administration of a topical product; if there is potential for inhalation, respiratory protection is recommended (NIOSH 2016). Assess risk to determine appropriate containment strategy (USP-NF 2017).

Storage/Stability

Altreno lotion, Atralin gel, Avita gel: Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Protect from freezing.

Avita cream: Store below 30°C (86°F). Avoid freezing.

Refissa: Store at 20°C to 25°C (68°F to 77°F). Do not freeze.

Renova: Store at 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Retin-A cream, Tretin-X cream: Store below 27°C (80°F).

Retin-A gel: Store below 30°C (86°F).

Retin-A Micro gel: Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Store pump upright.

Stieva-A [Canadian product]: Store at 15°C and 30°C (59°F and 86°F). Do not freeze.

Vitamin A Acid [Canadian product]: Store at 15°C and 30°C (59°F and 86°F).

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat pimples (acne).

• It is used on the face to treat wrinkles, skin spots, and skin that feels rough.

Frequently reported side effects of this drug

• Dry skin

• Redness

• Swelling

• Blisters

• Sensation of warmth

• Burning or stinging

• Peeling

• Skin discoloration

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Severe or persistent skin reaction

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

International issues:

Contraindications

Hypersensitivity to tretinoin or any component of the formulation. Note: There are no contraindications listed in Altreno, Atralin, or Retin-A Micro US labeling.

Documentation of allergenic cross-reactivity for retinoids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Fish allergies: Atralin gel contains soluble fish proteins; use caution in patients with sensitivities or allergies to fish.

• Hypersensitivity reactions: Discontinue tretinoin if drug sensitivity, chemical irritation, or a systemic adverse reaction occurs.

• Photosensitivity: Use is associated with increased susceptibility/sensitivity to UV light; avoid or minimize excessive exposure to sunlamps or sunlight. Daily sunscreen (SPF 15 or higher) use and other protective measures (eg, clothing over treated areas) are recommended. Use with caution in patients with personal or family history of skin cancer.

• Skin irritation: Treatment can increase skin sensitivity to weather extremes of wind or cold. Excessive dryness, redness, and swollen or blistered skin may occur. Also, concomitant topical medications (eg, medicated or abrasive soaps, cleansers, or cosmetics with a strong drying effect) should be used with caution due to increased skin irritation. Depending on the severity of irritation, use a moisturizer, reduce the amount or frequency, or discontinue use until irritation disappears.

Disease-related concerns:

• Eczema: Use with caution in patients with eczema; may cause severe irritation.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Cream 0.02%: Do not use the 0.02% cream for longer than 52 weeks when using for palliation of fine wrinkles.

• Cream 0.05%: Do not use the 0.05% cream for longer than 48 weeks when using for palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin.

• Gel: Flammable; do not expose to high temperatures or flame.

Other warnings/precautions:

• Appropriate use: For external use only; avoid contact with abraded skin, sunburned skin, mucous membranes, eyes, mouth, angles of the nose. When used for palliation of fine wrinkles, mottled hyperpigmentation, or facial skin roughness, should be used as part of a comprehensive skin care and sun avoidance program.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Reproductive Considerations

These products should not be used in women who are attempting to conceive or at high risk for pregnancy.

Pregnancy Considerations

Adverse events were observed in some animal reproduction studies following topical application of tretinoin. Teratogenic effects were also observed in pregnant women following topical use; however, a causal association has not been established.

When treatment for acne is needed during pregnancy, other agents are preferred (Chien 2016; Kong 2013; Leachman 2006). These products should not be used in women who are pregnant.

Breast-Feeding Considerations

It is not known if tretinoin is present in breast milk following topical application.

Tretinoin is an endogenous substance and likely present in breast milk. Although the manufacturer recommends caution when administering tretinoin (topical) to breastfeeding females, the use of topical agents is generally preferred over systemic agents for the treatment of facial acne in women who are breastfeeding; topical tretinoin may be compatible with breastfeeding; however, specific studies are not available. Avoid applying large amounts over prolonged periods of time to decrease the potential for systemic absorption (Butler 2014; Kong 2013; Leechman 2006). Mothers should wash hands following application. Because topical agents can be transferred to a breastfeeding infant, avoid direct skin-to-skin contact with treated areas (Anderson 2018). Use of alternative agents or postponement of therapy may also be considered (Zip 2002). When used for other indications, treatment should be postponed until after breastfeeding is complete (Korgavkar 2015).

Briggs' Drugs in Pregnancy & Lactation

• Tretinoin (Topical)

Adverse Reactions

>10%:

Dermatologic: Stinging of the skin (21%), local dryness (4% to 16%), hypopigmentation (≤12%)

Local: Application site erythema (2% to 51%), application site irritation (1% to 50%; severe: ≤3%), local skin exfoliation (1% to 49%), application site pruritus (2% to 35%), application site burning (8% to 30%), local desquamation (12%)

1% to 10%:

Dermatologic: Hyperpigmentation (≤2%)

Local: Application site dermatitis (4%), application site pain (1% to 3%)

Frequency not defined: Dermatologic: Skin photosensitivity

<1%, postmarketing, and/or case reports: Contact dermatitis, skin changes (atypical changes in melanocytes and keratinocytes, increased dermal elastosis; treatment lasting >48 weeks)

Allergy and Idiosyncratic Reactions

• Aniline Dye Allergy
• Retinoid Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Multivitamins/Minerals (with AE, No Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Food Interactions

Vitamin A toxicity may rarely occur. Management: Avoid excessive intake of vitamin A (cod liver oil, halibut fish oil).

Product Availability

Altreno 0.05% lotion: FDA approved August 2018; anticipated availability is fourth quarter 2018. Information pertaining to this product within the monograph is pending revision. Consult the prescribing information for additional information.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Avita: 0.025% (20 g, 45 g)

Refissa: 0.05% (20 g, 40 g) [contains edetate disodium, methylparaben, propylparaben]

Renova: 0.02% (20 g, 40 g, 60 g) [contains benzyl alcohol, cetyl alcohol, edetate disodium, methylparaben, propylparaben]

Renova Pump: 0.02% (44 g) [contains benzyl alcohol, cetyl alcohol, edetate disodium, methylparaben, propylparaben]

Retin-A: 0.025% (20 g, 45 g); 0.05% (20 g, 45 g); 0.1% (20 g, 45 g)

Tretin-X: 0.0375% (35 g [DSC]); 0.075% (35 g [DSC])

Generic: 0.025% (20 g, 45 g); 0.05% (20 g, 40 g, 45 g, 60 g [DSC]); 0.1% (20 g, 45 g)

Gel, External:

Atralin: 0.05% (45 g) [contains benzyl alcohol, butylparaben, ethylparaben, fish collagen hydrolyzates, isobutylparaben, methylparaben, propylparaben, trolamine (triethanolamine)]

Avita: 0.025% (20 g, 45 g)

Retin-A: 0.01% (15 g, 45 g); 0.025% (15 g, 45 g)

Retin-A Micro: 0.04% (20 g, 45 g); 0.1% (20 g, 45 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.04% (50 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.06% (50 g) [contains benzyl alcohol, edetate disodium, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.08% (50 g); 0.1% (50 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Generic: 0.01% (15 g, 45 g); 0.025% (15 g, 45 g); 0.04% (20 g, 45 g, 50 g); 0.05% (45 g); 0.1% (20 g, 45 g, 50 g)

Lotion, External:

Altreno: 0.05% (20 g, 45 g) [contains benzyl alcohol, methylparaben, trolamine (triethanolamine)]

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Retin-A: 0.01% (30 g); 0.025% (30 g); 0.05% (30 g); 0.1% (30 g)

Generic: 0.01% (3 g, 25 g, 45 g); 0.025% (3 g, 25 g, 45 g); 0.05% (25 g, 45 g); 0.1% ([DSC])

Gel, External:

Retin-A: 0.01% (30 g); 0.025% (30 g) [contains alcohol, usp]

Retin-A Micro: 0.04% (20 g, 45 g, 50 g) [contains benzyl alcohol, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro: 0.1% (2 g, 20 g, 45 g, 50 g)

Generic: 0.01% (25 g); 0.025% (25 g); 0.05% (25 g)

Anatomic Therapeutic Chemical (ATC) Classification

• D10AD01

Generic Available (US)

May be product dependent

Pricing: US

Cream (Avita External)

0.025% (per gram): $5.36

Cream (Refissa External)

0.05% (per gram): $7.04

Cream (Renova External)

0.02% (per gram): $7.91

Cream (Renova Pump External)

0.02% (per gram): $7.60

Cream (Retin-A External)

0.025% (per gram): $4.75

0.05% (per gram): $4.75

0.1% (per gram): $4.75

Cream (Tretinoin External)

0.025% (per gram): $5.02 - $6.38

0.05% (per gram): $5.63 - $7.15

0.1% (per gram): $6.57 - $8.35

Gel (Atralin External)

0.05% (per gram): $15.00

Gel (Avita External)

0.025% (per gram): $5.36

Gel (Retin-A External)

0.01% (per gram): $6.33

0.025% (per gram): $6.33

Gel (Retin-A Micro External)

0.04% (per gram): $26.15

0.1% (per gram): $26.15

Gel (Retin-A Micro Pump External)

0.04% (per gram): $21.96

0.06% (per gram): $21.87

0.08% (per gram): $21.87

0.1% (per gram): $21.96

Gel (Tretinoin External)

0.01% (per gram): $5.32 - $6.75

0.025% (per gram): $5.36 - $6.81

0.05% (per gram): $7.50 - $9.52

Gel (Tretinoin Microsphere External)

0.04% (per gram): $15.00

0.1% (per gram): $15.00

Lotion (Altreno External)

0.05% (per gram): $3.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Tretinoin is a derivative of vitamin A. When used topically, it modifies epithelial growth and differentiation. In patients with acne, it decreases the cohesiveness of follicular epithelial cells and decreases micromedo formation. Additionally, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones.

Pharmacodynamics/Kinetics

Onset of action: Acne: ≥2 weeks, may take ≥7 weeks; Facial wrinkles: Up to 6 months

Absorption: Minimal

Bioavailability: Avita cream and gel: <0.3%; Retin A Micro 0.1% gel: ~1%

Metabolism: Hepatic; forms metabolites

Excretion: Urine and feces

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Related Information

• Safe Handling of Hazardous Drugs

Index Terms

Altreno; Retinoic Acid; trans-Retinoic Acid; Vitamin A Acid

References

<800> Hazardous Drugs—Handling in Healthcare Settings. United States Pharmacopeia and National Formulary (USP 40-NF 35). Rockville, MD: United States Pharmacopeia Convention; 2017:83-102.

Altreno (tretinoin) [prescribing information]. Bridgewater, NJ: Bausch Health Americas, Inc; November 2019.

Anderson PO. Topical drugs in nursing mothers. Breastfeed Med. 2018;13(1):5-7.[PubMed 29298085]

American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics. 1997;99(2):268-278.[PubMed 9024461]

Atralin gel (tretinoin) [prescribing information]. Bridgewater, NJ: Coria Laboratories; August 2013.

Atralin gel (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; August 2014.

Avita (tretinoin) cream [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals; June 2018.

Avita (tretinoin) gel [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals; January 2018.

Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70(3):417.[PubMed 24528912]

Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of acne in pregnancy. J Am Board Fam Med. 2016;29(2):254-262.[PubMed 26957383]

Eichenfield LF, Hebert AA, Schachner L, Paller AS, Rossi AB, Lucky AW. Tretinoin microsphere gel 0.04% pump for treating acne vulgaris in preadolescents: a randomized, controlled study. Pediatr Dermatol. 2012;29(5):598-604.[PubMed 22712470 ]

Eichenfield LF, Krakowski AC, Piggott C, et al. American Acne and Rosacea Society. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131 Suppl 3:S163-86. doi: 10.1542/peds.2013-0490B.[PubMed 23637225]

Eichenfield LF, Matiz C, Funk A, Dill SW. Study of the efficacy and tolerability of 0.04% tretinoin microsphere gel for preadolescent acne. Pediatrics. 2010;125(6):e1316-1323.[PubMed 20498178 ]

Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-87. doi: 10.1007/s40265-013-0060-0.[PubMed 23657872]

Korgavkar K, Wang F. Stretch marks during pregnancy: a review of topical prevention. Br J Dermatol. 2015;172(3):606-615.[PubMed 25255817]

Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006;24(2):167-197.[PubMed 16677965]

National Institute for Occupational Safety and Health (NIOSH), "NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2012." Available at http://www.cdc.gov/niosh/docs/2012-150/pdfs/2012-150.pdf. Accessed January 21, 2013.

Refissa cream (tretinoin topical) [prescribing information]. San Antonio, TX: DPT Laboratories; November 2011.

Renova cream (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; March 2017.

Renova cream (tretinoin) [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC; September 2019.

Retin-A (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals; June 2018.

Retin-A cream, gel (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; June 2018.

Retin-A Micro (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals; January 2015.

Retin-A Micro (tretinoin) [product monograph]. Laval, Quebec, Canada: Valeant Canada LP; March 2012.

Retin-A Micro gel (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; October 2017.

Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259.[PubMed 19188870]

Stieva-A (tretinoin) [product monograph]. Mississauga, Ontario, Canada: GlaxoSmithKline Inc; August 2015.

Tretin-X (tretinoin) [prescribing information]. Cumberland, RI: Onset Dermatologics; February 2014.

Tretin-X cream (tretinoin) [prescribing information]. Cumberland, RI: Onset Dermatologies, LLC; March 2014.

US Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. http://www.cdc.gov/niosh/topics/antineoplastic/pdf/hazardous-drugs-list_2016-161.pdf. Updated September 2016. Accessed October 5, 2016.

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Brand Names: International

A-Acido (AR); Aberela (SE); Acetretin (AE); Acfen-A (MX); Acid A Vit (NL); Acnatac (DE); Acne-Free (EG); Acnederm (BG); Acnetin-A (TH); Acretin (EG, QA); Airol (AE, BH, CH, DE, GR, IT, KW, MY, PH, PK, PL, QA, TW); Alten (MY); Avitcid (FI); Betarretin (PE); Cordes VAS (DE); Cosmotrin (BD); Curacne (KW); Derm A (PH); Effederm (FR); Eudyna (EG, MY); Idaman (ID); Ketrel (HK, LB); Li Ling (CN); Locacid (PT, SK); Melavita (ID); Neocare (ES); Nilac (BD); Optimal Gel (ET); Renova (ZA); Retacnyl (CR, DO, GT, HN, KR, MX, MY, NI, PA, PE, PH, SG, SV, TH, VE); Retavit (IL); Retico (ID); Reticrem (CO); Retigel (CO, CR, DO, GT, HN, NI, PA, SV); Retin A (AT, GR, IT, PT); Retin-A (AE, BB, BH, BR, CH, CO, FR, JO, KW, LB, MT, MX, PE, PH, PK, QA, SA, TH, UY, ZA, ZW); Retino-A (IN); Retinova (SE); Retirides (ES); Retrieve (NZ, SG); Retrieve Cream (AU); Reviderm (ID); Roaccutane (BH, KW, QA, SA); Smooderm (BH); Stieva-A (AU, CL, CO, KR, MX, MY, PY, SG, TH, UY); Stieva-A Forte (MY); T3 Actin (ET, MY, VN); T3Actin (PH); Tracne (HK); Tracnesan (LK); Trena (BD); Trentin (ID); Tretin-A (LK); Trinon (BD)

Last Updated 4/29/20