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Details

Stereochemistry ACHIRAL
Molecular Formula 2C20H27O2.Zn
Molecular Weight 664.263
Optical Activity NONE
Defined Stereocenters 0 / 0
E/Z Centers 8
Charge 0

SHOW SMILES / InChI
Structure of TRETINOIN ZINC

SMILES

[Zn++].CC(\C=C\C1=C(C)CCCC1(C)C)=C/C=C/C(C)=C/C([O-])=O.CC(\C=C\C2=C(C)CCCC2(C)C)=C/C=C/C(C)=C/C([O-])=O

InChI

InChIKey=OYWXIJJKRYRHIN-DNOYCTHFSA-L
InChI=1S/2C20H28O2.Zn/c2*1-15(8-6-9-16(2)14-19(21)22)11-12-18-17(3)10-7-13-20(18,4)5;/h2*6,8-9,11-12,14H,7,10,13H2,1-5H3,(H,21,22);/q;;+2/p-2/b2*9-6+,12-11+,15-8+,16-14+;

HIDE SMILES / InChI

Description

Alitretinoin, or 9-cis-retinoic acid, is a form of vitamin A. It is also used in medicine as an antineoplastic (anti-cancer) agent developed by Ligand Pharmaceuticals. Alitretinoin (9-cis-retinoic acid) is a naturally-occurring endogenous retinoid indicated for topical treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma. Alitretinoin inhibits the growth of Kaposi's sarcoma (KS) cells in vitro. Alitretinoin binds to and activates all known intracellular retinoid receptor subtypes (RARa, RARb, RARg, RXRa, RXRb and RXRg). Once activated these receptors function as transcription factors that regulate the expression of genes that control the process of cellular differentiation and proliferation in both normal and neoplastic cells. In the United States, topical alitretinoin (in the form of a gel; trade name Panretin) is indicated for the treatment of skin lesions in AIDS-related Kaposi's sarcoma.

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
ACCUTANE

Approved Use

Accutane is indicated for the treatment of severe recalcitrant nodular acne. Nodules are inflammatory lesions with a diameter of 5 mm or greater. The nodules may become suppurative or hemorrhagic. “Severe,” by definition, means “many” as opposed to “few or several” nodules. Because of significant adverse effects associated with its use, Accutane should be reserved for patients with severe nodular acne who are unresponsive to conventional therapy, including systemic antibiotics. In addition, Accutane is indicated only for those female patients who are not pregnant, because Accutane can cause severe birth defects.

Launch Date

1982
Primary
RETIN-A

Approved Use

RETIN-A is indicated for topical application in the treatment of acne vulgaris. The safety and efficacy of the long-term use of this product in the treatment of other disorders have not been established.

Launch Date

1971
Palliative
TRETINOIN

Approved Use

retinoin Capsules are indicated for the induction of remission in patients with acute promyelocytic leukemia (APL), French-American-British (FAB) classification M3 (including the M3 variant), characterized by the presence of the t(15;17) translocation and/or the presence of the PML/RARα gene who are refractory to, or who have relapsed from, anthracycline chemotherapy, or for whom anthracycline based chemotherapy is contraindicated. Tretinoin is for the induction of remission only. The optimal consolidation or maintenance regimens have not been defined, but all patients should receive an accepted form of remission consolidation and/or maintenance therapy for APL after completion of induction therapy with tretinoin.

Launch Date

2007
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
314 ng/mL
40 mg single, oral
dose: 40 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ISOTRETINOIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
4055 ng × h/mL
40 mg single, oral
dose: 40 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ISOTRETINOIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
24 h
40 mg single, oral
dose: 40 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ISOTRETINOIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
0.1%
40 mg single, oral
dose: 40 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ISOTRETINOIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
Doses

Doses

DosePopulationAdverse events​
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Disc. AE: Cheilitis, Skin xerosis...
AEs leading to
discontinuation/dose reduction:
Cheilitis
Skin xerosis
Desquamation
Headache
Skin xerosis
Sources: Page: p.348
1000 mg single, oral
Overdose
Dose: 1000 mg
Route: oral
Route: single
Dose: 1000 mg
Sources: Page: p.74
unhealthy, 31
n = 1
Health Status: unhealthy
Condition: AIDS
Age Group: 31
Sex: M
Population Size: 1
Sources: Page: p.74
Disc. AE: Diarrhea...
AEs leading to
discontinuation/dose reduction:
Diarrhea
Sources: Page: p.74
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
DLT: Hypercalcemia, Skin toxicity...
Dose limiting toxicities:
Hypercalcemia (grade 4, 22.2%)
Skin toxicity (grade 3, 33.3%)
Anemia (grade 3, 11.1%)
Thrombocytopenia (grade 3, 11.1%)
Emesis (grade 3, 11.1%)
Hypercalcemia (grade 3, 11.1%)
Sources: Page: p.897
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 23
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 23
Sources: Page: p.897
DLT: Hypercalcemia, Skin toxicity...
Dose limiting toxicities:
Hypercalcemia (grade 4, 4.3%)
Skin toxicity (grade 3, 17.4%)
Emesis (grade 3, 4.3%)
AST/ALT ratio abnormal (grade 3, 4.3%)
Sources: Page: p.897
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.34
unhealthy, 4
n = 16
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 16
Sources: Page: p.34
1 mg/kg 2 times / day multiple, oral
Recommended
Dose: 1 mg/kg, 2 times / day
Route: oral
Route: multiple
Dose: 1 mg/kg, 2 times / day
Sources: Page: p.1
unhealthy
Health Status: unhealthy
Condition: Acne
Sources: Page: p.1
Disc. AE: Fetal damage...
AEs leading to
discontinuation/dose reduction:
Fetal damage (grade 4)
Sources: Page: p.1
AEs

AEs

AESignificanceDosePopulation
Cheilitis Disc. AE
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Desquamation Disc. AE
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Headache Disc. AE
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Skin xerosis Disc. AE
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Skin xerosis Disc. AE
12.5 mg/kg single, oral
Overdose
Dose: 12.5 mg/kg
Route: oral
Route: single
Dose: 12.5 mg/kg
Sources: Page: p.348
unhealthy, 29
n = 1
Health Status: unhealthy
Condition: Acne
Age Group: 29
Sex: M
Population Size: 1
Sources: Page: p.348
Diarrhea Disc. AE
1000 mg single, oral
Overdose
Dose: 1000 mg
Route: oral
Route: single
Dose: 1000 mg
Sources: Page: p.74
unhealthy, 31
n = 1
Health Status: unhealthy
Condition: AIDS
Age Group: 31
Sex: M
Population Size: 1
Sources: Page: p.74
Anemia grade 3, 11.1%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Emesis grade 3, 11.1%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Hypercalcemia grade 3, 11.1%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Thrombocytopenia grade 3, 11.1%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Skin toxicity grade 3, 33.3%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Hypercalcemia grade 4, 22.2%
DLT
100 mg/m2 2 times / day multiple, oral
Highest studied dose
Dose: 100 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 100 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 9
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 9
Sources: Page: p.897
Skin toxicity grade 3, 17.4%
DLT
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 23
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 23
Sources: Page: p.897
AST/ALT ratio abnormal grade 3, 4.3%
DLT
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 23
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 23
Sources: Page: p.897
Emesis grade 3, 4.3%
DLT
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 23
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 23
Sources: Page: p.897
Hypercalcemia grade 4, 4.3%
DLT
80 mg/m2 2 times / day multiple, oral
MTD
Dose: 80 mg/m2, 2 times / day
Route: oral
Route: multiple
Dose: 80 mg/m2, 2 times / day
Sources: Page: p.897
unhealthy, 4
n = 23
Health Status: unhealthy
Condition: Neuroblastoma
Age Group: 4
Sex: M+F
Population Size: 23
Sources: Page: p.897
Fetal damage grade 4
Disc. AE
1 mg/kg 2 times / day multiple, oral
Recommended
Dose: 1 mg/kg, 2 times / day
Route: oral
Route: multiple
Dose: 1 mg/kg, 2 times / day
Sources: Page: p.1
unhealthy
Health Status: unhealthy
Condition: Acne
Sources: Page: p.1
Overview

Overview

Drug as perpetrator​Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
major
minor
minor
minor
minor
minor
no
no
no
no
no
no
no
yes
yes
yes
yes
yes
PubMed

PubMed

TitleDatePubMed
Generation of radical oxygen species by neural crest cells treated in vitro with isotretinoin and 4-oxo-isotretinoin.
1990
Taste and olfactory disturbances after treatment for acne with isotretinoin, a 13-cis-isomer of retinoic acid.
1990
Post-isotretinoin vasculitis.
1990 Feb 10
Acute depression from isotretinoin.
1990 Jun
[Acne fulminans triggered by isotretinoin therapy].
1991
Acute depression from isotretinoin.
1991 Jul
Improvement of scleromyxedema associated with isotretinoin therapy.
1991 May
Fatty liver following isotretinoin therapy.
1991 May
[Successful use of isotretinoin in type Zumbusch generalized pustular psoriasis following recovered etretinate-induced hepatitis].
1991 Sep
Incidence of depression related to isotretinoin treatment in 100 acne vulgaris patients.
2006 Dec
The results and side effects of systemic isotretinoin treatment in 100 patients with acne vulgaris.
2006 Dec
[Panic attacks in a patient treated with isotretinoin for acne. Report of one case].
2006 Dec
A rare side-effect of systemic isotretinoin treatment: hoarseness.
2006 Nov
13 Cis-retinoic acid mediates apoptosis in Dalton's lymphoma ascites cells by regulating gene expression.
2007
Cytodifferentiation by retinoids, a novel therapeutic option in oncology: rational combinations with other therapeutic agents.
2007
Atrial tachycardia associated with isotretinoin use.
2007 Aug
Isotretinoin-induced pleuritic chest pain.
2007 Feb
Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective.
2007 Feb
Antitumor effect of the histone deacetylase inhibitor LAQ824 in combination with 13-cis-retinoic acid in human malignant melanoma.
2007 Jan
Cerebral ischemia probably related to isotretinoin.
2007 Jun
Molecular targeting of retinoic acid metabolism in neuroblastoma: the role of the CYP26 inhibitor R116010 in vitro and in vivo.
2007 Jun 4
Acneiform eruptions associated with epidermal growth factor receptor-targeted chemotherapy.
2007 Mar
CD69 on CD56+ NK cells and response to chemoimmunotherapy in metastatic melanoma.
2007 Nov
No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort.
2007 Summer
13 cis-retinoic acid regulates cytokine production and inhibits angiogenesis by disrupting endothelial cell migration and tube formation.
2008
13-cis-retinoic acid induces apoptosis by modulating caspase-3, bcl-2, and p53 gene expression and regulates the activation of transcription factors in B16F-10 melanoma cells.
2008
Isotretinoin and the risk of depression in patients with acne vulgaris: a case-crossover study.
2008 Apr
Hypercalcemia induced by 13 cis-retinoic acid in patients with neuroblastoma.
2008 Apr
Use of oral isotretinoin in photoaging therapy.
2008 Jan-Feb
[Isotretinoin embryopathy. Report of one case].
2008 Jun
Enhanced ocular isotretinoin toxicity in mitochondrial disorder.
2008 Jun
Sacroiliitis and polyneuropathy during isotretinoin treatment.
2008 Mar
A cerebellar demyelinating lesion following treatment of acne with isotretinoin.
2008 Mar
Gene microarray analysis of human renal cell carcinoma: the effects of HDAC inhibition and retinoid treatment.
2008 Oct
Hypercalcemia and 13-cis-retinoic acid in post-consolidation therapy of neuroblastoma.
2009 Feb
Different mRNA expression profiling of nuclear retinoid, thyroid, estrogen and PPARgamma receptors, their coregulators and selected genes in rat liver and spleen in response to short-term in vivo administration of 13-cis retinoic acid.
2009 Jan 30
Isotretinoin (13-cis-retinoic acid)-associated premature ventricular contractions.
2009 Jul-Aug
Temporal changes in gene expression in the skin of patients treated with isotretinoin provide insight into its mechanism of action.
2009 May
The use of isotretinoin in acne.
2009 May
Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients.
2009 May
Hypercalcemia and osteoblastic lesions induced by 13-Cis-retinoic acid mimicking relapsed neuroblastoma.
2009 Oct
Giant cobblestone-like papillae during isotretinoin therapy.
2009 Sep-Oct
The effect of isotretinoin treatment on plasma homocysteine levels in acne vulgaris.
2010 Aug
Antagonism of cytotoxic chemotherapy in neuroblastoma cell lines by 13-cis-retinoic acid is mediated by the antiapoptotic Bcl-2 family proteins.
2010 Dec
Retinoids activate RXR/CAR-mediated pathway and induce CYP3A.
2010 Jan 15
Onset of Kleine-Levin Syndrome in association with isotretinoin treatment.
2010 Jun
Psychiatric reactions to isotretinoin in patients with bipolar disorder.
2010 May
Sacroiliitis and severe disability due to isotretinoin therapy.
2010 May
Isotretinoin-induced encephalopathy.
2010 Nov
Chemical genomics profiling of environmental chemical modulation of human nuclear receptors.
2011 Aug
Patents

Sample Use Guides

acute promyelocytic leukemia (APL): The recommended dose is 45 mg/m2/day administered as two evenly divided doses until complete remission is documented. Therapy should be discontinued 30 days after achievement of complete remission or after 90 days of treatment, whichever occurs first. acne vulgaris: RETIN-A Gel, Cream or Liquid should be applied once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. Liquid: the liquid may be applied using a fingertip, gauze pad, or cotton swab. If gauze or cotton is employed, care should be taken not to oversaturate it, to the extent that the liquid would run into areas where treatment is not intended. Gel: Excessive application results in “pilling” of the gel, which minimizes the likelihood of over application by the patient.
Route of Administration: Other
Human bronchial SMCs were used and pretreated with or without tretinoin, also known as all-trans-retinoic acid (ATRA), (2 μM) for 20 min before the addition of PDGF (1 μg/ml), or ATRA alone. The neutral comet assay, which determines the incidence of double-stranded DNA breaks, was used to demonstrate that ATRA treatment induced apoptosis of bovine and human pulmonary artery SMC. In contrast, apoptotic cell death was not produced in response to ATRA in human bronchial airway SMC, as monitored by comet assay. Similarly, TUNEL assay and the measurement of mitochondrial membrane potential failed to demonstrate significant apoptosis by ATRA in airway SMCs. Positive controls, daunorubicin (DNR) and hydrogen peroxide, effectively elicited apoptosis in airway SMC. Because ATRA inhibited both morphologic and actin cytoskeletal changes induced by PDGF, it was characterized the effects of ATRA on PDGF-induced airway SMC migration using a modified Boyden chamber assay, which allows for determination of motility in random directions. PDGF caused a 4-fold increase in migration of airway SMCs after 24 h, and ATRA blocked these events. ATRA by itself had no effect. While the therapeutic level of ATRA in human plasma could reach 1–2 μM, the effects on airway SMC migration were observed with ATRA concentrations as low as 0.2 μM. DMSO, which is used as vehicle for ATRA and other retinoids, has no effect on PDGF-induced airway SMC migration. This does not appear to be due to the effects of ATRA on cell proliferation, as MTT assay showed that ATRA is not effective in inhibiting PDGF-induced cell proliferation; additionally, migration assay with 4 h of PDGF treatment also exhibits the ability of ATRA to inhibit migratory responses, as monitored using a modified Boyden chamber assay. Thus, although ATRA is ineffective in inhibiting proliferation and inducing apoptosis of airway SMCs, ATRA is an efficient inhibitor of airway SMC migration. Furthermore, using actinomycin D, a general inhibitor of gene transcription, showed that ATRA inhibition of SMC migration does not mediate gene transcriptional events.
Name Type Language
TRETINOIN ZINC
Common Name English
RETINOIC ACID, ZINC SALT
Common Name English
Code System Code Type Description
FDA UNII
7A9179CU3G
Created by admin on Sat Dec 16 05:44:10 GMT 2023 , Edited by admin on Sat Dec 16 05:44:10 GMT 2023
PRIMARY
PUBCHEM
22013415
Created by admin on Sat Dec 16 05:44:10 GMT 2023 , Edited by admin on Sat Dec 16 05:44:10 GMT 2023
PRIMARY
EPA CompTox
DTXSID00226884
Created by admin on Sat Dec 16 05:44:10 GMT 2023 , Edited by admin on Sat Dec 16 05:44:10 GMT 2023
PRIMARY
CAS
75980-27-7
Created by admin on Sat Dec 16 05:44:10 GMT 2023 , Edited by admin on Sat Dec 16 05:44:10 GMT 2023
PRIMARY