Tretiva is a systemic retinoid medication containing Isotretinoin, prescribed for the treatment of severe, recalcitrant nodular acne that has not responded to conventional therapies, including antibiotics. It works by markedly reducing sebum production, altering keratinization, and exerting anti-inflammatory effects, leading to long-term remission in a significant proportion of patients. Due to its mechanism of action and potential for serious side effects, it is reserved for the most severe cases under strict medical supervision by a qualified dermatologist.

Features

• Active ingredient: Isotretinoin (10 mg, 20 mg soft gelatin capsules)
• Pharmacologic class: Systemic retinoid
• Administration: Oral
• Available in blister packs of 10 capsules
• Requires prescription and enrollment in a risk management program (e.g., iPLEDGE in the US)
• Bioavailability is enhanced when taken with a high-fat meal

Benefits

• Achieves significant and often permanent clearance of severe nodular acne
• Dramatically reduces sebum production, minimizing oiliness and pore clogging
• Decreases inflammation, redness, and the frequency of new lesion formation
• Improves skin texture and reduces the risk of severe acne scarring
• Enhances patient self-esteem and quality of life through visible skin improvement
• Offers a finite treatment course, typically 15-20 weeks, for long-term results

Common use

Tretiva is specifically indicated for the treatment of severe recalcitrant nodular acne in patients aged 12 years and older. It is used when standard acne treatments, such as topical agents and oral antibiotics, have proven ineffective. The medication is not intended for mild or moderate acne, cosmetic use, or as a first-line therapy. Treatment is initiated and monitored by a dermatologist, with regular follow-ups to assess response and manage side effects.

Dosage and direction

The dosage of Tretiva is highly individualized based on patient weight, the severity of acne, and tolerability. The recommended cumulative dose range is 0.5 to 1.0 mg/kg/day, given in two divided doses with food to maximize absorption. Treatment typically continues for 15 to 20 weeks, or until the total cumulative dose of 120-150 mg/kg is achieved. Dosage adjustments may be necessary based on laboratory results and clinical response. It is crucial to swallow the capsules whole with a full glass of water and not to crush or chew them. Patients must strictly adhere to the prescribed regimen and not increase the dose without medical consultation.

Precautions

Tretiva is associated with serious risks requiring stringent precautions. It is teratogenic and must not be used during pregnancy. Female patients of reproductive potential must use two reliable forms of contraception for one month before, during, and for one month after therapy. Regular pregnancy tests are mandatory. Liver function, lipid levels, and complete blood counts must be monitored before treatment and periodically during therapy. Patients should avoid vitamin A supplements to prevent additive toxicity. Due to the risk of photosensitivity, sun avoidance and use of broad-spectrum sunscreen are advised. Mood changes, including depression, should be monitored closely. Patients must not donate blood during and for one month after therapy.

Contraindications

Tretiva is contraindicated in pregnancy or in women who may become pregnant during treatment or within one month after discontinuation. It is also contraindicated in patients with hypersensitivity to Isotretinoin or any component of the formulation. Other contraindications include hepatic insufficiency, hyperlipidemia that is not controlled, and concomitant use of tetracyclines due to the risk of pseudotumor cerebri. It should not be used in patients with chronically elevated blood triglyceride levels or a history of pancreatitis.

Possible side effects

Common side effects are mostly dose-dependent and include cheilitis (dry lips) in over 90% of patients, xerosis (dry skin), epistaxis (nosebleeds), dry eyes, and conjunctivitis. Musculoskeletal symptoms such as arthralgia and myalgia may occur. Less common but serious side effects include elevated liver enzymes and blood lipids, pancreatitis, inflammatory bowel disease, intracranial hypertension, visual disturbances, and hearing impairment. Psychiatric effects like depression, mood swings, and rarely suicidal ideation have been reported. Most side effects are reversible upon discontinuation but require prompt medical attention if severe.

Drug interaction

Tretiva has significant interactions with several drug classes. Concomitant use with tetracycline antibiotics increases the risk of pseudotumor cerebri and is contraindicated. Vitamin A supplements can lead to hypervitaminosis A. It may reduce the efficacy of combined oral contraceptives, though data is conflicting—thus, two forms of contraception are still mandated. Drugs that increase triglyceride levels, such as corticosteroids, should be used cautiously. It may interact with St. John’s Wort, potentially reducing contraceptive efficacy. Always inform your healthcare provider of all medications, including over-the-counter products and herbal supplements.

Missed dose

If a dose of Tretiva is missed, take it as soon as remembered on the same day. However, if it is nearly time for the next dose, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one, as this increases the risk of toxicity. Consistency in dosing is important for efficacy and safety, so try to adhere to the prescribed timing. Inform your dermatologist if multiple doses are missed.

Overdose

Overdose with Tretiva can lead to symptoms of hypervitaminosis A, including vomiting, facial flushing, cheilitis, abdominal pain, headache, dizziness, and ataxia. In severe cases, it may cause elevated intracranial pressure. There is no specific antidote; treatment is supportive and symptomatic. Gastric lavage may be considered if ingestion is recent. Patients should seek immediate medical attention or contact a poison control center. Due to the drug’s long half-life, monitoring may be required for an extended period.

Storage

Store Tretiva capsules at room temperature (15-30°C or 59-86°F) in a dry place, protected from light and moisture. Keep the blister packs in the original carton until use. Do not freeze. Keep out of reach of children and pets to prevent accidental ingestion. Do not use beyond the expiration date printed on the packaging. Proper disposal of unused medication is important; consult a pharmacist for guidance on take-back programs.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your dermatologist or qualified healthcare provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. The use of Tretiva must be supervised by a physician familiar with its risks and benefits.

Reviews

“After struggling with severe cystic acne for years and trying every treatment available, Tretiva was a game-changer. My skin is completely clear now, and the confidence it has given me is priceless. The dry lips and skin were challenging but manageable with moisturizers. Strict adherence to the precautions is non-negotiable.” – Priya M., 28

“As a dermatologist, I have prescribed Tretiva for appropriate patients with remarkable success. It remains the most effective treatment for severe nodular acne, often providing permanent remission. However, it demands rigorous monitoring for teratogenicity, lipids, and mental health. Patient education and compliance are critical.” – Dr. A. Sharma, MD Dermatology

“The treatment journey with Tretiva was tough due to the side effects, but worth it. My acne has not returned even two years post-treatment. Blood tests and birth control were a hassle, but necessary. I highly recommend it for those with severe acne, under expert supervision.” – Rohan K., 24

“I experienced mood swings and joint pain during my course, but my dermatologist adjusted the dose and these improved. The results are phenomenal—my skin hasn’t been this clear since I was a teenager. This medication is powerful and should be respected.” – Anjali T., 31