Tretinopak

Uses

Avobenzone is a sunscreen agent found in sunscreens that absorbs UV rays.

Sun protection factor, added in the sunscreen products for its wide spectrum ultraviolet absorption properties.

Octinoxate is a sunscreen agent found in sunscreens that absorbs UV rays.

As an active ingredient in sunscreens and lip balms. Used for protection against damaging effects of sun rays.

Ingredient in sunscreens for protection against damage effects of sun light, provides protection from sunburns, aging and skin cancer.

Titanium dioxide is a sunscreen agent found in sunscreens that absorbs UV rays.

Titanium dioxide is used in most sunscreens to block UVA and UVB rays, similar to zinc oxide.

• For the treatment of acne vulgaris in which comedones, papules and pustules predominate.
• For the treatment of hyperpigmentation, roughness and fine wrinkling of photodamaged skin due to chronic sun exposure.
• For the treatment of Acute promyelocytic leukaemia

Tretinopak is also used to associated treatment for these conditions: SunburnSunburnSunburnBlisters, Dermatitis, Eczematous, Sunburn, Wounds, Abrasions, Dry, cracked skin, UV protection therapyAcne Vulgaris, Alopecia, Cornification and dystrophic skin disorders, FAB classification M3 Acute promyelocytic leukemia, Skin hyperpigmentation, Solar Lentigines, Facial fine wrinkling, Keratinization disorders of the feet, Keratinization disorders of the hand, Moderate Melasma, Mottled hyperpigmentation, Severe Melasma, Severe, recalcitrant Cystic acne, Tactile roughness of facial skin

How Tretinopak works

It blocks UVA I, UVA II, and UVB wavelengths, thereby limiting the impact of UV rays on skin. Diminish the penetration of ultraviolet (UV) light through the epidermis by absorbing UV radiation within a specific wavelength range. The amount and wavelength of UV radiation absorbed are affected by the molecular structure of the sunscreen agent.

Absorbs UV-B (predominantly) and UV-A rays while accumulating in the outermost layer of the epidermis. Like any other photoprotective agents, octinoxate prevents the damage to cells and deoxyribonucleic acid (DNA) by reducing the p53 protein expression following UV exposure and also increases the skin's tolerability to UV rays .

Chemical sunscreen, it acts through absorption of UVB light and not UVA.

Diminish the penetration of ultraviolet (UV) light through the epidermis by absorbing UV radiation within a specific wavelength range. The amount and wavelength of UV radiation absorbed are affected by the molecular structure of the sunscreen agent.

Tretinoin binds to alpha, beta, and gamma retinoic acid receptors (RARs). RAR-alpha and RAR-beta have been associated with the development of acute promyelocytic leukemia and squamous cell cancers, respectively. RAR-gamma is associated with retinoid effects on mucocutaneous tissues and bone. Although the exact mechanism of action of tretinoin is unknown, current evidence suggests that the effectiveness of tretinoin in acne is due primarily to its ability to modify abnormal follicular keratinization. Comedones form in follicles with an excess of keratinized epithelial cells. Tretinoin promotes detachment of cornified cells and the enhanced shedding of corneocytes from the follicle. By increasing the mitotic activity of follicular epithelia, tretinoin also increases the turnover rate of thin, loosely-adherent corneocytes. Through these actions, the comedo contents are extruded and the formation of the microcomedo, the precursor lesion of acne vulgaris, is reduced. Tretinoin is not a cytolytic agent but instead induces cytodifferentiation and decreased proliferation of APL cells in culture and in vivo. When Tretinoin is given systemically to APL patients, tretinoin treatment produces an initial maturation of the primitive promyelocytes derived from the leukemic clone, followed by a repopulation of the bone marrow and peripheral blood by normal, polyclonal hematopoietic cells in patients achieving complete remission (CR). The exact mechanism of action of tretinoin in APL is unknown.

Dosage

Tretinopak dosage

Tretinoin cream: Tretinoin cream should be applied sparingly to the whole affected area once or twice daily. The skin should be thoroughly cleaned and dried before application. Patient should be advised that 6 to 8 weeks of treatment may be required before a therapeutic effect is observed. Moisturisers and cosmetics may be used during treatment with Cosmotrin cream but should not be applied to the skin at the same time. Astringent toiletries should be avoided.

Tretinoin gel: Tretinoin gel should be applied once or twice a day, before retiring, to the skin where lesions appear, using enough to cover the entire affected area lightly. The frequency of application can be adjusted to obtain maximum clinical efficacy with minimal erythema and scaling.

If Tretinoin gel is applied excessively, no more rapid or better results will be obtained and marked redness, peeling or discomfort may occur. Should this occur accidentally or through over-enthusiastic use, application should be discontinued for few days.

Patience is needed in this treatment, since the therapeutic effects will not usually be observed until after 6-8 weeks of treatment. During the early weeks of treatment, an apparent exacerbation of inflammatory lesions may occur. This is due to the action of the medication on deep, previously unseen comedones and papules. Once the acne lesions have responded satisfactorily, it should be possible to maintain the improvement with less frequent applications.

Moisturizers and cosmetics may be used during treatment with Tretinoin gel but should not be applied to the skin at the same time. The skin should be thoroughly washed before application of Tretinoin gel. Astringent toiletries should be avoided.

Capsule: 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.

If after initiation of treatment of Tretinoin the presence of the translocation is not confirmed by cytogenetics and/or by polymerase chain reaction studies and the patient has not responded to Tretinoin, alternative therapy appropriate for acute myelogenous leukemia should be considered.

Side Effects

True allergic contact dermatitis is rare but a primary irritant dermatitis, manifesting itself as irritation, erythema, peeling and sensation of warmth, is common. Slight stinging is common as a mild reaction in many people but usually settles with continuous use and/or reduction in the frequency of application of the drug.

Toxicity

A minimum toxic dose has not been established. Significant toxicity is not expected

Slightly hazardous in case of skin contact, eye contact, ingestion and inhalation. Octinoxate may form reactive singlet oxygen species and induce anti-estrogenic effects . UV-induced molecular breakdown of octinoxate may interfere with cellular processes or induce oxidative damage in human skin . The NOAEL (no observed adverse effect level) is 450 mg/kg bw/day for fertility and reproductive performance, for systemic parental and developmental toxicity in Wistar rats .

LD50, (oral, rat): > 5000 mg/Kg. LD50 (dermal, rabbit): > 5000 mg/Kg.

Rat - LD50 Intratracheal (>100ug/kg ) Effects: Structural or functional changes in bronchi and trachea. There is inadequate evidence in humans for the carcinogenicity of titanium dioxide. Cancer in experimental animals: There is sufficient evidence in experimental animals for the carcinogenicity of titanium dioxide. Overall evaluation: Titanium dioxide is possibly carcinogenic to humans (Group 2B).

Interaction

Particular caution should be exercised in using preparations containing peeling agents (i.e. sulfur, resorcinol, benzoyl peroxide or salicylic acid). Use of topical preparations with high concentrations of alcohol, menthol, spices or lime- such as shaving lotions, astringents and perfume- should be avoided, especially during initial therapy.

Volume of Distribution

Intended for local use only, no systemic absorption.

Six hours after titanium dioxide was administered to rats through IV injection at 250 mg/kg body weight, the highest concentration appeared in the liver; after 24 hours, the highest concentration was detected in the celiac lymph nodes, which filter the lymph from the liver.

Elimination Route

Can be systemically absorbed after skin application, being found in the deeper layers of the stratum corneum as well as urine, plasma, and breast milk . The mean maximum plasma concentration detected after application of 2mg/cm2 sunscreen was 7ng/mL in women and 16ng/mL in men .

Intended for local use only, no systemic absorption.

When male and female rats were fed a diet containing titanium dioxide (100 g/kg) for a period of about 32 days, a significant retention of titanium of 0.06 and 0.11 mg/kg wet weight was found only in the muscles; no retention was observed in the liver, spleen, kidney, bone, plasma, or erythrocytes

1-31% (topical)

Half Life

Intended for local use only, no systemic absorption.

The kinetics of TiO2 elimination in the rat lung following its deposition after 7 hr exposure at 10 and 50 mg/cu m were determined for periods up to 140 days...The retention half-time was 14 days for the first clearance phase and 88 days thereafter.

0.5-2 hours

Clearance

Intended for local use only, no systemic absorption.

The clearance of titanium dioxide from the lungs was studied in rats after inhalation of 15 or 100 mg/cu m. The average median aerodynamic diameter of the titanium dioxide particles was 1.48 um. After a single exposure, about 40-45% of the deposited particles were cleared from the lung in 25 days. At 15 mg/cu m, 0.7% was found in the hilar lymph nodes indicating penetration of titanium dioxide particles from alveoli into the lymphatic system and partial clearance by the lymphatic route. The clearance rate was similar after intra-tracheal administration of titanium dioxide. At an exposure of 100 mg/cu m, the clearance rate decreased drastically. /Other researchers/ demonstrated the presence of titanium dioxide in the lymphatic systems of 3 workers employed in processing titanium dioxide pigments.

Elimination Route

Can be detected in urine in unchanged form .

Intended for local use only, no systemic absorption.

The kinetics of TiO2 elimination in the rat lung following its deposition after 7 hr exposure at 10 and 50 mg/cu m were determined for periods up to 140 days.The retention half-time was 14 days for the first clearance phase and 88 days thereafter.

Pregnancy & Breastfeeding use

Tretinoin is contraindicated in pregnancy or suspected pregnancy. The drug should be avoided by breast feeding mothers.

Contraindication

Tretinoin is contraindicated in patients who are allergic to this drug. It is contraindicated in pregnancy or suspected pregnancy. It is also contraindicated in personal or familial history of cutaneous epithelioma.

Local irritation: The presence of cutaneous irritative signs (e.g. erythema, peeling, pruritus, sunburn, etc.) should prohibit initiation or recommencement of treatment with Tretinoin until the symptoms resolve. Tretinoin has been reported to cause severe irritation on eczematous skin and should be used with caution in patients with this condition.

Exposure to sunlight: Exposure to sunlight, including ultraviolet sun-lamps, should be avoided or minimised during the use of Tretinoin.

General precaution: Before application of Tretinoin, areas to be treated should be cleansed thoroughly. Abstain from washing the treated area frequently; twice daily is sufficient. Use of mild soap is recommended. Dry the skin without rubbing.

Avoid contact with eyes, eyelids, nostrils, mouth and mucous membranes. If contact in these areas occurs, careful washing with water is recommended.

Storage Condition

Store in a cool and dry place, away from light. Keep out of reach of children.

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