arsenic trioxide at a glance
Medicine class
Antineoplastic treatment
Main use
Induction of remission and consolidation treatment for specified forms of APL in adults
Administration
Intravenous infusion given by a specialist hospital team
Key monitoring
ECGs, electrolytes, blood counts, glucose, liver and kidney function, and coagulation tests
What is arsenic trioxide used for?
The selected product is licensed in adults for induction of remission and consolidation in:
Newly diagnosed low-to-intermediate-risk APL, with all-trans-retinoic acid.
Relapsed or refractory APL previously treated with a retinoid and chemotherapy, where the characteristic t(15;17) translocation and/or PML/RAR-alpha gene is present.
How does arsenic trioxide work?
APL cells usually contain an abnormal PML/RAR-alpha fusion protein that prevents normal blood-cell development. Arsenic trioxide promotes damage or degradation of this protein, helping abnormal cells mature or undergo programmed cell death. Its full mechanism is not completely understood.
arsenic trioxide preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 1 mg/mL, 2 mg/mL
How to take arsenic trioxide
Trained healthcare professionals prepare and administer arsenic trioxide intravenously under specialist supervision. The concentrate must be diluted and must not be mixed with, or infused through the same intravenous line as, other medicines.
The solution should be clear and colourless before administration.
Tell staff promptly about flushing, dizziness, a racing heartbeat or other symptoms during the infusion.
Food does not affect administration because treatment is intravenous.
arsenic trioxide side effects
Common or expected effects
- Changes in blood glucose, potassium or magnesium
- Tingling or altered sensation, headache or dizziness
- Nausea, vomiting or diarrhoea
- Rash or itching
- Muscle pain
- Fever, fatigue, pain or swelling
- Fast heartbeat or ECG changes
- Changes in liver blood tests
Get urgent medical advice
- Differentiation syndrome: unexplained fever, breathlessness, sudden weight gain, swelling or fluid around the lungs or heart
- Heart-rhythm disturbance: fainting, rapid or irregular heartbeat, marked dizziness or chest pain
- Severe infection, fever with low white-cell counts or unusual bleeding
- Severe liver injury, kidney failure or major electrolyte disturbance
- Encephalopathy: new confusion, reduced alertness or seizures
arsenic trioxide in pregnancy
Arsenic trioxide may harm an unborn baby. Pregnancy, possible pregnancy or pregnancy planning requires urgent discussion with the specialist team. Effective contraception is required during treatment and afterwards—six months for women who could become pregnant and three months for men who could father a child.
arsenic trioxide while breastfeeding
Arsenic passes into human milk and could seriously harm a breastfed child. Breastfeeding must stop before and throughout treatment and must not restart until at least two weeks after the final administration. Discuss feeding options with the specialist team.
arsenic trioxide interactions
The specialist team should review all prescribed, non-prescribed and complementary products before treatment.
QT-prolonging medicines, including amiodarone, sotalol, some macrolide or quinolone antibiotics, antipsychotics and tricyclic antidepressants
May further prolong cardiac repolarisation and increase the risk of a potentially dangerous ventricular arrhythmia.
Potassium-wasting diuretics
Reduced potassium or magnesium may increase the risk of serious heart-rhythm disturbances.
Amphotericin B
Electrolyte loss may increase the risk of QT prolongation and torsade de pointes.
Common questions about arsenic trioxide
Answers are fully visible for fast scanning and source review.
Why is arsenic trioxide used for APL?
APL commonly depends on an abnormal PML/RAR-alpha fusion protein. Arsenic trioxide promotes damage or degradation of this protein and helps abnormal promyelocytes mature or die.
Why are ECGs needed?
Arsenic trioxide can prolong the QT interval and, rarely, cause life-threatening abnormal heart rhythms. ECG and electrolyte monitoring help identify and reduce this risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.