Arsenic trioxide
Trade Name:
Trisenox
Type of Drug:
Arsenic trioxide is a chemotherapy drug.
How Drug Works:
The action of arsenic trioxide is not completely understood. Arsenic trioxide appears to cause changes in cancer cells that make them die. It also appears to correct the gene responsible for making a flawed protein (called the PML-RAR fusion protein) that causes acute promyelocytic leukemia. It is used to treat acute pro-myelocytic leukemia that no longer responds to first-line chemotherapy and ATRA (All-Trans-Retinoic Acid).
How Drug Is Given:
Arsenic trioxide is given by injection into a vein. The first set of treatments (induction) are given daily until the leukemic cells in the bone marrow disappear, up to 60 treatments. Then 3 to 6 weeks after induction, consolidation treatment is given 5 days a week for up to 5 weeks. The dose depends on your size.
Read the following information. If you do not understand it or if any of it causes you special concern, check with your doctor.

Before taking this drug, tell your doctor:

  • If you are trying to become pregnant, are pregnant, or breastfeeding. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. However, do not use oral contraceptives (“the pill”) without checking with your doctor.

  • If you think you may want to have children in the future. Many chemotherapy drugs can cause sterility.

  • If you have any of the following medical problems: chickenpox or exposure to chickenpox, gout, heart disease, congestive heart failure, shingles, kidney stones, liver disease, or other forms of cancer.

  • If you are taking any other prescription or over-the-counter drugs, including vitamins and herbals.
Should I avoid any other medicines, foods, alcohol, and/or activities?
Your prescription and nonprescription medicines may interact with other drugs, causing harm. Certain foods or alcohol can also interact with drug products. Never begin taking a new medicine—prescription or nonprescription—without asking your doctor or nurse if it will interact with alcohol, food, or other medicines. Some drug products can cause drowsiness and affect activities such as driving.
Precautions:
Arsenic trioxide can increase the time it takes for the heartbeat impulse to pass through the heart. You will have a baseline electrocardiogram (EKG), and this may be repeated during the treatment. In addition, you will have blood tests to make sure that the blood electrolyte values and the kidney function tests are normal. If they are abnormal, or if the EKG shows changes, your treatment will be stopped and the abnormalities corrected.
Tell your doctor if you are taking any medicines for an irregular heartbeat or fluid pills.
If you have acute promyelocytic leukemia (APL), the drug may cause APL differentiation syndrome, with fever, difficulty breathing, weight gain, fluid in or around the lung, and death. You will be watched very closely and need to report any of these symptoms right away so that treatment of the syndrome can begin.
Tell all the doctors, dentists, and pharmacists you visit that you are taking this drug.
  • Most of the following side effects probably will not occur.
  • Your doctor or nurse will want to discuss specific care instructions with you.
  • They can help you understand these side effects and help you deal with them.
Side Effects:
More Common Side Effects
  • Nausea
  • Skin redness
  • Vomiting
  • Weight gain
  • Diarrhea
  • Itching
  • Headaches
  • Dizziness
  • Fever, shaking chills (rigors), hives, difficulty breathing
  • Constipation
  • Low blood levels of potassium
  • Poor appetite
  • Low blood levels of magnesium
  • Tiredness (fatigue)
  • Difficulty sleeping
  • High sugar level in the blood
  • Cough
  • High white blood cell count
  • Skin inflammation
Less Common Side Effects
  • Heartburn
  • EKG changes, which can lead to slowing down of the heart
  • Dry mouth
  • Low red blood cell count with increased risk of anemia and tiredness (fatigue)
  • Low platelet count with increased risk of bleeding
  • Low white blood cell count with increased risk of infection
  • Chest pain
  • Pain, redness, and swelling at injection site
  • Aching of muscles and bones
  • High blood levels of potassium
  • Low blood level of calcium
  • Low blood sugar
  • Increased blood levels of liver function tests
  • Numbness or tingling of hands or feet
  • Tremor
  • Too little oxygen in the blood
  • Fluid around the lungs or heart
  • Wheezing
  • Breathing problems
Rare Side Effects
  • Fatal irregular heartbeats
  • Abdominal distention or tenderness
  • Seizures
  • Coma
  • Darkening of skin
Side Effects / Symptoms of the Drug

Call your doctor or nurse right away if you develop a rash, fever, chills, or difficulty breathing.

Report any bruising or bleeding, seizures, or chest pain immediately.
Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop any problems.
FDA Approval: This drug is approved for cancer treatment.