The Navigation Model of Therapy: Why Awareness Changes Everything
November 16, 2025
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Brand Name :
Trisenox
Synonyms :
arsenic trioxide
Class :
Antineoplastics
Brand Name :
Trisenox
Synonyms :
arsenic trioxide
Class :
Antineoplastics
Dosage Forms & StrengthsÂ
Injectable solutionÂ
1mg/mlÂ
Newly diagnosed low-risk acute promyelocytic leukemia (APL)
Treatment therapy involves of 1 induction and 4 consolidation cycles
Induction cycle
Administer arsenic trioxide at a dose of 0.15 mg/kg intravenously daily until achieving bone marrow remission, with a maximum duration of 60 days, in addition to
Take tretinoin at a dose of 22.5 mg/m² orally twice a day until achieving bone marrow remission, with a maximum duration of 60 days
Consolidation cycle
Administer arsenic trioxide at a dose of 0.15 mg/kg intravenously daily for first 5 days on weeks 1 to 4 of an 8-week cycle and that to total of 4 cycles when combined with tretinoin
Take tretinoin 22.5 mg/m² orally twice daily for first 7 days on weeks 1, 2, 5, and 6
Tretinoin should be omitted during weeks 5 and 6 of the fourth cycle of consolidation
Dosage Modifications
Differentiation syndrome
If symptoms are severe, consider discontinuing tretinoin
Administer dexamethasone 10 mg intravenously every 12 hours until the indications and symptoms go away, for at least 3 days
QTc prolongation
If half amount of dose is well-tolerated for a week, then raise the dose up to 0.11 mg/kg every day for a week
Hepatoxicity
If hepatotoxicity returns, permanently stop taking the drugs that were withheld
Myelosuppression
Consider decreasing dose of arsenic trioxide and tretinoin by 1 dose level
Dosing reduction levels for hematologic and nonhematologic toxicities
For arsenic trioxide
Starting level: 0.15 mg/kg intravenously daily
Level- 1: 0.11 mg/kg intravenously daily
Level- 2: 0.1 mg/kg intravenously daily
Level- 3: 0.075 mg/kg intravenously daily
For tretinoin
Starting level: 22.5 mg/m² orally twice a day
Level- 1: 18.75 mg/m² orally twice a day
Level- 2: 12.5 mg/m² orally twice a day
Level- 3: 10 mg/m² orally twice a day
Renal impairment
Severe: There may be increased exposure to arsenic trioxide
Safety and efficacy not determined for dialysis
Hepatic impairment
Limited data present
Severe (Child Pugh C): Monitor for poisoning
Dosage Forms & StrengthsÂ
Injectable solutionÂ
1mg/mlÂ
Refractory after retinoid and anthracycline chemotherapy
<4 years: Safety and efficacy not determined
≥4 years: Administer dose of 0.15 mg/kg intravenously daily until achieving bone marrow remission, with a maximum duration of 60 days
Wait for 3 to 6 weeks, then
Administer dose of 0.15 mg/kg intravenously daily for 25 doses
Dosing Considerations
Monitor: serum electrolytes and ECG
Refer to adult dosingÂ
may increase the hypotensive effect of arsenic trioxide
may increase the hypotensive effect of arsenic trioxide
may increase the hypotensive effect of arsenic trioxide
may increase the hypotensive effect of arsenic trioxide
may have an increased QTc-prolonging effect when combined with arsenic trioxide
may have an increased QTc-prolonging effect when combined with arsenic trioxide
may have an increased QTc-prolonging effect when combined with arsenic trioxide
may have an increased QTc-prolonging effect when combined with arsenic trioxide
may have an increased QTc-prolonging effect when combined with arsenic trioxide
It may enhance QTc interval when combined with erythromycin stearate
arsenic trioxide: they may enhance the hypotensive effect of loop diuretics
arsenic trioxide: they may enhance the hypotensive effect of loop diuretics
arsenic trioxide: they may enhance the hypotensive effect of loop diuretics
arsenic trioxide: they may increase the QTc-prolonging effect of osmotic diuretics
when both drugs are combined, there may be an increase in qtc interval  
when both drugs are combined, there may be increased toxicity of arsenic trioxide by QTC interval  
methyldopa/hydrochlorothiazideÂ
may increase the hypotensive effect of thiazide and thiazide like diuretics
may have an increased hypotensive effect when combined with arsenic trioxide
may increase the hypotensive effect of Arsenic Trioxide
It may enhance QTc interval when combined with lithium
when both drugs are combined, there may be an increased risk or severity of QTC prolongation  
when both drugs are combined, both increase the QTC interval  
both lapatinib and arsenic trioxide increase the QTc interval
when both drugs are combined, there may be an increased risk or severity of QTC prolongation
when both drugs are combined, there may be an increased QTc interval 
It may enhance QTc interval when combined with pentamidine
It may enhance the risk of adverse reactions when combined with Ethylenimine
It may enhance the risk of adverse reactions when combined with Ethylenimine
The potential for bleeding risk or its seriousness may elevate when arsenic trioxide is used together with troxerutin
When mometasone furoate is used together with arsenic trioxide, this leads to enhanced risk or seriousness of adverse outcomes
When arsenic trioxide is used together with capsaicin, this leads to enhanced risk or seriousness of methemoglobinemia
When arsenic trioxide is used together with elbasvir, this leads to a rise in the concentration serum of elbasvir
When arsenic trioxide is used together with grazoprevir, this leads to a rise in the concentration serum of grazoprevir
When ponesimod is used together with arsenic trioxide, this leads to enhanced risk or seriousness of bradycardia
When arsenic trioxide is used together with adenosine, this leads to enhanced risk or seriousness of QTc prolongation
When arsenic trioxide is used together with andrographolide, this leads to enhanced risk or seriousness of bleeding
When arsenic trioxide is used together givinostat, this leads to enhanced risk or severity of Qtc prolongation
arsenic trioxide leads to a reduction in the rate of excretion of eucalyptus oil which leads to increased level of serum
cefpirome leads to a reduction in the rate of excretion of arsenic trioxide which leads to increased level of serum
arsenic trioxide leads to a reduction in the rate of excretion of chromous sulfate, which leads to an increased level of serum
arsenic trioxide leads to a reduction in the rate of excretion of pentaerythritol tetranitrate, which leads to an increased level of serum
arsenic trioxide leads to a reduction in the rate of excretion of potassium acetate, which leads to an increased level of serum
arsenic trioxide leads to a reduction in the rate of excretion of potassium perchlorate, which leads to an increased level of serum
the therapeutic effectiveness of insulin aspart can be decreased when used in conjunction with arsenic trioxide
the serum concentration of digitoxin can be increased when it is combined with arsenic trioxide
arsenic trioxide may decrease the excretion rate of almasilate, leading to higher serum levels
QTc interval is decreased both by lenvatinib and arsenic trioxide
when both drugs are combined, there may be an increased QTC interval  
when both drugs are combined, there may be an increase in QTC interval
choline magnesium trisalicylate
It may enhance the risk of adverse reactions when combined with Salicylates
The severity of irregular heartbeat due to arsenic trioxide may be raised when administered with hydroxocobalamin
the risk of adverse effects may be increased
Actions and SpectrumÂ
In cancer cells, arsenic trioxide encourages programmed cell death. Multiple biological pathways and growth-supporting processes are impacted, which results in the death of cancer cells.Â
Cancer cells may differentiate when exposed to arsenic trioxide, losing their malignant traits and taking on a more mature, normal cell phenotype. Acute promyelocytic leukaemia (APL), a form of acute myeloid leukaemia (AML), has been successfully treated with arsenic trioxide.
Frequency defined Â
1-10%Â
Eye irritation (10%)Â
Convulsion (5%)Â
Gastrointestinal hemorrhage (8%)Â
Eyelid edema (5%)Â
Facial edema (8%)Â
Renal failure/impairment (8%)Â
Hypertension (10%)Â
Blurred vision (10%)Â
Petechiae (8%)Â
Crepitation (10%)Â
Flushing (10%)Â
Hypoglycemia (8%)Â
Night sweats (8%)Â
Urticaria (8%)Â
Neutropenia (10%)Â
Hyperpigmentation (8%)Â
Rales (10%)Â
Confusion (5%)Â
Oral candidiasis (5%)Â
Earache (8%)Â
Tinnitus (5%)Â
Pallor (10%)Â
Hypocalcemia (10%)Â
Palpitations (10%)Â
Anxiety (30%)Â
Coma (5%)Â
>10%Â
Cough (65%)Â
Upper respiratory infection (13%)Â
Weight gain (13%)Â
Hypokalemia (50%)Â
Hypomagnesemia (45%)Â
Vaginal hemorrhage (13%)Â
Anxiety (30%)Â
Constipation (28%)Â
Hyperglycemia (45%)Â
Diarrhea (53%)Â
Injection site reactions (4-15%)Â
Dyspnea (53%)Â
Hypotension (25%)Â
Sinusitis (20%)Â
Anemia (14%)Â
Anorexia/decreased appetite (23%)Â
Pyrexia (63%)Â
Dermatitis (33%)Â
Thrombocytopenia (19%)Â
Hyperkalemia (18%)Â
Parathesia (33%)Â
Arthralgia (33%)Â
Tachycardia (55%)Â
Sore throat (40%)Â
Febrile neutropenia (13%)Â
Tremor (13%)Â
Prolonged QTc interval (38%)Â
Leukocytosis (50%)Â
Pain (50%)Â
Herpes simplex (13%)Â
Dizziness (23%)Â
Depression (20%)Â
Pleural effusion (20%)Â
Headache (60%)Â
Vomiting (58%)Â
Chest pain (25%)Â
Epistaxis (25%)Â
Hypoxia (23%)Â
ALT increased (20%)Â
Abdominal pain (58%)Â
Fatigue (63%)Â
Insomnia (43%)Â
Edema (40%)Â
Pruritus (33%)Â
Nausea (75%)Â
Post marketing reportsÂ
Neoplasms benign, malignant and unspecified: pancreatic cancer, squamous cell carcinoma, Melanoma Â
Ear and labyrinth disorders: DeafnessÂ
Hematologic disorders: Pancytopenia, bone marrow necrosisÂ
Skin and subcutaneous tissue disorders: Toxic epidermal necrolysisÂ
Respiratory, mediastinal disorders and thoracic: Differentiation syndromeÂ
Infections and infestations: Herpes zosterÂ
Musculoskeletal and connective tissue disorders: myalgia, rhabdomyolysis, bone painÂ
Cardiac disorders: ventricular tachycardia in association with QT prolongation, Ventricular extrasystoles in association with QT prolongationÂ
Nervous system disorders: paresis, seizures, Peripheral neuropathy, confusionÂ
Black Box WarningÂ
None Â
Contraindication/Caution:Â
Contraindication:Â
Caution:Â
Pregnancy warnings:    Â
Pregnancy category: N/AÂ
Lactation: Excretion into human milk is known Â
Pregnancy Categories:        Â
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.Â
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.Â
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.Â
Category N: There is no data available for the drug under this category.Â
Pharmacology Â
By interfering with cell signaling pathways, impairing mitochondrial function, and activating pro-apoptotic proteins, arsenic trioxide encourages programmed cell death in cancer cells.Â
arsenic trioxide prevents angiogenesis, or the creation of new blood vessels that supply tumors, by inhibiting the activity of factors involved in blood vessel growth.Â
PharmacodynamicsÂ
The production of reactive oxygen species (ROS), which causes the mitochondrial membrane to permeabilize and release apoptotic components, arsenic trioxide impairs mitochondrial function.Â
Angiogenesis, which involves the formation of new blood vessels, which is essential for tumor growth and metastasis, is inhibited by arsenic trioxide.Â
PharmacokineticsÂ
Absorption  Â
arsenic trioxide is injected intravenously right into the circulation. This method guarantees immediate and total absorption.Â
DistributionÂ
The body has arsenic trioxide in all its tissues and organs. It can penetrate the blood-brain barrier and enter the central nervous system.Â
It is well known that arsenic trioxide strongly binds to albumin and other plasma proteins.Â
MetabolismÂ
The enzyme arsenic 3-methyltransferase (AS3MT) is principally responsible for the hepatic metabolism of arsenic trioxide. Less hazardous metabolites than the parent chemical is produced as a result of this metabolism.Â
Elimination and excretionÂ
The kidneys are the main organs used for the elimination of arsenic trioxide and its metabolites. They are eliminated by urine and have a half-life of 5 to 10 hours.Â
AdministrationÂ
arsenic trioxide is administered directly into a vein through an intravenous line.Â
Patient information leafletÂ
Generic Name: arsenic trioxideÂ
Why do we use arsenic trioxide?Â
Acute Promyelocytic Leukaemia (APL) is treated with arsenic trioxide as a significant component.Â
Patients with acute myeloid leukaemia (AML) who have relapsed or are resistant to current therapy may be treated with arsenic trioxide. All-trans retinoic acid (ATRA), for example, is frequently used in combination with it.Â
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