Key points
- Arsenic trioxide with tretinoin cures most patients with APL without chemotherapy [2]; the European guideline considers it the standard treatment for low- and intermediate-risk APL [3].
- It is given into a vein every day; induction until remission, then 4 consolidation cycles [1].
- The ECG and blood salts (potassium and magnesium) are checked regularly [1].
What is this drug and how does it work?
Arsenic trioxide breaks down the faulty protein that keeps APL cells immature and so gets rid of these cells [1].
For physicians
Degradation of PML-RARA through its PML moiety, with induction of partial differentiation and apoptosis [1].
Which cancers is it used for?
For physicians
How it is taken and dosing
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A daily infusion into a vein in hospital or a clinic, usually over 2 hours (up to 4 hours if there is a reaction) [1].
For physicians
Standard dosing (FDA label)
Arsenic trioxide
Newly diagnosed low-risk APL (with tretinoin)
Newly diagnosed low-risk APL (with tretinoin)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Induction | |||
| Arsenic trioxide | 0.15 mg/kg | IV | Daily until remission (maximum 60 days) |
| Consolidation: 4 cycles | |||
| Arsenic trioxide | 0.15 mg/kg | IV | 5 days a week, weeks 1 to 4 of each 8-week cycle |
Evidence: APL0406 (2013)
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Side effects
The most common side effects: nausea, cough, tiredness, fever, headache, abdominal pain, vomiting, a racing heart, diarrhoea, low potassium and magnesium, high blood sugar and swelling [1].
For physicians
Common adverse reactions (above 30%): nausea, cough, fatigue, pyrexia, headache, abdominal pain, vomiting, tachycardia, diarrhoea, dyspnoea, hypokalaemia, leucocytosis, hyperglycaemia, hypomagnesaemia, insomnia, dermatitis, oedema and QTc prolongation [1].
Serious side effects
Serious side effects: differentiation syndrome, dangerous heart rhythm changes, brain damage (encephalopathy, including Wernicke) and liver damage [1].
For physicians
When should I call my doctor?
- Palpitations, fainting or dizziness
- Fever, shortness of breath or weight gain
- Confusion, or problems with vision or walking
Interactions, pregnancy and precautions
- Other medicines: medicines that prolong the heart rhythm or lower potassium and magnesium (some diuretics, amphotericin) only with caution and under medical supervision [1].
- Pregnancy: this drug may harm an unborn baby; use effective contraception during treatment and tell your doctor straight away if you become pregnant. Do not breastfeed during treatment [1].
Frequently asked questions
Related cancer types
Treatment regimens (physicians)
References
3 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet
This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/drugs/arsenic-trioxide/