targretin

bexarotene

Targretin

Indications

Action

Pharmacokinetics

Time/action profile (improvement in lesions)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache (most frequent)
• weakness (most frequent)
• insomnia

Ear, Eye, Nose, Throat

• new/worsening cataracts (most frequent)

Cardiovascular

• peripheral edema (most frequent)

Gastrointestinal

• pancreatitis (life-threatening)
• abdominal pain (most frequent)
• nausea (most frequent)
• anorexia
• diarrhea
• liver function abnormalities
• vomiting

Dermatologic

• dry skin (most frequent)
• rash (most frequent)
• alopecia
• exfoliative dermatitis
• photosensitivity

Endocrinologic

• hyperlipidemia (most frequent)
• hypercholesterolemia
• hypothyroidism (most frequent)

Hematologic

• anemia (most frequent)
• leukopenia (most frequent)

Miscellaneous

• flu-like syndrome

Central nervous system

• headache (most frequent)

Cardiovascular

• edema

Dermatologic

• pain (most frequent)
• pruritus (most frequent)
• skin disorder (most frequent)
• rash (most frequent)

Endocrinologic

• hyperlipidemia

Hematologic

• leukopenia

Miscellaneous

• lymphadenopathy

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor for signs and symptoms of pancreatitis.
• Assess for visual difficulties. May cause cataracts.
• Lab Test Considerations: Monitor fasting blood lipid levels prior to therapy, weekly until lipid response is established (usually 2–4 wks), every 8 wks thereafter. May cause hyperlipemia and hypercholesterolemia. Maintain triglyceride levels <400 mg/dL during therapy. If fasting triglyceride levels are elevated or become elevated during therapy, institute antilipemic therapy. May require ↓ dose or stopping bexarotene.
  • Monitor liver function tests prior to therapy and after 1, 2, and 4 wks of therapy. If stable, monitor every 8 wks thereafter. May cause ↑AST, ALT, and serum bilirubin. May require interruption or discontinuation of therapy if levels are > 3 times the upper limit of normal.
  • Monitor thyroid function tests at baseline and periodically during therapy. Consider thyroid replacement if levels ↓.
  • Monitor WBC with differential at baseline and periodically during therapy. May cause leukopenia in the range of 1000 to <3000 WBC/mm³. Onset is usually 4–8 wks. Usually resolves within 30 days with dose ↓ or discontinuation of therapy.
  • Obtain a pregnancy test with a sensitivity of at least 50 mIU/L within 1 wk of starting bexarotene and monthly during therapy.

Potential Nursing Diagnoses

Implementation

• Triglycerides should be normal or normalized with medication prior to starting bexarotene.
• Oral: Administer all capsules at once, once a day with or immediately following a meal. Swallow capsules whole; do not chew or dissolve in liquid or in mouth.
• Topical: Initiate therapy with gel on second or third day of a normal menstrual period. Apply generous amount of gel to cover entire lesion. Allow gel to dry for 5–10 min before covering with clothing. If applied after shower or bath, wait 20 min before application. Do not apply gel to normal skin or mucosal surfaces. Do not cover with occlusive dressings. Wash hands following application. Do not use gel after the expiration date.

Patient/Family Teaching

• Instruct patient to take or apply bexarotene as directed. Take missed doses as soon as remembered unless close to time for next dose; do not double doses.
• Advise patient to avoid touching broken or leaking capsules and notify pharmacist. If contents get on skin, immediately wash area with soap and water and notify health care professional. Do not use capsules after expiration date.
• Advise patient to notify health care professional immediately if signs and symptoms of pancreatitis (persistent nausea, vomiting and abdominal or back pain) occur.
• Caution patient to wear protective clothing and avoid sunlight and artificial ultraviolet light to prevent phototoxocity reactions.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially vitamin A.
• Caution patient that bexarotene is teratogenic and should be avoided during pregnancy. Pregnancy tests will be taken before starting and monthly during therapy. Effective contraception must be used 1 mo before beginning therapy, during, and 1 mo following therapy. Two forms of contraception are recommended with at least 1 being condom, diaphragm, cervical cap, IUD, or spermacide. Patients should not breastfeed during therapy. Male patients whose partner is pregnant or capable of becoming pregnant should discuss precautions with health care professional.
• Explain need for regular blood tests to patient.
• Topical: Advise patient to avoid showering, bathing, or swimming for at least 3 hrs after application. Avoid insect repellent containing DEET or other products containing DEET during therapy. Keep gel away from flame; contains alcohol.
• Inform patient that redness, itching, burning, irritation, and scaling at application area may occur; notify health care professional if they become troublesome.

Evaluation/Desired Outcomes

• Decrease in lesions of cutaneous T-cell lymphoma.