Arsenic trioxide should be given only under the supervision of a doctor who has experience in treating people who have leukemia (cancer of the white blood cells).
Arsenic trioxide may cause a serious or life-threatening group of symptoms called APL differentiation syndrome. Your doctor will monitor you carefully to see whether you are developing this syndrome. Your doctor may ask you to weigh yourself every day during the first few weeks of your treatment because weight gain is a symptom of APL differentiation syndrome. If you experience any of the following symptoms, call your doctor immediately: fever, weight gain, shortness of breath, labored breathing, chest pain, or cough. At the first sign that you are developing APL differentiation syndrome, your doctor will prescribe one or more medications to treat the syndrome.
Arsenic trioxide may cause QT prolongation (heart muscles take longer to recharge between beats due to an electrical disturbance), which can cause serious or life-threatening heart rhythm problems. Before you begin treatment with arsenic trioxide, your doctor will order an electrocardiogram (ECG; test that records the electrical activity of the heart) and other tests to see whether you already have an electrical disturbance in your heart or are at higher than usual risk of developing this condition. Your doctor will monitor you closely and will order an ECG and other tests during your treatment with arsenic trioxide. Tell your doctor if you have or have ever had QT prolongation, heart failure, irregular heartbeat, or low levels of potassium or magnesium in your blood. Also tell your doctor if you are taking any of the following medications: amiodarone (Nexterone, Pacerone), amphotericin (Abelcet, Amphotec, Fungizone), cisapride (Propulsid), disopyramide (Norpace), diuretics ('water pills'), dofetilide (Tikosyn), erythromycin (E.E.S., E-Mycin, Erythrocin), moxifloxacin (Avelox), pimozide (Orap), procainamide (Procanbid, Pronestyl), quinidine (Quinidex), sotalol (Betapace, Betapace AF), sparfloxacin (Zagam), thioridazine (Mellaril), and ziprasidone (Geodon). Call your doctor immediately if you have an irregular or fast heartbeat or if you faint during your treatment with arsenic trioxide.
Arsenic trioxide injection may cause encephalopathy (confusion, memory problems, and other difficulties caused by abnormal brain function). Tell your doctor if you drink or have ever drunk large amounts of alcohol, if you have malabsorption syndrome (problems absorbing food), a nutritional deficiency, or if you are taking furosemide (Lasix). If you experience any of the following symptoms, call your doctor immediately: confusion; loss of consciousness; seizures; speech changes; problems with coordination, balance, or walking; or visual changes such as decreased visual perception, reading problems, or double vision. Be sure that your family or caregiver knows which symptoms may be serious so they can seek treatment if you are unable to call on your own.
Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests before and after to check your body's response to arsenic trioxide.
Talk to your doctor about the risks of taking arsenic trioxide.
Arsenic trioxide is used in combination with tretinoin to treat acute promyelocytic leukemia (APL; a type of cancer in which there are too many immature blood cells in the blood and bone marrow) in certain people as a first treatment. It is also used to treat APL in certain people who have not been helped by other types of chemotherapy or whose condition has improved but then worsened following treatment with a retinoid and other types of chemotherapy treatment(s). Arsenic trioxide is in a class of medications called anti-neoplastics. It works by slowing or stopping the growth of cancer cells.
Arsenic trioxide comes as a solution (liquid) to be injected into a vein by a doctor or nurse in a medical office or clinic. Arsenic trioxide is usually injected over 1 to 2 hours, but it may be injected over as long as 4 hours if side effects are experienced during the infusion. It is usually given once a day for a specific period of time.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before receiving arsenic trioxide injection,
Unless your doctor tells you otherwise, continue your normal diet.
Arsenic trioxide injection may cause an increase in your blood sugar. Call your doctor immediately if you have any of the following symptoms of hyperglycemia (high blood sugar):
If high blood sugar is not treated, a serious, life-threatening condition called diabetic ketoacidosis could develop. Get medical care immediately if you have any of these symptoms:
Arsenic trioxide injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
Arsenic trioxide injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( Web Site) or by phone (1-800-332-1088).
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at Web Site. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Symptoms of overdose may include:
Ask your doctor or pharmacist if you have any questions about arsenic trioxide injection.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.