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Antineoplastic agent (Cancer treatment)

Arsenic trioxide is an injectable medication used to treat a specific type of acute promyelocytic leukemia (APL) in patients who have not responded well to other treatments. It works by causing cancer cells to undergo programmed cell death and by damaging specific proteins that help the cancer grow. Because it can cause serious side effects, including life-threatening heart rhythm changes and a condition called differentiation syndrome, it must be administered under close medical supervision.

How it worksArsenic trioxide helps destroy leukemia cells by causing them to break apart and by damaging a specific fusion protein that is important for the cancer's survival.

Brand names:TRISENOX

Used for
Induction of remission and consolidation in patients with acute promyelocytic leukemia (APL) who have relapsed or are resistant to other therapies like retinoids and anthracycline chemotherapy.
Conditions
Relapsed or refractory acute promyelocytic leukemia (APL)
Class
ChemotherapyAntineoplasticAntineoplastic agent (Cancer treatment)HematologicCardiovascularHepaticNeurological

How to take

FormsInjection
RoutesIntravenous (IV)

The dose is based on body weight (0.15 mg/kg/day) and is given through an IV. Treatment usually involves an induction phase followed by a consolidation phase.

This medication is only given by healthcare professionals in a clinical setting via IV infusion. It is not an oral medication and is not used topically or as a self-administered injection at home.

Key warnings

Arsenic trioxide carries a boxed warning for three major risks: Differentiation Syndrome (which can be fatal), Cardiac Conduction Abnormalities (heart rhythm issues), and Encephalopathy (including Wernicke's).

  • ·Arsenic trioxide carries a boxed warning for three major risks: Differentiation Syndrome (which can be fatal), Cardiac Conduction Abnormalities (heart rhythm issues), and Encephalopathy (including Wernicke's).
  • ·Differentiation Syndrome: This can cause fever, breathing problems, weight gain, and multi-organ failure.
  • ·Heart Health: The drug can cause dangerous changes in your heart's electrical activity.
  • ·Liver Health: It can cause liver damage; doctors will monitor your liver function regularly.
  • ·Cancer Risk: Arsenic trioxide is known to be a human carcinogen.
  • ·Pregnancy: This drug can cause severe harm or death to an unborn baby.

Do not use if

  • ·Do not use arsenic trioxide if you have a known hypersensitivity or allergy to arsenic.

Side effects

Common

NauseaCoughFatigueFeverHeadacheAbdominal painVomitingDiarrheaInsomniaSkin irritation (dermatitis)Swelling (edema)

Serious

  • ·Differentiation syndrome (which can be life-threatening)
  • ·Heart rhythm changes (QTc prolongation)
  • ·Brain dysfunction (encephalopathy)
  • ·Liver damage (hepatotoxicity)
  • ·Increased risk of other cancers (carcinogenesis)

Seek help if

  • ·unexplained fever
  • ·breathing difficulties
  • ·sudden weight gain
  • ·irregular heartbeat
  • ·confusion

Interactions

  • ·Avoid or carefully monitor drugs that can change your heart rhythm (QT/QTc prolongation).
  • ·Avoid drugs that can cause electrolyte imbalances, as this increases heart risks.
  • ·Be cautious with drugs that can cause liver damage.

Special populations

PregnancyArsenic trioxide can cause fetal harm and may be harmful to an unborn baby. Women of childbearing age should use effective contraception while using this medication.

PediatricThe safety and effectiveness of arsenic trioxide for children with relapsed or refractory APL have been supported by clinical studies, showing no major differences in safety or effectiveness compared to adults.

GeriatricStudies in older adults (ages 65 and older) showed no overall differences in how safe or effective the drug was compared to younger patients.

Talk to your doctor

Monitor

  • ·Coagulation studies
  • ·Blood counts
  • ·Liver function (AST, alkaline phosphatase, bilirubin)
  • ·Electrolytes
  • ·ECG/Heart rhythm

Questions to ask

  • ·What are the signs of differentiation syndrome I should look for?
  • ·How often will my heart and liver be monitored?
  • ·What other medications should I avoid while on arsenic trioxide?
  • ·How will this affect my ability to have children?

Pharmacokinetics

MetabolismThe active form is arsenious acid (As III). It is metabolized into monomethylarsinic acid (MMA V), dimethylarsinic acid (DMA V), and arsenic acid (AsV).

Practical

OverdoseSymptoms of too much arsenic trioxide may include confusion, muscle weakness, and convulsions. If an overdose is suspected, stop the medication immediately and seek emergency medical care; doctors may use treatments like chelation therapy.

Ingredients

Inactive

sodium hydroxidehydrochloric acidwater

Educational summary derived from FDA labeling, AI-assisted. Not medical advice — consult a healthcare professional. Updated 2026-04-25.