LETTER
Neurotoxicity and Tretinoin
Lisa L. von Moltke, MD, and
David J. Greenblatt, MD
15 November 1996 | Volume 125 Issue 10 | Page 861
TO THE EDITOR:
We read with interest the case report linking neurotoxicity to the use of large amounts of topical tretinoin [1]. We wonder, however, whether some portion of the described clinical picture might be attributable to a confounding medication that has central nervous system activity, such as cyclobenzaprine. Although the most commonly reported adverse effects include dizziness, dry mouth, and drowsiness, ataxia and dysarthria have also been reported [2]. Obtaining plasma levels for other co-ingested medications may be a reasonable step in discovering the cause of the presenting problems of an unreliable patient who has access to unprescribed medication. Measurement of these levels can also yield surprising information after known ingestion of drugs whose plasma kinetics show large intersubject variability (such as cyclobenzaprine, with its half-life of 
3 days) or in patients with possible metabolic deficiencies, such as hepatic disease.
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Author and Article Information
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Tufts University, Boston, MA 02111.
1. Bernstein AL, Leventhal-Rochon JL. Neurotoxicity related to the use of topical tretinoin (Retin-A). Ann Intern Med. 1996; 124:227-8.
2. Cyclobenzaprine hydrochloride. Package insert. Danbury, CT: Danbury Pharmacal; 1992.
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