Drug Information / Accutane

About Accutane

I. Definition:

Isotretinoin (trade name: Accutane) is a powerful drug used in the treatment of acne. Four to five months of isotretinoin treatment usually leads to clearing of acne for one year or more after the medicine is stopped. Most other acne-controlling medicines are antibacterial agents, which are effective only if the medicine is used daily.

II. Side Effects:

Isotretinoin has significant side effects:
(percentages are the ratio of people who received the side-effect)

Chapped lips 90%

Dry skin and itching 80% - the use of daily alpha hydroxacids will help prevent this side effect.

Dryness of nose, mild nosebleed 80%

Irritation of the eyelids and eyes 40% - Vitamin E 400 IU each day may lessen this side effect.

Joint and muscle pains 15%

Temporary hair thinning 10%

Rash 7%

Intestinal symptoms 5%

Urinary symptoms 5%

Headache 5%
Increased sensitivity to sunburn 5%

Decreased night vision <1%

Depression, thoughts of suicide <1%

Isotretinoin may increase the level of blood fats, sometimes to risky levels. Occasionally it may affect the liver. That's why regular blood tests are necessary when you are taking isotretinoin; these tests must be done when you have fasted for 12 hours (no breakfast), so that the blood fat determinations are reliable. A baseline blood chemistry test is established before patients start isotretinoin.

The most damaging side effect of isotretinoin is serious birth defects if taken during pregnancy.

It is critically important for women not to take isotretinoin while pregnant, and not to become pregnant while taking it. Women who are, or expect to be, sexually active while taking isotretinoin must use an effective method of birth control. This usually means oral contraceptive pills and one other additional method of birth control such as a condoms for the male partner. A woman who does get pregnant while on isotretinoin must be prepared to have an abortion and must state this in writing before many physicians will prescribe isotretinoin for her.

Isotretinoin may cause birth defects as long as two months after it is stopped. After that time, it's safe to become pregnant. Because the birth defects caused by isotretinoin are so serious, it's important not to share the pills with others.

We don't know whether isotretinoin taken by men can cause birth defects, so it's best not to get a woman pregnant while taking isotretinoin. If she is not using birth control, the man should use a condom.

There are a few reports of patients having decreased night vision after using Accutane. One patient still had problems six months after the drug was stopped. If you experience trouble with your vision while on Accutane, call the office right away.

Some people develop headaches while on Accutane. If you develop a persistent headache while on Accutane, call your physician right away. A persistent headache, which will not go away while on Accutane, can be dangerous and you should stop the medication.

Accutane rarely causes depression and thoughts of suicide. If this were to occur stop the medicine immediately and call your physician.

III. How does isotretinoin work?

Isotretinoin decreases the amount of oil produced by the skin's sebaceous (oil) glands. It may be as long as two months before you see improvement in your skin. There's no medicine we can add to speed up isotretinoin's action. In fact, sometimes acne gets worse during the first month or so of treatment. Side effects, such as lip dryness, begin before the acne starts to clear.

IV. How To Use Isotretinoin:

Take the medicine with food, you can take the entire daily dose with supper, this increases the absorption of the medicine.

V. Long-term Results:

Isotretinoin isn't a permanent cure for acne, although it often buys time until nature clears your skin. Your skin may stay clear for months, even years, after isotretinoin is stopped. In about one person in 10, acne comes back after one year. About one person in four has acne again after two years. If your acne returns, antibiotics may work, or you may be treated with isotretinoin again. The use of daily alpha hydroxyacids will help prevent small flare-ups after a course of Accutane.

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