Isotretinoin

Brand Name: Accutane Roche Clarus

Prescription Needed: Yes

What is this drug used for?

Isotretinoin is used to treat severe acne that has not responded to oral or topical acne medications.  

Is there any reason not to take this drug?

Isotretinoin should not be used by pregnant women or women who plan to become pregnant while taking isotretinoin. This medication can cause serious harm to the fetus.

If you are a woman of child-bearing age it is critical that you review your birth control strategy with your healthcare provider before starting to take isotretinoin.

You should not take this drug if you are allergic to isotretinoin or parabens. Parabens is used as preservatives in the gelatin capsule.  

It is important to disclose your full medical history including any pre-existing conditions to your medical team.  

Before taking this medication tell your doctor specifically if you have ever had: 

  • depression or other mental illnesses
  • diabetes
  • liver disease
  • high triglycerides in the blood

Also tell your doctor if a family member has ever had:

  • depression or other mental illnesses
  • high triglycerides in the blood

What about possible side effects?

Tell your doctor of any and all side effects that you experience while taking this drug.

The common less serious side effects of isotretinoin include:

  • dry and itchy skin
  • chapped lips
  • dry eyes and throat
  • dry nose that may lead to nosebleeds
  • facial redness and peeling
  • joint pain

Isotretinoin can also cause a number of serious problems. You should stop taking isotretinoin and tell your doctor immediately if you experience any of these symptoms of more serious side effects:

Mental health problems

  • start to feel sad or have crying spells
  • lose interest in activities you once enjoyed
  • sleep too much or have trouble sleeping
  • become more irritable angry or aggressive than usual
  • have a change in your appetite or body weight
  • have trouble concentrating
  • withdraw from your family or friends
  • feel like you have no energy
  • have feelings of worthlessness or wrong guilt
  • start having thoughts about hurting yourself or taking your own life (suicidal thoughts)
  • start acting on dangerous impulses
  • start seeing or hearing things that are not real
  • aggressive and violent behavior

Changes to vision decreases in night vision

  • changes in vision or dryness of the eyes that is painful or constant

Bone and muscle problems

  • muscle weakness and aches
  • back pain
  • joint pain

Increased pressure in the brain (intracranial hypertension)

  • bad headaches
  • blurred vision
  • dizziness
  • nausea or vomiting
  • seizures (convulsions)

Damage to liver pancreas bowels esophagus

  • stomach pain
  • chest pain
  • difficulty swallowing
  • new or worsening heartburn
  • diarrhea
  • blood in stool
  • dark urine
  • yellowing of skin or eyes
  • vomiting

Hearing problems

  • worsening hearing
  • hear "ringing" in your ears

Allergic reactions

  • hives
  • swollen face or mouth
  • trouble breathing

This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication ask your doctor and/or pharmacist for more information and advice. 

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or may change the safety or effectiveness of either drug. Tell your doctor specifically if you are taking any of these drugs as these are the most common interactions and he/she may need to make changes or monitor you more closely:

Tetracycline medicines (e.g. doxycycline minocycline)

  • intracranial hypertension (increased pressure in the brain) may occur if isotretinoin is taken with tetracycline medicines
  • symptoms of intracranial hypertension include severe headache upset stomach and vomiting and changes in vision

Vitamin A supplements

  • vitamin A in high doses has many of the same side effects as isotretinoin
  • taking both together may increase your chance of getting side effects
  • check to see whether any of your vitamin supplements contain vitamin A

Progestin-only birth control pills (mini-pills).

  • May not work while you take isotretinoin; ask your doctor or pharmacist if you are not sure what type you are using.

WARNING 

Some people treated with isotretinoin have been reported to develop depression thoughts of suicide and rarely to commit suicide.

If symptoms of depression develop or worsen during treatment with isotretinoin the drug should be discontinued promptly and appropriate psychiatric treatment should be started as necessary.

If you have sex at any time without using 2 forms of effective birth control get pregnant or miss your expected period stop using isotretinoin and call your doctor right away.

If you get pregnant while taking isotretinoin stop taking it right away and call your doctor.

Other information

When you begin taking isotretinoin your acne may become worse before it starts to improve. 

Do not donate blood while you are taking isotretinoin and for at least 1 month after you stop taking it.

If you wear contact lenses you may have trouble wearing them while taking isotretinoin and after treatment.

Isotretinoin may make your skin sensitive to sunlight Avoid sunlight and ultraviolet lights as much as possible. Tanning machines use ultraviolet lights.

Isotretinoin may affect your night vision. Do not drive at night until you know if isotretinoin has affected your vision.

To avoid possible scarring do not have any laser treatments to your skin or hair removal by waxing until you have been off this drug for at least 6 months.

Swallow isotretinoin whole with a full glass of liquid. Do not chew or suck on the capsule. Isotretinoin can affect the tube that connects your mouth to your stomach (esophagus) if it is not swallowed whole.

You must return to your doctor as directed to make sure you don't have signs of serious side effects. Your doctor may do blood tests to check for serious side effects.

Children: The safety of isotretinoin in children is not established.

Seniors: There is little known about the use of isotretinoin in older adults. Older people may be at greater risk of problems and adverse effects from isotretinoin. 

Pregnant women: Isotretinoin will seriously harm your unborn child. Do not take this drug if you are pregnant or plan to become pregnant.

Women who are nursing: It is unclear whether this drug passes into the breast milk. Therefore avoid isotretinoin if you are nursing women to reduce the risk of harm to the baby. Talk to your doctor. 

People who drive or operate machinery: Should not do so until they know how this drug affects them personally. Isotretinoin can reduce your ability to see well at night. 

Overdose: If you experience vomiting headaches abdominal pain facial flushing dizziness and/or a lack of coordination or any other unusual reactions or if you seriously exceed the recommended dosage call your doctor or 911. 

Stopping the drug: Finish all the medicine that has been prescribed. If you miss a dose take it as soon as you remember. However if it is within 4 hours of your next scheduled dose take the missed dose and skip the next. Do not take a double dose. 

Storage conditions: Closed container; cool dry location away from excess moisture (not in the bathroom) and light; always out of reach of children.

Dietary precautions: Isotretinoin increases the amount of triglycerides (fat) in your blood so your doctor may suggest you cut back on dietary fat and alcohol. 

You should take isotretinoin with food. You don't have to keep the medicine in the refrigerator but keep it out of sunlight.