Guide To Isotretinoin (Accutane)

Isotretinoin, often sold as Accutane, is an oral medication that belongs to a group of medicines called retinoids. The standard dose for adult acne treatment is between 0.25 to 0.5 milligrams per kilogram of body weight. Most patients will take this twice daily. The maximum daily dose for adults is two milligrams per kilogram of body weight. Treatment may continue for up to twenty weeks. Due to the risk of side effects, patients can only obtain this medicine from certified pharmacies. They must also join a registry that tracks their treatment. Patients will be closely monitored during treatment. Suppose the patient's nodule count decreases by seventy percent or more. In that case, it may be possible to discontinue the medicine after less than twenty weeks. 

As mentioned, this medication is used as an acne treatment for severe forms of acne. Most patients will take other acne medications before receiving an isotretinoin prescription. In most cases, patients will have also tried home remedies for acne and over-the-counter acne washes as well. Topical acne spot treatments are also common before this medication. Many patients will use topical retinoids prior to this oral form also. It is also worth noting that this medication may help as an acne scar treatment. Of course, since it is an intense treatment for acne, patients must understand isotretinoin fully first.

How It Works 

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Isotretinoin, an oral retinoid, is a synthetic form of vitamin A. It permanently reduces the size of the sebaceous glands in the skin. This medication also decreases the amount of sebum that these glands secrete. In addition, isotretinoin reduces skin inflammation and decreases the bacteria that may be present on the skin. By drying out the skin, the medication creates an environment that is much less favorable for acne development. 

Typically, patients notice a significant reduction in clogged pores on this medication. It also helps increase the turnover rate of skin cells. Isotretinoin is believed to work by boosting the skin's production of neutrophil gelatinase-associated lipocalin. This is thought to kill cells in the sebaceous glands. Studies have shown that isotretinoin appears to block the action of MMP-9 in sebum. The drug may also impact hTERT and telomerase.

Uses And Benefits 

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Isotretinoin is most commonly used to treat severe cases of nodular acne. Generally, the medication is only considered for individuals who have not responded to antibiotics or other treatments. Certain doctors may choose to prescribe it as an off-label treatment for moderate acne that is resistant to other treatments. This medication may also be used for acne that causes scars or psychological distress to the patient. In these situations, isotretinoin may be prescribed at a lower dose than the standard dose for nodular acne. 

Some studies indicate that this medication may be beneficial for use in cutaneous T-cell lymphoma patients. The medication may also be used to prevent squamous cell carcinoma of the skin in patients who are at high risk for this condition. With a shorter half-life than similar medicines, some dermatologists consider isotretinoin to be the preferred treatment for female patients of child-bearing age with a high risk of skin cancer.

Potential Side Effects 

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Isotretinoin is associated with many potential side effects. Some of the most common ones are headaches, back and joint pain, nosebleeds, and vision problems. Patients may notice dryness that affects their skin, lips, nose, and eyes. Skin reactions could occur as well. Some patients on this medication develop cold symptoms, including sneezing, a sore throat, and a stuffy nose. Patients taking isotretinoin should call their doctor immediately if they experience hallucinations, vision changes, hearing difficulties, or increases in thirst or urination. They should inform their doctor right away if they develop symptoms of depression. This includes suicidal thoughts, episodes of unusual crying, sleep issues, or a loss of interest in previously enjoyed activities. 

Isotretinoin can cause liver and pancreas problems. Thus, patients should see their doctor as soon as possible if they notice jaundice, a rapid heart rate, dark urine, or appetite loss. Other side effects that merit this visit also include nausea, vomiting, and upper stomach pain that spreads to the back. They should obtain urgent medical attention for signs of stomach issues. This includes pain while swallowing, severe stomach or chest pain, heartburn, diarrhea, bloody stools, and rectal bleeding. 

Precautions To Remember 

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Isotretinoin may not be safe for patients with a history of inflammatory bowel disease, asthma, or diabetes. It may also be unsafe for those who have a history of heart disease, high cholesterol, liver disease, or osteoporosis. In addition, it may not be appropriate for individuals with mental health conditions, including depression and eating disorders. Patients should review their complete medical history with their doctor before isotretinoin is considered. This prescription is not safe for patients under twelve years old. 

Taking even a single dose of this medication during pregnancy could result in birth defects, premature birth, or miscarriage. Patients should never use this medication during pregnancy or breastfeeding. By law, female patients of child-bearing age must have regular pregnancy tests before, during, and after treatment with this medicine. They must agree to use two forms of birth control throughout their treatment as well. Frequent blood tests may be necessary for all patients who take isotretinoin. The tablet should be swallowed whole. It should also be taken with a full glass of water. Patients should check with their doctor about taking isotretinoin with or without food. Prescriptions for this medicine must be filled within one week after they are written. Patients will only receive a thirty-day supply with each prescription. 

Potential Medication Interactions 

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Patients should be aware of the potential medication interactions that could occur with isotretinoin. They should make sure that their doctor knows about all of the medicines they use, including prescriptions, over-the-counter medicines, herbal products, and nutritional supplements. Isotretinoin can interact with phenytoin and other anticonvulsants. Interactions could also occur if this medication is taken with dexamethasone or other oral steroids. Isotretinoin may not be safe for individuals who use these medicines. Doctors may prescribe a different medication in these cases. They could also change the doses to reduce the risk of an interaction. Patients may be advised to stop taking vitamin A supplements during treatment with isotretinoin as well.