Written By: Abier Hamami.RPH. CPHQWhat is Isotretinoin?
Isotretinoin ( trade names : Accutane/ Roacutane and more) is an oral derived form of vitamin A. used for the treatment and prevention of severe (Nodular) acne that is resistant to more conservative treatments such as creams, drying agents, and topical or oral antibiotics. The Food and Drug Administration approved isotretinoin for nodular acne in 1982.
What is the most important information you should know about Isotretinoin?
Isotretinoin can cause serious side effects. Before starting it, discuss with your prescriber how bad your acne is, the possible benefits of Isotretinoin, and its possible side effects, to decide ifIsotretinoin is right for you. Your prescriber will ask you to read and sign a form or forms indicating you understand some of the serious risks of it.
Women must NOT become pregnant while taking Isotretinoin, or for 1 month after stopping it to allow the body to get rid of it. Isotretinoin can cause severe birth defects in babies of women who take it while they are pregnant, even if they take it for only a short time
What should you discuss with your physician before taking isotretinoin?
Before taking isotretinoin, tell your physician if you have:A plan to become pregnant or actually are pregnantA personal or family history of mental problems including depression, suicidal behavior, or psychosis (loss of contact with reality, hearing voices, or seeing things that are not there);Diabetes;Asthma;Heart disease;Osteoporosis (bone loss) or weak bones;Anorexia nervosa;High cholesterol or triglyceride levels (types of fat) in the blood; orLiver disease.
You may NOT be able to take isotretinoin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
How does it work?
The exact mechanism of action of isotretinoin is not known; however, it may reduce acne by reducing the secretion of sebum (the oily substance secreted by The sebaceous glands which found in the skin of mammals). If less sebum is secreted it is likely that there will be less inflammation and keratinization.
How well does Isotretinoin work?
Most dermatologists believe it is a remarkable acne medication .For severe acne, isotretinoin cures approximately 35%-38% of patients after one course of treatment, and 70% of those who takeisotretinoin experience long-term remission. Adult women have higher relapse rates than teenagers. Also if you have very oily skin and giant blackheads, are a younger teenager, or have acne on your chest and back, then you have a greater chance of having a relapse of your acne.
Most dermatologists believe it is a remarkable acne medication.
What is the recommended dose?
The recommended dose of isotretinoin is 0.5 to 2 mg per kg of body weight daily. The daily dose usually is administered in two divided doses.
What is the duration of treatment?
One course of treatment will take on average, 4-6 months. Some people's acne clears quickly while in others improvement is gradual. Multiple courses can be taken.
How should you take it?
Isotretinoin should be taken with a meal. Swallow the capsules with a full glass of liquid to prevent the medication inside the capsule from irritating the lining of your esophagus (connection between mouth and stomach). For the same reason, do not chew or suck on the capsule.
What should you avoid while taking Isotretinoin?
1. For women:
Do not get pregnant. Isotretinoin is harmful to the fetus and therefore should not be used during pregnancy. Women of childbearing age must have two negative pregnancy test results before therapy is started, and a pregnancy test must be conducted during each month of therapy. Effective forms of birth control( 2 methods) must be used during therapy, and pregnancy should be avoided until at least one month after stopping isotretinoin.Do not breast feed while taking isotretinoin and for 1 month after stopping it.Do not use birth control pills that do not contain estrogen ("minipills"). They may not work while you take isotretinoin. Ask your physician or pharmacist if you are not sure what type you are using.Do not take drugs or herbal products while using birth control pills before consulting your physician. Because certain drugs or herbal products may make birth control pills not work as effectively. Example: St. John’s Wort (a herbal supplement )
2. For general:
Do not give blood while you take isotretinoin and for 1 month after stopping it. If someone who is pregnant gets your donated blood, her baby may be exposed to isotretinoin and may be born with birth defects.Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while you are using isotretinoin and for at least 6 months after you stop. It can increase your chance of scarring from these procedures. Check with your physician for advice about when you can have cosmetic procedures.Avoid sunlight and ultraviolet lights as much as possible. Tanning machines use ultraviolet lights. isotretinoin may make your skin more sensitive to light.Do not share isotretinoin with other people., and do not advice others to take it without consulting their physicians.Use caution when driving a vehicle at night. Isotretinoin can cause decreased night vision. The onset of decreased night vision may be sudden.
What are the possible side effects of Isotretinoin?
Accutane can cause serious side effects as:
Birth defects, premature births, and death in babies.Serious mental health problems. Stop taking Isotretinoin if you have depression including feelings of sadness, crying spells, irritability, changes in sleep patterns, unusual tiredness, trouble concentrating, loss of appetite, and/or suicidal thoughts or other mental problems;Serious brain problems. It can increase the pressure in your brain. This can lead to permanent loss of sight, or in rare cases, death. Stop taking isotretinoin and call your prescriber right away if you get any of these signs of increased brain pressure: bad headache, blurred vision, dizziness, nausea, or vomiting. Also, some patients taking isotretinoin have had seizures (convulsions) or stroke.Abdomen (stomach area) problems. Stop taking isotretinoin and call your prescriber if you get severe stomach, chest or bowel pain, trouble swallowing or painful swallowing, new or worsening heartburn, diarrhea, rectal bleeding, yellowing of your skin or eyes, or dark urine.Bone and muscle problems. isotretinoin may affect bones, muscles, and ligaments and cause pain in your joints or muscles. Tell your prescriber if you develop pain, particularly back pain or joint pain or muscle pain.Hearing problems. Stop using isotretinoin and call your prescriber if your hearing gets worse or if you have ringing in your ears.Vision problems. Stop taking isotretinoin and call your prescriber right away if you have any problems with your vision or dryness of the eyes that is painful or constant.Lipid (fats and cholesterol in blood) problems. Return to your prescriber for blood tests to check your lipids and to get any needed treatment. These problems generally go away when isotretinoin treatment is finished.Allergic reactions. Stop taking isotretinoin and get emergency care right away if you develop hives, a swollen face or mouth, or have trouble breathing, fever, rash, or red patches or bruises on your legs.
Also isotretinoin may cause other problems. Tell your prescriber if you have trouble breathing (shortness of breath), are fainting, are very thirsty or urinate a lot, feel weak, have leg swelling, convulsions, slurred speech, problems moving, or any other serious or unusual problems. Frequent urination and thirst can be signs of blood sugar problems.
Less serious side effects are:
The common less serious side effects of isotretinoin are dry skin, chapped lips, dry eyes, and dry nose that may lead to nosebleeds. People who wear contact lenses may have trouble wearing them while taking isotretinoin and after therapy.
Sometimes, people’s acne may get worse for a while. They should continue taking isotretinoin unless told to stop by their prescriber.
What about taking Isotretinoin with other drugs?
Do not take vitamin supplements containing vitamin A. This may increase your chance of getting side effects.Do not take tetracycline antibiotic such as tetracycline, minocycline, doxycycline, demeclocycline, or troleandomycin . Use of both drugs together can increase the chances of getting increased pressure in the brain.Do not take other acne medications unless otherwise directed by your doctor. They may interfere with the treatment or increase irritation of the skin.Tell your doctor if you are taking carbamazepine (a drug for seizures named: Tegretol, Carbatrol, Epitol). You may require a dosage adjustment or special monitoring during treatment.Tell your doctor if you are using steroids. These drugs may weaken your bones.
In general, drugs other than those listed here may also interact with isotretinoin. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
What should be done if a dose is missed?
If a dose is missed, just skip that dose. Do not take 2 doses the next time.
What happens if you overdose?
Seek emergency medical attentionSymptoms of an isotretinoin overdose include vomiting, abdominal pain, flushing of the face, inflammation of the lips, headache, dizziness, and clumsiness.
How should you store Isotretinoin?
Store isotretinoin at room temperature, between 59° and 86°F. Protect from light.Keep isotretinoin and all medicines out of the reach of children.
References:
http://www.fda.gov/CDER/DRUG/infopage/accutane/medicationguide.htm
http://www.rocheusa.com/products/accutane/
http://www.medicinenet.com/isotretinoin/article.htm
http://www.drugs.com/accutane.html
http://www.skinsite.com/info_accutane.htm
http://www.aocd.org/skin/dermatologic_diseases/accutane.html
http://www.acneguide.com/acus_treat/isotretinoin/isotretinoin_accutane.html
