Accutane, the brand name for the drug isotretinoin, is a medication used to treat severe nodular acne. The drug is reserved for patients who have failed other therapies such as antibiotics or other conventionally used acne medications.
Accutane is a retinoid, similar to retinoic acid and retinol (vitamin A), that helps treat many skin conditions. Acne develops when sebaceous glands produce too much sebum in the skin, which consists of oils, wax, and cholesterol. Accutane works by inhibiting sebaceous gland function and keratinization to prevent acne formation.
Accutane is available in 10, 20 and 40 milligram (mg) soft gel capsules taken by mouth. The dose is typically 0.5 to 1 mg per kilogram (kg) of your body weight per day. It is also important to take the drug with food to increase its absorption into the body. Doses are given twice a day over 15 to 20 weeks, and most patients are in complete remission at the end.
Over two million people have been prescribed Accutane to treat severe acne.- American Osteopathic College of Dermatology (AOCD)
Accutane can cause severe birth defects, so you cannot take it if you are pregnant or planning to become pregnant. iPLEDGE is an online patient monitoring system created to help prevent fetal exposure to the drug. Patients who are prescribed Accutane must sign up for the iPLEDGE program to receive their medication.
If you have reproductive potential, you must meet several requirements to receive an Accutane prescription. For example, two methods of contraceptives must be used one month before, during, and one month after drug use. Additionally, two pregnancy tests are conducted and must be negative before you can be prescribed the drug. Each month of use, you must have a negative pregnancy test to continue receiving the prescription.
Serious birth defects can occur if using Accutane while pregnant. Documented cases include:
In some cases, death has resulted from these abnormalities. There is also an increased risk of spontaneous abortions, and premature births have occurred.
Accutane may cause psychosis, depression and, rarely, suicide attempts, suicidal ideation, suicide, and aggressive or violent behaviors. Before beginning treatment, talk with your doctor about any prior mental health history. If you experience any mental health symptoms during therapy, contact your doctor immediately. Signs of depression to be aware of while taking Accutane include:
Pseudotumor cerebri is a condition in which the pressure around your brain increases. This can occur in patients taking Accutane in conjunction with the antibiotic tetracycline. Speak with your doctor if you develop these symptoms:
Many side effects can occur while taking Accutane. The more common and less severe include:
More serious side effects that can occur while taking Accutane include:
It is important to wear sunscreen regularly to ensure Accutane is working properly. During the first two to three weeks of treatment, your skin will be more sensitive to damage from sun, wind, or cold weather. So, avoid exposing your skin to the sun by wearing protective clothing and hats.
Accutane has not been shown to be addictive. Talk with your doctor if you have any concerns about the drug and alternate options that may be available.
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American Osteopathic College of Dermatology. “Accutane.” AOCD, https://www.aocd.org/page/Accutane
Food and Drug Administration. “Accutane label.” FDA, Jan. 2010, https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018662s060lbl.pdf
iPLEDGE. “About Isotrentinoin.” iPLEDGE, https://www.ipledgeprogram.com/iPledgeUI/aboutDrug.u
Makrantonaki, E., Ganceviciene, R., Zouboulis, C. “An update on the role of the sebaceous gland in the pathogenesis of acne.” Dermato-Endocrinology, Jan.-Mar. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051853/
Mayo Clinic. “Isotretinoin (Oral Route).” Mayo Clinic, Feb. 2020, https://www.mayoclinic.org/drugs-supplements/isotretinoin-oral-route/proper-use/drg-20068178