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Accutane
Accutane, the brand name for isotretinoin, is a powerful oral medication used to treat severe acne that has not responded to other treatments, such as topical medications or antibiotics. It is a form of vitamin A derivative (retinoid) that works by decreasing the amount of oil released by the skin’s oil glands, helping the skin renew itself more quickly. Accutane is typically prescribed for nodular or cystic acne, which can cause deep, painful lesions and scarring. Although highly effective, it requires careful monitoring due to its potential for serious side effects.
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Frequently Asked Questions
What should I do if I miss a dose of Accutane?
Take the missed dose as soon as you remember, but skip it if it's close to your next scheduled dose. Do not double the dose to catch up.
How long does Accutane take to work?
Most people begin to see improvement in their acne within 1-2 months of starting treatment, with full results typically seen after 4-5 months.
Can Accutane cause permanent changes?
Accutane can lead to long-lasting or permanent improvements in acne, but it may also cause long-term side effects, such as dry skin or changes in vision. Always discuss potential risks with your healthcare provider.
Can I take Accutane if I’m pregnant?
No, Accutane is highly contraindicated during pregnancy due to the risk of severe birth defects. Women must use two forms of contraception and undergo regular pregnancy testing while taking Accutane.
Does Accutane cause scarring?
Accutane does not directly cause scarring, but it helps reduce severe acne, which can minimize the risk of acne scarring over time.
Comprehensive Drug Guide
How Does Accutane Work?
Accutane works by reducing the size and activity of the skin’s sebaceous (oil) glands, resulting in less oil production. This decrease in oil production helps prevent the pores from becoming clogged and reduces the formation of acne. Accutane also helps regulate skin cell turnover, reducing the buildup of dead skin cells that can contribute to acne. Additionally, it has anti-inflammatory effects that further help reduce acne lesions.
Common Dosages
- Capsules: 10 mg, 20 mg, 30 mg, 40 mg
Typical Dosing
- The typical starting dose for Accutane is 0.5 to 1 mg/kg/day, divided into two doses. The total course of treatment usually lasts 15 to 20 weeks, with the dose adjusted based on the patient’s response and tolerability. The cumulative dose over the course of treatment is typically 120 to 150 mg/kg.
Typical Dosing
FDA Approved Indications
- Treatment of severe nodular or cystic acne that has not responded to other treatments, including antibiotics and topical therapies.
Who Shouldn't Take Accutane?
- Pregnancy, due to a high risk of severe birth defects. Women of childbearing potential must use two forms of birth control and undergo regular pregnancy testing while on Accutane.
- Breastfeeding, as isotretinoin may be harmful to infants.
- Severe liver disease.
- High cholesterol or triglycerides, as Accutane can further increase lipid levels.
Advice From The Pharmacist
- Accutane should be taken with a meal to improve absorption.
- Women of childbearing age must follow the guidelines of the iPLEDGE program, which requires two forms of contraception and regular pregnancy tests before, during, and after treatment.
- It is important to avoid vitamin A supplements and other retinoid medications while on Accutane, as this can increase the risk of side effects.
- Avoid alcohol and prolonged sun exposure while taking Accutane, as these can exacerbate side effects such as dry skin, increased sun sensitivity, and liver-related complications.
Side Effects of Accutane
Common Side Effects
- Dry skin, lips, and eyes
- Increased sun sensitivity
- Nausea
- Joint or muscle pain
- Elevated cholesterol or triglyceride levels
- Dryness in mucous membranes (such as the nose)
Uncommon/Severe Side Effects
- Severe birth defects if taken during pregnancy.
- Liver damage, characterized by symptoms such as dark urine, jaundice (yellowing of the skin or eyes), or severe fatigue.
- Mental health changes, such as depression, mood swings, or thoughts of self-harm.
- Vision or hearing changes.
Risks and Warnings of Accutane
- Accutane carries several significant risks, particularly for women of childbearing age, due to the high risk of severe birth defects. For this reason, it is dispensed only through the iPLEDGE program, which requires the use of two forms of contraception and regular pregnancy tests.
- Accutane can also cause serious side effects, such as liver damage, high cholesterol, and mental health changes (including depression and suicidal thoughts).
- Patients should be regularly monitored by their healthcare provider through blood tests and follow-up appointments while on the medication.
Interactions with Accutane
Common Drug Interactions
- Vitamin A supplements, which can increase the risk of toxicity.
- Tetracycline antibiotics, which can increase the risk of pressure buildup in the brain (pseudotumor cerebri).
- Steroids, which may reduce the effectiveness of Accutane.
- Alcohol, which can exacerbate liver damage and lipid elevation.
Alternatives to Accutane
- Topical retinoids (such as tretinoin or adapalene).
- Oral antibiotics (such as doxycycline or minocycline).
- Hormonal treatments, such as birth control pills or spironolactone (for women).
