Accutane is used to treat severe cystic acne (also known as nodular acne) that has not responded to other treatment (e.g., benzoyl peroxide or clindamycin applied to the skin or tetracycline or minocycline taken by mouth).
Accutane belongs to a class of drugs known as retinoids. It works by decreasing facial oil (sebum) production. High amounts of sebum can lead to severe acne. If left untreated, severe acne may cause permanent scarring. Accutane is a derivative of vitamin A that is found in the bloodstream of all people. The active substance of the drug is called isotretinoin. It is a retinoid, which decreases the amount of sebum secreted by the sebaceous glands in the skin, thus helping itto become clearer. The medicationis prescribed for severe acne treatmentmanifestedbynodules and cystic lesions. It is usually given after the patient has failed to respond tolight-based therapies, antibiotics, and other acne treatments.
How to use Accutane
Read the Medication Guide provided by your pharmacist before you start using isotretinoin and each time you get a refill. Read and sign a Patient Information/Informed Consent form before you start taking this medication. If you have any questions about isotretinoin, consult your doctor or pharmacist before taking the medication.
Swallow capsules whole. Do not crush or chew them. Isotretinoin is usually taken twice daily for 15-20 weeks, or as directed by your doctor. Directions for most generic forms of isotretinoin state that it should be taken with meals. However, the FDA has indicated that the Absorica brand may be taken with or without food. Food helps increase absorption of this drug into your bloodstream. Ask your doctor or pharmacist for more information. Take this drug with a full glass of water, and do not lie down for at least 10 minutes after taking it.
The dosage is based on your medical condition, weight, and response to treatment.Your acne may worsen during the first few days of taking this drug, and it may take up to 1-2 months before you notice the full benefit of this medication. If severe acne returns, a second course of treatment may be started after you have stopped taking the drug for 2 months. The manufacturer does not recommend long-term use of isotretinoin. Do not take more than the recommended dose.
Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the capsules.
Who should not use Accutane (Isotretinoin)?
It should not be used by pregnant women, as well as by women during lactation. This anti-acne agent is considered harmful mainly because its most insidious side reaction is a teratogenic effect: an overdose of retinoids when taken orally in pregnant women can cause severe fetal development disorders.
In addition, there are also temporary side effects of isotretinoin: they include dry skin and lips, hair loss, soreness, itching, rash, skin irritation, photosensitization (increased sensitivity of the skin to the sun), severe peeling of the skin of the palms and hands, as well as yellowing of the skin.
If the drug is taken orally, this substance can trigger more serious systemic side effects: strong headaches, nausea, vomiting, blurred vision, changes in mood, depression, mild bleeding from the nose, bowel problems, severe abdominal pain, diarrhea, decreased night vision, constant dry eyes, calcium deposits in tendons, and high cholesterol levels.
Side effects of Accutane:
Important things to remember about the side effects of accutane:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in more than 30%) for patients taking accutane:
- Typical retinoid toxicity: (symptoms that are similar to those found in patients taking high doses of vitamin A): Headache, fever, dry skin, dry mucous membranes (mouth, nose), bone pain, nausea and vomiting, rash, mouth sores, itching, sweating, eyesight changes.
These are less common side effects (occurring in 10-29%) for patients receiving accutane:
- Back pain
- Pain in muscles and joints
- Allergic reaction
- Abdominal pain
- Poor appetite
- Numbness and tingling of hands and feet
- Hair loss (thinning)
- Dry eyes, sensitivity to light (see eye problems)
- Decreased night vision, which may persist after treatment is stopped
- Swelling of the feet or ankles
- Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
- Abnormal blood tests: increased triglyceride, cholesterol and/or blood sugar levels.
- Increases in blood tests measuring liver function. These return to normal once treatment is discontinued (see liver problems).
Rare but serious possible side effects of accutane:
- Blood clots. Blood clots rarely can lead to pulmonary embolus or stroke - potentially life-threatening conditions.
- Pancreatitis (inflammation of the pancreas) is a rare side effect. Mainly noted in blood tests that return to normal after therapy is discontinued. Rarely may be severe causing symptoms. Symptoms of acute pancreatitis include pain in the upper abdomen that worsens with eating, swollen and tender abdomen, nausea, vomiting, fever, and rapid pulse. If these symptoms occur notify your health care professional immediately.
- A very serious side effect that has been observed in patients that have taken medications similar to accutane for treatment of leukemia, is called APL differentiation syndrome. This syndrome is a reaction between the drug and the leukemia. It is preventable with proper monitoring and immediate treatment. This syndrome produces fever, difficulty breathing, weight gain, lung and heart problems. It is generally treated with high-dose steroids. Be sure to let your health care professional know if you experience fever of 100.4F or 38C, difficulty breathing, or sudden weight gain.
Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction)
- Fever of 100.4 F (38 C) or higher, chills (possible signs of infection)
- Having thoughts or feeling like you may want to harm yourself or others
- Difficulty breathing, sudden weight gain, swelling, vision changes
- Severe abdominal pain
The following symptoms require medical attention, but are not emergency situations. Contact your health care provider within 24 hours of noticing any of the following:
- Black or tarry stools, or blood in your stools or urine
- Unusual bleeding or bruising
- Abdominal cramping
- Nausea (interferes with ability to eat and unrelieved with prescribed medications)
- Vomiting (more than 4-5 episodes within a 24-hour period)
- Diarrhea (more than 4-6 episodes in a 24-hour period)
- Mouth sores (painful redness, swelling or ulcers)
- Extreme fatigue (inability to perform self-care activities)
- Anxiety, changes in thinking or mood, confusion, difficulty concentrating or trouble sleeping, aggressive or violent behavior, or suicidal thoughts.
- Depressed (interfering with your ability to carry on your regular activities)
- Ringing in the ears, problems with hearing
- Yellowing of the skin or eyes
Always inform your health care provider if you experience any unusual symptoms.
- Before starting accutane treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
- Do not take vitamin A supplements. Vitamin A in high doses has many of the same side effects as accutane. Taking both together may increase your chance of getting side effects.
- Do not receive any kind of immunization or vaccination without your doctor's approval while taking accutane.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (accutane may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking accutane, the medication must be stopped immediately and the woman given appropriate counseling).
- Because of the extremely high risk that a deformed infant can result if pregnancy occurs while taking accutane in any amount even for short periods of time, for both men and women: Do not conceive a child (get pregnant) while taking accutane. Two methods of effective contraception are recommended for women of childbearing potential, unless absolute abstinence is the chosen method. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Take this medication at about the same time every day along with a meal that includes some fats.
- Avoid grapefruit juice
- Avoid wearing contact lenses if you have dry or irritated eyes
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
- When you start taking this drug, you may experience headache, loss of night vision, sleepiness or eyesight changes. Use caution when driving or engaging in tasks requiring alertness until response to drug is known.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.