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Isotretinoin (Accutane) for Severe Acne: Uses, Dosage, and Potential Side Effects

December 13, 2020

Isotretinoin is medication dermatologists prescribe to patients with severe, painful, and very deep acne cysts and nodular acne. Isotretinoin belongs to the retinoids category. Some common brand names for isotretinoin include Accutane®, Absorica® Amnesteem®, Sotret®, Myorisan®, Claravis®, and Zenatane™.

Mostly, Isotretinoin is recommended for stubborn acne that doesn’t respond to other topical treatments applied to the skin like clindamycin or benzoyl peroxides, or those taken orally like minocycline or tetracycline.

Overproduction of sebum leads to severe acne. If severe acne is left untreated, it can result in permanent acne scars. Accutane works by dipping the production of sebum (facial oil).

Isotretinoin Dosage Amounts and How to Take the Capsule

Before you start using Isotretinoin, read carefully, and understand the pharmacist’s instructions. After reading, you need to leave a signature on the patient consent form before you begin taking the drug. Ask your doctor or pharmacist anything that is not comprehensible.

Usage instructions in most cases include:

Isotretinoin is taken orally - Swallow the capsules whole and never crush or chew them.
Take the drug with a full glass of water and avoid lying down for at least 10 or 15 minutes after taking it.
Take once or twice daily for at least 15 to 20 weeks or as directed by your physician. One course of treatment can take up to four to five-month, and it can be a bit more or less. Doctors tailor the treatment course for each patient.
Most brands require you to take the capsule with meals. Absorica brand may, however, be taken without or with food. Foods help increase drug absorption into the bloodstream.
Ask your doctor or pharmacist to clarify any unclear information.
The dosage is usually based on your weight, medical condition, and response to treatment. The daily recommended dosage is 0.5 to 2 mg per kilogram of body weight. So if you weigh 80 kg, your dosage will be 40mg a day. Each pill has 10mg or 20mg amounts of Isotretinoin.

Results will start to show after a few weeks- Sometimes, acne spots worsen in the first few days after starting the drug. This may go on for 1 to 2 months, but you’ll begin to notice the full benefits of the treatment after that.

What if I forget to take it?

For those taking one dose per day - If you forget taking an Isotretinoin tablet, take it as soon as you remember. If you remember the next day, skip the dose you missed and take your next pill the usual time.
For those taking two doses per day – If you forget one dose, take it as soon as you remember, provided it’s not within two or so hours to your next dose. In case only a few hours are remaining to the next dose, just skip the one you forgot and take the other one at its usual time.
Never take more than one dose at the same time, even if you missed both. You can use an alarm clock for reminders if you are prone to forgetting your doses.
In case of overdose, urgently call your doctor, go to the hospitals’ Accident & Emergency department even when you show no signs. When going to the doctor, take the remaining medicine and the isotretinoin packet and the leaflet inside the drugs’ packet with you.

Dosage Changes Over Time

After a few weeks, the dosage may change. The doctor may recommend a higher dose if the acne seems to worsen and a lower dose if the side effects seem to worsen.

If you get a second wave of severe acne, the doctor may prescribe a second course of treatment two months after you stopped taking this drug.

Manufacturers, however, discourage long-term use of Isotretinoin as well as taking more dosage than the recommended.

Pregnant women should never use or get exposed in whichever way to isotretinoin as it can harm the unborn baby. Also, avoid getting pregnant for at least a month after stopping. After you begin taking Isotretinoin, you’ll undergo several blood tests. Isotretinoin can increase the risk of miscarriage. Also, avoid breastfeeding when you start taking the drug.

Potential Side Effects of Using Isotretinoin for Acne

Some of the most common Isotretinoin side effects include:

Itching,
Dry skin,
Headaches,
Nosebleeds,
Dry nose & nosebleed
Dry eyes
Dry lips, mouth,& throat
Cracks in the corners of the mouth,
Inflammation of the whites of the eyes,
Cracking or peeling skin,
Muscle/joint pain
Thinning hair,
Back pain,
Drowsiness/ dizziness
The skin may become very dry and sensitive to sunlight.
Rashes

Serious side effects can occur though rare. Stop the use of isotretinoin capsules and immediately consult a doctor if you experience:

Suicidal thoughts, mood changes, nervousness, anxiety, and aggression could signify depression.
Trouble seeing at night
Severe skin rash & blisters
Bloody diarrhea(it can be a symptom of gastrointestinal bleeding)
Stomach problems like nausea and vomiting i(it can be a sign of pancreatitis)
Inflammatory bowel disease
Unhealthy cholesterol levels
Changes in your fingernails or toenails or yellow skin and eyes could be a sign of liver damage.

Managing the Isotretinoin Side Effects

Here is what to do to cope with these side effects:

Dry Skin and Lips - To deal with dry skin, it is crucial to use mild moisturizers and cleansers to make your skin soft and supple and reduce dryness. The best moisturizer for sensitive skin is an oil-free moisturizer for the face. Use lip balms to make your lips soft. Make your baths shorter than 2 minutes, and use lukewarm water instead of hot water. Avoid any waxing, laser skin treatment, or dermabrasion when taking this drug for at least six months after you stop, as this can cause skin irritation and scarring.
Skin sensitivity to sunlight – Use high-factor sunscreen with over 30 SPF daily, even on cloudy days. Try as much as possible to stay indoors, especially when the sun is hottest, usually between 10 am and 4 pm. Avoid using sunbeds and sunlamps.
Dry throat and mouth - Consider chewing sugar-free gums or sweets.
Dry eyes- Talk with your doctor to recommend some eye drops. In case wearing contact lenses are causing any discomfort, go for glasses instead for the time being.
Headaches, back, and muscle pain – Talk with your doctor to recommend the ideal painkillers.
Dry nose and nosebleeds – You may consider applying a thin layer of petroleum jelly or vaseline inside the nose edges.
Nervousness and depression - If you notice signs of depression-like thoughts of harming yourself, stop taking the medications, and visit your doctor immediately.

Who Can and Can't Take Isotretinoin for Acne?

Isotretinoin capsules are recommended for adults and teenagers with severe cases of acne. Avoid taking isotretinoin capsules if you:

Are under 12 years
Are pregnant, planning to get pregnant, or is breastfeeding
Has an allergic reaction to Isotretinoin capsules or soya, or any other medicines. Get advice from a doctor.
Has a hereditary digestive disorder known as fructose intolerance as Isotretinoin contains sorbitol

To ensure that you can safely use Isotretinoin, let your doctor know if you have:

Had depression or any other mental disorder
A toddler who’s still breastfeeding or you think you could be or could get pregnant.
High levels of Vitamin A/ if you’re taking any vitamin A supplements.
A kidney or liver disease
An allergy to the Accutane or any other medicine
High levels of fats or cholesterol in your blood
Ulcerative colitis or Crohn’s disease
Diabetes: This may require closer monitoring as the capsules can cause blood sugar to rise.

Signs of a Severe Allergic Reaction

It’s possible to have a severe allergic reaction to the Isotretinoin capsules though it’s rare.

If you notice any of these signs, contact a doctor immediately:

If you’re gasping or wheezing
When you develop a skin rash that appears swollen, itchy, blistered, red, or peeling
If you have difficulties breathing or talking
Feeling chest or throat tightness
Swelling of the lips, face, throat, or the tongue

Due to potential complications of Isotretinoin, dermatologist only prescribes the treatment if you:

Enroll in the U.S. Food and Drug Administration (FDA) program
Sign a form that states you are aware of the potential risks and side effects of taking Isotretinoin drug
Agree to do regular dermatologists follow-up visits
Are ready to do regular (monthly) pregnancy tests before and in the course of taking the drug
Are sure you can avoid getting pregnant by using a reliable contraception method for one month before you start taking the drug, drug the course of treatment, and one month after stopping.
Avoid breastfeeding as the drug can get to the milk and harm the baby.

Isotretinoin Interactions with Other Medicines

Some medicines can interfere with the effectiveness of the drug. Tell your doctor if you’re taking:

Other acne treatments and acne scars treatment (mixing more than one acne treatment can cause skin irritation). After you’re done with the course, you can treat scarring using different methods such as micro-needling, chemical peeling, and silicone products, among others.
Vitamin A supplements
Tetracycline antibiotics including minocycline, doxycycline, lymecycline, and oxytetracycline
Herbal supplements or remedies - (There's, however, little information about the effects of using herbal supplements and medications while using isotretinoin capsules).

Key Takeaway

Isotretinoin has been proven to treat severe acne nodules and cysts. However, Isotretinoin for acne has several adverse effects. Therefore, always exercise caution when using it. Discuss with your dermatologist all the precautions to take and the results expected. Both you and your doctor should work together to decide whether this medicine is perfect for you.