Accutane (isotretinoin) is a prescription medication that is indicated for the treatment of nodular acne. It is usually used when other common drugs like Clindamycin, minocycline, or benzoyl peroxide have failed to handle the acne.
The drug belongs to a family of compounds called retinoids, specifically 13-cis-retinoic acid. It is a vitamin A derivative and should not be used with vitamin A supplements. This is to prevent excessive build-up of vitamin A in your tissues (vitamin A toxicity).
Isotretinoin works by reducing sebum production, a type of facial oil produced by sweat (sebaceous) glands on the face. An excessive amount of sebum can lead to severe acne and if not properly treated, permanent tissue (facial) scaring can occur.
The drug is said to be effective in eradicating nodular or severe acne because it does the following:
● Clogging of the acne
● Correcting the inflammation
● Killing of bacteria
● Eliminating or drastically reducing the amount of oil produced.
It is advised that you exercise a level of patience when using Accutane because the drug may appear to aggravate the acne initially before eradicating it.
Uses of Accutane
The drug is used for the following:
● Treatment of severe acne when treatment with other conventional drugs has proved ineffective
● Prevention and treatment of skin cancers
● Condylomata acuminata
● Autoimmune diseases like lupus erythematosus
● Pityriasis rubra pilaris
● Lichen planus
It may also be prescribed for other conditions not mentioned here because of the immunomodulatory, anti-inflammatory, and antitumor ability that it possesses.
Precautions to Ensure Before and While Using Accutane
Before using the drug, do well to inform your doctor if you have any allergies to retinoids.
You should tell your doctor if you have any history of the following:
● Anorexia (a condition that restricts people from eating their normal portions because they lack appetite).
● Diabetes Mellitus
● Asthma or other respiratory disorders
● Dyslipidemias (high blood cholesterol and high blood triglycerides)
● Heart disorders
● Inflammatory bowel disorders
● Mental health disorders
● Osteoporosis (conditions associated with the weakening of the bones)
● Suicidal attempts or thoughts
● Liver diseases
● Other pancreatic disorders
Before using the drug, you must inform your doctor if you are pregnant or planning to become pregnant soon. This is to avoid the risk of birth defects like ears, face skull, and eye abnormalities. Your unborn baby could also develop cardiovascular disorders, thymus gland parathyroid gland dysfunction, CNS disorders, and a reduction in intelligence quotient (IQ).
There are also reported incidences of premature births and miscarriages in pregnant women who were taking isotretinoin.
It is not certain whether it is excreted into breast milk, but breastfeeding mothers should not take isotretinoin (Accutane).
You are to limit driving or operating heavy machinery that requires clear vision at night or after dark until you are certain that you can carry out those activities safely and effectively. This is because the drug can affect night vision.
It is also advised that you do not donate blood for at least 4 weeks after taking Accutane.
Dosage and Drug Administration
It is important you follow your doctor’s directives on how to take the drug. Always read the drug guide that your healthcare provider or pharmacist provides before you commence treatment and whenever you request a refill.
You may also be required to read through and sign a consent form prior to therapy. The capsules should be taken by mouth and should not be sucked or chewed. It should be swallowed whole with a glass of water.
Usually, Accutane is consumed two times a day for a period of 16-20 weeks (4 – 5 months). It is better taken with food as it aids absorption. The dosage of Accutane you will consume depends on your age, weight, and severity of the condition.
For the treatment of acne in adults, the starting and maintenance dose is 0.5mg/kg body weight, which is to be taken twice per day. The maximum daily dose should not exceed more than 2mg/kg body weight. The duration is 5 months.
In children who are 12 years or older, the dosage is essentially the same as those of adults because it is based on the body weight of the individual. It is 0.25 – 0.50mg/kg body weight. The maximum daily dose should not exceed 2mg/kg body weight. This implies that someone who is 40kg will take 20mg of the capsules for a start.
Side Effects of Accutane
The following adverse reactions have been observed in people using Accutane:
● Hearing impairment and vision problems (especially at night)
● Faster than normal heart rate
● Upper abdominal pain
● Loss of appetite
● Increased intracranial pressure
● Severe headache
● Dryness of normally moist tissues like the eye, skin, lips, and nose. The dryness of the nose may also be accompanied by bleeding from the nose.
● Symptoms of a cold like sore throat, sneezing, and stuffy nose.
● Bone and joint pains
● Pains in the muscle
● Swelling of lips, throat, tongue, and face
● Ringing sensations in the ear
● Redness and blistering of the skin and even the gums
● Bleeding from the rectum
Missed Dose and Overdose
If you miss your dose, do take it as soon as you remember. However, if the time you remember is close to the time for your next dose, do skip the missed dose and wait for the next one. This is to minimize the incidences of overdose. In case of an overdose, call your poison control center and seek immediate emergency help.
Interactions of Accutane
Accutane interacts with over 100 drugs, food supplements/vitamins, and 5 pathological conditions.
It interacts with antibiotics like tetracycline, minocycline, and doxycycline; and contraceptives (birth control medications). Progestin-only pills and St John’s wort may not work effectively if taken with isotretinoin. It also interacts with steroids and phenytoin.
Alcohol interacts with isotretinoin to exacerbate the adverse effects of the drug such as faster heartbeat and vomiting. It interacts with vitamin A drugs (bexarotene and acitretin) to increase vitamin levels in the blood and tissues.
Additionally, the drug interacts with the following pathological conditions:
● Liver diseases
● Intracranial hypertension
● Psychiatric disorders
● Dyslipidemia (elevated triglycerides levels in the blood)
Accutane should be stored at room temperature away from light, moisture, and direct heat. It should be kept out of the reach of children and domestic animals.