Isotretinoin for Acne
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Isotretinoin is a powerful and effective medicine derived from vitamin A (retinoid medicine). Doctors prescribe it to treat severe acne only after other treatments have failed. Isotretinoin can cause some rare but serious side effects.
Isotretinoin usually needs to be taken for 3 to 6 months.
How It Works
Isotretinoin works by unclogging skin pores and shrinking oil glands.
Why It Is Used
Doctors use isotretinoin to treat people who:
- Have severe acne that does not get better with other treatments.
- Develop scars (particularly deep scars) after their pimples or cystic lesions heal.
How Well It Works
Isotretinoin is very effective for controlling most types of acne and for clearing it up for long periods of time. 1
All medicines have side effects. But many people don’t feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
The most dangerous side effects of this medicine are miscarriage and serious birth defects in babies whose mothers took the medicines during pregnancy. Women who can get pregnant need to use two forms of birth control so that they do not become pregnant while they are taking retinoid medicine. The risk of birth defects and miscarriage goes away about 1 month after the medicine is stopped.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Changes in mood or thoughts, or signs of depression .
Common side effects of this medicine include:
- Dry, scaly, itchy, red skin.
- Chapped lips.
- Dry eyes and dryness inside the nose and mouth.
- Fatigue, especially after physical activity.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Taking this medicine can cause high triglyceride levels. It can also cause liver damage. So you will have a blood test before starting this medicine and while you are taking this medicine to check your triglyceride levels and your liver function.
Isotretinoin may be linked to depression, psychosis, and, in rare cases, thoughts of suicide, suicide attempts, and suicide. The link between isotretinoin and these mood changes is not clear and is being watched very closely. Talk with your doctor about whether isotretinoin is right for you or your child. If you or your child is taking isotretinoin and has signs of depression , see your doctor for treatment. Even if you stop taking isotretinoin, depression may not improve.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don’t take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
Isotretinoin is strictly regulated for use in women because of the danger of miscarriage and of serious birth defects in babies whose mothers took the medicine during pregnancy. Doctors may prescribe these medicines only for a female who is not pregnant and who does not intend to become pregnant while taking the medicine. You must also use two methods of birth control and have pregnancy tests on a regular basis while using this medicine.
Companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that women taking this drug understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
- Habif TP (2010). Acne, rosacea, and related disorders. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 217–263. Philadelphia: Mosby.
Last Revised: March 25, 2013
Author: Healthwise Staff
Medical Review: Kathleen Romito, MD – Family Medicine & E. Gregory Thompson, MD – Internal Medicine