What Is Accutane?
Accutane (isotretinoin) is a drug used to treat severe nodular acne. If nodular acne doesn’t respond to other treatment methods, such as antibiotics, then your doctor may recommend you try Accutane. While Accutane was a brand name isotretinoin product until recently, the name is now used generically to refer to the drug.
Accutane has been known to cause a range of side effects, including severe birth defects and mental health issues. When taken during pregnancy, Accutane can lead to a miscarriage or premature birth, birth defects in newborns, and the newborn’s death. The Centers for Disease Control and Prevention (CDC) advise women not to take Accutane while pregnant.
How Does Accutane Work?
Accutane works by affecting the way that acne develops in a few different ways. This includes reducing the size of the skin’s oil glands by as much as 58% and the production of oil by 80%. Less oil leads to less acne bacteria, since this bacteria lives in skin oil. Accutane also helps reduce inflammation and slows down clogging in the pores.
Accutane derives from vitamin A and occurs naturally, which means the body can quickly eliminate the drug from the bloodstream. In many ways, this makes it a safer method of treatment than antibiotics or vitamin A. Due to its similarity to vitamin A, the drug should not be taken at the same time as vitamin A.
Accutane should be taken twice per day. Unless your doctor gives other instructions, the capsule should be taken with a substantial meal, as this helps the body to absorb the drug. Since the drug can irritate the esophagus if chewed, sucked, or allowed to melt, you should always swallow the capsule whole with a full glass of water.
Accutane is prescribed in 30-day supplies. Your doctor should give you a specific dosage according to your weight, but this dosage can change over the course of your treatment. Never take a higher dosage than that prescribed, and if you forget to take one of your daily doses, always skip that dose instead of taking two doses simultaneously. Overdosing on Accutane can lead to serious health problems.
Uses of Accutane
Accutane is typically used to treat severe nodular acne. This condition causes the skin to break out in red, swollen lumps that are often larger than normal acne, can last for months, and may lead to permanent scarring if left untreated. Accutane is often prescribed when other treatments fail to reduce the acne symptoms.
In some cases, Accutane may also be used to treat mild or moderate acne, other skin conditions, and some types of cancer. This is less common due to the potential for side effects, which can be severe.
Brands of Accutane include:
Accutane Side Effects
Accutane can cause a variety of side effects. During the first weeks of treatment, about one in five patients experience an acne flare up, but this will clear up over time. In most cases, Accutane treatment takes about four to six months to completely cure acne, though some patients need to take the drug for another four to six months for it to be effective.
Common Accutane Side Effects
- Dry skin, eyes, and nose
- Peeling skin
- Chapped lips
- Cheilitis (inflamed lips)
- Skin rash
- Conjunctivitis (pink eye)
- Pruritus (itchy skin)
- Blisters and sores on the face, arms, legs, and inside the mouth and throat
- Hair loss
Patients who are allergic to Accutane may develop hives, swelling of the mouth or face, and bruises and red spots on the legs. Contact your doctor if you suspect you might be allergic to isotretinoin.
Serious Accutane Side Effects
Taking isotretinoin can lead to some serious and potentially fatal side effects. Doctors often run periodic blood tests on patients during their treatment to monitor their health and test for adverse effects.
Accutane can negatively affect the brain by heightening the pressure placed on it. In extreme cases, this can lead to permanent blindness and even death.
Other side effects caused by pressure on the brain include:
- Bad headaches
- Blurred vision
- Vomiting or nausea
Accutane has been known to cause damage to the internal organs (liver, bowel, pancreas, and esophagus), which can result in stomach issues that may be permanent. Symptoms to watch for include:
- Severe pain in the stomach, bowels, or chest
- Difficult or painful swallowing
- Dark urine
- Rectal bleeding
- Yellowing of the eyes and skin (jaundice)
Accutane can also damage the bones and muscles, causing joint pain and muscle weakness. In other cases, it may cause ringing in the ears or hearing loss, which can be permanent. Accutane sometimes negatively affects night-time vision, but in most cases, this will resolve after you stop taking the drug.
Accutane may increase the cholesterol and fat in the blood, although these issues usually resolve themselves after treatment is finished. Blood sugar problems may also occur, including diabetes. Accutane use may decrease the number of white and red blood cells in the body, and may cause faintness, weakness, or excessive thirst.
Accutane can also cause mental health conditions, including psychosis, depression, and suicidal thoughts.
If you experience any severe symptoms while taking Accutane, stop taking the medication and seek medical assistance immediately.
Accutane, Pregnancy and Birth Defects
The CDC does not recommend Accutane for women who are pregnant or trying to become pregnant. The drug has been linked to a higher risk of miscarriage and serious birth defects, including deformities of the face, skull, brain, and heart.
Due to these risks, women are recommended to take pregnancy tests on a monthly basis while taking Accutane. It is also recommended to use at least two different types of birth control while taking the drug, starting one month before treatment and continuing for at least a month after.
If you become pregnant while on Accutane, stop taking the drug immediately and contact your doctor.
Who Should Take Accutane?
For some patients, Accutane treatment poses serious risks. Women who are pregnant, trying to become pregnant, or breastfeeding should not use Accutane. If you are allergic to any of the ingredients in the drug, you should not use it.
For children and teenagers, Accutane should be a last resort. If your child has nodular acne and has tried a variety of other treatments with little or no success, then Accutane may be the best option. Speak to your child’s doctor before they begin taking Accutane, and monitor them closely for adverse effects. If a teenager is still growing, Accutane may stunt bone growth.
While taking Accutane and for a minimum of six months after treatment has ended, you should avoid donating blood and having any cosmetic procedures done, including waxing or laser surgery. You should also avoid ultraviolet light, tanning beds, and sunlight while taking the drug.
Before taking Accutane, inform your doctor of any health conditions that you or a member of your family experiences. This includes mental health problems, anorexia, allergies to food or medications, diabetes, asthma, osteoporosis, heart disease, and liver disease.
You should also inform your doctor of any medications you currently take, including herbal supplements, prescription and over-the-counter drugs, and vitamins, particularly Vitamin A. Unless your doctor says otherwise, Accutane should not be taken with Dilantin, Corticosteroid medicines, and St. John’s Wort. Tell your doctor before starting any new medication while taking Accutane.
Accutane’s severe side effects have been the subject of several lawsuits. In January 2017, a patient who developed Crohn’s disease after using Accutane for only four months sued Hoffman LaRoche, a Swiss drug-making company that previously sold Accutane to patients in the U.S. Hoffman LaRoche was accused of not adequately warning patients of the risk of developing Crohn’s disease while taking the drug.
In this case, the New Jersey Supreme Court awarded the claimant $25 million. At the time, approximately 3,600 Accutane lawsuits were pending against the drug manufacturer in the state of New Jersey.