Isotretinoin for Acne

Isotretinoin is a retinoid medication that is taken by mouth to treat severe nodular acne. Typically, it is used once other acne treatments have not worked, such as oral antibiotics. Usually isotretinoin is taken for 4 to 6 months, although the length of treatment can vary from person to person. While most patient’s acne improves and may even clear with this medication, in 20% of patients acne can come back. This requires additional acne treatment or even a second cycle of isotretinoin.

How should I take isotretinoin?

  • Isotretinoin dosing is weight-based and should be taken exactly as prescribed.
  • If you miss a dose, skip that dose. Do not take 2 doses at the same time.
  • Take with food to help with absorption.
  • All instructions in the iPLEDGE program packet (www.ipledgeprogram.com) that was provided must be followed (see below).
  • You will get a 30 day supply of isotretinoin at a time. It cannot be automatically refilled. Make certain that you have been given enough medication to last 30 days as pharmacists are unable to refill or make changes within a month.
  • You must return to your dermatologist every month to make sure you are not having any serious side effects from isotretinoin. For female patients, this visit will always include a monthly pregnancy test. Other laboratory studies, including liver function tests, cholesterol and triglycerides, must also be conducted before and during treatment.

What should I avoid while taking isotretinoin?

  • Do not get pregnant from one month prior or 1 month following taking any isotretinoin.
  • Do not donate blood while take isotretinoin or until 1 months after coming off the medication.
  • Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while taking this medication and for at least 6 months after you stop.
  • Do not share isotretinoin with any other people. It can cause birth defects and other serious health problems.
  • Do not use any other acne medications, including medicated washes, cleansers, creams or antibiotic pills during your treatment with isotretinoin unless expressly directed to by your dermatologist.

Initiating isotretinoin & the iPLEDGE Program

  • The iPLEDGE Program is a strict, government-required program to prevent females from becoming pregnant while on isotretinoin. All females and males must participate. Note: Your provider must follow this program and cannot change any of the requirements.
  • Before starting isotretinoin, your provider will talk to you about the safe use of this medication and you will need to sign consent forms in order to receive treatment.
  • If you fail to keep appointments, you will be unable to get your prescription filled.
  • For male patients and women of non-childbearing age: There is no waiting period. Once laboratory tests are done, treatment can start.
  • For females of childbearing age:
    • You must be on two specific forms of birth control before starting isotretinoin. Your provider must get 2 negative pregnancy tests, 30 days apart, before you can proceed with the medication. The second pregnancy test must be obtained within 5 days of the menstrual cycle. If you choose not to be sexually active during treatment, you still must have the 2 negative pregnancy tests.
    • You must answer a series of questions either online or by phone every month.
    • Monthly prescriptions must be filled within 7 days of the visit to the dermatologist. It is important that you notify your physician well before the 7th day if there are any unforeseen delays, such as prior authorizations.
    • For more information, visit: https://www.ipledgeprogram.com/PatientInformation.aspx

What are the possible side effects of isotretinoin? What should I do?
Most side effects from isotretinoin are mild and can be easily improved with simple remedies. Others are more concerning.

  • Dry skin and eyes, chapped lips and dry nose that may lead to nosebleeds.
    • Dry Skin: Apply sensitive skin moisturizers to dry skin at least two times a day. You may need sunscreen (SPF 30) in the morning and to reapply when outside.
    • Dry Eyes: Use saline eye drops or artificial tears.
    • Dry Nose/Nosebleeds: Use saline nasal spray and petrolatum jelly into the nose, during the day and at bedtime. To stop nosebleeds, hold pressure. If this does not work, call your dermatologist.
    • Chapped lips: apply petrolatum-based lip balms routinely. Avoid anything “medicated.” Contact your dermatologist for excessive dryness, cracks, tenderness or pain.
  • Increased blood fats and cholesterol (usually in patients with a personal or family history of cholesterol or triglyceride problems).
  • Vision problems affecting your ability to see in the dark and drive at night.
  • Bone, muscle and tendon aches can occur. Additional stretching before and after activities may help relieve aches. If you are otherwise healthy, consider the use of ibuprofen or naproxen. If you are unsure if you can use these pain medications, ask your doctor first. Also, call your doctor if you experience severe back pain, joint pain, or a broken bone
  • Changes in mood, including anxiety, depressive symptoms or suicidal thoughts which may or may not be temporary. Notify your doctor if your or a family member have suffered from these conditions or if you have any concerns during treatment.
  • Serious birth defects or miscarriage can occur while taking this medication and for one month after taking your last dose of isotretinoin. You must not get pregnant while taking isotretinoin. Once the medication is out of your system, 30 days, there is no effect on the baby.
  • Increased pressure in the brain. Call your doctor right away if you experience bad headache, blurred vision, dizziness, nausea or vomiting, or seizures.
  • Skin rash – call your doctor right away if you develop any rashes or blisters on the skin.
  • Liver damage – call your doctor right away if you experience severe stomach, chest or bowel pain, painful swallowing, diarrhea, blood in your stool, yellowing of your skin or eyes, or dark urine.
  • Gastrointestinal bleeding. If you experience unusual abdominal pain or red or black/tarry stools, call your doctor immediately. You should also notify your doctor if you or a family member has a history of ulcerative colitis or Crohns disease.
  • Worsening acne. Mild worsening of acne can occur in the first few weeks of using isotreinoin. If your acne is getting significantly worse, call your doctor. This may require temporarily stopping the isotretinoin and possibly adding other medications.

© 2015 The Society for Pediatric Dermatology