Considering treatment with Isotretinoin (Accutane)
Isotretinoin or it’s original trade name Accutane is a medicine used to treat severe cystic acne, or stubborn acne not responding to many other treatments over a period of time.
A lot of people have heard about isotretinoin, but there is always some concern about the use and safety of this medication.
Isotretinoin has many potential serious side effects, so we do not take this medication lightly, but when used properly it is a fantastic medication that can be life changing for many people. This drug is metabolized by the liver – so before we prescribe it for anyone I need to do lab tests (blood work) to ensure your liver is healthy enough for isotretinoin. Once we ensure that we are able to prescribe it we also order more blood tests to be done once a month while on this drug. This medication requires monthly visits to my office and monthly blood tests to make sure we do not encounter any problems – and we very rarely do. Occasionally we see the cholesterol and triglycerides increase slightly, but it never usually is a big issue for my patients. The length of treatment is about a six month course, so we will need to see you once a month and get blood work for at least that long.
Another potentially concerning side effect of this medication is the possibility for it to cause severe birth defects for any female patient that gets pregnant while on Isotretinoin. This drug gets passed through the placenta to the baby and can affect organ development. Therefore, it is essential that all female patients do not get pregnant while taking this drug. A question that we get all the time, and I want to clarify here, is that Isotretinoin does not affect a woman’s ability to become pregnant. Not while on it, or in the future. For my female patients we also do a blood and urine pregnancy test every month as part of the required monitoring for this medication.
Last of the potential major side effects we will mention is a possible link between this medication and the risk of depression or mood changes. While I always ask patients and screen for this side effect we almost never encounter any patients having major changes because of the drug.
This medication has been prescribed for a very long time. It works great and can be life changing for many that take it. For some, it is the last means of treatment you may ever need for a lifetime and for the majority of my patients they never need any more topical therapy or antibiotics again!
While on Isotretinoin (Accutane)
Now that you have decided to go on Isotretinoin there are a few things you need to know. The most common side effect of this medication is dry skin. Not dry skin that you may have experienced from applying certain topical medications, but dry skin anywhere on the body. The most common place is the lips – dry chapped lips happens to all of my patients. This should not be seen as a deal breaker, just something you need to know and prepare for. We recommend Aquaphor and vaseline to keep your lips moisturized and healthy. Start applying it right away and as often as you need to. Especially at night. You should always use a gentle skin cleanser such as Dove soap, or a soap free cleanser (CeraVe, Cetaphil, Aveeno to name a few). Moisturizer every day is essential and should be done once to twice a day.
Some patients may experience joint aches or body pains, especially if you are very active or physical. If it disrupts your day to day activities you should let me know. Occasional head aches or night time blurry vision may also occur, but these are rare. Some patients may report bloody noses as a result of dryness in the nasal passages. If this happens the best way to prevent it is to apply a thin layer of Aquaphor or vaseline to the inside part of each nostril before bed. If that does not help a simple nasal saline spray, which can be purchased over the counter, can be used a few times daily to hydrate the mucous membranes of the nose.
Isotretinoin is also a photo-sensitive medication. This means the medication makes you more susceptible to getting sun burned when outdoors. It is very important to take precaution and use SPF 30 or greater on any sun exposed area when you are in the sun, even for just a few minutes.
This medication is best absorbed when taken with food – so make sure you eat when taking it. If you skip a dose do not worry, just take your next scheduled dose and do not double up.
When on this medication you do not need to use any other acne product. You will not be taking any antibiotics or using any topical medications or medicated cleansers.
When you begin this medication it may not clear you up right away. Be patient. Some patients see results in the first month, others need to be on it for 3-4 months or more until we get good control of your breakouts. A typical course of isotretinoin is about six months. However, we sometimes need to keep patients on it for a little while longer depending on your results. One thing Isotretinoin does not do is make your acne worse when you first begin taking it. This is a common misconception and myth that I hear all the time. No acne treatment is designed to make your acne worse before it makes it better.
Remember to keep your monthly appointments with me and to get your blood work done about one week before you are scheduled to see me.
What is iPLEDGE?
Now that you are on Isotretinoin you need to know about the prescribing database known as iPLEDGE. iPLEDGE is an online registry for all Isotretinoin prescriptions. When you began this medication you were given a booklet to read through and sign consent forms. In the back of the booklet there are three yellow cards with an identification number that is now unique to you. Every month when you are in the office we need to input some information that indicates you are able to receive this medication. When you go to the pharmacy to pick up your medication you will need to bring one of these cards with you so that the pharmacist may be able to identify that you are eligible to receive this prescription. Female patients (and only female patients) will need to log in to the iPLEDGE program and answer a few simple questions ensuring that you know the risks involved about pregnancy and birth defects before you go to the pharmacy. Shortly after female patients are first registered in iPLEDGE they will receive a letter in the mail with login information to allow you to do this. This must be done every month, no exceptions.