Isotretinoin

Isotretinoin is a synthetic retinoid which reduces sebaceous gland size and sebum production. It regulates cell proliferation and differentiation. It is a derivative of vitamin A that increases skin cell turnover and prevents clogged pores. It kills acne-causing bacteria by controlling sebum production and acts as an anti-inflammatory to decrease inflammation (redness and swelling).

• Severe, recalcitrant nodular acne (unresponsive to conventional therapy and systemic antibiotics)

Adult Dose (Oral):

• 0.5-1 mg/kg/day divided BID for 15-20 weeks
• Up to 2 mg/kg/day (as tolerated) if very severe with scarring
• Hepatic impairment: Contraindicated

Child Dose (≥12 years):

• 0.5-1 mg/kg/day divided BID for 15-20 weeks
• Up to 2 mg/kg/day (as tolerated) if very severe with scarring

Renal Dose: Severe renal impairment: Reduce initial dose (e.g., 10 mg daily), then gradually increase to 1 mg/kg as necessary

Common Side Effects:

• Dry skin
• Rash
• Increased liver enzymes
• Dry mouth, lips and eyes

Others: Night vision decreased, drowsiness, dizziness, headache, muscle and joint pain, increased cholesterol and triglycerides

Precautions:

• Isotretinoin may affect your ability to drive (night vision decreased, drowsiness, dizziness)
• Take with food
• Avoid sunlight exposure (use sun-cream or protective clothing)
• Avoid face waxing and laser treatment (skin becomes more fragile)
• Avoid tetracycline (may reduce effectiveness)
• Do not use if pregnant, planning pregnancy or breastfeeding
• For dry mouth, lips and eyes: drink plenty of water, use moisturizer, avoid contact lenses
• Regular monitoring of liver function and lipid profile required

Contraindications:

• Pregnancy
• Lactation
• Hepatic impairment
• Liver disease

Drug Interactions:

• Additive toxicity with vitamin A or its derivatives
• Decreased efficacy of microdosed progesterone (use 2 forms of contraception)
• Increased risk of bone loss with phenytoin
• Increased risk of osteoporosis with systemic corticosteroids
• Increased risk of pseudotumor cerebri with tetracyclines (Potentially Fatal)

Food Interactions: Caution is advised when consuming alcohol with Isotretinoin; consult your doctor.

Use in Pregnancy: Highly unsafe during pregnancy; significant harmful effects to developing baby; contraindicated in pregnancy; effective contraception required during and after treatment.

Use in Lactation: Probably unsafe; limited data suggests drug may pass into breastmilk and harm baby.

Renal Impairment: Probably safe in kidney disease; dose adjustment may not be needed; severe renal impairment: reduce initial dose (e.g., 10 mg daily).

Hepatic Impairment: Unsafe in liver disease; avoid use; regular monitoring of liver function required.

Overdose: Symptoms of vitamin A toxicity (headache, nausea, vomiting, drowsiness, dizziness, blurred vision, dry skin); symptomatic treatment; no specific antidote.