PEBC: What You Need to Know: Isotretinoin

Brand Examples:

Accutane, Clarus, Epuris

Indication:

-Oral retinoid (a form of vitamin A) which is used for severe acne, especially with nodules and scarring

-Effective but reserved as last line therapy due to monitoring and adverse effects

Dosing:

Approximately 0.5 to 2 mg/kg/day, can be divided BID for tolerability

Adverse Effects:

MOST IMPORTANT: Dryness of mucous membranes: eyes, lips, skin, mouth, nose (advise to moisturize)

-thirst

-myalgia

-increased cholesterol

-photosensitivity → use sunscreen

-increased liver function tests

-depression or mood changes

Contraindicated in pregnancy! Hence, females need rigorous testing for pregnancy monthly before, during and after treatment. Patients must be on two forms of birth control (oral contraceptive and condoms).

Drug Interactions:

-Duplication with vitamin A derivatives such as vitamin A supplements or topical retinoids

-Tetracyclines: increased risk of benign intracranial hypertension → must discontinue tetracycline

-Methotrexate: increased risk of liver toxicity

-Other acne medications: may worsen dryness