A Clinical Perspective
Accutane is Roche's brand name (it is called Roaccutane in Europe) for isotretinoin, a chemical cousin of vitamin A. It is prescribed to treat severe, disfiguring cystic acne that has not cleared up in response to milder medications such as antibiotics. Accutane works on the oil glands within the skin, shrinking them and diminishing their output. It is taken by mouth for several months and then discontinued, with the effect lasting for a few months thereafter.
Possible Side Effects
Abnormal hair growth or loss, allergic reaction, bleeding gums, blood in urine, bowel inflammation and pain, bruising, changes in blood sugar, cholesterol levels, and skin pigmentation, chest pain, decreased night vision, decreased tolerance to contact lenses, a delay in wound healing, depression, difficulty sleeping, dizziness, drowsiness, dry or fragile skin, dry or cracked lips, dry mouth and nose, fatigue, flushing, headache, hearing problems, heartbeat irregularities, herpes, itching, joint pain, liver disorders, menstrual changes, nail disorders, nausea, nervousness, nosebleeds, peeling palms or soles, pinkeye, rash, skin infections, stomach and intenstinal discomfort, stroke, sudden drop in blood pressure, sweating, swelling due to fluid retention, tendon and ligament problems, urinary discomfort, vision problems, vomiting, weakness, and weight loss.
- Accutane is a last resort. A doctor should eliminate all other possible methods for dealing with the acne before turning to Accutane.
- The drug is known to cause severe birth defects, and women must watch a videotape and sign a consent form before taking it. They must also have two negative pregnancy tests before taking Accutane, and have monthly pregnancy tests while taking it. Two forms of birth control should be used while a woman is on Accutane.
- Because Accutane affects the body's processing of fats and sugars, it should not be used by people with diabetes, high triglyceride or cholesterol levels, obesity, or alcoholism.
- Accutane has been known to cause increased pressure inside the skull, particularly in individuals also taking tetracycline. Symptoms of this include headache, nausea, and visual disturbances; these should be reported to a doctor.
- The drug has been recorded as having caused depression and other mental problems, including thoughts of suicide. This is still under investigation at this writing, following the kamikaze flight of a Florida teenager taking Accutane.
- Persons taking Accutane should not donate blood or stay out in the sun too much. They should also avoid waxing for hair removal or any skin resurfacing treatments such as dermabrasion.
- Because Accutane is related to vitamin A, individuals on the drug should not take vitamin A supplements - this would be equivalent to overdosing.
- Symptoms of an Accutane overdose include abdominal pain, dizziness, dry or cracked lips, facial flushing, incoordination and clumsiness, headache, and vomiting.
The recommended dosage range is 0.5 to 2 milligrams per 2.2 pounds of body weight, divided into two doses daily, for 15 to 20 weeks. Most doctors will start a patient at 0.5 to 1 milligram per 2.2 pounds per day.
The PDR Pocket Guide to Prescription Drugs, page 6.