Isotretinoin

Brand names of isotretinoin

  • Accutane

An oral drug, isotretinoin is used to treat severe acne and to prevent it in both teenagers and adults and has been approved by the FDA in May 1982. Acne is primarily a skin inflammation caused by the secretion of sebum (oily substance) from the glands in the skin known as sebaceous glands. Sebum causes the inflammation which when healed forms a scar (keratinization). Sometimes the acne is so severe that the skin is permanently scarred. How exactly isotretinoin works is unknown but it probably reduces the sebum secretion. The less the secretion the less will be the inflammation leading to reduced scarring.

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Things you need to tell your physician before taking isotretinoin

Before you begin to take isotretinoin inform the doctor if you are allergic to it or any of the other ingredients that are in isotretinoin capsules. The pharmacist will readily provide you with a medication guide for a list of all the ingredients that are inactive. Also mention if you are allergic to parabens which are preservatives.

Your doctor will need to monitor you for reactions or change the dosage of your medication if you are taking any medications for seizures, oral steroids, tetracycline antibiotics or vitamin A supplements, so take care to mention these. Besides these if you are taking or have plans to take other prescribed and non prescribed medications like vitamins, herbal products or nutritional supplements make a mention to your doctor of these too.

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If any one in your family or you has had the following medical conditions you need to inform the doctor about them as well. So mention any suicidal tendencies or attempted suicides if they have happened in the family besides mentioning depression, mental illness, diabetes, asthma, osteoporosis (fragile bones that break easily) or other conditions that cause bones to turn weak, a high triglyceride count, anorexia nervosa which is an eating disorder, or any heart or liver disease.

Avoid breast feeding if you are taking isotretinoin and also for one month after you have stopped taking it.

Isotretinoin can make your skin sensitive to sunlight so avoid the sun. Wear protective clothing and sunglasses and use sunscreen if you think you will be exposed to the sun for a long time.

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There are some changes that might take place as a result of taking isotretinoin, so you should be aware that this medication might change thoughts and behavior and mental health. Studies have shown that patients who took isotretinoin became depressed, violent, psychotic or tried to hurt or kill themselves and sometimes succeeded.

If the following list of mental, physical and behavioral changes occur as a result of taking isotretinoin then either you, if you are capable of doing so, or your family must inform the doctor immediately. These are serious symptoms and need to be reported, anxiety, crying spells and sadness, loss of interest in activities you enjoyed earlier, withdrawing from friends and family, lack of energy, any feelings of worthlessness or guilt, suicidal tendencies, dangerous thoughts or if you imagine seeing and hearing things (hallucinations), difficulty concentrating, lower performance in school or at work, sleep related problems, sleeping too much or unable to sleep or unable to awake, irritation, anger, aggressive behavior, changes in appetite or weight.

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Certain eye related problems may also occur suddenly while on treatment or after treatment with isotretinoin like dry eyes and so wearing contact lenses could become difficult. Also your night vision could weaken making it difficult to see in the dark and so be careful while driving or operating machinery.

Any beauty treatments like waxing, dermabrasion and laser treatment on the skin should be completely shunned during treatment and six months after that too. Consult your doctor about when to begin these treatments as these could lead to development of scars while on isotretinoin.

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Talk to your doctor if you need to take part in energetic sports and physical activity as isotretinoin could weaken or thicken the bones abnormally and so bone injury while performing physical activities cannot be ruled out. In case you break a bone, the healthcare provider must be made aware that you are on isotretinoin.

Usage

When other treatments, like oral antibiotics fail to work then isotretinoin is used to treat severe acne. Isotretinoin is used last for treating acne because of the serious nature of the side effects.

High amounts of sebum or facial oil leads to acne. So isotretinoin, which is classified as retinoid, is used to decrease the production of sebum as severe acne can lead to permanent scars.

How to use isotretinoin

Before you begin with isotretinoin make sure to read the medication guide that the pharmacist will provide to you and also each time you buy a refill. You will also need to read carefully and sign a Patient Information/ Informed Consent form before you start this medication. Any questions and doubts about isotretinoin should be directed to your doctor or pharmacists.

Capsules need to be swallowed whole with a full glass of water and should not be crushed or chewed. Isotretinoin treatment runs for 15 to 20 weeks and the capsule is taken twice a day with food unless the doctor directs otherwise. The medication is absorbed faster into the bloodstream when taken with food. You must not lie down for at least half an hour after the medicine is taken. The dosage is decided on factors such as your medical condition and your response to treatment.

At first the acne might worsen after you begin with isotretinoin. Noticeable changes will be seen after a month or two. In case there is a relapse and the acne returns a second course of medication will probably need to be taken after a gap of two months. Long term use is not recommended and neither is it advisable to take more of the dose than recommended.

How isotretinoin works

Isotretinoin decreases the size and causes interference in the functions of the sebaceous glands. These tiny glands are located along hair shafts on the body's surface. The thick oily substance they produce is a natural lubricant for the skin. During pregnancy, menstruation and puberty these glands are so stimulated that they produce more sebum than can be released through the pores in the skin. This means that the hair follicle is blocked which turns into a characteristic acne skin lesion. Once the composition of sebum is thinned and production reduced with isotretinoin acne will improve.

Side effects

Serious
Common
Less common

Possible interactions

Herbal remedies especially St. John's wort should be taken with caution as it may cause extreme sun reactions. Photosensitivity could be increased. Medicinal yeast has not been tested with isotretinoin even though it has a Commission E monograph acne indication. It is advisable to talk to the doctor before combining any herbal remedies with isotretinoin. Food intake is good as it increases the absorption of the medication and will help to maintain the correct blood levels. Exposure to the sun, as mentioned earlier can cause photosensitivity and so should be avoided.

Storage instructions

Isotretinoin should be stored in the same container it came in with the lid tightly closed. Store it at room temperature away from heat and moisture and out of reach of children. Do not store the medication in the bathroom and throw away any medication that has crossed the expiry period in consultation with the pharmacist who will direct you to dispose of unused medicine safely.

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