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Isotretinoin

Isotretinoin is a generic medication used for the treatment of severe acne and most commonly known under the brands Accutane and Roaccutane. It is a retinoid, meaning it is derived from vitamin A and is found naturally in the body, produced by the liver in small quantities. more...

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History

Prior to the development of isotretinoin, the mainstay treatment of severe acne was oral antibiotics such as the tetracyclines and erythromycin. While these drugs have proven efficacy, they worked against only one contributing factor of acne, Propionibacterium acnes bacteria. The antibiotics gradually became less effective over time as more resistant strains of the bacterium became prominent.

An early, effective treatment of acne was high doses of the fat soluble vitamin A. At these dose levels (sometimes 500,000 IU per day) effects such as reduced production of sebum and dry hair could be noticed. However the vitamin also had many other prominent side effects which inhibited its widespread use.

The development of the derivative of retinoic acid, isotretinoin (13-cis-retinoic acid), and its release in 1982 by Hoffmann-La Roche was a great step forward in the treatment of acne. The synthetic compound provided better therapeutic benefit than vitamin A, while also producing fewer side effects. In February 2002 Roche's patents for isotretinoin expired, there are now many other companies selling cheaper generic versions of the drug.

Today isotretinoin is usually prescribed after other acne treatments have failed to produce results. The treatment of acne usually begins with topicals, moves onto oral antibiotics (or a combination) and finally isotretinoin therapy. This is because other treatments, while less effective than isotretinoin, produce far fewer side effects.

Brand names

Isotretinoin is produced under many brand names by many manufacturers. It is available typically as 5 mg, 10 mg, 20 mg and (in the USA) 40 mg capsules.

Some brands of isotretinoin include:

Accure® by Alphapharm
Accutane® and Roaccutane® by Roche
Aknenormin® by Hermal
Amnesteem® by Mylan
Ciscutan® by Pelpharma
Claravis® by Barr
Isohexal® by Hexal Australia
Isotroin® by Cipla
Oratane® by Douglas Pharmaceuticals
Sotret® by Ranbaxy

Indications

Isotretinoin is indicated for treatment for a number of dermatological conditions, most commonly acne. It is generally not used as a first-line treatment due to the potential side effects. Antibiotics (such as the tetracyclines) are usually prescribed before isotretinoin.

Severe forms of acne (conglobata, fulminans and nodulocystic) as well as acne that scars can be successfully treated with isotretinoin.

Acne that has not responded to other treatment will usually respond to isotretinoin. Dysmorphophobic patients may also be prescribed isotretinoin.

Read more at Wikipedia.org

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Using Isotretinoin the Right Way for Acne - Brief Article
From American Family Physician, 10/15/00

What is isotretinoin?

Isotretinoin (brand name: Accutane) is a medicine for very bad acne that did not get better after you tried other medicines. It is important for you to take isotretinoin the right way. You should know about the side effects of isotretinoin. Talk to your doctor if you have any questions about this medicine or if you have side effects when you take it.

General Information

You should take isotretinoin with food. You don't have to keep the medicine in the refrigerator, but keep it out of sunlight. Try not to keep it in a place that is very warm.

Isotretinoin has been prescribed just for you. Don't share it with other people. Keep isotretinoin away from children. You may not give blood while you are taking this medicine or for at least one month after you stop taking it.

Before Treatment Starts

Tell your doctor if you or anyone in your family has diabetes, liver disease, heart disease or depression. You should also tell your doctor if you are allergic to any medicines, especially parabens (which are in the isotretinoin capsules). Be sure to tell your doctor if you are taking any other medicines, even over-the-counter medicines.

Isotretinoin is like vitamin A, so you should not take vitamin A pills or multivitamins with vitamin A while you are taking isotretinoin.

During Your Treatment

Your acne may get worse when you start using isotretinoin. This usually just lasts for a little while. You can tell your doctor if this happens to you because you might need to use other medicines along with the isotretinoin in this stage.

The dosage of isotretinoin is different for each person. During your treatment, your doctor may change your dosage. Be sure to take isotretinoin just the way your doctor tells you. If you miss one dose, don't take extra the next time.

Be sure you keep all of your appointments with your doctor because your doctor needs to check on you often. Your doctor may check your liver tests and cholesterol levels. During treatment you may have some of the following side effects. These side effects usually go away when you stop taking isotretinoin:

* Dry skin and lips (your doctor can tell you which lotions or creams to use)

* Fragile skin (easily injured), itching or rash

* Increased sensitivity to the sun (easily sunburned)

* Peeling skin on your palms and soles

* Thinning hair

* Dry, red eyes (you may find that you can't wear your contact lenses during treatment)

* Nosebleeds

* Bleeding gums

* Pain in your muscles

* Decreased night vision. If you have any vision problems, you should stop taking isotretinoin and talk to your doctor right away.

A few people have even more serious side effects. If they aren't treated, the problem could last forever. If you have any of the side effects listed below, stop taking isotretinoin and check with your doctor right away:

* Headaches, nausea, vomiting or blurred vision

* Depression or changes in your mood

* Severe stomach pain, diarrhea or bleeding from your rectum

* Very dry eyes

* A yellow color in your skin or eyes, and dark yellow urine

After You Stop Taking Isotretinoin

Your skin might go on getting better even after you stop taking isotretinoin. Most of the side effects of isotretinoin go away in a few days or weeks after you stop taking isotretinoin. If your side effects last more than a few weeks after you stop taking isotretinoin, talk to your doctor.

Some patients have to take isotretinoin more than one time. If you need to take isotretinoin again, you can start taking it again 8 to 10 weeks after your first treatment is over. Do not give blood for at least one month after you stop taking isotretinoin.

Attention, Girls and Women:

You must not take isotretinoin if you are pregnant or if there is any chance you might get pregnant while taking this medicine!

Isotretinoin causes severe birth defects, including malformation of the head and face, mental retardation and severe internal defects of the brain, heart, glands and nervous system. It can also cause miscarriage, premature birth and death of the fetus.

You must use two forms of birth control at the same time for at least one month before you start taking isotretinoin and for all the time you are taking this medicine. Keep using two kinds of birth control for one month after you stop taking isotretinoin. If you are using Depo-Provera as your form of birth control, you may not need to use two forms of birth control. Check this with your doctor.

Your doctor will make sure you are not pregnant before starting isotretinoin and check again every month while you are taking it. You will be asked to read and sign a consent form to show that you understand the dangers of birth defects and agree to use birth control. If your period is late, stop taking isotretinoin and call your doctor right away. If you get pregnant while you are taking isotretinoin, talk with your doctor about going on with the pregnancy.

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