Isotretinoin

eye-soe-TRET-i-noin

Oral route(Capsule, Liquid Filled)

Isotretinoin must not be used by female patients who are or may become pregnant. There is an extremely high risk that severe birth defects will result if pregnancy occurs while taking isotretinoin. If pregnancy does occur during treatment of a female patient who is taking isotretinoin, isotretinoin must be discontinued immediately, and she should be referred to an Obstetrician-Gynecologist experienced in reproductive toxicity for further evaluation and counseling. Because of isotretinoin's teratogenicity, it is approved for marketing only under a special restricted distribution program called iPLEDGE(TM). The prescriber, patient, and pharmacy must be registered and meet all of the requirements of iPLEDGE before distribution .

Commonly used brand name(s)

In the U.S.

• Accutane


• Amnesteem


• Claravis


• Sotret

Available Dosage Forms:

• Capsule, Liquid Filled

Therapeutic Class: Antiacne

Chemical Class: Retinoid

Uses For isotretinoin

Isotretinoin is used to treat severe, disfiguring nodular acne. It should be used only after other acne medicines have been tried and have failed to help the acne. Isotretinoin may also be used to treat other skin diseases as determined by your doctor.

Isotretinoin must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and have failed. Isotretinoin must not be taken during pregnancy because it causes birth defects in humans. If you are able to bear children, it is very important that you read, understand, and follow the pregnancy warnings for isotretinoin.

isotretinoin is available only under a registered distribution program called the iPLEDGE™ program.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, isotretinoin is used in certain patients with the following medical conditions:

• Folliculitis, gram-negative (bacterial infection of the skin on the face beginning near the nose).


• Hidradenitis suppurativa (sweat gland problem).


• Rosacea (red skin disorder of the face, usually of the nose and cheeks).


• Thickened or patchy skin disorders, such as keratosis follicularis, palmoplantar keratoderma, lamellar ichthyosis, or pityriasis rubra pilaris.

Before Using isotretinoin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For isotretinoin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to isotretinoin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of isotretinoin in children younger than 12 years of age. Safety and efficacy have not been established.

isotretinoin should be used with caution in teenagers, especially those with bone problems or diseases.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of isotretinoin in the elderly. However, elderly patients may have a greater risk of problems and side effects when taking isotretinoin.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	X	Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking isotretinoin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using isotretinoin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Desogestrel


• Dienogest


• Doxycycline


• Drospirenone


• Estradiol Cypionate


• Estradiol Valerate


• Ethinyl Estradiol


• Ethynodiol Diacetate


• Etonogestrel


• Levonorgestrel


• Medroxyprogesterone Acetate


• Mestranol


• Minocycline


• Norelgestromin


• Norethindrone


• Norgestimate


• Norgestrel


• Tetracycline

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using isotretinoin with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use isotretinoin, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of isotretinoin. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcoholism, severe or


• Diabetes mellitus or


• Metabolism disorder, family history of or


• Severe weight problems—Use with caution. May increase risks for more serious problems.

• Anorexia (eating disorder) or


• Epiphyseal closure, premature or


• Osteomalacia (softening of the bones) or


• Osteoporosis (brittle bones), childhood or family history of or


• Other bone disorders or diseases—Use with caution. It is not known whether isotretinoin affects bone loss.

• Asthma or


• Depression, history of or


• Eye or vision problems or


• Hearing problems or


• Heart disease or


• Hepatitis or


• Hypertriglyceridemia (high triglycerides in the blood) or


• Intestinal disorders, history of or


• Pancreatitis (inflammation of the pancreas) or


• Pseudotumor cerebri (swelling in the brain) or


• Psychosis, history of or


• Vitamin A overdose (too much vitamin A in the body)—Use with caution. May make these conditions worse.

• Kidney disease or


• Liver disease—Use with caution. Effects may be increased because of slower removal of the medicine from the body.

Proper Use of isotretinoin

Isotretinoin comes with a patient information form and medication guide. It is very important that you read and understand this information. Be sure to carefully follow these instructions and ask your doctor if you have any questions.

Women of reproductive age must sign up for a pregnancy risk program called iPLEDGE™ in order to receive their isotretinoin prescription each month. You can sign up on the internet (www.ipledge.com) or by telephone (1-866-495-0654). Be sure to ask your doctor if you have any questions about this program. It is very important that you understand and follow all of the requirements. You will not get another prescription unless you follow the instructions for the program.

Isotretinoin must not be taken by women of reproductive age unless two effective forms of contraception (birth control) have been used for at least 1 month before the beginning of treatment. Contraception must be continued during the period of treatment, which is up to 20 weeks, and for 1 month after isotretinoin is stopped. Be sure you have discussed this information with your doctor.

If you are a woman who is able to have children, you must have a pregnancy blood test within 1 week before beginning treatment with isotretinoin to make sure you are not pregnant. Treatment with isotretinoin will then be started within the week, on the second or third day of your next normal menstrual period. In addition, you must have a pregnancy blood test each month while you are taking isotretinoin and one month after treatment is completed.

Swallow the capsule whole, with food and a full glass (8 ounces) of water or other liquid. Do not break, crush, or chew the capsule.

It is very important that you take isotretinoin only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

It is very important that you not share isotretinoin with anyone else because of the risk of birth defects and other serious side effects.

Dosing

The dose of isotretinoin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of isotretinoin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules):
  
  • For acne:
    
    • Adults and teenagers over 12 years of age—Dose is based on body weight and must be determined by your doctor. The dose is usually 0.5 to 1 milligram (mg) per kilogram (kg) of body weight per day, divided and given in 2 doses. Your doctor may adjust your dose as needed.
    
    
    • Children younger than 12 years of age—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

If you miss a dose of isotretinoin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using isotretinoin

It is very important that your doctor check the progress of you or your child at regular visits to make sure isotretinoin is working properly. Blood tests may be needed to check for unwanted effects.

Isotretinoin causes birth defects in humans if taken during pregnancy. If you suspect that you may have become pregnant, stop taking isotretinoin and check with your doctor right away.

Using isotretinoin while you are pregnant can cause very serious birth defects. Use two forms of effective birth control to keep from getting pregnant while you are using isotretinoin (even if the medicine is temporarily stopped), and for at least one month after you stop taking the medicine. The most effective forms of birth control are hormone birth control pills, patches, shots, vaginal rings, or implants, an IUD, or a vasectomy (for men). One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap.

Do not take other medicines without checking first with your doctor. This includes vitamins, herbal products, and prescription or nonprescription (over-the-counter [OTC]) medicines. Some medicines or nutritional supplements (e.g., St. John's wort) may cause your birth control pills to not work as well.

During the first 3 weeks you are taking isotretinoin, your skin may become irritated. Also, your acne may seem to get worse before it gets better. Check with your doctor if your skin condition does not improve within 1 to 2 months after starting isotretinoin or at any time your skin irritation becomes severe. Full improvement continues after you stop taking isotretinoin and may take up to 6 months. Your doctor can help you choose the right skin products to reduce skin dryness and irritation.

You or your child should not donate blood to a blood bank while using isotretinoin or for 30 days after you stop taking it. This is to prevent a pregnant patient from receiving blood that contains the medicine.

In some patients, isotretinoin may cause a decrease in night vision. This problem may occur suddenly. If it does occur, do not drive, use machines, or do anything else that could be dangerous if you are not able to see well. Also, check with your doctor.

Isotretinoin may cause dryness of the eyes. If you or your child wear contact lenses, your eyes may be more sensitive to them during the time you are taking isotretinoin and for up to 2 weeks after you stop taking it. To help relieve dryness of the eyes, check with your doctor about using a lubricating solution, such as artificial tears. If eye inflammation occurs, check with your doctor right away.

Isotretinoin may cause dryness of the mouth and nose. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Avoid overexposing your skin to sunlight, wind, or cold weather. Your skin will be more prone to sunburn, dryness, or irritation, especially during the first 2 or 3 weeks of treatment. However, you or your child should not stop taking isotretinoin unless the skin irritation becomes too severe. Do not use a sunlamp or tanning beds.

To help isotretinoin work properly, use sunscreen or sunblocking lotions with a sun protection factor (SPF) of at least 15 on a regular basis. Also, wear protective clothing and hats.

Isotretinoin may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, check with you doctor right away.

Serious skin reactions can occur with isotretinoin. Check with your doctor right away if you or your child have any of the following symptoms while using isotretinoin: blistering, peeling, or loosening of the skin; chills; diarrhea; itching; joint or muscle pain; rash; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; or unusual tiredness or weakness.

Isotretinoin may cause bone or muscle problems, including joint pain, muscle pain or stiffness, or difficulty moving. You may get hurt more easily during rough sports. You may heal more slowly. If isotretinoin is for your child, tell the doctor if you think your child is not growing properly.

Do not take vitamin A or any vitamin supplement containing vitamin A while taking isotretinoin, unless otherwise directed by your doctor. To do so may increase the chance of side effects.

It is very important that you or your child not use wax epilation to remove hair while you are taking isotretinoin and for 6 months after stopping it. Isotretinoin can increase your chance of scarring from wax epilation.

It is very important that you or your child not have any cosmetic procedures to smooth your skin (e.g., dermabrasion, laser) while you are taking isotretinoin and for 6 months after stopping it. Isotretinoin can increase your chance of scarring from these procedures.

isotretinoin may affect blood sugar levels. If you or your child are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

Pancreatitis may occur while you are using isotretinoin. Tell your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.

Isotretinoin may cause some people to have hearing problems within a few weeks after they start taking it. Stop using isotretinoin and check with your doctor right away if you or your child have hearing loss, a continuing ringing or buzzing, or any other unexplained noise in the ears.

Liver problems may occur while you are using isotretinoin. Stop using isotretinoin and check with your doctor right away if you or your child are having more than one of these symptoms: abdominal pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; itching; loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

Stop using isotretinoin and tell your doctor right away if you or your child have abdominal or stomach pain, rectal bleeding, or severe diarrhea. These may be symptoms of a serious condition called inflammatory bowel disease.

isotretinoin lowers the number of some types of blood cells in your body. Because of this, you or your child may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

isotretinoin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Bone or joint pain


• burning, redness, itching, or other signs of eye inflammation


• difficulty in moving


• nosebleeds


• scaling, redness, burning, pain, or other signs of inflammation of the lips


• skin infection or rash

Rare

• Abdominal or stomach pain (severe)


• attempts at suicide or thoughts of suicide (usually stops after medicine is stopped)


• back pain


• bleeding or inflammation of the gums


• blurred vision or other changes in vision


• changes in behavior


• decreased vision after sunset or before sunrise (sudden or may continue after medicine is stopped)


• diarrhea (severe)


• headache (severe or continuing)


• mental depression


• nausea and vomiting


• pain or tenderness of the eyes


• pain, tenderness, or stiffness in the muscles (long-term treatment)


• rectal bleeding


• yellow eyes or skin

Incidence not known

• Attack, assault, or use of force


• black, tarry stools


• bleeding from sore in the mouth


• bloating


• bloody cough


• bloody or cloudy urine


• bone pain, tenderness, or aching


• burning or stinging of the skin


• chest pain


• chills


• confusion


• constipation


• convulsions


• cough or hoarseness


• dark-colored urine


• decrease in height


• difficulty in breathing


• difficulty in speaking


• difficulty in swallowing


• discharge from the eyes


• dizziness


• double vision


• ear pain


• excessive tearing


• fainting


• fast, irregular, pounding, or racing heartbeat or pulse


• fever with or without chills


• fractures and/or delayed healing


• general feeling of discomfort or illness


• heartburn


• high blood pressure


• hives


• inability to move the arms, legs, or facial muscles


• inability to speak


• indigestion


• inflamed tissue from infection


• irregular yellow patch or lump on the skin


• irritation


• joint pain, redness, stiffness, or swelling


• killing oneself


• lack or slowing of normal growth in children


• loosening of the fingernails


• loss of appetite


• loss of bladder control


• loss or change in hearing


• muscle cramps or spasms


• muscle spasm or jerking of all extremities


• muscle weakness


• noisy breathing


• pain in the ribs, arms, or legs


• pain or burning in the throat


• pain or tenderness around the eyes and cheekbones


• painful cold sores or blisters on the lips, nose, eyes, or genitals


• painful or difficult urination


• pains in the chest, groin, or legs, especially calves of the legs


• pains in the stomach, side, or abdomen, possibly radiating to the back


• pale skin


• pinpoint red spots on the skin


• redness or soreness around the fingernails


• redness, soreness, or itching skin


• sensitivity of the eyes to sunlight


• shortness of breath


• skin rash


• slow speech


• sneezing


• sore throat


• sores, ulcers, or white spots on the lips or tongue or inside the mouth


• sores, welting, or blisters


• stuffy or runny nose


• sudden loss of consciousness


• sudden loss of coordination


• sudden onset of severe acne on chest and trunk


• sudden onset of shortness of breath for no apparent reason


• sudden onset of slurred speech


• swelling of the eyelids, face, lips, hands, lower legs, or feet


• swollen, painful or tender lymph glands in the neck, armpit, or groin


• tightness in the chest


• unusual bleeding or bruising


• unusual tiredness or weakness


• unusual weight gain or loss


• use of extreme physical or emotional force


• watery or bloody diarrhea


• wheezing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Crusting of the skin


• difficulty in wearing contact lenses (may continue after medicine is stopped)


• dryness of the eyes (may continue after treatment is stopped)


• dryness of the mouth or nose


• dryness or itching of the skin


• headache (mild)


• increased sensitivity of the skin to sunlight


• peeling of the skin on palms of the hands or soles of the feet


• stomach upset


• thinning of the hair (may continue after treatment is stopped)

Incidence not known

• Abnormal menstruation


• burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feeling


• changes in fingernails or toenails


• continuing ringing or buzzing, or other unexplained noise in the ears


• dandruff


• darkening of the skin


• flushing


• hair abnormalities


• hair loss


• increased hair growth, especially on the face


• large amount of triglyceride in the blood


• lightening of normal skin color


• lightening of treated areas of dark skin


• nervousness


• oily skin


• redness of the face


• severe sunburn


• skin rash, encrusted, scaly and oozing


• sleeplessness


• stomach burning


• sweating


• trouble sleeping


• unable to sleep


• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness


• unusually warm skin of the face


• voice changes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: isotretinoin side effects (in more detail)

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More isotretinoin resources

• Isotretinoin Side Effects (in more detail)
• Isotretinoin Use in Pregnancy & Breastfeeding
• Isotretinoin Drug Interactions
• Isotretinoin Support Group
• 227 Reviews for Isotretinoin - Add your own review/rating

• Accutane Consumer Overview


• Accutane Prescribing Information (FDA)


• Amnesteem Prescribing Information (FDA)


• Claravis Prescribing Information (FDA)


• Isotretinoin Monograph (AHFS DI)


• Isotretinoin MedFacts Consumer Leaflet (Wolters Kluwer)


• Sotret Prescribing Information (FDA)

Compare isotretinoin with other medications

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• Rosacea