Isotretinoin is a medication that is taken by mouth to treat moderate to severe acne or acne that is not responsive to other treatments. Usually isotretinoin is taken for approximately 6-8 months, although the length of treatment can vary. Isotretinoin is the closest thing we have to a “cure” for acne. It is the only treatment where the effects on acne last for years after the medication is finished. While every patient’s acne will clear with this medication, in a small percentage the acne may come back eventually (though it will usually be much less severe) and may require additional acne treatments (many patients who have previously done a course of Accutane prefer to do a second course because they’ve seen how effective it was the first time compared to other acne treatments).
Common Side Effects (and how to manage them)
Chapped lips: We recommend 100% petroleum jelly or Aquaphor applied frequently throughout the day to the lips. If the lips are very dry, Dr. Dan’s Cortibalm Lip Balm can be purchased at the front desk.
Dry skin: Use a gentle soap and moisturize frequently (especially if your skin is itchy).
Recommended face cleansers: Neutrogena ultra gentle foaming or creamy wash; CeraVe foaming or hydrating cleanser; Cetaphil daily facial or gentle skin cleanser.
Recommended face/body moisturizers: Cetaphil Cream, CeraVe cream, Neutrogena Hydroboost.
Recommended body moisturizers: Cerave Cream, Cetaphil Cream, Aveeno Eczema Therapy Cream.
Joint/muscle aches: If you need to take over the counter pain reliever we recommend using Advil (ibuprofen) or Aleve (naproxen). Avoid taking Tylenol (acetaminophen).
Nosebleeds: Prevent by applying Aquaphor or Vaseline to the inside of your nose sparingly, or by using Ayr saline nasal gel.
Dry eyes (especially if you wear contacts): Use lubricating eye drops such as Systane or Refresh.
Sun sensitivity: Minimize sun exposure. Wear sun protective clothing. Wear SPF 30 or higher sunscreen daily and if outside for an extended amount of time make sure to reapply every 2 hours!
Recommended facial sunscreens: (Elta MD Clear SPF 46, La Roche Posay, Cetaphil Daily Facial Moisturizer with SPF 50, CeraVe AM SPF 30, Aveeno Positively Radiant SPF 30, Neutrogena Clear Face SPF 55, Neutrogena Ultra Sheer Dry-Touch Sunscreen,)
During your course
Stop all other acne medications during your Accutane course. (Including antibiotics, prescription creams, and over the counter acne washes). Continue oral contraceptives and spironolactone if applicable.
Avoid vitamins with high doses of Vitamin A (ok if it contains less than 5,000IU of Vitamin A).
AVOID WAXING unwanted hair. Tweezing, threading and shaving are safe to continue.
Do not have any chemical peels, laser treatments, body piercings, tattoos, or elective surgical procedures while on Accutane or for 1 month following completion.
Do not donate blood while on Accutane.
Limit alcohol use while on Accutane.
It’s ok if you run out of your medication before your next appointment. Accutane stays in your system for several days and missing a few days (or even weeks) will not impact the final outcome!
Our office will check labs, including your liver function tests and your triglycerides, before you start treatment and after two months of treatment. If everything is normal, you will not need any further bloodwork. If something is abnormal, there is a small chance of more bloodwork. You should try to be fasting if possible when you have your labs drawn (if not we might have to recheck them if your triglycerides are elevated). Females will need a urine pregnancy test every single month and one month after completing the treatment course.
Rare side effects:
Concerning: severe nausea, vomiting, diarrhea, abdominal pain, unusually severe headaches especially if accompanied by vomiting or vision changes, mood changes, personality changes, or depression -- contact your doctor immediately!
For females the most serious side effect is severe birth defects if you become pregnant while on Accutane (isotretinoin). There is no long term risk of birth defects after you finish your course and it has no effect on your ability to become pregnant in the future. Isotretinoin is regulated by the iPledge program to help prevent accidental pregnancy while on this medicine, and for one month after you stop the medication. This program requires you to use two forms of birth control to prevent pregnancy.
After being entered into the iPledge system by our office, please look out for a letter delivered to the address you provided to us with your user name and password. Make sure you register in the iPledge system as soon as you receive this information in the mail. After each monthly appointment, females will need to log on to iPledge and complete the required questions prior to receiving their prescription.
Pregnancy tests: 7 Day Window
Monthly pregnancy tests are required by iPledge. The day you get your pregnancy test (included in your blood work), is Day 1 of your 7 day window, which is the window of time you are allowed to pick up your prescription. If your window closes before you can get the medication, you will need to have another pregnancy test drawn. If you have not heard from the pharmacy by the day following your appointment, please call them.
Our practice will send your prescription to one of two specialty pharmacies that we use (but have no ownership or control over). These pharmacies will do everything in their power to get you the least expensive medication for your course of therapy, and they will in general contact you to make sure you are on track to receiving your medications on time. They will overnight the medication to you so that there is no delay in therapy.
Big Country Pharmacy