How long is a course of Accutane?
Isotretinoin (Accutane) is typically a 6 month course. If you cannot tolerate the medication, we can sometimes lower the dose and treat you for longer than 6 months. We try to meet two goals: one is the cumulative dose in your body based on your weight, and the second is clear skin for 1-2 months before stopping the medication.
Do I have to come in every month for a visit?
Yes, you do need to be seen for a visit monthly. This medication is very regulated, because of issues with pregnancy in females. Because of this, it is a requirement that we see every patient who is on the medication every month. Females are required to answer questions that demonstrate that they understand the issues surrounding pregnancy and the medication. In addition, at the onset of therapy and after the first and second months of therapy, we check bloodwork to monitor your liver function and triglycerides. Once labs are no longer needed, male patients and some female patients who are no longer considered child-bearing (menopause and hysterectomy only) may be able to follow-up via televisits. Information about this is on our website, and you can ask if you would like us to send you the link.
What skin care regimen should I use on Accutane?
We ask people to stop all their acne medications, including oral antibiotics, prescription topicals, and over the counter acne treatments. These can all increase side effects. We recommend very mild cleansers and moisturizers regularly. Specific recommendations include:
- Facial cleansers: Cetaphil gentle skin cleanser or Cerave hydrating cleanser
- Moisturizers: Cerave AM and Cerave PM for the face. Cerave cream for the body.
- Lips: Aquaphor or petroleum jelly all day long.
My lips are so chapped! What else can I do?
You can try Dr. Dan’s Cortibalm which is over the counter. It can sometimes be tough to find in stores, but online it is pretty readily available. If this is not enough, a prescription topical steroid might be necessary.
I have dry, rough patches on my body. What is this?
Accutane can cause the skin to become dry and itchy. We recommend moisturizing with Cerave cream or something else that works for you. If you have patches that are not improving, we may need to give you a prescription topical steroid at your follow-up visit.
Can I get acne scar treatment while on Accutane?
We have to wait until you have completed your course of Accutane before treating any scarring. Because Accutane can impact wound healing, we recommend avoiding any elective procedures (laser, microdermabrasion, facials anywhere other than under our care, chemical peels, cosmetic surgery, tattoos, piercings) while you are on the medication and for 6 months following the completion of therapy.
What can I do for scarring when I am done?
Microneedling is a very popular treatment for acne scarring, particular scarring with textural changes. Sometimes topical treatments can help, but in general, either chemical peels or microneedling are preferred. In some cases, treatment with fractional laser may be recommended.
Do I need to wear sunscreen when on Accutane?
Absolutely! You should wear sun protection all the time, but particularly on Accutane, your skin may be a little more sensitive to the sun. We have seen some bad sunburns on Accutane. We recommend SPF 30 daily, SPF 50 if you will be out, and long sleeves, hats, and the usual precautions. We love Elta MD sunscreens which we carry in the office.
Why do you use a specialty pharmacy to order the medication?
We use specialty pharmacies for Accutane prescriptions because they have been supremely helpful in getting the medication covered for our patients. Not only this, but they ship the medication directly to you, and they also will switch brands if a certain brand is going to be more affordable. They take care of the prior authorizations, and they work really hard to make sure you don’t miss your 7 day window (you have exactly 7 days to fill the prescription) each month. We can use a regular local pharmacy, but if they require a prior authorization, our office will not do it, and we will send the prescription to a specialty pharmacy instead. We don’t have any affiliation with the pharmacies other than just being happy with the care they provide.
Why am I not receiving brand “Accutane?”
The brand Accutane is not made anymore. Instead, isotretinoin (the active ingredient) is now made by a few other companies. Some common brands you will see are: Absorica, Claravis, Myorisan, Zenatane, Amnesteem, and Sotret. All brands need to be taken with a fatty meal EXCEPT Absorica. Absorica can be taken with or without food.
Your office only prescribes 30 days, and I can’t come back for 31 days. Is that okay?
It is very typical to run out of the medication for a few days prior to your next refill. This is very common, and there is no problem with this. We are looking to get a cumulative dose in your body. Being off for up to a week will not be a problem. However, if you run out for longer periods of time, this may affect your total length of treatment. For females, if you wait too long to come back for your refill, you are at risk of getting kicked out the iPledge system, and you would have to start the process all over again.
Do I need to be fasting for the bloodwork?
We are checking your triglyceride levels (lipids) in the blood. For an accurate number, fasting is best. However, most young, healthy individuals don’t have a problem, and if your non-fasting numbers are fine, then you can continue to be non-fasting for the follow-up tests. Sometimes if the triglycerides go high, we may make you repeat a fasting lab test.
Can I take other medications when on Accutane?
Accutane is safe with many other medications, but there are some interactions. It’s always a good idea to double check and let your other doctors know that you are on Accutane, so they can make sure there are no medication interactions. Multivitamins are okay as long as they don’t have an extra high dose of vitamin A. We recommend not taking more than 5,000 IU of Vitamin A per day.
What medications should I avoid?
Please avoid taking any unnecessary supplements while on Accutane. Specifically, we strongly discourage appetite supplements, diet pills, workout supplements of any kind, and protein shakes.
Can I drink alcohol on Accutane?
We do recommend that you refrain from drinking while on Accutane. Alcohol is metabolized through the liver, as is Accutane, and if alcohol raises your liver enzymes, we will have to blame the Accutane and make you discontinue it.
Can I wear contact lenses?
If you wear contact lenses, lubricate your lenses well before inserting or removing them. Do not ever sleep in them. We recommend lubricants such as Refresh Tears or Refresh PM.
What do I do about nosebleeds?
Nosebleeds are not common, but they can happen on Accutane due to the dryness. We recommend using Ayr nasal gel or saline solutions to help with this. If nosebleeds are excessive and won’t stop with normal pressure, go to an emergency room or urgent care that is on your insurance plan.
What do I do for hair removal?
Minimize tweezing and threading while on Accutane, AVOID WAXING. You may experience prolonged redness, burns, or skin erosions. Always inform anyone performing these treatments that you are on Accutane.
What are dangerous signs to look out for while I’m on this medication?
If you have a headache associated with blurry vision, this needs to be reported immediately to the office. The medication needs to be stopped and you will need an ophthalmologist to look at the back of your eyes. Please let us know if you are having depressed mood, suicidal thoughts, or homicidal thoughts. Also, if you have any signs of an allergic reaction (hives, throat swelling, trouble breathing), we recommend going to an emergency room for evalaution.