Isotretinoin is a form of vitamin A which works by decreasing the rate of sebum (oil) production by the sebaceous or oil glands hence, it is used to treat severe forms of acne such as nodular and cystic acne & acne conglobata that has not responded to antibiotics and other treatments. It also increases the rate at which the skin is renewed and therefore, can be used in the treatment of photoaged skin and other conditions which cause difficulties in the formation of the skin’s stratum corneum (the outermost layer of the skin).
Contraindications: Pregnancy and lactation. If you become pregnant during treatment or for at least one month after you stop taking isotretinoin. This is due to the fact that it can cause congenital birth defects, miscarriages, premature birth or fetal death. Pregnancy test must be done to ensure that you are not pregnant prior to taking this drug. Two reliable method of birth control must be used while using isotretinoin to avoid pregnancy during treatment. If ever you become pregnant or missed your menses, stop taking tretinoin immediately and inform your doctor. Other contraindications are: hepatic or renal insufficiency, hypervitaminosis A, patients with excessively elevated blood lipid values and those taking supplementary treatment with tetracycline.
Special precautions: diabetes, obesity, alcoholism, disturbances of lipid metabolism and psychiatric disorders.
Adverse reactions: dry mucosa, dermatitis facialis, pruritus, sweating, syncope (fainting); occasionally, reversible alopecia (baldness), hypercholesterolemia and increase triglycerides in the blood; bone, muscle and joint pains and rarely, inflammatory bowel disease; hyperuricemia; benign intracranial hypertension, hearing loss or any visual disturbances & photosensitivity reactions, hematuria (red blood cells in the urine), proteinuria, lymphadenopathy and depression (including feelings of sadness, irritability, unusual tiredness, trouble concentrating, and loss of appetite) with suicidal thoughts and/or behavior during, and soon after stopping treatment with isotretinoin. Inform your doctor once you begin to have suicidal thoughts during or shortly following treatment with isotretinoin.
What to avoid while taking isotretinoin: dermabrasion or laser treatment or any wax hair removal systems due to the possibility of scarring; exposure to sunlight or UV rays because it may increase skin sensitivity and a severe sunburn could result; driving at night (decreased night vision).
Inform your doctor before taking isotretinoin if you have the following conditions:
• a personal or family history of mental disorders such as depression, suicidal behavior, or psychosis (delusions, visual and auditory hallucinations); diabetes; asthma; heart disease; osteoporosis (decrease bone density or weak bones); anorexia nervosa; hypercholesterolemia or high triglyceride(fat) levels in the blood and liver disease. You may need some dosage adjustments before taking the isotretinoin if you have any of the above conditions.
Seek emergency consult if you have symptoms of isotretinoin overdose such as vomiting, abdominal pain, flushing of the face, inflammation of the lips, headache, dizziness and clumsiness.
Drug interactions: vitamin supplements containing vitamin A; tetracycline group of antibiotics (e.g. Panmycin, Sumycin) , minocycline, doxycycline, demeclocycline, troleandomycin; carbamezepine (Tegretol, Carbatrol, Epitol); oral birth control pills that do not contain estrogen (“minipills”) because it may not work during isotretinoin treatment.
Isotretinoin, a retinoid, is available as Accutane in 10-mg, 20-mg and 40-mg soft gelatin capsules for oral administration. Each capsule contains beeswax, butylated hydroxyanisole, edetate disodium, hydrogenated soybean oil flakes, hydrogenated vegetable oil, and soybean oil. Gelatin capsules contain glycerin and parabens (methyl and propyl), with the following dye systems: 10 mg ¾ iron oxide (red) and titanium dioxide; 20 mg ¾ FD&C Red No. 3, FD&C Blue No. 1, and titanium dioxide; 40 mg ¾ FD&C Yellow No. 6, D&C Yellow No. 10, and titanium dioxide. Chemically, isotretinoin is 13-cis-retinoic acid and is related to both retinoic acid and retinol (vitamin A). It is a yellow to orange crystalline powder with a molecular weight of 300.44.
Isotretinoin has the following structural formula: