ACCUTANE (ORAL ISOTRETINOIN)
OTHER BRANDS: EPURIS AND CLARUS
Accutane is an oral medication for the treatment of acne. It is a pill that is taken continuously for 5 months. At the end of this period, 95% of patients are completely clear and there is a possibility that the acne will be cured forever.
Accutane works by producing a long-lasting effect on your skin cells, oil glands and the bacteria on your skin. This effect may last from 1 month to many years depending on the amount taken, your age and the severity of your acne. In some cases patients outgrow the acne before the effect wears off. In those cases, a single course of the Accutane "cures" the patient of acne. This happens about 40% of the time.
In another 50% of cases, the patient is clear of all pimples for 6 months to 2 years but as the effect decreases, may experience a return of some acne and may require some medicated creams or lotions to control it completely.
In 10% of cases, the acne may reappear after 1 to 6 months and may be bad enough to need another 5 months of Accutane.
Accutane is the most effective medication we have against pimples but it is expensive and it has some side effects. It's use must be carefully considered.
The cost depends on the number of pills that you need to take per day. This depends on your weight. A patient that weighs less than 50 kg (110 lb) will have to pay about $80 dollars a month for the medication. Someone who weighs between 50 to 70 kg (154lb) will pay about $120; more than 70 kg, about $150 a month for the five months. This medication is covered by most drug plans and by the Ontario Drug Benefit program.
Most of the side effects do no more than make you feel uncomfortable but some can be more serious. Use of this medication must be carefully monitored by your physician. The side effects will go away when you stop taking the pills but while you are taking them you may experience:
1. Dryness-95% of patients suffer from dryness not just on the acne prone areas but all over the body. You may have some redness and itching. Your lips may become cracked and chapped. Your nose and throat will be dry. Some people experience mild nose bleeds.
2. Stiffness-40% of patients will complain of this. Accutane sometimes irritates the muscles and linings of your bones. You may experience this as stiffness or as a mild ache. Some people complain of joint or back pain, some of rib or chest tenderness. You may have to cut back your physical activity to allow for this.
3. Headaches-30% of patients will experience mild, temporary headaches that improve with Tylenol and do not affect work or school. In extremely rare cases, headaches can become so severe Accutane has to be stopped.
4. Decreased night vision-you may not be able to see as well in the dark while you are taking Accutane so you must be more careful driving at night or avoid it altogether on this medication.
5. Thinning of the hair-occurs in about 6% of patients. This is usually very mild and returns to normal afterwards.
6. Mood changes such as increased irritability and depression can occassionally occur. This is usually not very severe and may get better with a lower dose. However, if serious depression occurs the medication must be stopped. Your friends and relatives should be aware of this possibility and be on the lookout for changes.
7. Serious birth defects-will occur if a woman is pregnant when she starts taking Accutane or gets pregnant while taking it. Women must not take Accutane if they are pregnant. If they take Accutane they must prevent pregnancy during the 5 months on the medication and for an additional 3 months afterwards by either abstaining from sexual activity or by using a reliable method of birth control such as the birth control pill or IUD. If a baby is exposed to Accutane in the womb the probability of serious birth defects is so high that an abortion is usually recommended.
8. Very rare but severe side effects, can include pseudotumor cerebri (a swelling of the brain which can cause severe headaches and coma), rhabdomyositis (inflammation of the muscles which can cause muscle and kidney damage), toxic epidermal necrolysis (a severe blistering of the skin which can sometimes be fatal) and depression. Some patients have developed inflammatory bowel disease while taking Accutane, although we believe this was not caused by the medication.
Accutane can cause some changes that can only be detected by testing the blood. If a patient decides to take this medication, blood samples must be taken before the start, after 2 weeks, and every month after that. A final blood test is needed 1 month after the last pill is taken. The blood is tested for 3 things:
1. Increased fat and cholesterol - mild elevations generally are not a problem and return to normal after a few months. Large increases may require dropping the dose of the medication or stopping it altogether.
2. Changes in liver function tests - occur rarely with Accutane but may require decreasing the dosage or stopping the medication.
3. Changes in the number of blood cells. There can be minor variations from one blood test to the next due to how much water you've been drinking or due to minor infections. However, if there are serious, unexplained changes, you may have to stop the medication.
All these side effects should not prevent you from taking Accutane if you really need it. This medication has been in use for almost 35 years and has been taken by hundreds of thousands of people with good results. However it must be used under supervision and only after careful consideration. This handout is meant to enhance the discussion of this medication with your doctor, not replace it.
HOW TO TAKE ACCUTANE AND DEAL WITH ITS SIDE EFFECTS
YOUR ACCUTANE IS FOR YOUR USE ONLY AND SHOULD NOT BE GIVEN TO ANYBODY ELSE
ALWAYS TAKE ACCUTANE ON A FULL STOMACH, RIGHT AFTER DINNER IS USUALLY BEST. IF YOU FORGET TO TAKE IT FOR 1 OR MORE DAYS, JUST START TAKING THE REGULAR AMOUNT AGAIN WHEN YOU REMEMBER. DO NOT TAKE ANY EXTRA TO MAKE UP FOR THE MISSED DAYS.
ACCUTANE CAN CAUSE OCCASIONAL MILD HEADACHES. YOU CAN TAKE TYLENOL FOR THESE HEADACHES. VERY RARELY, ACCUTANE CAN CAUSE SEVERE HEADACHES WITH NAUSEA, VOMITING, WEAKNESS, NUMBNESS OR VISUAL PROBLEMS. IF THIS OCCURS, CALL OUR OFFICE IMMEDIATELY. IF YOU CAN'T REACH US, YOU SHOULD CALL YOUR FAMILY PHYSICIAN OR GO TO THE EMERGENCY DEPARTMENT RIGHT AWAY.
YOU MAY EXPERIENCE SOME MILD STIFFNESS IN YOUR MUSCLES. THIS IS NORMAL. VERY RARELY, ACCUTANE CAN CAUSE SEVERE INFLAMMATION OF THE MUSCLES WHICH CAN LEAD TO PERMANENT MUSCLE OR KIDNEY DAMAGE. IF YOU EXPERIENCE SEVERE PAIN IN YOUR MUSCLES, STOP ACCUTANE AND SEEK MEDICAL ATTENTION RIGHT AWAY. IT IS FOR THIS REASON THAT YOU SHOULD MAINTAIN A MODERATE LEVEL OF PHYSICAL ACTIVITY DURING ACCUTANE. YOU SHOULD NOT INCREASE YOUR LEVEL OF PHYSICAL ACTIVITY JUST BEFORE OR DURING YOUR COURSE OF ACCUTANE. YOU DON'T WANT TO CONFUSE SORE MUSCLES FROM TOO MUCH EXERCISE WITH A SIDE EFFECT OF ACCUTANE.
USE CHAPSTICK ON YOUR LIPS AS OFTEN AS POSSIBLE, EVERY HOUR OR TWO. YOU WILL ALSO BE GIVEN HYDROCORTISONE OINTMENT FOR YOUR LIPS. THIS SHOULD BE APPLIED TWO OR THREE TIMES A DAY, AFTER MEALS, IF YOUR LIPS BECOME CRACKED. YOU STILL NEED TO USE CHAPSTICK ON TOP OF THE CORTISONE OINTMENT EVERY TWO HOURS OR SO. EVEN WITH THE BEST OF CARE, YOUR LIPS WILL BE DRY AND OCCASIONALLY CRACKED WHILE YOU REMAIN ON ACCUTANE.
YOU MAY FIND DRIED BLOOD IN YOUR NOSE OR DEVELOP OCCASIONAL NOSEBLEEDS BECAUSE OF THE DRYNESS. RHINARIS GEL, SECARIS GEL OR NASOGEL MAY BE APPLIED IN EACH NOSTRIL WITH A COTTON SWAB (Q-TIP) THREE TO FOUR TIMES A DAY. THESE PRODUCTS WILL HELP MOISTURIZE THE LINING OF YOUR NOSE AND PREVENT NOSEBLEEDS. ALL OF THESE PRODUCTS ARE AVAILABLE WITHOUT PRESCRIPTION AT YOUR PHARMACY.
IF YOUR EYES BECOME ITCHY OR FEEL GRITTY, OR IF YOUR VISION BECOMES FUZZY, IT MAY BE DUE TO DRYNESS FROM ACCUTANE. TEARS NATURALE, ISOPTO TEARS, SYSTANE ULTRA OR ANY BRAND OF UNMEDICATED EYE DROPS CAN BE USED AS OFTEN AS NECESSARY. IF UNMEDICATED EYE DROPS DON'T HELP, YOU SHOULD SEE YOUR DOCTOR.
WASH YOUR FACE AND BODY WITH A MILD CLEANSER SUCH AS DOVE SOAP OR ONE OF THE OTHERS SUGGESTED IN THE APPROVED PRODUCT LIST. AFTER WASHING YOU CAN USE A MOISTURIZER SUCH AS CETAPHIL OR CERAVE MOISTURIZING CREAM. OCCASIONALLY, THE BACK OF YOUR HANDS MAY BECOME RED AND ITCHY. IF THAT HAPPENS YOU CAN APPLY A TOPICAL CORTISONE SUCH AS HYDROCORTISONE 1% OINTMENT ON THE AFFECTED AREAS TWICE A DAY UNTIL THEY ARE BETTER. KEEP ON USING YOUR MOISTURIZER.
ACCUTANE MAKES YOUR SKIN MORE SENSITIVE TO THE SUN. SOMETIMES EVEN MODERATE AMOUNTS OF SUN CAN RESULT IN A SEVERE BURN. APPLY SUNSCREEN WITH AN SPF OF 30 OR MORE TO EXPOSED AREAS BEFORE YOU GO OUTSIDE FOR MORE THAN FIFTEEN MINUTES.
ACCUTANE IS A SAFE AND EFFECTIVE DRUG FOR YOUR ACNE IF DIRECTIONS ARE FOLLOWED. I HOPE THESE TIPS WILL MAKE YOUR TREATMENT MORE COMFORTABLE.