Should you take Accutane for your acne?

You’ve tried the drug store creams and the expensive department store lotions to clear pimples. Maybe you’ve even been prescribed a topical drug or an oral tetracycline antibiotic by your dermatologist—yet, your painful acne persists. If this sounds familiar, it might be time to ask your doctor about isotretinoin.

What is Accutane (isotretinoin)?

Commonly known by its original brand name Accutane, isotretinoin is a generic medication

that’s now marketed under various labels, including Absorica, Claravis, Amnesteem, and Zenatane. The brand name Accutane was discontinued in 2009. Although approved by the U.S. Food and Drug Administration (FDA), isotretinoin is often referred to as the acne drug of last resort. It is a powerful Vitamin A derivative prescribed for patients who “have severe, nodular acne or cystic acne, those with acne resistant to traditional treatments, or patients who have physical or emotional scarring,” says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. “Isotretinoin is the closest we have to a cure for acne. It is the single most effective drug that we have and gives long-lasting results.”

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How does Accutane work?

Isotretinoin is a retinoid that works by decreasing the amount of pore-clogging oil your body produces—even after you stop using it. And unlike spot treatments, the drug, which is taken orally, addresses acne all over the body, including back, neck, and chest. 

“While we cannot promise a complete cure,” says Dr. Zeichner, “the overwhelming majority of patients will be clear or almost clear for good.” 

Of course, with a powerful drug comes the risk of serious side effects. Isotretinoin is a closely monitored medication, and though considered safe by most, it requires patients to have monthly check-ins with their physician to monitor their health and well-being. 

Here’s what you need to know about the drug if you (or your teenager) are considering it.

What are the requirements for taking Accutane?

A dermatologist will only prescribe isotretinoin after all other methods of acne treatment fail. Once your doctor identifies you as a good candidate for the drug, you will have to enroll in the government registry iPLEDGE, a program designed to prevent women from getting pregnant while on the medication, as it carries a high risk of severe birth defects. For female patients , the iPLEDGE program requires two negative pregnancy tests (and the promise to use two different forms of birth control). Note: Progestin-only birth control pills may not work while taking isotretinoin. Your prescriber must verify the results of these pregnancy tests before dispensing the drug. Monthly blood tests thereafter will check for pregnancy and monitor liver function (as isotretinoin can affect the liver). For men, iPLEDGE requires the same monthly blood draw to monitor liver function. Once you’re given your monthly prescription, you have a seven-day window in which to fill it. If you miss that window, you will have to wait 30 days for a new prescription. 

What is the right Accutane dosage?

Isotretinoin dosage is determined by the patient’s weight. According to Doris Day, MD, a New York City–based dermatologist, many doctors start their patients on a graduated plan to help mitigate side effects and allow the body to adjust. “I [increase] the dose relatively slowly,” she says. “It’s really the total dose that matters, so I up it to a dose that’s therapeutic in month two or even month three.” (A therapeutic dose is typically around 1 milligram of Accutane per kilogram of weight.) On a graduate dosage schedule, patients should expect to be on the drug for five to seven months. Read your medication guide to learn more about correct isotretinoin use.

Do you take Accutane with food?

Doctors also recommend taking isotretinoin with fatty foods to aid absorption. While on the drug, you should limit or avoid alcohol altogether (again, because of your liver) and let your physician know if he or she is going to prescribe any antibiotics, as there can be drug interactions. 

How effective is Accutane?

Some patients (around 20%, according to Dr. Zeichner) will require a second cycle of isotretinoin to clear their acne. There is a lifetime dosage cap for the drug, so Dr. Day recommends consulting with a board-certified dermatologist to make sure you’re staying within the limit. 

According to the American Osteopathic College of Dermatology, after four to five months of treatment with Accutane, most patients’ acne will be cleared, though some will require a second round. In the first five months of treatment, about 1 in 5 patients will experience a slightly worsening of their acne. Only about 1 in 500 will experience acne that worsens dramatically. 

Accutane side effects

The biggest potential side effect is serious birth defects. “Even after taking just one pill, it causes very, very, very severe and horrific birth defects,” Dr. Day says. Women should wait at least one month after getting off of isotretinoin before getting pregnant or breastfeeding to avoid health problems in babies. For this same reason, women cannot donate blood while on isotretinoin and should wait for at least one month after discontinuing the drug to do so. This is to ensure your blood isn’t given to a pregnant woman.

The most common side effect of isotretinoin is dryness—dry eyes, dry mouth, and dry skin. Isotretinoin also causes photosensitivity, so you’ll want to make sure to use sun protection when outdoors and avoid direct sunlight and tanning beds. You could also experience:

• Aches
• Joint pain 
• Problems with night vision
• Some hair shedding
• Increased cholesterol 
• Elevated sugars

Other possible side effects include: yellowing of the eyes or skin, and nosebleeds. It can also lead to increased inflammation of the pancreas, liver damage, bone loss and stroke. 

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Reproductive side effects of Accutane

It’s not safe for women who are pregnant or trying to conceive to take Accutane. That’s because women who take isotretinoin and become pregnant are at a high risk of miscarriage, preterm birth, birth defects, and in full-term pregnancies, death of the baby shortly after birth. Birth defects include abnormalities of the face, eyes, ears, skull, central nervous system, and cardiovascular system. To avoid becoming pregnant while taking Accutane, it’s required that women use two forms of birth control starting one month before treatment begins and continuing for a month after completion.

Small amounts of the drug may be present in the semen of men being treated with Accutane, but whether or not this impacts the health of a developing fetus has not been determined. Consult with a provider if there’s a chance your partner may become pregnant or is already pregnant. According to a small study, sexual side effects such as erectile dysfunction and low libido may occur among men who are taking Accutane. 

Long-term side effects of Accutane

Isotretinoin can affect growth in children, so teenagers should seek medical advice from their pediatrician before using it. You should also avoid waxing and dermabrasion, as these can cause permanent scars in those who take isotretinoin. Isotretinoin has also been associated with inflammatory bowel disease (IBD). It’s important that you understand the possible adverse effects of isotretinoin before you take it.

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Mental health side effects of Accutane

The connection between isotretinoin and mental health problems is a murky one. A handful of high-profile cases in the early 2000s, in which patients on Accutane died by suicide, led to questions about whether it could cause depression or suicidal thoughts and inspired stricter regulations. But, according to Dr. Zeichner, studies show that patients on isotretinoin may actually have lower suicide rates.

“We know that acne itself, especially severe acne, is independently associated with depression,” he says. “Recent data has shown that suicide rates in patients on isotretinoin are actually lower than the general population. However, in all acne patients, especially those on isotretinoin, it is important to have a comprehensive care plan in place to monitor patients for mood changes.” 

Dr. Day agrees: “What I think is important,” she says, “is to warn patients about these side effects and help them understand that if you don’t feel well while taking this medicine, you need to stop taking it and call your doctor right away because we can do something about it.”

Accutane interactions

Multiple medications and supplements are contraindicated with Accutane. People taking the drug should avoid the following: 

• Vitamin A: Supplements containing vitamin A can cause toxicity when combined with Accutane.
• Tetracyclines: When taken at the same time as tetracyclines there is an increased risk of benign intracranial hypertension, a build-up of pressure around the brain that can cause headaches, vision disturbances, and nausea/vomiting.
• Mini-pill contraceptives: Oral birth controls that don’t contain estrogen may not be effective during Accutane therapy. 
• St. John’s wort: This herbal supplement may decrease the effectiveness of hormonal contraceptives, so it is not recommended while taking Accutane due to its pregnancy-associated risks.
• Phenytoin: Although no formal research has been conducted to gauge whether the combination of phenytoin and Accutane contributes to bone loss, use caution if taking these drugs together.
• Systemic corticosteroids: Because systemic corticosteroids are known to cause osteoporosis, caution should be used when combining this class of medication with Accutane (though further research is needed to determine if the combination worsens this effect).

How much does Accutane cost?

The average price of Isotretinoin is approximately $359 for a supply of 30, 10 mg capsules. Use singlecare.com to compare prices at different pharmacies before filling your prescription to get the best price.

The bottom line: Is Accutane safe? 

Isotretinoin is the most powerful, FDA-approved drug dermatologists have in their arsenal to help patients prevent and manage their acne, but there are risks to be considered.

“It’s a life-changing drug for some people, and I hope it stays on the market because there are great uses for it,” Dr. Day says. “But it’s not a drug that anybody should take lightly.” 

FAQs

How severe should acne be to consider Accutane?

Currently, Accutane is recommended for cases of severe nodular acne. It may also be an option for moderate acne that is treatment-resistant, or if acne is causing scarring or distress to a patient. 

How long does it take for skin to clear on Accutane?

The majority of patients will experience a full clearing of their acne within 4-6 months, with most seeing visible results within the first few weeks of treatment.

Does Accutane permanently clear acne?

It’s possible that Accutane will permanently cure acne, though this isn’t guaranteed. 

What if Accutane doesn’t work?

Your dermatologist will carefully monitor you during treatment with Accutane. If you’re not responsive to the medication, other acne treatment options, such as oral dapsone, will be considered.