How to Start Using Accutane

Co-authored by Laura Marusinec, MD

Last Updated: October 9, 2022 References

Accutane, or isotretinoin, is one of the most powerful and effective treatments for severe acne on the market. The trade-off to its effectiveness is the associated side effects, as well as the drug’s known risk for causing serious birth defects.^{[1]
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Research source} If you have exhausted your acne treatments, you may want to consider taking Accutane.

Part 1

Part 1 of 3:

Getting a Prescription for Accutane

Only a dermatologist can tell you if Accutane is right for you. Many dermatologists will not see patients without a referral from a doctor (depending on your insurance plan), so you may wish to visit your regular healthcare provider first.
2
Understand the types of acne that benefit from Accutane treatment. Accutane is used to treat severe acne, called "severe recalcitrant nodular acne", that has not responded to other forms of treatment.
- Nodular acne (sometimes referred to as cystic acne) is the most severe form of acne. Pustules develop on the body in the form of hard, painful, cysts that are often larger than normal areas of acne.
- Left untreated, this form of acne can lead to heavy scarring, as well as potential psychological problems associated with stress and self-esteem.
3
Consider other forms of treatment. If your acne is persistent, but not severe, then you may want to consider a different form of treatment. Accutane is not used for mild to moderate acne because of the risk and range of its side effects.
- Prescription oral antibiotics may be used to successfully treat moderate acne.
- Other treatment options include phototherapy (light treatment) and laser treatments. These are often successful in treating moderate acne and acne scarring.^{[2]
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4
Discuss the risks with your doctor. Side effects range from mild discomforts, such as dry skin, to complications that can be serious. Up to 80% of Accutane users will experience at least some side effects.^{[3]
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- The FDA placed a warning on Accutane in 1998 informing healthcare providers and the public about an increase in the incidence of depression, suicidal thinking, and suicide attempts.
- Recent research shows that Accutane users have a higher risk of developing digestive disorders, including ulcerative colitis, Crohn’s disease, and Inflammatory Bowel Disease.
- Many lawsuits have been filed against the original manufacturer specific to people that developed serious side effects while taking Accutane.^{[4]
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Tell your doctor about any medical conditions you have before starting treatment. You should tell your doctor about any medical or psychological conditions you have, as well as any medications or supplements, including vitamins, that you take. Also consult with your doctor if:^{[5]
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- You are allergic to vitamin A-containing drugs (such as other retinoids)
- You have diabetes or a family history of diabetes
- You have high blood fats or a family history of high blood fats
- You or someone in your family has a psychiatric disorder (including mood disorders such as depression)
- You have liver disease
- You are overweight or obese
- You have an eating disorder
- You have a problem with alcohol abuse
- You have a bone loss condition (e.g., osteoporosis)
If both you and your dermatologist agree to proceed with Accutane treatment, your doctor will ask you to agree to several specific conditions before you can proceed.^{[6]
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Participate in the iPLEDGE program if you are female. Due to the risk of birth defects, enrollment in this program is required for women of child-bearing age. The iPLEDGE program involves routine pregnancy tests and a commitment to avoid pregnancy by promising to use 2 acceptable forms of birth control during Accutane therapy.
- Acceptable forms of birth control include oral contraceptives, contraceptive injections, implanted devices, patches, physical contraceptives, such as condoms or diaphragms, and a solemn swear of abstinence (meaning absolutely no sexual contact) during the course of treatment with Accutane.
Individuals are required to sign an informed consent before beginning therapy, and must be considered reliable in understanding and following instructions.
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Be prepared to follow additional safety protocols. You can't donate blood while you are taking Accutane, or in the first month after you stop taking it. In addition, you must agree not to share the prescription with anyone.
- Encourage people with similar symptoms to see a dermatologist and obtain a prescription for Accutane.
The brand name product, Accutane, is no longer made, but several companies make the generic formulation, isotretinoin. The generic form of Accutane is covered under most insurance plans, so you can obtain a monthly dosage for a relatively inexpensive price.

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Part 2

Part 2 of 3:

Taking Accutane

For female patients of child-bearing age, the prescription must be filled and picked up within 7 days of the office visit when the tests were done to confirm that you are not pregnant. For everybody else, each prescription must be filled and picked up within 30 days of the office visit.
Doses are to be taken orally, with food, and at approximately the same time each day. Food in your stomach helps the drug to be absorbed.
3
Stick to your regimen, and commit to it. An Accutane regimen will usually last several months. Remember to take your pill every day. It may be helpful to set a daily alarm on your cell phone or your alarm clock to remind yourself not to miss a dose.
- If you do miss a pill, take it as soon as you remember unless it is almost time for your next dose. In that case, just skip the dose you missed completely. Do not double up doses in an effort to catch up.
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Understand other commitments required to take Accutane. In addition to birth control, monthly blood tests are required to monitor for changes, including the balance of different forms of cholesterol in your blood (specifically, your triglyceride levels). Routine lab work is necessary to ensure that Accutane is not causing any internal damage to your liver or kidneys.
- Triglycerides refer to the fatty acids that are normally found in your blood. These may peak when eating particularly fatty foods, such as fast food or other deep fried meals. Maintaining a healthy diet helps the drug to be better absorbed, and helps to avoid abnormally high levels of fatty acids sometimes caused by eating meals high in fats.
Taking Accutane during pregnancy has been shown to significantly increase the risk of birth defects. Women who get pregnant while taking Accutane have a 30% chance of birth defects, as opposed to the normal 3-5% chance.
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Avoid using other acne products. Remember that Accutane works by targeting your sebaceous glands. Using over-the-counter and prescription acne products will only aggravate your skin and increase dryness. Talk with your dermatologist about using any skin products while taking Accutane.
- Use a gentle skin cleanser, such as Dove or Aveeno, when using Accutane to avoid skin irritation.
As the saying goes: Knowledge is power. Let your dermatologist know if you are experience anything unusual during your treatment. Ask about specific side effects to look for, such as blurry vision or severe back pain.

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Part 3

Part 3 of 3:

Understanding More about Accutane

1
Learn what Accutane is and how it works. The generic name for Accutane is isotretinoin. The drug is a derivative of vitamin A, and falls in a class of medications known as retinoids. Accutane works in 4 ways.
- Accutane helps to control the size of the sebaceous glands, which are the glands that produce oil. This reduces the amount of oils produced by these glands. At the same time, it decreases the amount of acne-causing bacteria that live in the oil from these glands. Accutane also slows down the development of some cells that cause pores to get blocked, and it decreases inflammation of the skin.^{[7]
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The dose is determined by body weight and by the severity of the acne. The usual dose ranges are 0.5-1.0mg/kg per day. For example, in someone that weighs about 150 pounds, the dose would range from about 20mg to 35mg, taken twice every day.^{[8]
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Take Accutane for the length of time prescribed. One course of therapy can last for 4 to 5 months. Sometimes more than 1 course of therapy may be needed. The best response happens when the cumulative dose, or the total dose taken over a period of time, is considered. Your doctor knows how to monitor your progress and keep up with the cumulative dose in order for you to get the greatest benefit from Accutane therapy.
As many as 85% of people treated with Accutane see great results after just 1 treatment course, lasting about 4 to 5 months. More than 1 course of treatment may be needed to permanently clear the skin and avoid any future relapse of the acne.^{[9]
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Trustworthy Source

American Academy of Dermatology
Professional organization made of over 20,000 certified dermatologists

Go to source} Although there is no guarantee that everyone will see improvement, most people see their acne disappear, and in many cases it never comes back.
Acne commonly develops during the adolescent and early adult years, but acne can also occur later in life. If left untreated, severe acne may result in physical disfigurement and associated psychological problems. According to the FDA and the parent drug company, acne leads to more feelings of insecurity and inferiority than any other disease.

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Tips

Keep a moisturizing lip balm handy. 90% of people who use accutane experience dry or chapped lips. Use lip balm to reduce dryness, chapping, and cracking of lips.^{[10]
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Note that males taking Accutane do not increase the risk of causing birth defects. Isotretinoin does not carry over to sperm cells.^{[11]
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As with most acne products, you may notice that your acne becomes more severe during the first few weeks of treatment. This is normal.

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Warnings

Accutane is powerful and effective for treating some forms of acne, but is also associated with serious side effects. Any changes in mood, feelings of depression, or suicidal thinking should be discussed immediately with your healthcare provider. Stop the medications and contact your doctor.

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Since Accutane is a vitamin A derivative, do not take vitamin A products while you are taking Accutane. Combining vitamin A products with Accutane can cause drug interactions with potentially serious results.

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Do not donate blood while taking Accutane, and for at least 1 month after finishing your treatment. Donating blood may inadvertently cause problems in other people.

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There is a high risk of birth defects in women that are pregnant, or get pregnant while taking Accutane. For this reason, precautionary measures are in place to prevent pregnancy while taking Accutane.

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Avoid contact sports while taking Accutane to avoid injury. One of the side effects associated with Accutane involves possibly weakening your bones.

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Do not use any other treatments for acne during your course of therapy with Accutane.

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Developing gastrointestinal problems, such as Crohn’s disease and ulcerative colitis, are more common in people taking Accutane. Other side effects are also possible. Talk to your doctor if you experience anything unusual while taking Accutane.

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Notify your doctor immediately if you think you are pregnant or if you notice anything unusual during your treatment.

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