Isotretinoin: What is it? Precautions, Side Effects, Dosage, Interaction and Recommendations

Acne is the most common cause of spots. Most people with acne are between 12 and 25 years old, but some older people are also affected.

The small sebaceous glands are found just below the surface of the skin and form an oil (sebum) that keeps the skin soft and smooth.

Small pores in your skin allow the sebum to reach the surface of your skin. In acne, some of these pores become blocked, causing swollen spots.

What is Isotretinoin?

Isotretinoin belongs to a group of medicines known as retinoids. It is a form of vitamin A. It works by reducing the production of the natural oil in your skin released by the sebaceous glands and helping the skin to renew itself more quickly.

It is also believed to reduce inflammation, acne with many spots filled with pus that can affect the back and chest, as well as the face. The medication also kills the bacteria that cause acne and relieves redness and pain.

A skin specialist will prescribe Isotretinoin capsules. Isotretinoin is used to treat severe nodular acne that has not responded to other treatments, including oral antibiotics or skin treatments.

It is available in soft gelatin capsules of 10mg, 20mg, 30mg and 40mg for oral administration. Chemically, Isotretinoin is 13-cis-retinoic acid and is related to retinoic acid and retinol (vitamin A). It is a crystalline powder of yellow to orange color.

Each capsule contains the following inactive ingredients: butylated hydroxyanisole, edetate, disodium dihydrate, gelatin, glycerin, hydrogenated vegetable oil, purified water, soybean oil, titanium dioxide and white wax (beeswax).

Isotretinoin is only available at a certified pharmacy under a special program called iPLEDGE. You must be registered in the program and understand the risks and benefits of taking this medication.

Important information

Isotretinoin in a single dose can cause serious birth defects or the death of a baby. Never use this medicine if you are pregnant or plan to become pregnant.

You must have a negative pregnancy test before taking Isotretinoin. You will also be asked to use two contraceptive methods to prevent pregnancy while taking this medication. Stop using Isotretinoin and call your doctor at once if you think you might be pregnant.

Isotretinoin is available only under a special program called iPLEDGE. It is dangerous to try to buy Isotretinoin on the Internet or from unskilled providers.

Isotretinoin capsules start working after a week to 10 days and Isotretinoin capsules work very well: 4 out of 5 people who use them have clear skin after 4 months.


Some medications are not suitable for people with certain conditions, and sometimes a medication can only be used if special precautions are taken.

For these reasons, before you start taking Isotretinoin, it is important for your doctor to know if you are pregnant, trying to have a baby, or breastfeeding. This is very important because Isotretinoin is harmful to babies.

If you have diabetes, or if you have a dry eye condition, if you have been told that you have high levels of fats ( lipids ) in your blood.

If you have ever had a mental health problem, such as a depressive illness , or if you have ever had suicidal thoughts, if you know you have a condition where there is too much vitamin A stored in your body, it is called hypervitaminosis A.

If you have a problem with the way your liver works, or if you have a problem with the way your kidneys work, if you have ever had an allergic reaction to a medicine, or if you are allergic to soy or peanut.

If you are taking other medications. This includes any medication you are taking that is available to buy without a prescription, as well as herbal medicines and complementary medicines.

It is particularly important for your doctor to know if you are taking a tetracycline antibiotic or a vitamin supplement.

Isotretinoin can cause a miscarriage, a premature birth, serious birth defects, or the death of a baby if the mother takes this medicine at the time of conception or during pregnancy.

Even a dose of Isotretinoin can cause significant birth defects in the baby’s ears, eyes, face, skull, heart and brain. Never use Isotretinoin if you are pregnant.

You should not use Isotretinoin if you are allergic.

It is not known if Isotretinoin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medication.

Isotretinoin is not approved for use by children under 12 years of age.

How should I take Isotretinoin?

Before starting treatment, read the manufacturer’s printed information leaflet from inside the capsule package and any additional information provided by the doctor.

These will give you more information about Isotretinoin and will give you a complete list of the side effects you may experience while taking it.

Take Isotretinoin exactly as your doctor tells you to. There are several concentrations of Isotretinoin capsules available: 5mg, 10mg, 20mg and 40mg. Your dose will be calculated from your weight, each dose can be a combination of different potencies of the capsule.

Isotretinoin is taken once or twice a day. Your doctor will tell you how many capsules you should take for each dose and the time (s) of the day to take them. This information will also be printed on the package label to remind you of what the doctor told you.

Follow all instructions on your prescription label. Do not take this medication in larger or smaller amounts or for longer than recommended.

Each Isotretinoin prescription must be completed within 7 days of the date it was written by your doctor. You will not receive more than 30 days of Isotretinoin supply at a time.

If your doctor deems it necessary, your dose may be adjusted during the course of your treatment. If this happens, be sure to carefully follow the instructions given by your doctor.

You will be prescribed a course of treatment that lasts from 4 to 6 months. Only one course of treatment is needed.

If you forget to take a dose, take it as soon as you remember (unless it is almost time for your next dose, in which case take the next dose when appropriate and skip the missed dose). Do not take two doses together to make up for the forgotten dose.

Always take Isotretinoin with a full glass of water. Do not chew or suck the capsule, swallow it whole. Take Isotretinoin with food, during a meal is ideal.

Use this medication for the full prescribed time. Your acne may get worse at first, but then you should start to get better. While using Isotretinoin, you may need frequent blood tests.

It is very important that you do not share Isotretinoin with anyone else, even if they have the same symptoms as you. Store at room temperature away from moisture, heat and light.

Missed dose

Skip the missed dose and take the medication at the next regularly scheduled time. Do not take additional medications to make up for the forgotten dose.

If you take the capsules once a day and remember that you missed a dose that day, take it as soon as you remember it. If it is the next day when you remember it, skip the missed dose and take the next capsule at the usual time.

If you take the capsules twice a day and forget to take a dose, take it as soon as you remember it, unless it is within 2 hours of your next dose. In this case, skip the missed dose and take the next capsule at the usual time.

Never take a double dose. Never take an extra dose to make up for the one you forgot.

If you miss doses frequently, it may be useful to set an alarm to remind you. You can also ask your pharmacist for advice on other ways to help you remember to take your medication.

In case of overdose

Seek emergency medical attention. Symptoms of overdose may include headache, dizziness, vomiting, stomach pain, heat or tingling in the face, swollen or cracked lips and loss of balance or coordination.

What should I avoid while taking Isotretinoin?

Do not donate blood while taking Isotretinoin and for at least 30 days after stopping. Donated blood that is then given to a pregnant woman can cause birth defects in her baby if the blood contains any level of Isotretinoin.

Do not take a vitamin or mineral supplement that contains vitamin A.

While you are taking Isotretinoin and for at least 6 months after your last dose do not use wax hair removers or have dermabrasion or laser treatments for your skin, it can cause scarring.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Isotretinoin can make your skin more sensitive to sunlight and can cause sunburn. It is recommended that you use a sunscreen and a lip balm with a sun protection factor of at least 15 before going out in the sun.

Isotretinoin can affect your vision, especially at night. Be careful if you drive or do something that requires you to see clearly.

Make the most of your treatment

It is important that you keep your regular appointments with your doctor. This is so your doctor can verify your progress. You will have to do some tests before and during treatment.

The tests will check several things, that your liver and blood remain healthy, that the amount of fat in your blood stays within normal amounts and (in women) that you are not pregnant.

Some people find that their acne gets worse when they start taking Isotretinoin. This can happen, but it usually resolves quickly in 7-10 days.

Isotretinoin is likely to make your skin feel very dry. Many people find that using a moisturizer and a lip balm regularly from the day the treatment begins helps reduce this.

You may find that your eyes feel drier than normal. Ask a pharmacist or optician to recommend some lubricant drops suitable for use. If you normally wear contact lenses, you may prefer to wear glasses instead for a while.

Prescriptions of Isotretinoin must be dispensed within seven days of being prescribed by a doctor. Whenever possible, it should be the same day. Each time a new prescription is given, take it to your pharmacy to have it shipped immediately.

If you buy over-the-counter medications or vitamin supplements, ask a pharmacist which ones are suitable for you to take. Also, do not use or take any other treatment for acne.

Rarely, some people who take Isotretinoin become depressed and have experienced some mood swings. It is important to tell your doctor right away if you feel “low” or anxious, or if you start thinking about hurting yourself.

Side effects

Along with its useful effects, most medications can cause unwanted side effects, although not everyone experiences them.

The best place to find a complete list of side effects that can be associated with the capsules is the manufacturer’s printed information leaflet that comes with the medication.

Talk to your doctor or pharmacist if any of the following continues or becomes bothersome.

The most common side effects of Isotretinoin include: cheilitis, epistaxis, hypertriglyceridemia , pruritus , skin xerosis, decrease in “good” cholesterol, increase in liver enzymes, increase in serum triglycerides, musculoskeletal signs and symptoms, dryness of the nose, xerodermia and xerostomia.

Along with its necessary effects, Isotretinoin can cause some unwanted effects. Although not all of these side effects can occur, if they do occur they may need medical attention.

Get emergency medical help if you have symptoms of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Isotretinoin and call your doctor at once if you have:

  • Problems with your vision or hearing.
  • Severe headache, dizziness, seizures, sudden numbness or weakness.
  • Depressed mood, trouble sleeping, crying episodes, changes in behavior, feeling aggressive or irritable.
  • Hallucinations, (seeing or hearing things that are not real), thoughts about suicide or hurting oneself.
  • Muscle weakness, pain in the bones or joints or in the back.
  • Severe diarrhea, rectal bleeding, bloody or tarry stools.
  • Pale skin, feeling dizzy or short of breath.
  • Dark urine or jaundice (yellowing of your skin or eyes).
  • Severe stomach or chest pain, pain when swallowing.
  • Severe skin reaction such as fever, sore throat, swelling of the face or tongue, burning eyes, pain in the skin followed by a red or purple rash that spreads (especially on the face or upper body) and causes blistering and peeling

Common side effects may include:

  • Dryness of your skin, lips, eyes or nose (may have nosebleeds).

This is not a complete list of side effects and others may occur. Call your doctor for medical information about side effects.

How to Deal with Side Effects:

Dry skin or lips : apply a moisturizer and lip balm often (the best type of moisturizer is a facial moisturizer without oil for sensitive skin). Try to keep your showers shorter than 2 minutes, using warm water instead of hot.

The skin becomes more sensitive to sunlight: move away from the bright sun and use a sunscreen without oil of high factor 15 or higher even on cloudy days. Do not use a solar lamp or sun beds.

Dry eyes : ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and they become uncomfortable, you may need to wear glasses while taking this medication.

Mouth or dry throat : try chewing gum without sugar or candy.

Dry nose and nosebleeds : try applying a thin layer of Vaseline on the inside edges of the nose

Headaches and joint, muscle and back pain: ask your pharmacist to recommend an analgesic. Light exercise should not be a problem, but try to avoid intense exercise because it can worsen joint or muscle pain.

How to Store Isotretinoin

  • Keep all medications out of the reach and sight of children.
  • Store in a cool, dry place, away from heat and direct light.
  • Do not keep the capsules obsolete or unwanted. Return them to your local pharmacy, which will discard them for you.


Habitual Adult Dose for Acne:

Maintenance dose : 0.25 to 0.5 mg / kg orally twice a day.

Maximum dose : up to 2mg / kg / day.

Duration of therapy : up to 20 weeks.

  • Patients should take some formulations of this medication with food.
  • Before increasing the dose, patients should be asked about their compliance with the treatment (for example, taking this medication with food).
  • Patients with severe acne, scars or primary manifestations in the trunk may require a dosage of 2mg / kg / day.
  • Any patient requesting refills requires a new prescription and a new authorization from the iPLEDGE program.
  • The safety and efficacy of once daily dosing has not been established, therefore, dosing is not recommended once a day.

Use : Treatment of severe recalcitrant nodular acne in patients who do not respond to conventional therapy, including systemic antibiotics.

Habitual Pediatric Dose for Acne

Maintenance dose : 0.25 to 0.5 mg / kg orally twice a day.

Maximum dose : 2mg / kg / day.

Duration of therapy : up to 20 weeks.

Interaction with other medications

Tell your doctor about all your current medications and any that you start or stop using, especially:

  • Vitamin or mineral supplements.
  • Other medications for acne (using both together can worsen skin irritation).
  • Grass of San Juan.
  • A tetracycline antibiotic, which includes doxycycline, oxytetracycline, minocycline and limecycline.

There is very little information about taking herbal remedies and supplements while using Isotretinoin capsules.

This list is not complete. Other drugs can interact with Isotretinoin, including prescription and over-the-counter medicines, vitamins and herbal products. Not all possible interactions are listed in this medication guide.

Things a Doctor Wants You to Know About this Acne Treatment

If you’re fighting acne, you’ve probably heard about Isotretinoin. While there are many avenues against acne to try, such as making changes in your diet and changing your skin care routine, when everything else fails and acne is really severe, the word ‘Isotretinoin’ begins to whisper.

It comes from vitamin A:

Do you wonder where this drug has power? Well, it’s actually from a natural source. It is a derivative of vitamin A and part of the same family as retinol, and can only be prescribed by specialist dermatologists.

It is used in severe cases of acne when first and second line treatments are used, including topical retinoids, topical and oral antibiotics, and things like the contraceptive pill has not been successful.

It works by closing the production of oil from your skin:

Isotretinoin is an anti-inflammatory drug that attacks the sebaceous glands (the parts that produce the oil) in the skin and reduces its oil production. It also helps reduce the amount of bacteria that live on the skin.

The combined effect of reduced natural oil production, reducing the number of bacteria that cause acne and reducing inflammation help prevent acne outbreaks.

The Results are Pretty Impressive:

While it is extreme, they have the results to back it up, it has a success rate of approximately 80% when administered for 4-5 months.

It is not for All Types of Acne:

While an avalanche of pimples can make you want to try anything to get rid of them, there are some characteristics that must be present in your skin for Isotretinoin to be adequate.

Blackheads, nodules (solid, painful bumps under the skin), cysts (lumps filled with pus under the skin), and scars must appear before you can consider Isotretinoin initiation.

Secondary Effects that Alter the Mood:

If there were magic pills without side effects, it would be a happy world, but along with the positive benefits to combat acne, there are some serious precautions / side effects.

There have been reports of psychiatric disorders, including very low moods and depression, associated with taking Isotretinoin for acne.

It could have some strange effects on your skin:

It turns out that something that is aggressively depleting your oil production can also alter other parts of your skin, all these symptoms were a possibility: broken lips, dermatitis , very dry skin, scaly skin, itching, a red rash and delicate and fragile skin.

You will have to make many visits to your doctor:

Due to the possible extremity of side effects, your doctor will want to continue to register you, you will need to make periodic follow-up visits to monitor the physical and possible psychological effects of taking Isotretinoin.

Some people can not take it:

As with all oral medications, there will be some people who really need to avoid it. Of course, your doctor will talk to you about this.

Isotretinoin is prohibited for any pregnant person, nursing or with impaired liver function, as well as a precaution that should be exercised for anyone with diabetes, depression or deterioration of kidney function.

It is very dangerous for pregnant women:

Even if you are not trying to have a baby, you should think about the possibility that you might become pregnant when you start taking Isotretinoin. You will be informed that you should start taking contraceptives, even if you are not currently sexually active. Isotretinoin can cause serious harm to a developing fetus.

Men and Isotretinoin Capsules:

Men can safely take Isotretinoin capsules if they and their partner are trying to have a baby, or if their partner is pregnant.

Isotretinoin capsules do not seem to damage sperm. Only small amounts of Isotretinoin enter the semen, which is too little to harm the unborn baby of your partner.

It will make you Super Sensitive to the Sun:

We all know that we should use sunscreen religiously, but that will be even more important if you are taking this pill.

Isotretinoin makes your skin extremely photosensitive. This means that you are more sensitive to sunlight and much more likely to burn yourself.

Every day you should use a sunscreen since UV rays are present even if the sun is not shining.


  • Try not to wash the affected areas of the skin more than twice a day. Too much washing can irritate your skin and make spots worse.
  • Wash the skin with spots with a mild soap or cleanser and warm water. Very hot or cold water can make acne worse.
  • Never “clean” pimples or tighten spots. This can make them worse and cause permanent scars.
  • Do not use too much makeup and cosmetics. Use water-based products described as noncomedogenic (this means that the product is less likely to block the pores of your skin).
  • Remove makeup before going to bed.
  • Use a fragrance-free, water-based moisturizer if dry skin is a problem.
  • Shower as soon as possible after exercising, since sweat can irritate acne.
  • Wash your hair regularly and try to keep your hair from falling on your face.
  • Use a sunscreen without oil.