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 skin’s surface and form an oil (sebum) that keeps the skin soft and smooth.

Tiny 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 helps the skin renew itself more quickly.

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

A skin specialist will prescribe Isotretinoin capsules. Isotretinoin treats 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 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 unique 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 severe congenital disabilities 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 unique program called iPLEDGE. It is dangerous to buy Isotretinoin on the Internet or from unskilled providers.

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


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

Before taking Isotretinoin, your doctor needs 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 a dry eye condition, you have been told to have high blood fat ( lipids ) levels.

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 too much vitamin A is 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.

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

Your doctor needs to know if you are taking a tetracycline antibiotic or a vitamin supplement.

Isotretinoin can cause a miscarriage, premature birth, severe congenital disabilities, 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 congenital disabilities 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. It would help if you did not breastfeed 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 the doctor provides.

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

Take Isotretinoin precisely as your doctor tells you to. Several Isotretinoin capsules are 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 longer than recommended.

Each Isotretinoin prescription must be completed within seven days of your doctor’s written date. You will not receive more than 30 days of Isotretinoin supply.

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

You will be prescribed a treatment course lasting 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. Taking Isotretinoin with food during a meal is ideal.

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

You must 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 helpful to set the 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. Overdose symptoms 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 at least 30 days after stopping. Donated blood given to a pregnant woman can cause congenital disabilities in her baby if the blood contains any level of Isotretinoin.

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

While taking Isotretinoin at least six 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 would help if you used 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.

You must 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 average 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 regularly using a moisturizer and a lip balm from the day the treatment begins helps reduce this.

You may find that your eyes feel drier than usual. Ask a pharmacist or optician to recommend some lubricant drops suitable for use. If you usually wear contact lenses, you may prefer to wear glasses 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 acne treatment.

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

Side effects

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

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

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, hypertriglyceridemiapruritus, 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 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 reactions 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 sunscreen without high factor 15 or higher oil, even on cloudy days. Do not use a solar lamp or sunbeds.

Dry eyes: ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and 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.

Ask your pharmacist to recommend an analgesic for headaches, joint, muscle, and back pain. Light exercise should not be a problem, but 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. Please return them to your local pharmacy, and 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 2 mg/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 have 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 includes doxycycline, oxytetracycline, minocycline, and lymecycline.

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 are fighting acne, you have probably heard about Isotretinoin. While there are many avenues against acne, such as changing your diet and skincare routine, when everything else fails, and acne is severe, the word ‘Isotretinoin’ begins to whisper.

It comes from vitamin A:

Do you wonder where this drug has power? Well, it is 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, including topical retinoids, topical and oral antibiotics, and things like the contraceptive pill, have not been successful.

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

Isotretinoin is an anti-inflammatory drug that attacks the skin’s sebaceous glands (the parts that produce the oil) and reduces its oil production. It also helps reduce the number 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, some characteristics 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 considering 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 severe precautions/side effects.

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

It could have some strange effects on your skin:

It turns out that something aggressively depleting your oil production can also alter other parts of your skin; these symptoms are possible: broken lips, dermatitis, dehydrated 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 registering 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 need to avoid it. Of course, your doctor will talk to you about this.

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

It is hazardous 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 take this pill.

Isotretinoin makes your skin extremely photosensitive. You are more sensitive to sunlight and more likely to burn yourself.

You should use sunscreen every day 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 non-comedogenic (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 keep your hair from falling on your face.
  • Use sunscreen without oil.