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isotretinoin

Pronunciation

Generic Name: isotretinoin (oral) (EYE so TRET i noyn)
Brand Name: Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane, Accutane

What is isotretinoin?

Isotretinoin is a form of vitamin A. It reduces the amount of oil released by oil glands in your skin, and helps your skin renew itself more quickly.

Isotretinoin is used to treat severe nodular acne that has not responded to other treatments, including antibiotics.

Isotretinoin is available only from 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 medicine.

Isotretinoin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about isotretinoin?

Isotretinoin in just a single dose can cause severe birth defects or death of a baby. Never use this medicine if you are pregnant or may become pregnant.

You must have a negative pregnancy test before taking isotretinoin. You will also be required to use two forms of birth control to prevent pregnancy while taking this medicine. Stop using isotretinoin and call your doctor at once if you think you might be pregnant.

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Isotretinoin is available only under a special program called iPLEDGE. It is dangerous to try and purchase isotretinoin on the Internet or from vendors outside of the United States.

What should I discuss with my healthcare provider before taking isotretinoin?

Isotretinoin can cause miscarriage, premature birth, severe birth defects, or death of a baby if the mother takes this medicine at the time of conception or during pregnancy. Even one dose of isotretinoin can cause major birth defects of the baby's ears, eyes, face, skull, heart, and brain. Never use isotretinoin if you are pregnant.

For Women: Unless you have had your uterus and ovaries removed (total hysterectomy with oophorectomy) or have been in menopause for at least 12 months in a row, you are considered to be of child-bearing potential. You must have a negative pregnancy test before you start taking isotretinoin. A pregnancy test is also required before each prescription is refilled, right after you take your last dose of isotretinoin, and again 30 days later. All pregnancy testing is required by the iPLEDGE program.

You must agree in writing to use two specific forms of birth control beginning 30 days before you start taking isotretinoin and ending 30 days after your last dose. Both a primary and a secondary form of birth control must be used together.

Primary forms of birth control include:

  • tubal ligation (tubes tied);

  • vasectomy of the male sexual partner;

  • an IUD (intrauterine device);

  • estrogen-containing birth control pills (not mini-pills); and

  • hormonal birth control patches, implants, injections, or vaginal ring.

Secondary forms of birth control include:

  • a male latex condom with or without spermicide;

  • a diaphragm plus a spermicide;

  • a cervical cap plus a spermicide; and

  • a vaginal sponge containing a spermicide.

Not having sexual intercourse (abstinence) is the most effective method of preventing pregnancy.

Stop using isotretinoin and call your doctor at once if you have unprotected sex, if you quit using birth control, if your period is late, or if you think you might be pregnant. If you get pregnant while taking isotretinoin, call the iPLEDGE pregnancy registry at 1-866-495-0654.

You should not use isotretinoin if you are allergic to it.

To make sure isotretinoin is safe for you, tell your doctor if you have:

  • a history of depression or mental illness;

  • asthma;

  • liver disease;

  • diabetes;

  • heart disease or high cholesterol;

  • osteoporosis or low bone mineral density;

  • an eating disorder such as anorexia;

  • an intestinal disorder such as inflammatory bowel disease, ulcerative colitis, or Crohn's disease; or

  • a food or drug allergy.

It is dangerous to try and purchase isotretinoin on the Internet or from vendors outside of the United States. The sale and distribution of isotretinoin outside of the iPLEDGE program violates the regulations of the U.S. Food and Drug Administration for the safe use of this medication.

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

Isotretinoin is not approved for use by anyone younger than 12 years old.

How should I take isotretinoin?

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

Each prescription of isotretinoin must be filled within 7 days of the date it was written by your doctor. You will receive no more than a 30-day supply of isotretinoin at one time.

Always take isotretinoin with a full glass of water. Do not chew or suck on the capsule. Swallow it whole.

Take isotretinoin with food.

Use this medicine for the full prescribed length of time. Your acne may seem to get worse at first, but should then begin to improve.

While using isotretinoin, you may need frequent blood tests.

Never share this medicine with another person, even if they have the same symptoms you have.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include headache, dizziness, vomiting, stomach pain, warmth or tingling in your 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 you stop taking it. Donated blood that is later given to a pregnant woman could lead to 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 skin treatments. Scarring may result.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Isotretinoin can make your skin more sensitive to sunlight and sunburn may result.

Isotretinoin may impair your vision, especially at night. Be careful if you drive or do anything that requires you to see clearly.

Isotretinoin side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty 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, seizure (convulsions), sudden numbness or weakness;

  • depressed mood, sleep problems, crying spells, changes in behavior, feeling aggressive or irritable;

  • hallucinations, (see or hearing things that are not real), thoughts about suicide or hurting yourself;

  • muscle weakness, pain in your bones or joints or in your back;

  • severe diarrhea, rectal bleeding, bloody or tarry stools;

  • pale skin, feeling light-headed or short of breath;

  • dark urine, or jaundice (yellowing of your skin or eyes);

  • severe stomach or chest pain, pain when swallowing; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

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

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Isotretinoin dosing information

Usual Adult Dose for Acne:

Severe recalcitrant nodular acne: 0.5 to 1 mg/kg/day orally in 2 divided doses; patients whose disease is very severe with scarring or is primarily manifested on the trunk may require up to 2 mg/kg/day

Usual Adult Dose for Melanoma - Metastatic:

Study (n=17)
Combination therapy with interferon alfa: 60 mg/day, divided in 3 equal doses, for 6 months

Usual Adult Dose for Granuloma Annulare:

0.5 to 1 mg/kg/day orally in equally divided doses twice a day

Usual Pediatric Dose for Acne:

Severe recalcitrant nodular acne:
12 years or older: 0.5 to 1 mg/kg/day orally in 2 divided doses

Usual Pediatric Dose for Acute Nonlymphocytic Leukemia:

Pediatric Oncology Group Study (n=41)
1 month or older: 100 mg/m2/day orally, given as a single dose, for 4 weeks

What other drugs will affect isotretinoin?

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

  • vitamin or mineral supplements;

  • St. John's wort; or

  • a tetracycline antibiotic, including doxycycline or minocycline.

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

Where can I get more information?

  • Your pharmacist can provide more information about isotretinoin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.01. Revision Date: 2015-12-21, 1:18:04 PM.

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