Isotretinoin
3 medicines
Isotretinoin is an oral retinoid for severe acne that causes serious birth defects in pregnancy, so anyone who could become pregnant must use two forms of contraception and have regular pregnancy tests throughout treatment.
Key facts
- Isotretinoin (sold as Roaccutane, Accutane and generics) is an oral retinoid, a compound related to vitamin A, used for severe acne that has not responded to other treatment.
- A course usually runs 4 to 6 months; acne can look worse in the first few weeks before it improves.
- It causes serious, predictable birth defects if taken during pregnancy. Anyone who could become pregnant must use two effective methods of contraception and have a pregnancy test before starting, monthly during treatment, and after stopping.
- Seek urgent care for thoughts of self-harm, a sudden mood change, or yellowing of the skin or eyes.
What isotretinoin treats
Isotretinoin treats severe nodular or cystic acne, acne that is scarring or likely to scar, and acne that has failed courses of oral antibiotics and topical treatment. It is reserved for severe cases because of its risks and is not used for mild or moderate acne that responds to gentler options.
How isotretinoin works
Isotretinoin shrinks the sebaceous glands in the skin and reduces how much oil they produce. It also changes the way skin cells shed inside hair follicles, so pores are less likely to become blocked. Less oil and fewer blocked follicles together mean fewer new spots, less inflammation, and time for existing lesions to heal.
Before you take it
- Do not take isotretinoin if you are pregnant or breastfeeding, or if you could become pregnant without using two reliable forms of contraception throughout treatment and for a month after stopping.
- You need a negative pregnancy test before starting and further tests each month while you take it, as part of a formal pregnancy-prevention program your prescriber runs.
- Tell your prescriber about depression, anxiety, past self-harm, liver disease, high blood cholesterol or triglycerides, and any vitamin A supplements you take.
- Do not donate blood during treatment or for a month afterward, in case it is given to someone who is pregnant.
Side effects
Common effects include dry lips, skin, eyes and nose, sometimes with nosebleeds, along with joint or muscle aches and increased sun sensitivity.
Stop and seek urgent medical care for any of these:
- Thoughts of self-harm, severe low mood, or a sudden change in behaviour.
- Yellowing of the skin or eyes, dark urine, or persistent nausea.
- Sudden loss of night vision or other vision changes.
- Severe headache with nausea or vomiting.
Safety essentials
- Isotretinoin causes serious birth defects. Pregnancy must be ruled out before treatment starts and prevented throughout, using two effective contraceptive methods together with monthly pregnancy tests.
- Tell your prescriber straight away about any change in mood or thoughts of self-harm; both have been linked to isotretinoin.
- Expect marked dryness of skin, lips and eyes for the whole course. Avoid waxing, dermabrasion and laser skin procedures during treatment and for several months after, since skin heals more slowly and can scar.
- Get isotretinoin only through a specialist prescriber who can run the required pregnancy-prevention and blood monitoring program.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.