Isotretinoin

Sounds like 'iso-tret-in-noin'

Easy-to-read medicine information about isotretinoin – what is it, how to take isotretinoin safely and possible side effects.

Type of medicine Also called
  • Acne treatment
  • Belongs to a group of medicines known as retinoids
  • Oratane®

What is isotretinoin?

Isotretinoin is used to treat severe acne. It works by reducing the amount of oil made by the glands in your skin, inhibiting the growth of bacteria, reducing pore clogging and decreasing inflammation. 

Isotretinoin is one of a group of medications known as retinoids. In New Zealand isotretinoin is available as capsules (5mg, 10mg and 20 mg). 

Isotretinoin is an effective treatment for acne. About 9 out of 10 people treated with isotretinoin see a significant improvement in their acne after a single course of isotretinoin, although during the first few weeks of treatment the acne may worsen before it starts to improve.   

Dose

  • The usual dose of isotretinoin is 10 mg or 20 mg once a day until the acne has cleared (usually 3–5 months).
  • Your doctor will then reduce your dose by half for a further 2-4 months to avoid the acne coming back and scarring. 
  • Always take your isotretinoin exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much isotretinoin to take, how often to take it, and any special instructions.

How to take isotretinoin

  • Take isotretinoin once a day, at about the same time each day.
  • Isotretinoin is best taken with or just after food. 
  • Swallow the capsules whole – do not split or chew them.
  • Keep taking isotretinoin until the prescribed course is completed. It usually takes a few weeks before you begin to notice a difference to the acne. Sometimes isotretinoin causes a worsening of acne about three to four weeks into treatment.
  • If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Precautions

Risk of birth defects

Isotretinoin can cause birth defects and is harmful to unborn babies.

Do not use isotretinoin if you are pregnant or planning a pregnancy.

If you are sexually active, ask your doctor about reliable contraceptive options.

Do not take isotretinoin if you are pregnant, or if there is a chance you could become pregnant.

  • Before you start treatment, your doctor may arrange a pregnancy test to ensure that you are not pregnant.
  • If you are sexually active, ask your doctor about reliable contraceptive options. You must use reliable birth control for at least 1 month before you start isotretinoin, the whole time you are taking isotretinoin and for at least 1 month after you finish taking it. Read more about methods of contraception.
  • You may be asked to sign a consent form to make sure you have understood the seriousness of this. For example Isotretinoin_consent_form – BPAC (April 2009).
  • Note: no contraceptive precautions are required for males who are taking isotretinoin; birth defects have not been identified in children fathered by men who have taken isotretinoin.

Dry skin, lips, nostrils and eyes

Because isotretinoin reduces oil production in the skin, it can cause dry skin, dry mouth, chapped lips, dry nostrils and dry eyes. These effects can be uncomfortable. Here are some tips to manage them, but if you have any questions, ask your doctor or pharmacist for advice.

  • Lips: from the start of treatment, use an emollient lip balm that has a sunscreen. It is important to apply the lip balm often during the day such as in the morning as soon as you awake, after any food, snack or drink, last thing at night and any other time in between that your lips become dry. 
  • Skin: from the start of treatment, use a non-perfumed moisturizing cream. Use non-soap cleansers, as these are less likely to irritate the skin, compared with a soap cleanser. Avoid beauty treatments such as chemical peels, dermabrasion and waxing during treatment, and for at least 6 months after stopping.
  • Eyes: your eyes may become dry and itchy, especially if you wear contact lenses. Ask your pharmacist to recommend a suitable eye lubricant (also called artificial tears). Read more about eye lubricants. While you are taking isotretinoin, you may need to wear glasses instead of contact lenses.
  • Nostrils: the inside of the nostrils may become dry and crusted and lead to mild nose bleeds. Applying a thin layer of petroleum jelly gently to the inside of the nose may help.

Increased sensitivity to the sun

Isotretinoin can make you more sensitive to the sun and your skin is more likely to burn.

  • Avoid unnecessary sun exposure.
  • When outside, protect your skin by using an oil-free sunscreen (SPF50+). Apply the sunscreen to all areas especially the face, neck and ears. Read more about using sunscreen.  
  • Wear clothing that protects you from the sun.
  • Wear sunglasses when outdoors.

Night vision may be affected

Night vision may be affected by isotretinoin. Good night vision is important for airline pilots and those flying after dark. Pilots taking isotretinoin or considering a course of isotretinoin must report to their national aviation authority to discuss how this treatment affects their flying privileges.

In New Zealand, this is the Civil Aviation Authority of New Zealand (CAA). Civil aviation licence holders, including Air Traffic Controllers, have an obligation under section 27 C of the Civil Aviation Act to ground self and report to CAA in case of any change in medical condition that may affect flight safety. CAA considers the use of isotretinoin to be a change in medical condition.

Other precautions

  • Do not take isotretinoin if you are breastfeeding.
  • If you have problems with your liver, or if you know you have high lipid (cholesterol) levels in your blood, let your doctor know.
  • Donating blood by males and females on isotretinoin is not allowed during treatment, and 4 weeks after treatment has finished. This is in case the blood is used for a pregnant woman.
  • Avoid waxing for hair removal: waxing can cause permanent scars in people taking isotretinoin. To avoid scarring, you must not wax while taking isotretinoin and for 6 months after you stop taking isotretinoin. This applies to hot wax and cold wax.
  • Blood test monitoring: before you start treatment, your doctor will send you for blood tests to exclude pregnancy, and to monitor your liver, blood fats and blood count. These tests should be repeated at least once during a 16 to 30-week course of isotretinoin.

Possible side effects

Side effects What should I do?
  • Headache
  • Tiredness
  • Muscle aches
  • These are common symptoms of isotretionoin that will likely go away with time.
  • Tell your doctor if troublesome. 
  • Mood changes, anxiety, depression, or worsening depression, low mood, aggressive tendencies, thoughts or talk of suicide and self-harm.
  • If you experience any of these symptoms, tell your doctor immediately or ring Healthline on 0800 611 116
  • Severe headache with blurred vision.
  • Tell your doctor immediately or ring HealthLine on 0800 611 116
  • Severe diarrhoea, especially if it contains blood.
  • Tell your doctor immediately or ring HealthLine on 0800 611 116

Interactions

Isotretinoin interacts with a few medications such as some antibiotics and vitamin A products. Check with your doctor or pharmacist before taking any other medicine or supplements.

Learn more

References

  1. Prescribing isotretinoin for patients with acne in primary care BPAC, 2017
  2. Isotretinoin DermNet NZ
  3. Isotretinoin (systemic) New Zealand Formulary
  4. Isotretinoin British Association of Dermatologists
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 03 Jun 2019