ISOTRETINOIN

Main uses in hair loss: folliculitis decalvans (uncommon), folliculitis rarely lichen planopilaris

Other names: Accutane, Clarus

What is Isotretinoin?

  • Isotretinoin is a type of vitamin A pill. 
  • It is sometimes used for acne, but can also be used for certain types of scarring hair loss conditions

How is Isotretinoin prescribed?

  • Your physician will advise your how much and how often you should take this medication
  • FOR WOMEN: Women of child bearing age must use two forms of contraception before Isotretinoin is prescribed.  One of these forms of contraception is usually a birth control pill.  This must be used for a full month before starting isotretinoin. The isotretinoin is started on day 2 after your period. However, before starting isotretinoin, you are required to have two negative pregnancy tests. One of these will be two weeks before starting treatment and the other will be one month before starting treatment. Your doctor will advise you how he would like you to schedule these tests.  If you suspect at any time that you might be pregnant, you must see your doctor. You must not become pregnant on isotretinoin as the baby will be deformed.

Who should not use Isotretinoin?

Isotretinoin can not be used by everyone. Speak to your doctor and pharmacist if isotretinoin is right for you.

  • Do not take Isotretinoin if you are allergic to Isotretinoin
  • Tell your physician if you have ever had colitis (inflammation in the bowel)
  • Isotretinoin can not be used during pregnancy or breast feeding
  • Patients with allergy to peanut oils can not use some forms of isotretinoin
  • Patients with low white blood cells counts can’t use isotretinoin
  • Patients with untreated hypothyroidism can’t use isotretinoin
  • Patients with high cholesterol can’t use isotretinoin
  • Patient with liver or kidney disease can’t use isotretinoin
  • Patients taking doxycycline or tetracycline can’t take isotretinoin
  • Patients with diabetes may or may not be able to use isotretinoin
  • Patients taking Prednisone need to watch that the fats in the blood don’t rise too quickly if taking isotretinoin

What side effects are possible with Isotretinoin?

There are many side effects possible with isotretinoin. Be sure to speak to your physician and pharmacist about all the side effects and then read the information in the drug packing leaflets carefully before starting this drug. The following is a list of some but not all of the side effects:

  • Teratogenicity to a developing baby – isotretinoin is harmful to a developing fetus and must not be taken during pregnancy.
  • Dry mouth, dry eyes, dry nose in most people
  • Sticky skin sometimes
  • Altered night vision (halos around lights)
  • Bone thinning if used for many years
  • Increased cholesterol (10-30 % of people) and triglycerides (20-40 %) **
  • Irritation of the pancreas if fats rise to high levels ( this gives abdominal pain and a serious condition called pancreatitis)
  • Irritation of the liver (in 15 % of people)
  • Muscle pain
  • Headaches
  • Depression
  • Hair shedding is rare but can occur with isotretinoin
  • Nail changes
  • Colitis (inflammation of the bowel). The risk of developing colitis may be increased with isotretinoin but this is controversial.
  • Increased sensitivity to the sun

What side effects should prompt me to STOP Isotretinoin?

  • Stop taking Isotretinoin and seek medical help immeidately if you experience reactions such as rash, fever, itching, joint pain, swollen lymph nodes, and or sores on the genitals.
  • Stop taking Isotretinoin and seek medical help immediately if an allergic reaction develops (shortness of breath; closing of your throat; hives; swelling of your lips, face, or tongue; rash; or fainting);
  • Stop taking Isotretinoin if you get dark urine or whitish stools and seek medical help immeidately
  • Stop taking Isotretinoin if you develop severe watery diarrhea and abdominal cramps and seek medical help immeidately
  • Stop taking Isotretinoin if you develop unusual bleeding or bruising and seek medical help immeidately

Are any blood tests needed BEFORE I start Isotretinoin?

The following FASTING blood tests are sometimes ordered by physicians. Be sure sure to check with your doctor as to what he or she wishes to order.

  • CBC,  Liver tests (AST, ALT, amylase, bilirubin)
  • Creatinine (kidney tests)
  • Fasting lipids (fats, cholesterol)
  • Pregnancy tests in women (two negative ones are needed before starting isotretinoin)
  • These blood tests are repeated monthly for THREE months and then every 3-6 months
  • Patients on long term isotretinoin may get x-rays of the spine, wrists, and ankles and an ophthalmologic (eye) exam

Are any blood tests needed AFTER I start Isotretinoin?

Periodic blood tests and other tests may be ordered by your physician if you start isotretinoin. Very close follow up and frequent visits to the prescribing doctor are needed for those who start this medication 

  • CBC,  Liver tests (AST, ALT, amylase, bilirubin) Creatinine (kidney tests)
  • Fasting lipids (fats, cholesterol)
  • Pregnancy tests in women
  • Patients on long term isotretinoin may get x-rays of the spine, wrists, and ankles and an ophthalmologic (eye) exam


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