Accutane acne treatment, side effects, risk, caution, safety and danger, hair loss and dry skin, sexual dysfunction information by Ray Sahelian, M.D.
April 22 2014

 

Accutane is a medicine used since 1982 for the treatment and prevention of severe acne. This medication should only be used by those with severe acne who have failed all other treatments. The dose should be kept to a minimum that works in order to minimize side effects. Swiss drugmaker Roche Holding AG stopped selling this acne drug in 2009 since it has reached the end of its life cycle and is losing ground to generic alternatives. Generics have been available since 2002, known as isotretinoin.

 

How Accutane works to reduce pimples
The inflammation in acne is caused in part by an increased secretion of sebum (oily substance) from glands in the skin (sebaceous glands). The sebum provokes inflammation, and the inflammation resolves (heals) with the formation of a scar (keratinization). Exactly how it works is not known in precise detail; however, it appears that it treats acne by reducing the secretion of sebum. If less sebum is secreted it is likely that there will be less inflammation and keratinization.

 

Source

Accutane acne drug belongs to a family of compounds called retinoids, derivatives of vitamin A. It's known that large doses of retinoids can damage the developing fetal nervous system, which is why it cannot be given to pregnant women.

 

Accutane side effects, safety, risks, caution danger
Accutane has serious short term and long term side effects. Low dose pills are preferable. You may consider a low dose treatment initially to avoid the more long term serious side effects with high dose Accutane pill. Dietary changes may reduce the need for high dose use of the drug. Besides the side effects mentioned below, headache is a common short term Accutane side effect.

 

Testimonial
I wanted to share that I have had dry and itching skin for 15 years, apparently due to the lasting negative effects of Accutane. It's driven me crazy, and I even had to move to Hawaii in order to avoid headaches from dehydration. No matter how much water I drank, it wouldn't absorb. I got off all diuretics, including alcohol and caffeine, but nothing would help. Phyto ceramides were recommended to me a few months ago by a friend who read about them on Life Extension com, and I'm having great success. My itching got 95% better within 3 weeks. I'm still dry and peeing all the time because of how much fluid I drink, but I'm not itching any more, and it's a major relief. So I'm writing to share that, but also curious if there are any further recommendations, besides what's on your skin page, about keeping skin moist through internal, not topical, means. What about hyaluronic acid, collagen, silica hydride.

 

Hair problems, testimonials
I took 40mg Accutane two times a day for 6 months. I stopped the medication 3 months ago. About 4 months ago I noticed significant hair loss. This has continued for all 4 months. My dermatologist claims I have telogen effluvium as a result. Since I took the full course, will I lose all my hair? If so, can I expect it to grow back?
    In many cases hair loss continues for several weeks after stopping the acne drug isotretinoin, and then it stabilizes. In some cases hair can regrow again and it others it may be permanent. It is difficult to predict in any one individual whether the hair loss will reverse or not.

 

Accutane is a common cause of hair loss by many teenagers and young adults who use it for the treatment of their moderate to severe acne. Some users notice their hair loss immediately after taking the Accutane pills, some suffer the hair loss during treatment, and some face the hair loss even after stopping the pills. The best option for those who have hair loss from Accutane is to find natural ways to treat their acne through diet and thus perhaps dietary changes may reduce the dosage required or more frequent breaks can be taken.

 

I am a 38 year old female that has cystic acne on my chin. I took Accutane when I was 25, and did not experience any bad side effects from it. My dermatologist suggested I do a second treatment but I am terrified that my experience the second time around will be far less pleasant. Do you know if the chance for negative side effects increases if Accutane is repeated?
    We have not looked into this matter in any great detail, so we are not sure if a second round would have a higher likelihood of side effects. Our guess would be that it does, but we can't be sure. Hair thinning can occur in 10 to 25 percent of users.

 

5 months ago I was on Roaccutane for 6 months at 50mg per day. Ever since my lips have been dry and chapped. I have tried everything including Bactroban, GLA supplements, Flaxseed oil, Vitamin E, Hydrocortisone, Locoid lipocream and many other lip balms, salves and ointments and nothing seems to be helping! I am a healthy 20 year old male with no history of medical problems. It is the only side effect remaining from the Roaccutane. My dermatologist who placed me on the medication says it is due to persistant thinning of the oral mucosa. However his response on this matter is "your lips will eventually return to normal".

 

Gastrointestinal side effects

People taking the acne drug Accutane appear to run an increased risk of developing inflammatory bowel disease.  American Journal of Gastroenterology, 2006.

 

In 2010 a New Jersey jury required Hoffmann-La Roche pharmaceutical company that makes Accutane to pay a $25 million judgment in a lawsuit filed by an Alabama man who blamed the drug for his inflammatory bowel disorder. Andrew McCarrell of Moody, Ala., aged 38, took the acne drug in his 20s. He says Hoffmann-La Roche Inc. failed to adequately warn of its side effects. McCarrell eventually had his colon removed. Hoffmann-La Roche stopped selling the drug in 2009. It cited generic competition and the cost of defending against lawsuits, which have sought to blame the drug for suicidal behavior and birth defects.

 

In 2007, Swiss drugmaker Roche Holding AG was found guilty by not warning a patient of the bowel disease risks associated with its potent acne medicine Accutane. A New Jersey jury awarded the patient $2.5 million in damages. The trial was the first of about 400 U.S. lawsuits involving Accutane, which has been on the market since 1982. Roche plans to appeal. "Notwithstanding the verdict, the cause of inflammatory bowel disease remains unknown and there is no reliable scientific evidence that Accutane causes inflammatory bowel disease," the company said in a statement. Andrew McCarrell, a 36-year-old computer manager from Alabama, said he had undergone multiple surgeries, including having his colon removed, after taking the drug in 1995. His symptoms included chronic diarrhea and incontinence, according to court documents.

 

Liver and cardiac side effects, danger, risk

Accutane seems to raise the danger for potential heart and liver problems more than doctors had expected. The findings came from lab tests on 13,772 patients taking the popular acne drug and underscore the need to closely monitor people taking Accutane, which is sold in three generic versions. Abnormal results for cholesterol and liver function were more common than expected in those using Accutane. Most dermatologists already knew it could increase levels of cholesterol, liver enzymes and blood fats called triglycerides that can raise the risk of heart disease. But the new study found higher than expected percentages of patients developing these abnormal lab results.

 

Psychiatric danger, effects on the mind and brain

Since its introduction to the market, Accutane has been associated with a variety of adverse psychiatric effects, including depression, psychosis, mood swings, violent behavior, suicide, and suicide attempts.

 

I followed treatment with Accutane acne medication at the age of 16 years, now I am 23 years old. While taking it I had no problem apart from that I psychologically double-checked always my actions. Later, when treatment was completed around 2 months I started to feel a drop of energy, as a lack of confidence and I had the impression of having symptoms of paranoid because I thought that people was always judging me and i had to verified. Five months later I had suicidal thoughts but very light, and I got a girlfriend and my symptoms of paranoid reappeared because I thought she was cheating me with someone else and strong suicidal thoughts reappeared to with symptoms of social-phobia . At that time I went to the hospital and the psychiatrist suggested to my parents put me into a centre for child because I was not on depression but with great thoughts of suicide. i stayed in the centre for 4 months and when i got out i was well.

 

Accutane and depression

Accutane has been linked to reports of depression and suicidal behavior among users. However, human studies have yielded conflicting results as to whether the drug itself contributes to these problems. Depression is a complex disorder and, therefore, difficult to pin down to a single cause. For example, Accutane users often have severe acne, which itself may lead to depression. Because the new study was conducted in mice, researchers were able to examine the direct effects of Accutane's active ingredient on signs of depression -- which, in mice, manifests as listless, sedentary behavior. They found that mice given the drug every day for six weeks began to show such lethargy during tests that gauged their stress responses. In contrast, the animals showed no movement problems in other situations, including tests of physical coordination. This suggests the drug's effects were depression-related, according to the researchers, led by Dr. Kally C. O'Reilly of the University of Texas at Austin. Accutane might alter the regulation of brain chemicals like dopamine and serotonin, which are implicated in depression. Another possibility is that the drug might affect the production or survival of cells in brain regions linked to depression. Between 1982 and 2000, the U.S. Food and Drug Administration received 431 reports of depression, suicide or suicidal behavior among Accutane users. Neuropsychopharmacology, 2006.

 

Sexual dysfunction
Seeing as you are a medical doctor, I thought you might be interested to know that my sexual difficulties occurred age 35 after taking 2 courses of anti-acne drug Roaccutane (Accutane in the US). I went from having a very strong sex drive to pretty much none at all almost overnight. Five years later the problem remains - there is loss of feeling and a disconnect between brain and genitals. I have discovered through research on the internet that many people have had the same experience as me and yet there are no warnings of loss of libido / impotence, erectile dysfunction as side effects of this drug. Had I been warned this could happen, I would never have taken it. Few doctors seem to be aware of this link between Accutane and sexual difficulties, hence it is difficult to get help/be taken seriously. All I can do now is to explore herbal libido treatments and hope that something works for me.

 

Accutane acne medication Dose

The recommended dose is 0.5 mg per kg of body weight daily. The daily dose usually is administered in two divided doses for 14 to 20  weeks. Accutane acne medication should be taken with food.

Accutane dosage interval
A single course of Accutane therapy for 15 to 20 weeks has been shown to result in prolonged remission of acne in many patients. If a second course of therapy is needed, it should not be initiated until at least ten weeks after completion of the first course, because experience has shown that patients may continue to improve while off of it. The suggested Accutane dosage range is 0.5 to 1.0 mg per kg per day given in two divided doses with food. This medication is better absorbed with food. During treatment the dosage may be adjusted according to response of the disease and/or the appearance of clinical side effects. Adult patients whose disease is very severe with scarring or is primarily manifested on the trunk may require dosage adjustments up to 1.5 mg/kg/day.


Drug Interaction

Accutane is closely related to vitamin A. Therefore, the use of both at the same time may lead to vitamin A side effects. Additional drugs that may interact with Accutane include alcohol, benzoyl peroxide, salicylic acid, or other drying medicines used for acne; corticosteroids (example: prednisone); medicines for seizures; other drugs that make you more sensitive to the sun such as sulfa drugs; progestin-only birth control hormones (examples: 'Minipills' like Aygestin, Micronor, Nor-QD or injectable / implantable products such as Depo-Provera or Norplant.

 

Danger Accutane and Pregnancy

Accutane is known to cause birth defects when used during pregnancy. It can cause brain and heart defects in infants if a woman takes it during or immediately before pregnancy. Women who take it must have pregnancy tests and use birth control or abstain from sex.

 

Accutane review
This medication is helpful in severe cystic acne when no other treatment has worked. However, it is suggested to try as much of the dietary approach in order to reduce the severity of the acne and hence reduce the required dosage. The less dosage of Accutane, the less the side effects.

 

Questions
I have adult acne, does Accutane work for adult acne or only for teenage acne?
   It works for both adult and teenage acne.

 

Interactions with herbs and supplements
I was just wondering if there were any major contraindications to using Accutane along with a multivitamin supplement and whether there would be a benefit or risk.
   I don't think there would be a major problem using a mineral and vitamin supplement with this medication.

 

I'm 22 years old from Israel. I have many health problems including Gilbert disease but mainly fibromyalgia that causing me alot of pains. Unfortunately i just started Accutane for the third time because of persistent acne mostly in the back, and i already have alot of dry eyes and more pains. i know that Accutane can pressure the liver yet there are some inconclusions about Gilbert and its affect. My previous Accutane attempts may have caused my fibro and my years of dry eyes, and maybe it has something to do with bad liver and alot of toxins in my body because of that. i just bought milk thistle here, and i bought the green herbs itself. I put it in a glass of water and drink it after 15 minutes and i wanted to know if it has the same affect as pills? i bought it in health store, is it the good part of the milk thistle? I'm not sure what to do with the Accutane as it did help only in 5 days and with the minimum of 10 mg.
    This acne medication does have cumulative effect but I am not sure if the long period of 4 years could still have an influence.
 

Alcohol use
I need to know if drinking alcohol while taking Accutane is bad, and in what way. Recently (past few weeks), I drink fairly heavily (5-7 drinks) on one night out of the week, with maybe the occasional drink now and then. Sometimes, though rarely, I drink heavily on two nights of the week. I am on 120 mg of Amnesteem. I know there is the liver issue since they both damage it. But what I really want to know is: Does alcohol reduce the effects of Accutane Amnesteem?
    I am not aware of any studies that show the benefits of this acne medication are reduced by once or twice weekly consumption of alcohol.