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Accutane

Accutane
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Accutane (isotretinoin), a chemical cousin of vitamin A, is prescribed for the treatment of severe, disfiguring cystic acne that has not cleared up in response to milder medications such as antibiotics.

Uses

Isotretinoin is used to treat severe acne that is resistant to more conservative treatments such as creams, drying agents, and topical or oral antibiotics. Complete remission or prolonged improvement is seen in many patients after one course of 15 to 20 weeks of isotretinoin. Because of its serious side effects, isotretinoin should be used only for severe resistant acne.
It works on the oil glands within the skin, shrinking them and diminishing their output. You take isotretinoin by mouth every day for several months, and then stop. The antiacne effect can last even after you have finished your course of medication.

How to take

Because isotretinoin can cause severe birth defects, including mental retardation and physical malformations, a woman must not become pregnant while taking it. Before starting isotretinoin therapy, women of childbearing age will be asked to read a pamphlet, watch a video, and sign a detailed consent form regarding the danger of birth defects. You must have two negative pregnancy tests before beginning isotretinoin therapy, and must take monthly pregnancy tests while using isotretinoin.
In addition, you must use 2 forms of birth control during isotretinoin therapy, and for 1 month before and after. Each prescription for isotretinoin must bear a yellow qualification sticker signifying that you meet these requirements. Scientists have not ruled out the possibility that hormone-based contraceptives (birth control pills and implants) may be less reliable when taken with isotretinoin, so a second form of birth control should always be used while taking isotretinoin. If you accidentally become pregnant while taking isotretinoin, you should immediately consult your doctor.

Side effects

The most common side effects of isotretinoin are dry skin, itching, dry nose, nosebleeds (epistaxis), cracks in the corners of the mouth (chilitis), dry mouth, and inflammation of the whites of the eyes. Joint aches also are common. Patients may develop an increase in blood cholesterol and triglycerides. Psychiatric problems such as depression, hallucinations and suicidal behavior have been reported. Rare side effects include skin infections, peeling, sun sensitivity, hearing impairment and hepatitis. Rarely, isotretinoin can cause brain swelling (pseudotumor cerebri or intracranial hypertension), which produces nausea, vomiting, headache, and changes in vision.

Precaution


Before using this drug, tell your doctor or pharmacist your medical history, including: diabetes, family or personal history of high blood fats (triglycerides), family or personal history of psychiatric disorders, liver disease, pancreatitis, bone loss conditions (e.g., osteoporosis/osteomalacia, decreased bone density), any allergies. Do not donate blood while you take isotretinoin and for at least one month after you stop taking it. Avoid exposure to the sun and sunlamps. Use a sunscreen and wear protective clothing when you are exposed to direct sunlight. Isotretinoin can affect your night vision. Be cautious when driving or operating any machinery after dark. If you wear contact lenses, you may not tolerate them as well as usual while using this medication. Do not have cosmetic procedures to smooth your skin (e.g., waxing, laser, or dermabrasion) during and for six months after isotretinoin therapy. Skin scarring may occur. Avoid the use of alcohol while taking this medication, as it may worsen drug side effects (e.g., pancreatitis risk). Limited information suggests isotretinoin may cause some bone loss effects. Therefore, playing impact sports (e.g., football) may result in bone problems, including an increased risk of fractures. Limited information also suggests isotretinoin may stop normal growth in some children (epiphyseal plate closure). Consult your doctor for more details. Caution is advised when using this drug in children because they may be more sensitive to its effects, especially back, joint, or muscle pain. You must have two negative pregnancy tests before starting this medication. You must have a monthly pregnancy test during treatment with isotretinoin. If the test is positive, you must stop taking this medication and consult your doctor immediately. This drug must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. This drug should not be used by those who may become pregnant during treatment. Consult your doctor (see also Warning section). It is not known if this drug passes into breast milk. Due to the potential risks to an infant, do not breast-feed while using this medication. Use two reliable forms of birth control together, starting one month before treatment, during and at least one month after stopping the drug.

Drug interactions

Isotretinoin is closely related to vitamin A. Therefore, the use of both vitamin A and isotretinoin at the same time may lead to vitamin A side effects.
Treatment with tetracycline (Achromycin) and isotretinoin should not be given at the same time since the combination has been associated with brain swelling. (See side effects below.)

Missed dose

If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Storage

Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight. Do not store in the bathroom. Keep away from children and pets.