Accutane is the trade name for Isotretinoin (13-cis-retinoic acid). It belongs to the family of Retinoids.
Among several other purposes, it is primarily manufactured to treat acne. It is a derivative of vitamin A. For the same reason it is not advisable to take Vitamin A while taking Accutane, because it accumulates in tissues.
It is useful for treating almost all the different types of acne.
As it is a naturally occurring compound analogous to Vitamin A, the human body is able to effectively eliminate it within 9 days period.
Its use is, however, reserved for the severe form of acne.
It is normally the second line of defense in acne treatment after the regular antibiotics and when all other regimes have failed. It is used for the moderate to severe forms of, previously unresponsive acne lesions with scarring and pigmentation.
The dose for the previously resistant acne forms in an adult patient, range from 0.5 mg/kg/day to 2 mg/kg/day, for about 6 months.
Recurrence of acne may occur in some patients which can be improved with a second round of treatment with Accutane.
Uses of Accutane, Other than Acne Treatment :
- Accutane is known for its anti-cancer properties. It promotes apoptosis (cell death) in the cancerous cells. It binds to the receptor for the retinoic acid (RARs) and allows the transcription for cell differentiation and apoptosis.
- It has anti-inflammatory action and it promotes keratinization especially of sebaceous gland linings.
How does Accutane work?
Acne is caused by excessive oil production (sebum) from sebaceous glands of the skin. The increased amounts of oil clog the pores of the facial glands and acne results.
Accutane decreases the extra sebaceous gland secretions (skin oils). The reduction in sebum diminishes the amount of nutrients for acne causing bacteria.
It diminishes the bacterial count for Propionibacterium acnes. Accutane has anti-inflammatory actions which ameliorate acne.
Moreover, accutane promotes cell differentiation and growth of skin cells. In this way the clogged pores are quickly replenished and acne formation is prevented.
These are all the reasons it has a great impact in treating acne breakouts.
Accutane Side Effects
Side effects of taking Accutane are largely dependent on dosage. At lowest possible dose, no side-effects are seen. At a higher dosage variety of side effects might be experienced.
- Troubled mood (depressive thoughts)
- Joint pain
- Blood-red eyes with itching
- Tinnitus (ringing sound in ears)
- Tingling sensation
- Purpura, easy blood vessel rupture
- Pain in joints and stomach
- Irritability and aggression
- Cracked and dry skin
- Dry lips
- Skin rashes
- Decreased night vision
- Itching on skin
If any of these develop, the concerned physiscian should be consulted as soon as possible!
Accutane During Pregnancy
Accutane is not recommended to be used while one is pregnant.
Women taking Accutane for acne should exercise birth control. It can cause fetal abnormality and congenital anomalies in embryo.
As for the male partners, additional precaution is advised (condom or any spermicidal spray).
If a female on Accutane accidentally becomes pregnant, the intake of Accutane should be stopped immediately and a referral must be made for the Gynecologist for further examination.
Similarly, do not take Accutane while taking multivitaminamins containing Vitamin A.
Links to Suicide & Depression
Consumption of Accutane can lead to generation of suicidal ideas and thinking, a rather rare adverse effect as reported by NHS. Several instances were reported where change in behavior, agitation, mood swings, generation of negative thoughts and feelings akin to psychosis were noted.
The basis of this belief is that Accutane has Isotretinoin as its active ingredient. Isotretinoin has been known to cause negative or the suicidal thoughts and numerous experiments on mice have confirmed this link.
University of Bath had conducted numerous experiments on mice and concluded that it does cause depression whereas its effects on humans are yet to be studied.
Roche, a big pharmaceutical from Switzerland, have refused to take its Roaccutane off the shelves, on the grounds that there is no scientifically proven link between intake of Accutane and human psychosis or depression. On the other hand they suggested that a person may feel low due to acne problem and this anxiety might cause the possible behavioral changes leading to suicide. Accutane is constantly under observation for its suicidal side effect throughout the world.
Why It Should Not Be Taken With High Fat Meal
Accutane increases triglycerides levels in blood. Fasting blood sugar can give a more accurate picture of true/false elevated levels of triglycerides.
If at the start of treatment the lipid profile shows increasing levels of triglycerides then it should be discontinued as the effects are reversible.
Accutane has been studied for its effect on Triglycerides (TG), LDL and VLDL levels during acne treatment. It has been shown to increase their concentration in blood. Increased concentrations of these lipids are additional risk factor for heart disease (atherosclerosis) and pancreatitis.
Accutane decreases the HDL (the good cholesterol) levels in blood
Chylomicrons are vehicles for transporting lipoproteins from intestine to other organs. Accutane is shown to slow down the metabolism for chylomicrons. This in turn will increase the chances of fatty deposits in blood vessels leading to occluding the arteries.
The risk for atherosclerosis increases significantly with Accutane intake for longer periods and in subjects with strong positive familial history of heart attacks and cardiac conditions.
Several studies have reported effect on lipid profile of the Isotretinoin (Accutane). A retrospective study at Turkey also studied its effect on lipid enzymes for the six months and found the same results.
This increase in lipids associated with the use of Accutane can be controlled through intake of vegetable and whole grains and avoiding dietary intake of carbohydrates and saturated fat.
The mechanism underlying this involves type 2 diabetes and some apolipoproteins which change lipid profile.
Accutane and Liver enzymes- The connection:
A study in Brazil was conducted on 130 patients who were receiving oral Accutane for acne. After three months their alanine aminotransferase (AST) enzymes levels were checked. 11 percent of the subjects had high levels of triglycerides, well beyond the normal range. 8.6% had increased levels and about 6% had increased levels of triglycerides within the normal range.
A constant monitoring of lipid enzymes and any sign of pancreatitis is a must while a person is on Acne treatment.
The dose of Accutane and the subsequent increase in triglyceride and AST and ALT levels does not have a direct association with the amount of drug taken but it is rather related to the weight of the patient. Which means in simple words would mean that decreasing the dose won’t help!
Oral medications are not always suitable for some people. They may benefit from the topical application of Isotretinoin. Topical Isotretinoin has Accutane as an active ingredient.
The mechanism through which it works is by diminishing the inflammatory reactions in the skin and by prevention of pore clogging.
Pore clogging of the sebaceous glands also lead to formation of whiteheads and blackheads in addition to acne.
Topical Isotretinoin is most commonly given in conjunction with oral antibiotics for more better results.
Apply it cautiously after cleaning the skin and look out for any adverse reactions that might occur with otherwise sensitive skin. It is recommended that a small patch be applied first and observed for any allergic reaction or redness of the skin.
Do not apply the topical preparation on the cut, bruised or peeled off skin.
Do not apply on the sensitive areas. Like, eyes, nostrils etc. Wash properly if it gets into the skin folds.
While using isotretinoin, avoid direct sunlight or use a proper sunblock in case of stepping out in the broad daylight.
Topical Accutane also causes dry skin, so keep applying moisturizers.
The treatment with topical application is slow so patience is the key!
The topical isotretinoin is now largely being replaced by other retinoids with lesser side effects e.g. Adapalene.
Dangers of Buying Accutane Online
Accutane is not a regular OTC (over the counter) drug. Caution must be practiced while taking Accutane for acne. A healthcare provider should consulted before taking it and necessary precautions taken.
In U.S. it is illegal to sell it outside iPLEDGE programme.
If you want to use it for acne control, ask your doctor. Your doctor will probably want to know about your history of any of the following:
- History of depression
- Mental illness
- Heart disease
- High cholesterol
- Bone disorders
- Inflammatory bowel disease
- Ulcerative colitis
- Crohn’s disease
- Respiratory disorder (Asthma)
- an eating disorder (anorexia nervosa)
- liver disease
- Possible Pregnancy
- Blood donation
Benefits Vs Side-Effects, is it worth it?
There is an apt saying: “No pain, no gain”. Accutane as a cure for acne is an alternative to antibiotics and x-ray therapy.
Like many other drugs, Accutane also has potential side effects. Most common are headaches, skin rash, hair loss, photosensitivity to sunlight etc. Some of the side effects are clinically and scientifically proven others are still a hypothesis.
These may be permanent or temporary. The pros and the cons of the isotretinoin treatment must be weighed against the cost of the treatment and health risk involved versus the elimination of acne.
The major concern regarding Accutaneuse arose when two major side effects related to health were first documented. First was teratogenicity leading to serious birth defects in neonates? Second is the elevated cholesterol levels.
There is no doubt about the fact that the results of isotretinoin treatment have been impressively amazing. So, it might be suggested that treatment should be tailored according to the individual needs. The listings of the possible risks will allow clinicians to look out for any possible side effect.
Isotretinoin has been long known for inducing fetal abnormalities. Namely, cleft lip, eye and ear deformity, hydrocephalus, problems in corticospinal stract and agenesis of cerebellar vermis. Isotretinoin is a by-product of vitaminamin A and when accumulated in excessive amounts it can lead to birth defects in pregnant women.
Before starting treatment with Isotretinoin pregnancy test should be taken. Treatment should commence only if the result is negative.
There are many generic versions available in market for Isotretinoin. They are not safe in pregnancy either.
Cholesterol and lipid profile:
It is not a problem in young adults. Elderly patients and those who are at risk should be closely evaluated for any increase in VLDL and LDL levels.
An episode of acute pancreatitis may be experienced while the person is on Isotretinoin treatment.
Variations in lipid profile alone will not pose risk for heart disease or fatty liver. A positive family history and concomitant alcohol consumption might act as contributing factors.
Persons with depressive tendencies should not be prescribed or closely monitored. There has been no connection found between isotretinoin treatment and depressive or suicidal tendencies in humans.
Consult with Doctor before Commencing Accutane Treatment
It should be taken as per concerned doctor’s recommendation. Do not take Accutane for longer periods.
Take it for the total duration of prescribed time. Its effects are slow, but eventually acne will begin to fade and skin will improve.
If you skipped a dose, start from the next obligatory dose. Do not take extra pill to complete the count.
Tell your doctor, if you are
- already taking Vitamin A supplements
- Expecting a baby
- Planning a baby
- Nursing mother (breast feeding)
- Taking steroids
- Any other medicine like Phenytoin (for convulsions)
- Taking Antibiotic, especially tetracycline group
- Herbal medication
- Any other supplements
- Have had skin cancer (or any familial history)
- Having eczema
These drugs may have adverse interactions with Accutane, so any medicines and supplements should be mentioned to your health care provider.
Your doctor would probably preclude you from donating blood while you are on oral Accutane.
In case of over dosage, symptoms can develop. It can range from headaches to stomach pain and lightheadedness (vertigo). If any of these symptoms develop, call the ER and get yourself checked asap!