Oral Accutane: What to Do After a Break in Treatment?

Oral isotretinoin issues?

I just completed a 28-day course of oral isotretinoin, taking one 20mg capsule daily.
However, I finished the 28th capsule and, due to scheduling conflicts, I delayed getting my next prescription for a week.
Should I restart the treatment and recalculate the dosage, or can I continue without any issues? Also, will taking one capsule daily provide an adequate cumulative dose? Thank you for your response, and I appreciate the hard work of all the doctors.

Sun Wen, 10~19 year old female. Ask Date: 2017/01/03

Dr. Wu Yuxin reply Dermatology

It depends on the severity; if it's not severe, the impact won't be significant.
However, you should consult your attending physician about this issue, as they are the most familiar with your condition.

Reply Date: 2017/01/03

More Info

When it comes to the use of oral isotretinoin (commonly known as Accutane), it is essential to adhere to the prescribed regimen to achieve the best results in treating severe acne. Your question about what to do after a break in treatment is quite common among patients undergoing this therapy.

Firstly, it is important to understand that isotretinoin works by reducing the size and activity of sebaceous (oil) glands, decreasing sebum production, and promoting the turnover of skin cells. The treatment typically lasts for several months, and the total cumulative dose is a critical factor in determining the effectiveness of the therapy. The standard cumulative dose recommended for most patients is around 120-150 mg/kg of body weight, which can vary based on individual circumstances.

In your case, you mentioned that you completed 28 days of treatment at a dose of 20 mg per day. This means you have taken a total of 560 mg of isotretinoin so far. If you have delayed your next refill by a week, it is generally advisable to resume the treatment as soon as you obtain your medication. A short interruption of a week is not likely to significantly impact your overall treatment outcome, especially if you continue with the prescribed dosage thereafter.

However, if you have missed a longer period (more than a week), it is crucial to consult with your prescribing physician. They may recommend adjusting your treatment plan or possibly recalculating your cumulative dose based on the time missed. It is essential to maintain regular follow-ups with your dermatologist, who can monitor your progress and make necessary adjustments to your treatment plan.

Regarding your concern about whether the accumulated dose will be sufficient, it is essential to consider the total duration of treatment and the cumulative dose. If you continue taking 20 mg daily, you will accumulate approximately 140 mg per week. Depending on your target cumulative dose, your dermatologist will guide you on how long you should continue the treatment.
In summary, if you have only missed a week, you can generally resume your isotretinoin treatment at the same dosage without needing to recalculate. However, if you have concerns about the duration of your treatment or the cumulative dose, it is best to discuss these with your healthcare provider. They can provide personalized advice based on your specific situation and ensure that you are on track to achieve the best possible results from your treatment.

Lastly, while on isotretinoin, it is essential to be aware of potential side effects, including dry skin, chapped lips, and increased sensitivity to the sun. Regular monitoring of liver function and lipid levels is also necessary, as isotretinoin can affect these parameters. Always communicate any side effects or concerns with your healthcare provider, as they can help manage these issues effectively.

In conclusion, continue your isotretinoin treatment as prescribed, keep in touch with your dermatologist, and ensure you are following their recommendations closely for the best outcomes in your acne treatment journey.

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