Oral A Acid Dosage Guidance for Acne Treatment: Key Considerations

Medication Consultation

Hello Dr.
Yu-Hsin,
I would like to inquire about my boyfriend, who is currently taking oral isotretinoin at a dosage of 20mg.
If he has been on this dosage for one month, can he switch to 10mg and take two capsules a day next month? His current weight is 60kg.
How long would he need to take the medication to exceed his weight in cumulative dosage? What is the calculation method for this? He visited a dermatologist who mentioned that a six-month course would be sufficient based on his weight.

Yi Dan, 20~29 year old female. Ask Date: 2019/10/24

Dr. Wu Yuxin reply Dermatology

Without actually seeing the lesion, it is impossible to determine the issue.
You should consult your attending physician, as they are the most familiar with your condition.

Reply Date: 2019/10/24

More Info

When it comes to the oral administration of isotretinoin (commonly referred to as A acid) for acne treatment, there are several important considerations regarding dosage, duration, and individual patient factors. Isotretinoin is a powerful medication that is typically prescribed for severe acne that has not responded to other treatments, such as antibiotics or topical therapies.

Dosage Considerations
The standard dosing regimen for isotretinoin is often based on the patient's weight. The typical recommended dose ranges from 0.5 to 1.0 mg/kg/day, depending on the severity of the acne and the patient's response to treatment. For a patient weighing 60 kg, this translates to a daily dose of approximately 30 mg to 60 mg.
In your boyfriend's case, if he has been taking 20 mg daily for a month, he is currently below the recommended dosage for his weight. If he wishes to switch to 10 mg capsules, he could take two capsules daily to achieve a total of 20 mg. However, this is still below the optimal dosing range for his weight.

Duration of Treatment
The duration of treatment with isotretinoin can vary widely among individuals. A typical course lasts about 4 to 6 months, but this can be adjusted based on the patient's response and any side effects experienced. The goal is to reach a cumulative dose of approximately 120-150 mg/kg over the course of treatment.
To calculate how long your boyfriend would need to take isotretinoin to exceed this cumulative dose, you would first need to determine the total dose he has received so far. For example, if he continues at 20 mg daily for one month, he would have taken approximately 600 mg (20 mg x 30 days). If he maintains this dose, he would need to continue treatment until he reaches the cumulative target based on his weight.

Side Effects and Monitoring
Isotretinoin can cause a range of side effects, including dry skin, chapped lips, and potential mood changes. Regular follow-up appointments with a dermatologist are essential to monitor for side effects and assess the effectiveness of the treatment. Blood tests may also be required to check liver function and lipid levels, as isotretinoin can affect these parameters.

Conclusion
In summary, your boyfriend should ideally be taking a dosage that aligns more closely with his weight to achieve optimal results. If he is considering reducing his dosage to 10 mg twice daily, this would still be below the recommended range for his weight, and he may not achieve the desired results as quickly. It is crucial that he consults with his dermatologist to discuss his treatment plan, including any adjustments to his dosage and the duration of treatment. The dermatologist can provide personalized guidance based on his specific condition and response to the medication.
In addition, if he has concerns about the duration of treatment or the potential for acne recurrence after stopping isotretinoin, these are important topics to address with his healthcare provider. The goal is to ensure that he receives the most effective treatment while minimizing the risk of side effects and recurrence of acne.

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