Oral Isotretinoin: Side Effects, Resistance, and Costs

Oral isotretinoin

I would like to ask about the side effects and long-term consequences of oral isotretinoin used in dermatology.
Is there a possibility of developing resistance? Also, what is the reasonable price range for a single oral isotretinoin capsule currently?

Iven, 20~29 year old female. Ask Date: 2004/01/15

Dr. Hou Fangmin reply Pharmacology

For patients with severe cystic acne who do not respond to traditional treatments, isotretinoin (Roaccutane) can effectively treat the condition.
It is suitable for patients with severe cases and can help regulate the growth and differentiation of epidermal skin cells.
The oral dosage of isotretinoin is 10 mg per capsule, costing NT$41.
Dosage should be adjusted according to the patient's weight.
The initial treatment dose is 0.5 mg/kg per day; after four weeks, it can be adjusted to 0.5 to 1.0 mg/kg based on individual needs.
The maximum daily dose is 1 mg/kg, but such high doses should not be used for extended periods.
Each treatment course lasts approximately 16 weeks, with at least an 8-week interval before starting the next course.
Common side effects of this medication include mucosal dryness, similar to symptoms of hypervitaminosis A.
Applying lip balm can alleviate symptoms on the lips.
Nasal mucosal dryness may lead to hoarseness, while ocular dryness can cause conjunctivitis and reversible corneal opacities, which can be relieved with mild eye ointments; it is advisable to wear regular glasses during treatment.
Other side effects include photophobia and decreased night vision.
Liver function tests should be conducted one month before and after treatment.
Patients should avoid sun exposure or ultraviolet radiation therapy while on this medication and may only use mild topical agents as adjunctive therapy.
There is a high risk of teratogenicity associated with isotretinoin; therefore, it is contraindicated for pregnant women, women who may become pregnant during treatment (women of childbearing age), and breastfeeding mothers.
The most severe side effect of isotretinoin is fetal malformation.
Patients must strictly follow their physician's instructions regarding medication use.

Reply Date: 2004/01/15

More Info

Oral isotretinoin, commonly known as Accutane, is a powerful medication primarily used to treat severe acne that has not responded to other treatments. While it can be highly effective, it also comes with a range of potential side effects and considerations regarding resistance and cost.

Side Effects of Oral Isotretinoin
The side effects of isotretinoin can be significant and vary from mild to severe. Common side effects include:
1. Dryness: One of the most common side effects is dryness of the skin, lips, and mucous membranes. Patients often experience chapped lips and dry eyes, which can be uncomfortable.

2. Photosensitivity: Isotretinoin can make the skin more sensitive to sunlight, increasing the risk of sunburn. Patients are advised to use sunscreen and wear protective clothing when outdoors.

3. Mood Changes: Some patients report mood swings, depression, or anxiety while on isotretinoin. Although a direct causal relationship has not been definitively established, it is essential for patients to be monitored for any psychological changes.

4. Liver Function: Isotretinoin can affect liver function, leading to elevated liver enzymes. Regular blood tests are necessary to monitor liver health during treatment.

5. Cholesterol Levels: The medication can also increase triglyceride levels, which may require dietary changes or additional medication to manage.

6. Birth Defects: Isotretinoin is highly teratogenic, meaning it can cause severe birth defects if taken during pregnancy. Women of childbearing age must use effective contraception and undergo regular pregnancy tests before and during treatment.

7. Other Effects: Less common side effects include joint and muscle pain, headaches, and potential issues with vision.

Resistance to Isotretinoin
Unlike antibiotics, isotretinoin does not typically lead to bacterial resistance. It works by reducing the size and activity of sebaceous glands, decreasing sebum production, and promoting skin cell turnover. However, some patients may experience a recurrence of acne after completing treatment. This is not due to resistance but rather the underlying factors that contribute to acne, such as hormonal changes or genetic predisposition.

Cost of Oral Isotretinoin
The cost of isotretinoin can vary widely based on factors such as the pharmacy, insurance coverage, and the specific formulation prescribed. On average, the price for a month’s supply of isotretinoin can range from $100 to $300 without insurance. Generic versions may be available at a lower cost, and some patients may qualify for patient assistance programs through pharmaceutical companies to help offset expenses.

Conclusion
Oral isotretinoin can be a highly effective treatment for severe acne, but it is essential to be aware of its potential side effects and the importance of monitoring during treatment. Patients should have open discussions with their healthcare providers about any concerns, including mood changes and physical side effects. Regular follow-ups and blood tests are crucial to ensure safety while on this medication. Additionally, understanding the financial implications and exploring options for cost reduction can help make treatment more accessible. Always consult with a dermatologist for personalized advice and management strategies tailored to individual needs.

Similar Q&A

Is Oral A Acid Effective for Skin Issues? Dosage and Side Effects Explained

Is oral acyclovir really effective? How much does it cost? Are there any side effects? Thank you.

Dr. Jiang Zheen reply Dermatology
Oral isotretinoin is a highly effective medication, with a cost of 40 NTD for a 10 mg capsule. Side effects include increased dryness of the skin, particularly in mucous membrane areas. It is important to avoid pregnancy while taking the medication and for three months after disc...

Can Taking Mycoterk with Oral A-Retinoids Affect Acne Treatment?

I have previously had issues with acne and have been taking oral isotretinoin. Currently, I am taking one 20mg capsule of oral isotretinoin per week. Will taking Terbinafine, which is used to treat nail fungus, affect my treatment?

Dr. Wu Yuxin reply Dermatology
test awaiting response

Managing Acne and Skin Sensitivity: The Role of Oral A-Retinoids

Hello, Doctor. Since middle school, I have been experiencing acne in the T-zone. Initially, I was treated with antibiotics, but my condition fluctuated. Later, I saw some improvement with glycolic acid peels and mandelic acid treatments, but I still continued to get acne. I am un...

Dr. Wu Yuxin reply Dermatology
Your concerns need to be assessed in person to confirm the skin condition. Sometimes, it may not be a single issue but rather a combination of factors. It is recommended to consult a nearby dermatologist.

Effects of Oral Accutane on Sun Exposure During Treatment

Hello, doctor. I recently started taking oral isotretinoin. During the treatment period, I will be going through military service. I would like to know what effects sun exposure may have while taking oral isotretinoin.

Dr. Wu Yuxin reply Dermatology
You should consult the physician who prescribed your medication regarding this issue.