Is It Safe to Continue A Acid Treatment with High Cholesterol?

A acid?

Hello...
I have a question.
About a year ago, I suddenly started breaking out with acne.
I have seen both traditional Chinese medicine and Western medicine.
Recently, I began treatment with isotretinoin as recommended by my doctor.
I weigh 50 kg, and the doctor said I need to take two 20 mg capsules a day.
However, I found online that most people take only one capsule a day.
I had blood drawn yesterday, and my liver enzymes and triglycerides are normal, but my cholesterol is at 214.
Can I continue taking isotretinoin? Should I just take one capsule instead? One capsule costs 120, so taking two would be 240 a day...
Does it really have to be that expensive? Would it be cheaper at a large hospital?

Jun, 20~29 year old female. Ask Date: 2008/01/20

Dr. Jiang Zheen reply Dermatology

The maximum oral dosage of vitamin A acid is 1 mg per kilogram of body weight, but in general clinical use, a daily dose of 20 mg to 40 mg is quite effective.
It tends to increase triglyceride levels, so it's best to check them every 1 to 2 months for safety.
In my personal experience, a dose of 20 mg is sufficient.
In our hospital, a 10 mg capsule costs 45.5 NTD, and you should be able to obtain it at a public hospital for a lower price.
Wishing you peace, and Jesus loves you.

Reply Date: 2008/01/20

More Info

When considering the continuation of isotretinoin (commonly referred to as A acid) treatment in the context of elevated cholesterol levels, it is essential to understand both the medication's effects and the implications of high cholesterol. Isotretinoin is a powerful medication primarily used to treat severe acne, particularly nodular acne that has not responded to other treatments. While it can be highly effective, it also comes with a range of potential side effects, including impacts on lipid levels, particularly triglycerides and cholesterol.

Firstly, isotretinoin is known to cause an increase in triglycerides and cholesterol levels in some patients. The degree of this increase can vary significantly from person to person. In your case, with a cholesterol level of 214 mg/dL, it is important to assess whether this level poses a risk for cardiovascular issues, especially if there are other risk factors present, such as family history, smoking, or obesity. Generally, a total cholesterol level below 200 mg/dL is considered desirable, while levels between 200-239 mg/dL are borderline high, and levels above 240 mg/dL are high.

Given your cholesterol level, it is advisable to consult with your healthcare provider before continuing isotretinoin. They may recommend monitoring your lipid levels more closely during treatment or adjusting your dosage. The standard starting dose of isotretinoin is often 0.5 to 1.0 mg/kg/day, and while some patients may require higher doses, it is crucial to tailor the treatment to your specific needs and health status. If your doctor has prescribed two 20 mg capsules daily, this may be appropriate based on your weight and the severity of your acne, but it is worth discussing whether a lower dose could still be effective while minimizing the risk of elevating your cholesterol further.

Additionally, regarding the cost of isotretinoin, prices can vary significantly between different pharmacies and healthcare facilities. It is often more economical to obtain medications from larger hospitals or through patient assistance programs. Some insurance plans may also cover part of the cost, so it is advisable to check with your insurance provider regarding coverage for isotretinoin.

In summary, while it may be possible to continue isotretinoin treatment with a cholesterol level of 214 mg/dL, it is essential to do so under the guidance of your healthcare provider. They can help monitor your cholesterol levels and make necessary adjustments to your treatment plan to ensure both the effectiveness of the acne treatment and the safety of your overall health. Regular follow-ups and blood tests are crucial during isotretinoin therapy to manage any potential side effects effectively.

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