Can Oral Isotretinoin and Hepatitis Medication Be Taken Together?

Can oral isotretinoin be taken together with liver protective medications?

Hello, Pharmacist Hou:
I am currently taking two medications, oral isotretinoin and Liv52, for a long-term condition (I am a hepatitis carrier, and my liver enzyme levels are around 100, indicating inflammation).
The doctor who prescribed Liv52 strictly prohibited me from taking isotretinoin in the future, but I find that if I don’t take isotretinoin, my acne does not improve, so I have been taking it secretly! I am unsure if there are any interactions between these two medications when taken together.
If they should not be taken simultaneously, are there any alternative options? Currently, my medication schedule is on a three-day cycle as follows:
Day 1: Take Liv52 after each meal
Day 2: Take Liv52 after each meal
Day 3: Take isotretinoin after lunch
Thank you!

Lin Xiansheng, 30~39 year old female. Ask Date: 2014/02/27

Dr. Hou Fangmin reply Pharmacology

Hello Mr.
Lin,
1.
The use of isotretinoin may lead to adverse reactions such as elevated liver transaminases, triglycerides, or cholesterol, as well as potential teratogenic effects.
Liver function should be assessed before treatment and one month after starting therapy, followed by checks every three months.
Isotretinoin is contraindicated in patients with liver dysfunction, hypervitaminosis A, or hyperlipidemia.
2.
According to health insurance regulations, only a dermatologist with the appropriate qualifications can prescribe this medication, and a patient consent form must be submitted.
This consent form includes the requirement that "female patients must use effective contraception for four weeks prior to, during, and for at least four weeks after treatment with oral isotretinoin."
3.
This medication may interact with other drugs and foods, leading to adverse reactions.
Therefore, during treatment, it is advised to avoid concomitant use of tetracycline antibiotics, vitamin A medications, alcoholic beverages, and milk.
The concurrent use of tetracycline antibiotics may cause increased intracranial pressure, with symptoms including severe headache, nausea, vomiting, and visual disturbances.
Co-administration of vitamin A medications may lead to side effects such as transient headache, dizziness, vomiting, facial flushing, abdominal pain, and ataxia due to hypervitaminosis A.
When taken with food or milk, the absorption of isotretinoin may be increased; excessive alcohol consumption may elevate triglyceride levels in the blood.
4.
Therefore, if your liver function is compromised, it is best to avoid this medication.
Acne should ideally be managed by a dermatologist, who can provide appropriate long-term monitoring of liver function.
Is this response satisfactory for you? Wishing you health and happiness.

Reply Date: 2014/02/27

More Info

When considering the simultaneous use of oral isotretinoin and hepatitis medication, it is crucial to understand the potential interactions and the implications for your health, especially given your current liver condition.
Oral isotretinoin is a powerful medication primarily used to treat severe acne. It works by reducing the size and output of sebaceous glands, leading to decreased oil production and, consequently, less acne. However, isotretinoin is known to have significant side effects, particularly on the liver. It can elevate liver enzymes and cause lipid abnormalities, which is a concern for anyone with pre-existing liver conditions, such as hepatitis.

On the other hand, hepatitis medications, depending on the specific type (e.g., antiviral medications for hepatitis B or C), are designed to manage liver inflammation and viral load. These medications can also have their own side effects and may interact with other drugs, including isotretinoin.

Given your situation—being a hepatitis carrier with elevated liver enzymes—your doctor’s advice to avoid isotretinoin is very important. The combination of these two medications could potentially exacerbate liver issues, leading to further complications. The liver is responsible for metabolizing many drugs, and introducing isotretinoin could increase the burden on your liver, potentially leading to elevated liver enzymes and worsening inflammation.

If you are experiencing severe acne and feel that isotretinoin is necessary, it is essential to discuss this with your healthcare provider. They may consider alternative acne treatments that are safer for your liver condition. Options may include topical treatments, antibiotics, or other systemic therapies that do not carry the same risk as isotretinoin.

Moreover, if you are determined to continue with isotretinoin, your healthcare provider may suggest close monitoring of your liver function tests (LFTs) to ensure that any adverse effects are caught early. This would typically involve regular blood tests to check your liver enzymes and overall liver health.

In summary, while there may not be a direct drug interaction between oral isotretinoin and hepatitis medications, the potential for increased liver toxicity makes their concurrent use risky, especially in someone with existing liver inflammation. It is crucial to adhere to your doctor’s recommendations and explore safer alternatives for acne treatment. Always consult with your healthcare provider before making any changes to your medication regimen, as they can provide personalized advice based on your health history and current condition.

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