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Isotretinoin is an oral retinoid used to treat severe forms of acne and acne that has failed to respond to various other treatments. It is available under various trade and generic names, including Accutane, Oratane and other formulations supplied by multiple manufacturers.

Typical capsule strengths commonly dispensed are 5 mg, 10 mg, 20 mg, 30 mg and 40 mg. This medicine acts systemically and is reserved for nodulocystic acne or persistent inflammatory disease after standard therapies have not worked.

Use the navigation links to jump quickly to information on Adverse effects or peruse Other possible therapies.

Before kicking off isotretinoin - what to tell your prescriber

Before a prescription is issued, give your clinician a full medical and medication history so they can plan suitable tracking and monitoring of performance and risk reduction steps. Key issues to disclose include:

  • Current pregnancy, planning pregnancy soon, or breastfeeding status.
  • Personal or family history of mental health conditions, including depression, psychosis or previous self harm.
  • Existing liver disease or previous abnormal liver blood tests.
  • High blood lipids such as elevated triglycerides or a history of pancreatitis.
  • Bone or joint problems, or concerns regarding long term bone health.
  • Chronic bowel symptoms or a diagnosis of inflammatory bowel disease.
  • Diabetes, prediabetes or glucose intolerance.
  • Diseases affecting the cardiovascular system or other significant medical conditions.
  • Allergies to isotretinoin, related retinoids, vitamin A or any capsule ingredient.

If anything is unclear, ask your prescriber to explain. For requirements about pregnancy testing and contraception see Entry allowed by law & PBS.

Steps to take isotretinoin

Swallow the capsules whole with a glass of water. Taking the dose with a meal or with food increases absorption and may reduce stomach upset. Try to take it at a similar time each day for consistency.

Do not chew, open or crush the capsules. Follow the exact dosing schedule prescribed by your clinician and do not alter the dose without clinical advice. For adolescents, clinicians may initiate treatment when clinically appropriate and will typically arrange closer continuous monitoring.

If an a drug overdose is suspected, contact the Poisons Information Centre in Australia on 13 11 26 or attend the nearest emergency department immediately.

Advice for when you miss a dose

If you forget to take your dose, take the a dose was skipped as soon as you remember, unless the next dose is due within about four hours. If the next dose is imminent, omit the a dose was skipped and continue with your usual dosing times. Never double the next dose to make up for a missed one.

Medicines, supplements and foods that can interact

Do not put together.

  • High dose vitamin A supplements or multivitamins with large amounts of vitamin A because of the risk of hypervitaminosis A.

Use this sparingly and with caution. and discuss with your clinician

  • Tetracycline antibiotics (for example doxycycline) - combined use can increase the risk of intracranial hypertension.
  • Corticosteroids with systemic action.
  • Orlistat as a fat absorption blocker and other drugs that markedly change fat absorption, which may alter isotretinoin uptake.
  • Warfarin and other agents that reduce coagulation belong to anticoagulants. - isotretinoin may affect clotting tests and warfarin effect.
  • Some antiepileptic medicines which may interact and need time sensitive monitoring.
  • Topical agents that cause irritation (benzoyl peroxide, salicylic acid) - concurrent use can increase dryness and irritation unless advised by your clinician.
  • Bottle of alcohol - increases liver workload and may raise triglyceride levels; consider reducing alcohol intake while on treatment.
  • Herbal products such as Saint John's wort which can alter the effectiveness of hormonal contraception.

This is not the complete list. Give your healthcare team a complete list of all prescription medicines, over the counter products, vitamins and herbal remedies you use, and disclose alcohol and tobacco use.

Watchfulness, safety measures, and practical guidance

  • Acne can flare temporarily in the first weeks of treatment.
  • Monthly reviews with the prescriber are common to assess responsecould be attainable side effects and for repeat prescriptions.
  • Baseline and periodic blood tests are routine, most often liver function tests and fasting lipid profile.
  • Do not donate blood while taking isotretinoin and for at least 30 days after finishing treatment.
  • Report mood or behavior changes promptly; seek immediate help if you develop severe depression or suicidal thoughts.
  • Night vision or dark adaptation may be affected; if visual symptoms occur avoid driving at night and report them to your clinician.
  • Dry eyes and contact lens discomfort are frequent; lubricating drops can help. Protect your skin from strong sunlight and avoid tanning beds.
  • Avoid procedures that injure the skin surface (waxing, dermabrasion, laser resurfacing) during treatment and for several months afterwards due to increased risk of scarring.
  • If you have diabetes or prediabetes discuss glucose and lipid continuous monitoring since metabolic markers may change on treatment.

For warning signs that require urgent attention see Untoward effects.

Possible effects to watch for

Symptoms that need urgent medical assessment

  • Allergic reactions such as widespread rash, itching, hives, facial or throat swelling, or breathing difficulty.
  • Severe aching head, visual disturbances (blurring or double vision) or loss of night vision that could indicate raised intracranial pressure or other problems.
  • Chest pain, fainting, irregular heartbeat or palpitations.
  • Difficulty hearing or persistent tinnitus..
  • Severe epigastric pain, ongoing vomiting or other signs of pancreatitis.
  • Major changes in mood or behavior including withdrawal, severe depression or thoughts of harming yourself.
  • Very dark urine, yellowing of the skin or eyes, easy bruising or bleeding suggesting liver injury.
  • Marked muscle weakness or severe unexplained muscle or joint pain.
  • Noticeable changes to menstrual patterns.

Common, usually manageable effects

  • Rough, dry lips and dry skin are very common; regular use of moisturizers and lip balm helps.
  • Saliva deficiency and nasal mucosa which can lead to nosebleeds.
  • Mild disabling headaches or temporary increased hair shedding.
  • Increased skin sensitivity and occasional flushing.

If persistent or bothersome undesired effects occur, contact your prescriber to discuss symptom control or dose adjustments. Refer also to Real-time monitoring with Safety guidelines for additional advice.

Data on a computer, there are memory and storage, each with a different role. and retrieval and disposal methods

  • Keep medicines in their original packaging and out of reach of children.
  • Store at room temperature, ideally between 15 and 30 C, away from heat, direct sunlight and moisture.
  • Do not use capsules beyond the expiry date. Ask your pharmacist about safe disposal of unused or expired medicines; do not dispose of them in household waste unless advised.

Alternative and related medicines

If isotretinoin is unsuitable, alternate options depend on acne type and patient factors. Discuss choices with your GP or dermatologist. Other possibilities and adjuncts include:

  • Topical retinoids such as adapalene and tretinoin for comedonal acne and maintenance therapy.
  • Benzoyl peroxide products for antimicrobial and keratolytic effects, often combined with other agents.
  • Oral antibiotics like doxycycline or minocycline for inflammatory acne, typically used for limited durations.
  • Hormonal therapies for appropriate patients, for example combined oral contraceptives or spironolactone to lower androgen driven oil production.
  • Other systemic retinoids such as acitretin which are used for different skin conditions and have different pregnancy constraints.
  • Different brands or generic isotretinoin formulations (for example Roaccutane and other generics) which may vary slightly in price but have similar efficacy.

For a rough cost comparison of these options see Prices shown in AUD.

Indicative australian living costs (AUD)

Prices vary by brand, dose, pharmacy location, PBS eligibility and whether a concession card applies. The figures below are approximate only.

  • Isotretinoin (Accutane, Oratane, generics) - when PBS criteria are satisfied many prescriptions are subsidised. Typical PBS general patient co-payment is around AUD 30 to 32 per script; concession cardholders often pay about AUD 7 to 8. Private prescriptions may range roughly from AUD 60 to AUD 120 per month depending on dose and manufacturer.
  • Doxycycline - commonly PBS listed; private price usually about AUD 10 to 25 per month.
  • Topical adapalene or tretinoin - retail tubes usually cost between AUD 25 and AUD 60.
  • Benzoyl peroxide preparations - typical retail cost about AUD 8 to 25 depending on size and concentration.
  • Combined oral contraceptives - monthly cost varies from about AUD 10 to 30 depending on brand and PBS status.
  • Spironolactone - typical monthly cost approximately AUD 10 to 20 for commonly used doses.

Prices and subsidy rules change. Ask your pharmacist for current comparisons between brands and generics and confirm the findings the PBS website for the latest subsidy that information.

Additional aspects about Accutane