Meds and you

27 September 2013

Isotretinoin (oral)

Isotretinoin is a retinoid. Retinoids are drugs that are derived from vitamin A. On the skin it acts to cause a reduction of natural skin oil.


Isotretinoin is the active ingredient of Oratane capsules (Nappi code: 701469-001, 701471-001) & Roaccutane capsules (Nappi code: 761125-019, 761133-003).

General information
Isotretinoin is a retinoid. Retinoids are drugs that are derived from vitamin A. On the skin it acts to cause a reduction of natural skin oil, thereby assisting in the treatment of acne.

In South Africa isotretinoin is registered for the treatment of severe acne that is resistant to conventional therapy, which includes treatment with antibiotics.

In some patients acne may worsen during the first few weeks of treatment with this medication. This, together with symptoms such as very dry, flaky and itchy skin, usually improves as treatment continues.

It is advised that your doctor evaluate your liver function prior to treatment, one month after the start of treatment, and as deemed appropriate during treatment.

Severe caution is advised to prevent falling pregnant while taking this medication as this group of drugs can cause abnormalities in the foetus. Isotretinoin should not be used in women of childbearing age, unless they are using effective contraception as precaution. Contraceptive measures should be started 1 month prior to therapy, and should be continued for at least 1 month after stopping treatment.

Excessive exposure to sunlight, sunbeds or skin irritants should be avoided to prevent damage to the skin. Should sunburn occur, treatment should be stopped until the skin has recovered.

You should furthermore not donate blood for at least one month after stopping treatment.

For this medication to be effective, it has to be taken regularly, even if you do not notice an immediate effect.

Tell your doctor about all other medicines you are taking, including prescription and non-prescription medicines, vitamins and herbal supplements.

How does isotretinoin work?
Isotretinoin reduces the production of sebum, the oily substance produced by sebaceous glands in the skin. This causes drying and peeling of the skin, making it useful in treating acne. It is also believed to have a mild anti-inflammatory and antibacterial activity.

Fast facts

Drug schedule: schedule 5
Available as: isotretinoin is available as capsules.
What does it do? Isotretinoin is used to treat acne that is unresponsive to conventional therapy.
Overdose risk: medium
Dependence risk: low
Is isotretinoin available as a generic? yes
Is Isotretinoin available on prescription only? yes

User information

Onset of effect: the full effect of this drug may only be seen after 2 - 6 weeks.
Duration of action: after the drug is stopped, effects on the skin may still be visible for a couple of weeks after stopping treatment.
Dietary advice:v this medication should best be taken with food.
Stopping this medicine: this drug can be safely stopped when it is no longer needed. Premature stoppage may cause a return of initial symptoms. The best results are obtained when the full course is completed.
Prolonged use: prolonged use may lead to increased side effects which may include heart and blood vessel disease, and potential bone density changes. Liver function tests every 3 months are advised.

Special precautions
Consult your doctor before using this drug if:

  • you have kidney or liver disease
  • you have high levels of blood cholesterol
  • you are pregnant or intend to fall pregnant
  • you have diabetes
  • you have a history of depression
  • you have gout
  • you have pancreatitis
  • you wear contact lenses
  • you are taking other medication

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.
Porphyria: avoid. This medication may cause serious adverse effects. Consult your doctor before use.
Infants and children: this medication is not intended for use in children.
The elderly: caution is advised in the elderly as side effects are more likely to occur.
Driving and hazardous work: this medication may affect your vision, and should be used with caution until you know how it affects you.
Alcohol: avoid concomitant use of alcohol with this medication.

Possible side effects

Side Effect
Consult your doctor

Only if severe
In all cases
dry mucous membranes


dry lips


dry eyes




nose bleeds


joint pain


muscle pain




hair loss




impaired vision


abdominal pain




mood changes


suicidal ideation




Drug interactions

vitamin a risk of vitamin A toxicity
tetracyclines risk of increased intracranial pressure
preparations that may dry the skin increased risk of skin irritation

Disease interactions
Consult your doctor before using this drug if you have kidney or liver disease, high levels of blood fat, you are pregnant, you have diabetes, a history of depression, gout or if you have pancreatitis.

Overdose action
A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage
Adults, oral: 0.5 -20mg/kg/day

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.


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