Overview:
Isotretinoin is a useful drug that can help with the treatment of severe acne and its related problems. It was first approved by the FDA (Food and Drug Administration)as an oral formulation in 1982. It was used in patients where the acne was not responding to conventional therapy and antibiotics. The drug has proved to be extremely effective and the best solution for acne treatment over the years.
How Does Isotretinoin Work?
The primary purpose of Isotretinoin is to prevent acne breakouts by decreasing the size of sebaceous glands. Sebaceous glands are the chief glands that help in sebum secretion. Sebum is a combination of fat molecules, which are lipids, that form a protective covering over the surface of the skin. They help to retain moisture by keeping the skin hydrated. It is essential to keep the skin moisturized and fight infections.
Uses:
Isotretinoin is useful in treating cystic or nodular acne and severe recalcitrant nodular acne, which do not respond to other drugs like Benzoyl Peroxide and Clindamycin. The drug belongs to retinoids, which control high amounts of sebum, which causes acne. If left, severe untreated acne causes permanent damage to the skin, resulting in irreversible scars.
Dosage:
Based on the body weight, the doses are determined by the doctor. The commonly available doses are 10 mg and 20 mg. The dose is prescribed for 15 to 20 weeks twice daily to achieve better results. If an individual misses a dose, it is important to take it as soon as possible. However, if it is almost time for the next dose, it is better to follow the regular schedule. Patients should avoid double dosing or overdosing on the drug. The drug is to be stored safely in a closed container. It is safer to keep the drug away from children. Also, constantly check the label to avoid using expired drugs.
Warnings:
Isotretinoin is a teratogenic drug, as it causes birth defects in children. So it is highly recommended to avoid the drug during pregnancy or if an individual plans to become pregnant. It is better to take birth control pills before starting the treatment and after stopping the duration of the treatment for a month to avoid birth defects. It is safe to take a pregnancy test before starting the treatment.
During the treatment, it is safer to avoid vitamins, specifically vitamin A supplements. Consuming vitamin A supplements may increase the risk of side effects. In the first three weeks, the individual may experience severe acne and skin irritation. The skin condition gradually improves after a month. Complete improvement is noticed after stopping the treatment, which may take up to six months. It is better to avoid blood donation to prevent pregnant patients from receiving blood that contains the medicine.
Some patients may experience dry mouth, nose, and skin which is quite common. The doctor may suggest a moisturizer and a lip balm. Some individuals may experience gastric ulcers during drug intake. So, specific drugs to treat the symptoms are prescribed. In addition, the patient experiences photosensitivity. Hence it is extremely important to apply sunscreen with high SPF (Sun Protection Factor) to prevent sun radiation from damaging the skin.
For Patients
What Is Severe Recalcitrant Nodular Acne?
It is a form of acne, which is an inflammatory reaction. It appears as painful lumps on the skin’s surface. If left untreated, the scars can damage the skin. If these scars are infected, they may become pustules. It is better to avoid popping acne to prevent the infection from spreading.
Learn More About Isotretinoin :
When and How Often to Take Isotretinoin?
The drug is preferably taken once or twice a day, depending on the severity of the acne, as prescribed by the doctor. The drug is consumed after food. It is important to drink plenty of water to stay hydrated in the course of treatment, as there is constant dehydration. It is better to take Isotretinoin every day at a particular time to avoid missing the dose and for high efficacy.
How Effective Is Isotretinoin?
Isotretinoin is an extremely effective drug that is used worldwide in the treatment of various forms of acne. The drug is usually taken for a complete cycle of six months to see visible results. During the drug intake, there are higher chances of experiencing discomforts like dizziness, chapped lips, heartburn, and dry skin.
What Are the Things to Inform The Doctor Before They Prescribe Isotretinoin?
It is always important to give a proper drug and medical history before starting any drug to avoid drug interactions. Women who are pregnant or have a possible chance of becoming pregnant should properly inform the doctor to avoid consuming the drug, as it may cause birth defects in children. Also, the drug should be avoided in patients with any previous history of severe allergic reactions.
Starting Isotretinoin :
How to Take Isotretinoin?
The drug is consumed after food once or twice daily. It comes in a capsule form and should be swallowed with water. It is preferably advised not to skip doses for better results. However, in case of missing a dose, taking it as soon as possible is a better solution. In case, it is already time for the next dose, then skipping the dose and following the routine is unavoidable.
Things to Do After Taking Isotretinoin :
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It is important to avoid sunlight as much as possible because the skin is extremely photosensitive during drug intake.
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Keeping the skin moisturized is also important; hence drinking water and applying moisturizer can help to protect the skin and maintain hydration.
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Individuals experiencing chopped lips are advised to apply lip balm frequently to prevent bleeding from the lips.
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Individuals experiencing gastric ulcers can take drugs like Ranitidine a half-an-hour before food, as it forms a protective coating over the mucosa and prevents irritation or burning sensation while swallowing food.
Dietary Alterations:
Unless recommended by the doctor, no specific dietary alterations are recommended, and patients can follow a regular diet. However, avoiding fatty foods like cheese, ghee, and fried items can help reduce excess oil in the body. Also, drinking plenty of water helps to eliminate unnecessary toxins from the body and keeps the cells hydrated.
What Should Be Done When a Dose Is Missed?
Missing a dose can reduce the overall effects of the drugs. In unavoidable cases, the missed dose can be consumed whenever the patient remembers. However, missing doses regularly can affect the outcome of the treatment and also prolongs the treatment duration.
What Should Be Done to Treat Isotretinoin Overdose?
It is very rare to overdose on Isotretinoin; however, in case of overdosing, gastric lavage is given to completely eliminate the drug particles from the body.
How to Store Isotretinoin?
The drug is stored in an air-content container. Avoid exposing the drug to sunlight, as it may lose its efficacy. Also, it is better to store the drug at room temperature.
How to Handle Isotretinoin?
Always wear gloves while taking the medication from the bottle to avoid contamination. Since it is a capsule, the entire drug has to be swallowed after food, as recommended by the doctor.
How to Dispose of Isotretinoin?
Contacting a safe disposal program is the best way to dispose of unused drugs. Do not flush it into the toilet or throw it in the dustbin, as there are chances of pets and others consuming it. Also, to prevent any biohazard waste, it is safe to dispose of the drugs separately.
Avoid Self-Medication:
It is important to avoid self-medication as it may cause unwarranted consequences and affect overall health. It is always safer to consult a doctor and take a few lab tests before proceeding with the treatment as suggested by the doctor.
For Doctors
Indication
The drug is indicated for acne treatment, specifically in patients who do not respond to any other form of skin treatment. The drug has good results for severe recalcitrant nodular acne. The drug is given for two months to six months, depending on the severity of the acne.
Pharmacology
A drug is a form of retinol or vitamin A supplement. It is administered systemically and is an effective acne therapy. The pharmacologic strength varies between 0.5 to 1.0 mg/kg per day.
Mechanism of Action
The drugs alter the lipid composition of the skin by acting on the sebaceous gland and minimizing sebum production. Thereby, the bacterial microflora is drastically reduced.
Absorption
The drug is lipophilic and is best absorbed when consumed with a high-calorie meal. A minimum fat of 50 g per dose is required for drug absorption.
Distribution
The drug is primarily bound to the plasma protein albumin. It is taken orally, and almost three metabolites have been found in human plasma.
Metabolism
The drug is conjugated and excreted via the feces and urine. The half-life of the drug ranges between 7 to 39 hours.
What Are the Warnings and Precautions of Isotretinoin?
The drug has to be avoided in pregnant and breastfeeding mothers as it is teratogenic. It is important to also avoid it in patients with retinol allergy.
Drug Interactions
Serious drug interactions have been noticed in the following drugs,
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Demeclocycline.
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Lymecycline.
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Minocycline.
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Tetracycline.
Other Specifications
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Isotretinoin in Pregnant Women: Isotretinoin is unsafe for pregnant women; hence it has to be strictly avoided during the time of pregnancy. If consumed unknowingly, it may cause birth defects in children.
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Isotretinoin in Lactating Women: Lactating women and breastfeeding mothers should avoid Isotretinoin as it is completely contraindicated.
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Isotretinoin in Pediatric Patients: The exact use of the drug in pediatric patients is yet to be known, as it is usually prescribed only in adolescents. During adolescence, the human body undergoes various alterations and hormonal changes, which causes acne breakouts.
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Isotretinoin in Geriatric Patients: The drug is rarely used in elders above 30 years of age. Usually, with age, the sebaceous glands tend to reduce in size, and there is limited sebum secretion. So, the drug is rarely used in elderly people.
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Isotretinoin in Renal Impairment Patients: The potential risk of the drug in geriatric patients is yet to be known. However, most study reports show very scarce renal symptoms, and hence it can be consumed.
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Isotretinoin in Hepatic Impairment Patients: The risk of drugs in hepatic patients is not known, however, a few studies show potentially low risk and are safe to consume.
