Isotretinoin (Roaccutane)

We look at everything you need to know if you’ve been prescribed isotretinoin, a vitamin A derivative for severe acne, or the branded version Roaccutane

What is isotretinoin used for?

• Severe acne.

Isotretinoin (brand name Roaccutane) can have serious side effects and its use must be supervised by a dermatologist. It’s reserved for treating severe acne (such as nodular or conglobate acne or acne at risk of permanent scarring) that hasn’t improved with standard treatment involving oral antibiotics and topical medicines.

How does isotretinoin work?

Isotretinoin belongs to a group of medicines known as retinoids, which are derivatives of vitamin A. Isotretinoin taken by mouth works by reducing the production of the skin’s natural oil (sebum).

Acne occurs due to an excessive production of sebum from over-active sebaceous glands in the skin. The sebum blocks the sebaceous glands, which prevents the oil from flowing freely out and causes an accumulation of sebum under the skin. The bacteria associated with acne thrive in these conditions. They feed on the sebum, and produce waste products and fatty acids that irritate the sebaceous glands, making them inflamed and causing spots.

Isotretinoin decreases the size and activity of the sebaceous glands in the skin, which reduces the amount of sebum that is produced. This stops the glands becoming blocked, and means bacteria are less likely to thrive. It also reduces the inflammation in the skin.

How long does isotretinoin take to work?

Your acne may get worse when you first start taking isotretinoin, but this usually improves within 7 to 10 days of continued treatment. In most cases, complete or near-complete clearing of acne is achieved with a 16 to 24 week course of treatment, and you’re then likely to remain free of acne for a long time. Repeat courses are not normally recommended, unless a definite relapse is seen after treatment is stopped. Repeat courses should not be started until at least eight weeks after stopping treatment, as your acne may still improve in this time.

How do I take isotretinoin?

• The isotretinoin dose prescribed and how often to take it varies from person to person. Always follow the instructions given by your doctor. These will be printed on the dispensing label that your pharmacist has put on the medicine.
• Isotretinoin capsules are usually taken once or twice a day. The capsules should be swallowed whole with a drink, either with or just after food (on a full stomach).
• If you forget to take a dose take it as soon as you remember, unless it’s nearly time for your next dose. In this case just leave out the missed dose and take your next dose as usual when it’s due. Do not take a double dose to make up for a missed dose.