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Accutane

Accutane is a potent medication that is used for [severe] types of acne.  By the time, this medication is used, many other medications such as antibiotics, creams, or other medications have already been used and failed.

Accutane is also known as Isotretinoin and is used to treat severe recalcitrant nodular or cystic Acne.

The primary concern/risk with this medication is the increased risk for serious birth defects (Teratogenicity)  for those who take this medication while pregnant.

There is more than 30% risk for birth defects when taken with women who then become pregnant. There are concerns for absorption through the skin is seen and therefore even handling the medication should be limited by women intending to become pregnant.

Those providers who prescribe this medication must be part of a specific program called iPledge.

iPLEDGE program

–  Women intending to take this medication must attempt at all possible not to become pregnant while taking this medication.
–  Patients taking this medication should not donate blood for at least one month after stopping the medication.

Treatment Options

–  Other than acne – this medication can also be used in the treatment of some cancers.
–  Brain cancer, Pancreatic cancer, and other cancers.
–  It can also be used to treat Harlequin-type ichthyosis.
–  This drug is not intended for every day or simply “bad acne”.

Mechanism of Action

–  This medication is a retinoid and is a derivative of Vitamin A.
–  Mostly unknown
–  The drug may amplify certain proteins in the skin that reduces sebum production
–  It may cause cell death in many cells – especially those that are at the base of causing acne.

What are the Side Effects of Accutane?

There are some potentially dangerous side effects. Close monitoring of symptoms while taking this medication is often highly recommended. It can be so concerning, that some families of patients may be asked not to touch the medication. Often this includes patients that are pregnant or can be pregnant.

Side Effects

–  Severe teratogen – abnormal physiological development of the fetus. [Causes Birth Defects]
–  Dryness of skin, lips, and mucous membranes
–  Itching
–  Hair loss
–  Skin peeling
–  Nose Bleeds
–  Eye irritation
–  Change and/or loss of vision
–  Elevated Liver enzymes
–  Muscle and Joint pains
–  Elevated glucose in the blood
–  Stomach pains
–  Depression
–  Other

Pharmacokinetics

–  When given orally – it is best absorbed after a high-fat meal.
–  It binds to Albumin inside the bloodstream.
–  The metabolites of Isotretinoin are excreted through feces and urine.
–  Half-life is 21 hours.

History of Accutane

–  The Retinoic acid derivative of this medication was first developed in the early 1980s by Hoffmann-La Roche.
–  Dr. Gary Peck is who first discovery of its use in the treatment of acne.
–  February 2002-  Roche’s patents for Isotretinoin expired.
–  There are many companies that now sell Accutane.
–  It can even be found over the internet without a prescription.
–  This is a very concerning development due to the lack of knowledge about the major side effects.