Isotretinoin

In Aotearoa New Zealand isotretinoin is available as capsules in different strengths (5 mg, 10 mg and 20 mg).

• The usual dose of isotretinoin is 10 mg or 20 mg once a day until your acne has cleared (usually 3 to 5 months but it can take up to 18 months).
• Your healthcare provider will then reduce your dose for a further 2 to 4 months to avoid the acne coming back and scarring. 
• Always take your isotretinoin exactly as your healthcare provider has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

• Timing: Take isotretinoin once a day, at about the same time each day. Isotretinoin is best taken with or just after food. Swallow the capsules whole with a glass of water. Don't split or chew them.
• Missed dose: If you forget to take your dose, take it as soon as you remember. But, if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.

Don't take isotretinoin if you're pregnant, or there's a chance you could become pregnant.

• Before you start treatment, your healthcare provider may arrange a pregnancy test to make sure you're not pregnant.
• If you're sexually active, ask your healthcare provider about reliable contraceptive options. You must use reliable birth control for at least 1 month before you start isotretinoin, while you're taking isotretinoin and for at least 1 month after you finish taking it. Read more about methods of contraception.
• You may be asked to sign a consent form to make sure you have understood the seriousness of this, eg, Isotretinoin consent form(external link).
• Note: No contraceptive precautions are required for males who are taking isotretinoin; birth defects have not been identified in children fathered by men who have taken isotretinoin.

Dry skin, lips, nostrils and eyes

Because isotretinoin reduces oil production in the skin, it can cause dry skin, dry mouth, chapped lips, dry nostrils and dry eyes. These effects can be uncomfortable. Here are some tips to manage them, but if you have any questions, ask your healthcare provider or pharmacist for advice.

• Lips: From the start of treatment, use an emollient lip balm that has a sunscreen. It's important to apply the lip balm often during the day, such as in the morning as soon as you wake up, after any food, snack or drink, last thing at night and any other time in between that your lips become dry.
• Skin: From the start of treatment, use a non-perfumed moisturizing cream. Use non-soap cleansers, as these are less likely to irritate the skin, compared with a soap cleanser. Avoid beauty treatments such as chemical peels, dermabrasion and waxing during treatment and for at least 6 months after stopping.
• Eyes: Your eyes may become dry and itchy, especially if you wear contact lenses. Ask your pharmacist to recommend a suitable eye lubricant (also called artificial tears). Read more about eye lubricants. While you're taking isotretinoin, you may need to wear glasses instead of contact lenses.
• Nostrils: The inside of the nostrils may become dry and crusted and lead to mild nose bleeds. Applying a thin layer of petroleum jelly gently to the inside of your nose may help.

Increased sensitivity to the sun

Isotretinoin can make you more sensitive to the sun and your skin is more likely to burn.

• Avoid unnecessary sun exposure.
• When you're outside, protect your skin by using an oil-free sunscreen (SPF50+). Apply the sunscreen to all areas especially the face, neck and ears. Read more about using sunscreen.
• Wear clothing that protects you from the sun.
• Wear sunglasses when outdoors.

Avoid waxing for hair removal

Waxing can cause permanent scars in people taking isotretinoin. To avoid scarring, you mustn't wax while taking isotretinoin and for 6 months after you stop taking isotretinoin. This applies to hot wax and cold wax.

Changes in mood and behaviour

There have been reports of depression, low mood and behaviour changes from some people taking isotretinoin, although it hasn't been confirmed that isotretinoin was the cause. Special care is needed if you have a history of depression. Contact your healthcare provider immediately if you experience any changes in your mood, become withdrawn, have distressing thoughts, or feelings about suicide or harming yourself, or you're feeling sad, anxious, worthless or hopeless.

Night vision may be affected

Night vision may be affected by isotretinoin. Good night vision is important for airline pilots and those flying after dark. Pilots taking isotretinoin or considering a course of isotretinoin must report it to their national aviation authority to discuss how this treatment affects their flying privileges.

In Aotearoa New Zealand, this is the Civil Aviation Authority of New Zealand(external link) (CAA). Civil aviation licence holders, including Air Traffic Controllers, need to tell the CAA they're taking isotretinoin as this may affect flight safety. CAA considers the use of isotretinoin to be a change in medical condition.

Other things to know:

• Breastfeeding: Don't take isotretinoin if you're breastfeeding.
• Blood donation: Don't donate blood while taking isotretinoin and for 4 weeks after treatment has finished. This is in case the blood is used for a pregnant woman.
• Other medicines: Isotretinoin interacts with some medicines such as some antibiotics and vitamin A products (including multivitamins), herbal supplements and rongoā Māori. Check with your healthcare provider or pharmacist before starting isotretinoin and before starting any new products.

Like all medicines, isotretinoin can cause side effects, although not everyone gets them. If you're concerned about any symptoms you think might be related to your medicine, talk to your healthcare provider. The following information offers some guidance but doesn't include all possible side effects.

Common side effects

Tell your healthcare provider if these side effects bother you:

• Dry skin, lips, eyes and nostrils. Blurry vision, especially at night. Increased skin sensitivity to the sun, and in general. Read more about these in the section ‘What to know while you are taking isotretinoin’ above.
• Itchy skin.
• Hair thinning or loss.
• Nail problems.
• Headache.
• Feeling tired.
• Muscle aches.

 
Tell your healthcare provider immediately or phone Healthline free on 0800 611 116 if these occur

• Mood changes, anxiety, depression or worsening depression, low mood, aggressive tendencies, thoughts or talk of suicide and self-harm.
• Severe headache, blurred or changes in vision, pounding in one or both ears.
• Signs of problems with your liver, such as pains in your stomach, loss of appetite or yellowing of your skin and eyes.
• Severe diarrhoea (runny poo), especially if it contains blood.
• Bone pain, morning stiffness and reduced range of motion.

Read more about medicines and side effects and reporting a reaction you think might be a side effect.