Isotretinoin: What to know before you start

Isotretinoin can permanently clear stubborn, severe acne — but it’s a potent drug with rules. If you’re considering it, you need straightforward facts: how it works, what to watch for, and simple steps to stay safe. This page gives that practical, no-nonsense guide.

How isotretinoin works and who it’s for

Isotretinoin (brand names include Accutane, Roaccutane) is a vitamin A derivative. It shrinks oil glands, cuts oil production, calms inflammation, and helps prevent clogged pores. Dermatologists usually reserve it for severe nodular acne, acne that hasn’t responded to antibiotics, or scarring acne. Typical treatment is one course lasting about 4–6 months. Doses vary by weight, often 0.5–1 mg/kg/day, with a goal cumulative dose around 120–150 mg/kg. Your dermatologist will pick the best plan for you.

Key risks and practical precautions

Teratogenicity is the single biggest risk. Isotretinoin causes severe birth defects. If you can get pregnant, you must follow strict pregnancy prevention: use two reliable forms of contraception or meet your country’s program requirements (in the U.S. that’s iPLEDGE). Expect a pregnancy test before starting and monthly tests during treatment, plus one after stopping. Avoid pregnancy for at least one month after finishing treatment.

Common side effects are predictable and manageable: dry lips (cheilitis), dry skin, nosebleeds, and increased sun sensitivity. Use a thick lip balm, gentle moisturizer, and daily sunscreen. Harsh scrubs and waxing should be avoided because skin becomes fragile and heals slowly.

There are lab risks too. Isotretinoin can raise triglycerides and liver enzymes. Your provider will usually order baseline blood tests (lipids and liver function) and repeat them after a few weeks, then as needed. Also avoid high-dose vitamin A supplements—combining them increases the risk of toxicity.

Cautions with other drugs: don’t take tetracycline antibiotics with isotretinoin (rare but serious risk of raised pressure in the skull). Avoid starting other acne procedures like deep chemical peels or laser resurfacing until your skin has fully recovered.

There’s discussion about mood changes and depression while on isotretinoin. Reports vary. If you or someone close notices sudden mood shifts, suicidal thoughts, or major behavior change, contact your doctor right away.

Practical tips: follow lab and pregnancy testing schedules, keep moisturizers and lip balm handy, use SPF every day, avoid donating blood while on treatment and for one month after stopping, and stay in touch with your dermatologist about any new symptoms. Most people finish a single course and see dramatic improvement. If you have questions, your dermatologist or pharmacist should answer them directly.

If you want more detailed drug info, side-effect management, or links to pregnancy-prevention programs, check trusted medical resources or ask your prescriber. Isotretinoin works, but it demands respect and careful monitoring.