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Isotretinoin Brand Names
Absorica | Absorica LD | Accutane | Amnesteem | Claravis
What is Isotretinoin
Isotretinoin is an oral retinoid indicated for the treatment of severe recalcitrant nodular acne in non-pregnant patients 12 years and older with multiple inflammatory nodules with a diameter of at least 5 mm.
Due to significant adverse effects associated with its use, isotretinoin should be reserved for the treatment of patients with severe nodular acne that is unresponsive to conventional therapy, including antibiotics.
It has also been used in the symptomatic management of keratinization disorders such as lamellar ichthyosis, keratosis follicularis, and pityriasis rubra pilaris. Isotretinoin and PUVA (psoralen and UVA light) may be as effective as etretinate and PUVA for the management of severe psoriasis.
The antineoplastic effects of isotretinoin may be beneficial in the treatment and prevention of basal cell and squamous cell skin cancer, cervical cancer, head and neck cancer, lung cancer, or prostate cancer.
Isotretinoin is the synthetic 13-cis isomer of the naturally occurring tretinoin (trans-retinoic acid). Isotretinoin is associated with an increased risk of teratogenicity; therefore, the drug is only available through the isotretinoin iPLEDGE REMs program.
Prescribers, patients, pharmacies, prescribers, and distributors must be registered in the iPLEDGE program.
Female patients of reproductive potential have more restrictive requirements than males or females who cannot get pregnant, including the need for pregnancy tests before the use of the drug and monthly during treatment. For more information see www.ipledgeprogram.com.
Indications
- acne vulgaris
- cervical cancer
- chronic myelogenous leukemia (CML)
- cystic acne
- head and neck cancer
- ichthyosis
- keratosis follicularis
- neuroblastoma
- pityriasis rubra pilaris
- squamous cell skin carcinoma
For the treatment of severe recalcitrant cystic acne vulgaris (nodular acne) in patients with multiple inflammatory nodules with a diameter of at least 5 mm
Side Effects
- abdominal pain
- acneiform rash
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anemia
- anxiety
- arthralgia
- back pain
- blurred vision
- bone fractures
- bronchospasm
- cataracts
- cheilitis
- chest pain (unspecified)
- colitis
- conjunctival hyperemia
- conjunctivitis
- constipation
- contact dermatitis
- corneal opacification
- depression
- diabetes mellitus
- diarrhea
- diplopia
- dizziness
- drowsiness
- edema
- elevated hepatic enzymes
- emotional lability
- epiphyseal closure
- epistaxis
- erythema
- erythema multiforme
- esophageal ulceration
- esophagitis
- euphoria
- fatigue
- fetal death
- flushing
- gingivitis
- glomerulonephritis
- hallucinations
- headache
- hearing loss
- hematoma
- hematuria
- hepatitis
- hirsutism
- hypercholesterolemia
- hyperglycemia
- hyperhidrosis
- hyperostosis
- hypertriglyceridemia
- hyperuricemia
- ileus
- impaired wound healing
- impotence (erectile dysfunction)
- increased intracranial pressure
- infection
- inflammatory bowel disease
- insomnia
- keratitis
- lacrimation
- lethargy
- libido decrease
- lymphadenopathy
- malaise
- menstrual irregularity
- musculoskeletal pain
- myalgia
- nasal dryness
- nausea
- neutropenia
- night blindness
- ocular irritation
- ocular pruritus
- optic neuritis
- osteopenia
- osteoporosis
- palpitations
- pancreatitis
- paresthesias
- pharyngitis
- photophobia
- photosensitivity
- proteinuria
- pruritus
- pseudotumor cerebri
- psychosis
- purpura
- pyuria
- rash
- retinal hemorrhage
- rhabdomyolysis
- seborrhea
- seizures
- sinus tachycardia
- skin hyperpigmentation
- skin hypopigmentation
- spontaneous fetal abortion
- Stevens-Johnson syndrome
- stroke
- suicidal ideation
- syncope
- teratogenesis
- thrombocytopenia
- thrombocytosis
- tinnitus
- toxic epidermal necrolysis
- urticaria
- vasculitis
- visual impairment
- vomiting
- weakness
- weight loss
- xerophthalmia
- xerosis
- xerostomia
Monitoring Parameters
- CBC
- LFTs
- ophthalmologic exam
- pregnancy testing
- serum electrolytes
- serum lipid profile
Contraindications
- agranulocytosis
- alcoholism
- anorexia nervosa
- blood donation
- breast-feeding
- children
- contact lenses
- contraception requirements
- corticosteroid therapy
- depression
- diabetes mellitus
- driving or operating machinery
- hearing impairment
- hepatic disease
- hepatitis
- hypercholesterolemia
- hyperlipidemia
- hyperostosis
- hypertriglyceridemia
- infants
- inflammatory bowel disease
- leukopenia
- neonates
- neutropenia
- obesity
- osteomalacia
- osteoporosis
- pancreatitis
- papilledema
- paraben hypersensitivity
- pregnancy
- pregnancy testing
- psychosis
- reproductive risk
- retinoid hypersensitivity
- suicidal ideation
- sunlight (UV) exposure
- visual disturbance
Interactions
- Adapalene; Benzoyl Peroxide
- Azelastine; Fluticasone
- Beclomethasone
- Benzoyl Peroxide
- Benzoyl Peroxide; Clindamycin
- Benzoyl Peroxide; Erythromycin
- Benzoyl Peroxide; Sulfur
- Betamethasone
- Budesonide
- Budesonide; Formoterol
- Cholestyramine
- Ciclesonide
- Colestipol
- Conjugated Estrogens; Medroxyprogesterone
- Corticosteroids
- Cortisone
- Deflazacort
- Dexamethasone
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Elagolix; Estradiol; Norethindrone acetate
- Eravacycline
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Fludrocortisone
- Flunisolide
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosphenytoin
- Hydrocortisone
- Leuprolide; Norethindrone
- Levomefolate
- Levonorgestrel
- Lomitapide
- Medroxyprogesterone
- Mestranol; Norethindrone
- Methotrexate
- Methoxsalen
- Methylprednisolone
- Mipomersen
- Mometasone
- Norethindrone
- Norgestrel
- Orlistat
- Phenytoin
- Porfimer
- Prednisolone
- Prednisone
- Salicylic Acid
- Segesterone Acetate; Ethinyl Estradiol
- Sodium Thiosulfate; Salicylic Acid
- St. John’s Wort, Hypericum perforatum
- Tetracyclines
- Triamcinolone
- Verteporfin
- Warfarin
