Isotretinoin – What are the indications and contraindications?

October 14, 2020 3:39 am Published by

Isoretinoin (Accutane) is a synthetic retinoid used in the treatment of severe nodular acne not responsive to conventional treatment including systemic antibiotics.

MOA:

  • Reduces sebaceous gland size and sebum production and regulates cell proliferation and differentiation

Indications:

  • Nodular acne

Contraindications:

  • Hypersensitivity
  • Hepatic or renal insufficiency
  • Hypervitaminosis A
  • Hyperlipidemia
  • Concurrent use of Tetracyclines
  • Pregnancy (category X)

Adverse Effects:

  • Cheilitis (most common), photosensitivity, eczema, skin fragility, thinning of the hair, pruritus, epistaxis
  • Arthralgia, decreased bone mineral density
  • Constipation, decreased appetite, pancreatitis
  • Conjunctivitis, visual impairment (discontinue drug if experiencing visual difficulties)
  • Auditory impairment (may continue after discontinuation of drug, discontinue drug if hearing impairment or tinnitus develops)
  • Depression, mood disturbances, psychosis
  • Increased ESR, increased CPK, hypertriglyceridemia, decreased HDL, increased LFTs, thrombocytopenia

Isotretinoin is teratogenic. Before administration, a pregnancy test must be performed and 2 contraceptive methods should be used throughout therapy. Pregnancy must be avoided for 3 months after discontinuing the drug. Patients on the drug should be instructed not to donate blood during therapy and 1 month after discontinuation. All patients, prescribers, wholesalers, and dispensing pharmacists must register and be active in the iPLEDGE risk evaluation and mitigation strategy program.

From a pharmacognosy perspective, Equisetum arvense, Galium aparine, Rumex crispus and Smilax officinalis are alternatives that can be beneficial in treating acne. Other herbal treatments include Melaleuca alternifolia, which is a topical antifungal and antimicrobial, and Verbena officinalis and Vitex agnus-castus, which are hormonal modulators useful in the treatment of menstrual acne.

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This post was written by Omar Rifai