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What are the side effects of oral isotretinoin?

We may not know that oral isotretinoin is considered by many as a very controversial drug because of some of the side effects associated with it (in fact there are congressional hearings and attempts to take it off the market). On the other hand there are also many considered oral isotretinoin treatment to be life saving as no other drug available at this time that can actually treat and often clear those severe, scarring, and disfiguring acne.

Nevertheless, through proper counseling and monitoring, oral isotretinoin can really be a miracle cure for those with severe, scarring acne condition as well as help avoiding the worst side effects that might happen.

Potential Side Effects of Oral Isotretinoin

Common side effects:
  1. Dry skin, dry eyes, chapped lips and dry mouth – it is noted that some new formulations of oral isotretinoin are less affected by food and also have fewer side effects in terms of dryness of skin, eyes, and mouth and less of a potential effect on our lipids;
  2. Nosebleeds;
  3. Muscle aches, backaches, and mild headaches usually at the start of oral isotretinoin therapy;
  4. Skin fragility especially on the hands.
Uncommon or serious side effects:
  1. Hypertriglyceridemia (liver function abnormalities) – studies show that this can be improved with continued administration of the drug or after oral isotretinoin was stopped; however, regular blood tests are still required to ensure our liver function as normal. What is important is that we should try to avoid drinking alcohol while on this acne therapy as oral isotretinoin is easily metabolized or digested by our liver;
  2. Severe headaches;
  3. Mood swings/depression/suicidal ideation – though this may be due to different reasons, should this happen, oral isotretinoin should be discontinued in these cases;
  4. Pseudotumor cerebri (i.e. increased pressure build-up on the brain);
  5. Bone changes (including osteoporosis) - typically found in patients on higher doses of the drug or in whom high doses are used over longer periods of time than usual. Example of this included loss of bone density, bone fractures or delayed healing;
  6. Visual changes, e.g. decreased night vision, may last even after oral isotretinoin was stopped.
Most serious but avoidable:

Birth defects – it is very important for any woman who is of child-bearing potential who plans on taking isotretinoin to have two negative pregnancy tests before starting oral isotretinoin treatment and for at least 1 month after the therapy. Adequate contraception is essential, and the importance of this cannot be overstated before and during treatment, and for 4 weeks after discontinuing oral isotretinoin treatment. It is good to know that oral isotretinoin is a potent teratogen that is known to cause birth defects in children whose mothers get pregnant while taking oral isotretinoin or within 1 month after stopping isotretinoin. To know more about “should women continue topical or oral acne treatment while they are pregnant,” we may want to read here.

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