Isotretinoin (Accutane) Guidelines

What to expect:

• Dryness is universal: chapped lips, dry skin, dry/irritated eyes, possible nosebleeds.

• Sun sensitivity & night vision: burn more easily; night driving may be harder.

• Course length: typically 6-8 months; some need longer or a second course.

How to take it:

• Dose with food: take with your largest meal that includes fat.

• Same time daily: If you miss a dose, take when remembered. Skip it if near next dose - don’t double.

• Don’t share your medication with others.

Visits & labs:

• Monthly office visits: pharmacy can only dispense up to 30 days at a time.

• Labs: fasting lipids + liver enzymes at baseline & after peak dose (often ~2 months), then as directed.

• Before fasting labs: avoid alcohol for 36 hours.

iPLEDGE & pregnancy precautions (causes birth defects):

• If you can become pregnant:

• Two forms of birth control (or strict abstinence) - 1 month before, during, & 1 month after treatment.

• Pregnancy tests: 2 before starting, monthly during, at end of therapy, and 1 month after.

• Complete iPLEDGE questions monthly & pick up within 7 days of the pregnancy test date.

• If you cannot become pregnant: monthly authorization still required; 30-day pickup window.

• Do not breastfeed or donate blood during treatment or for 1 month after.

Medicines & products to avoid:

• No vitamin A supplements, oral retinoids, tetracyclines (doxycycline, minocycline, etc.), St. John’s wort, or heavy alcohol.

• Cosmetic procedures: no waxing, dermabrasion, or laser while on treatment + 6 months post unless cleared by dermatologist.

• Hold other acne meds (topicals & oral antibiotics). If an antibiotic is needed, call us.

Skin, eye, and nose care:

• Skin: gentle cleanser, moisturize twice daily, SPF 30+ sunscreen every morning, hat/sun-protective clothing.

• Lips & Nose: frequent bland balm/ointment to lips, saline spray for nose.

• Eyes: lubricating drops; contacts may be uncomfortable (switch to glasses if needed).

Travel & activity:

• Sun-heavy trips: strictly use sun protection; ask us if a short medication pause makes sense.

• Exercise: muscle aches are common. For severe pain or dark urine - stop and call.

Urgent reasons to stop and call us:

• Positive pregnancy test or missed period.

• Severe headache, vision changes, nausea/vomiting, abdominal pain, rectal bleeding/severe diarrhea, yellow skin/eyes, very dark urine, severe muscle pain/weakness, signs of allergic reaction.

• Severe mood changes (depression, suicidal thoughts).

Pharmacy pickup:

• Start early in case of prior authorization or pharmacy delays.

• Patients who can become pregnant: 7-day window from pregnancy-test (missing 1st month = lockout).

• Patients who cannot become pregnant: 30-day window.