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Isotretinoin - Side Effects That Need Medical Monitoring By The Physician

Click here to view the A-Detail™ on Accutane®.

Certain Isotretinoin (Accutane®) side effects will not be as apparent to your patient and will need to be monitored by you during their acne treatment. These include effects on the patient's bones, lipids, liver and pregnancy status.

Pregnancy:

  • This drug is teratogenic and causes fetal abnormalities
  • Patients cannot risk becoming pregnant
  • Patients must avoid pregnancy 1 month before, during, and 1 month after use of this drug
  • Pregnancy prevention programs are offered to ensure that your patient will avoid getting pregnant, talk to your patient about this

Bones:

  • Hyperostosis, osteophytes (bony spurs) may develop, but are usually of little consequence
  • There is a possible risk that your patient's bones will become thinner (osteoporosis)
  • (however, more work needs to be done, as studies have been inconclusive)
  • Premature closure of bony epiphyses can occur in children, which may reduce long bone growth

Lipids:

  • Cholesterol/ triglyceride levels may increase, this must be followed by the doctor
  • Patients may experience a short term increase in cholesterol, though this is not thought to be very significant
  • Pancreatitis is a risk if their triglycerides rise quickly and the level becomes high, this is very rare, however

Liver:

  • May be mildly irritating to the patient's liver
Blood tests occasionally show changes but they are usually of little consequence. It is rare to have to discontinue Accutane® because of liver abnormalities. Drug induced hepatitis has been reported.

Neurologic:

  • A pseudotumor in the cerebrum can occur, which can cause increased brain fluid pressure, headaches, vomiting, and visual disturbances
  • Depression and suicidal thoughts have been reported in some patients,
  • nobody knows for sure, though, if it was isotretinoin or other factors that caused these feelings
  • Your patient may experience headaches

Muscloskeletal:

  • There is a risk of inflammation around joints, and tendonitis
  • Aches and pains around joints, and lower back pain are common
These symptoms do not produce permanent damage in the joints and often taking anti-inflammatory painkillers can give you relief.

Blood:

  • Your patient's ability to produce white blood cells may be diminished (called leukopenia) however, this is rare.