How it is administered

Isotretinoin is taken by mouth as a capsule. It is available in several strengths, including 10 mg, 20 mg, 25 mg, 30 mg, 35 mg, and 40 mg. The capsules should be swallowed whole with a full glass of liquid to reduce the risk of irritation to the esophagus. It is typically given in two divided doses each day, with or without meals, depending on the specific product instructions. Some brands recommend taking it with food to improve absorption.

How it works

Isotretinoin is a retinoid, which is a type of medication related to vitamin A. It works by reducing the size and activity of sebaceous (oil) glands in the skin, which leads to a decrease in sebum (oil) production. This helps to prevent the formation of acne lesions. Isotretinoin also affects the process of keratinization, which is the way skin cells mature and are shed. By normalizing this process, isotretinoin helps prevent clogged pores and reduces inflammation.

Although its primary use is for severe, recalcitrant nodular acne, isotretinoin's impact on cell growth and differentiation is why it has been studied in other conditions, including some cancers. However, for blood cancers, isotretinoin is not a standard treatment. Its mechanism of action involves influencing gene expression and cell differentiation, which is why it has been explored in research for certain types of leukemia, but it is not routinely used for these conditions.

Who Should take it

Isotretinoin is approved for patients 12 years of age and older who have severe, recalcitrant nodular acne that has not responded to other treatments, including systemic antibiotics. It is reserved for those with many large, inflamed acne nodules, especially when there is a risk of scarring or when the acne is located on the trunk and face.

For blood cancers, isotretinoin is not an approved or standard therapy. Its use in cancer is limited to research settings or very specific cases, and it is not recommended for routine blood cancer treatment.

Who should not take it

Isotretinoin should not be taken by anyone who is pregnant or who may become pregnant, as it can cause severe, life-threatening birth defects. It is also contraindicated in people with a known allergy to isotretinoin, vitamin A, or any of the capsule ingredients.

Patients with a history of severe psychiatric disorders, liver disease, or very high blood lipid levels should not take isotretinoin unless specifically advised and closely monitored by their doctor. It should not be used in children under 12 years of age or in patients who have not completed their skeletal growth unless the benefits outweigh the risks.

Commonly used with

Isotretinoin is usually used alone for severe acne because of its potency and risk of side effects. Patients are advised not to take vitamin A supplements at the same time, as this can increase the risk of toxicity. It should not be used with tetracycline antibiotics due to an increased risk of intracranial hypertension (pseudotumor cerebri).

For patients who can become pregnant, isotretinoin is used with strict birth control measures because of the risk of birth defects.

Commonly tested with

Isotretinoin has been studied with hormonal contraceptives to ensure effectiveness of birth control during therapy. It has also been tested in combination with other acne treatments in research settings, but it is not typically combined with other systemic acne medications in routine practice.

In cancer research, isotretinoin has been studied in combination with chemotherapy agents for certain types of leukemia, but this is not common clinical practice for blood cancers.