Isotretinoin (Accutane): what to expect and how to stay safe
Isotretinoin can clear severe, scarring acne when other treatments fail. It works well, but it’s a strong medicine with predictable side effects and strict safety rules — especially for people who can become pregnant. This page gives straight answers so you know what to expect and what to ask your doctor.
Who is isotretinoin for and how it’s used
Doctors typically reserve isotretinoin for nodular, cystic, or severe acne that hasn’t improved with antibiotics and topical meds. Dosing usually runs from about 0.5 to 1 mg/kg per day, taken in divided doses or once daily. Most courses last 4–6 months. Your prescriber may aim for a cumulative total dose — often around 120–150 mg/kg — to lower the chance acne returns, but plans vary by patient.
What to expect during treatment
Skin often gets drier within days: chapped lips, dry eyes, nosebleeds and flaky skin are common. Some people see a temporary flare of more inflammation in the first few weeks. Visible improvement usually starts after 6–8 weeks and keeps improving over months. You may also notice muscle aches, mild hair thinning, or changes in mood. Most side effects improve after the course ends.
There are a few lab changes doctors watch for. Isotretinoin can raise cholesterol and triglycerides and affect liver enzymes. That’s why your provider will check blood tests before starting and periodically while you’re on the drug.
Safety, monitoring, and pregnancy rules
Isotretinoin causes severe birth defects. If you can get pregnant, you must use reliable contraception before, during, and for a month after treatment. In many countries there’s a formal safety program requiring negative pregnancy tests and documented contraception. If you’re male, isotretinoin isn’t known to cause birth defects through sperm, but you should still avoid donating blood during treatment and for one month after.
Avoid taking vitamin A supplements while on isotretinoin — adding extra vitamin A raises the risk of toxicity. Also don’t combine isotretinoin with tetracycline antibiotics (like doxycycline) because of a rare risk of raised pressure in the skull (intracranial hypertension). Tell your doctor about all meds and supplements you take.
Simple steps help manage side effects: heavy lip balm for chapped lips, gentle moisturizers for dry skin, artificial tears for dry eyes, and sunscreen to protect sensitive skin. Skip waxing and aggressive skin procedures during and for months after treatment — your skin will be more fragile. Keep follow-up bloodwork as advised and report any severe mood changes or unexplained symptoms right away.
Isotretinoin can be life-changing for severe acne but demands careful monitoring and planning. Talk openly with your prescriber about expectations, side effects, contraception, and follow-up tests so you get the best outcome with the least risk.
