Isotretinoin

Pregnancy test, complete blood count, liver function tests, renal function tests, lipid profile.

p.o., topical (Roaccutan®)

Treatment with isotretinoin should be started at a dose of 0.5 mg/kg of body weight per day.

For most patients, the dose ranges from 0.5 to 1.0 mg/kg of body weight per day. In patients with very severe acne or acne on the trunk, a higher daily dose of up to 2.0 mg/kg of body weight may be necessary.

Complete blood count, liver and kidney function tests, and lipid profile before starting therapy, 1 month afterward, and then every 3 months. Monthly pregnancy tests for women of childbearing age, starting 1 month before the start of therapy and continuing until 5 weeks after the end of therapy. At least two methods of contraception must be used. Have the patient sign the forms regarding teratogenicity!

Absolute contraindications: Pregnancy and breastfeeding; women of childbearing age (unless all conditions of the pregnancy prevention program are met); hypervitaminosis A; treatment with tetracyclines.

Relative contraindications: Diabetes; hepatic or renal disease; dyslipidemia.

Do not combine with tetracyclines ➝ Risk of pseudotumor cerebri. Acne fulminans may develop 4–6 weeks after starting treatment; in that case, use steroids to control the inflammation. Dosage for acne fulminans: 1 mg/kg body weight/day.

Depression, bone pain, blepharitis, conjunctivitis, dry eyes and mouth, eye irritation, decreased night vision, cheilitis, dermatitis, dry skin, localized exfoliation, pruritus, erythematous rash, skin vulnerability (risk of abrasions), elevated blood triglycerides, decreased high-density lipoprotein (HDL) levels ➝ lipid-lowering agents. Increased photosensitivity ➝ UV protection!

Do not exceed a cumulative dose of 150 mg/kg body weight. Calculate the total dose regularly.