Isotretinoin (Accutane) is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses. Some serious side effects have been reported from taking it.

Isotretinoin (Accutane) is a vitamin A derivative known as a retinoid. Your body reacts to it similar to how it reacts to vitamin A. Because vitamin A can build up in your tissues, it can quickly become a problem. You should not take vitamin A supplements while taking this drug.

Isotretinoin is available as a variety of brand names, including Absorica, Amnesteem, Claravis, Myorisan, and Sotret. The original brand, Accutane, is no longer on the market. However, the drug is sometimes still referred to by this name.

Since isotretinoin is designed to treat severe acne, it has a visible effect on the skin. The medication can be very effective in treating severe acne because it targets:

  • clogged pores
  • bacteria
  • inflammation
  • oil production

It’s important to know that when you first start using it, your acne may get worse before it gets better.

Read on to learn about the effects of isotretinoin on the body.

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Illustration by Alyssa Kiefer

The dose of isotretinoin a doctor prescribes may be linked with the severity of the side effects you may experience. People prescribed lower doses may not have any common side effects, while higher doses may result in more severe side effects, according to the American Osteopathic College of Dermatology.

Some of the more common side effects of isotretinoin can include:

  • dry skin
  • dry mouth
  • chapped lips
  • dry nasal passages, which may cause nosebleeds

While taking isotretinoin, your skin may be more sensitive to the sun. Be sure to use sun protection and skin moisturizers when outdoors. Avoid using any type of indoor tanning device.

Because your skin can become fragile and may be at an increased risk of scarring, the Food and Drug Administration (FDA) recommends that cosmetic procedures, such as hair removal techniques like waxing, dermabrasion, or laser treatments, should be delayed until you’ve been off isotretinoin for at least 6 months.

However, a 2017 study found insufficient evidence to support this recommendation. It may be best to speak with a doctor about any upcoming cosmetic procedures while taking isotretinoin.

Other common side effects of isotretinoin can include:

  • skin itching
  • skin irritation
  • thinning hair
  • fragile skin
  • dry eyes
  • skin infections
  • rash
  • bone or joint pain
  • muscle aches
  • digestive and intestinal symptoms
  • headache

This is not a complete list of potential side effects or risks of taking isotretinoin.

Isotretinoin can also cause more serious side effects.

Isotretinoin may cause increased pressure in your brain, which is a life threatening condition. Symptoms of increasing brain pressure can include:

  • severe headache
  • blurred vision
  • dizziness
  • nausea
  • vomiting
  • seizures
  • stroke

Gastrointestinal disorders have been reported as a serious side effect of taking this medication. These may include:

But recent studies have not been able to establish a causal relationship between isotretinoin and these gastrointestinal diseases. Tell a doctor if you notice any concerning gastrointestinal symptoms while taking isotretinoin.

Other serious side effects can include:

  • pancreatitis, or inflammation of the pancreas
  • increased cholesterol and triglyceride levels
  • liver problems including hepatitis
  • blood sugar problems, including diabetes
  • decreased night vision
  • ear ringing or hearing loss

Allergic reaction

Any medication can cause a serious allergic reaction. Symptoms can include:

  • hives
  • swelling of the mouth or face
  • breathing problems or anaphylaxis

An allergic reaction to medication can be life threatening. If you experience these symptoms after taking medication, call 911, contact your local emergency services, or have someone take you to the nearest hospital. It is possible to develop an allergy after repeated exposure to a medication.

Isotretinoin is dangerous for unborn babies.

People in their childbearing years should take a pregnancy test before starting this medication. An effective form of birth control, plus a backup method, should be used.

People should not get pregnant for 4 weeks after this medication is stopped. If you do get pregnant, stop taking the medication and talk with a doctor right away.

Taking isotretinoin during pregnancy can cause miscarriage, death of the fetus, or premature birth. It can also lead to severe birth defects such as:

  • small or missing ears
  • hearing loss
  • small eyes, which is called microphthalmia
  • missing eyes
  • a small or missing thymus gland, which is responsible for making white blood cells
  • a cleft palate
  • congenital heart defects

It can also cause a buildup of fluid and pressure on the brain called hydrocephalus. Babies may be born with an underdeveloped brain and small head, which is called microcephaly. This can lead to intellectual and developmental disabilities.

It’s unclear whether the drug passes to babies through breast milk. People should not breastfeed while taking isotretinoin or for at least 8 days after their last dose.

Anyone who plans on taking isotretinoin must register with iPLEDGE. It is an FDA-approved restricted distribution program designed to tell people about the risks of birth defects and to prevent pregnancy while taking the drug.

While taking isotretinoin, your red and white blood cell counts may decrease. Symptoms may include feeling faint and having difficulty breathing.

Isotretinoin can also build up in your bloodstream. You may develop problems with blood sugar and blood fat levels.

A doctor may also need to monitor your liver function, blood sugar, and cholesterol levels while you’re taking this medication, especially for longer periods of time.

Some cases of sexual dysfunction linked to long-term isotretinoin use have been reported, but more detailed studies are needed to better explain these results.

Stop taking isotretinoin immediately and talk with a doctor if you experience any of the side effects or symptoms below. They may potentially lead to longer-term problems, such as organ damage, if not addressed promptly. These symptoms can include:

Some people taking isotretinoin may go through mood changes, such as irritability or sadness.

The potential for serious mental health problems, including depression, psychosis, and suicidal thoughts, has been reported with isotretinoin. Warning signs may include:

  • emotional outbursts
  • withdrawal
  • seeing or hearing things that aren’t real

Stop taking isotretinoin and talk with a doctor immediately if you have any of these symptoms.

Some conflicting research exists related to the mental health side effects of taking isotretinoin.

Newer research published in the Journal of the American Academy of Dermatology has not found evidence of an increased risk for depression linked to isotretinoin treatment for acne. A 2019 study also suggests the use of isotretinoin in patients with acne was linked with improved depression symptoms.

More research is needed to fully understand the relationship between isotretinoin use and mental health side effects.

Your skin may keep improving for a period of time after you’ve stopped taking the medication.

Most side effects from taking isotretinoin go away within a few days to a few weeks after treatment stops. But side effects may persist longer even after treatment ends. If left untreated, these side effects could result in permanent problems. In some cases, these may include conditions such as scarring or vision loss.

Because of the danger to pregnant people, it is not recommended to donate blood while taking this medication or for a full month after you have stopped taking it.

Contact a doctor as soon as possible if your side effects continue for more than a few weeks after you stop taking isotretinoin.

Isotretinoin can do a good job of clearing up your skin, but there is the potential for side effects while taking the medication. Most side effects fade within a few weeks after you stop taking the medication. Some side effects are more serious and need immediate treatment.

Serious birth defects can occur if people become pregnant while taking the drug.

Have a detailed conversation with a doctor to explore the risks and benefits of taking isotretinoin. A healthcare team can also work with you to manage any side effects.