What is Roaccutane and how does it work?
Roaccutane is a member of a group of drugs, closely related to vitamin A, called retinoids. Isotretitinoin is the generic name of a drug marketed by a number of companies, but the original brand name was Roaccutane. It works in a variety of ways, targeting several of the factors that cause acne and other skin conditions including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle and cause acne.
What skin conditions are treated with Roaccutane?
Roaccutane is licensed and commonly used to treat moderate and severe acne, often where there is risk of scarring. Your dermatologist may occasionally use Roacutane to treat other skin conditions such as hidradenitis suppurativa and rosacea. In the United Kingdom Roaccutane may only be prescribed if you are under the care of a dermatologist.
Will Roaccutane cure my acne?
A large proportion of patients (about 9 out of 10) see a significant improvement in their acne with a single course of Roaccutane, although during the first few weeks of treatment the acne may worsen before it starts to improve.
A small number of patients continue to have milder (although improved) acne following Roaccutane that can be controlled with conventional therapies, such as antibiotics. Others may relapse after stopping treatment with Roaccutane, and occasionally, a prolonged or second course of treatment is required.
What dose should I take and for how long?
Your dermatologist will calculate the amount of Roaccutane you need according to your body weight and decide on an appropriate starting dose. At future appointments, the dose of Roaccutane may be changed depending on how well you are coping with the side effects and responding to the medication. Most patients take between 20 mg and 80 mg of isotretinoin each day, and a course commonly lasts around 24 weeks. With doses in the lower end of this range, which are often better tolerated, a course may last longer than 24 weeks. Your acne may continue to improve for up to 8 weeks after treatment.
How should I take Roaccutane?
As isotretinoin is best absorbed into the body with food containing some dietary fat, it should ideally be taken after a meal or a snack with milk rather than on an empty stomach. The capsules need to be swallowed whole and should not be crushed or split open. Keep the capsules in a cool (5 to 25°C) dark place away from children.
What are the common side effects of Roaccutane?
In general, dryness of the skin, lips, and eyes is the most common side effect. Using a non-comedogenic moisturiser (one that does not block the skin pores) and a lip balm regularly will help to prevent these symptoms. An increased risk of skin infections accompanies the skin becoming dry and cracked. Nosebleeds may occur if the inside of the nose becomes very dry. Dry eyes may interfere with the wearing of contact lenses and may be helped by using artificial tears. The skin may also peel and become fragile, with wounds taking longer to heal. Whilst taking Roaccutane, and for six months afterwards, your skin will be more delicate than usual; waxing, epilation, dermabrasion and laser treatment should be avoided. Shaving is normally tolerated, but the use of a moisturiser afterwards is advisable.
Roaccutane may increase your skin’s sensitivity to the sun. You should, therefore, avoid direct sun exposure whilst taking this medication. Where necessary a sun-protection product with a high protection factor of at least SPF 30 should be used. You should also avoid the use of sun beds. Muscles and joints may ache especially after exercise. Temporary hair thinning may occasionally occur. Isotretinoin can affect your vision, in particular, the ability to see at night, and caution is required in people whose job requires good night vision, such as drivers and those who operate heavy machinery. If you develop difficulties seeing at night or in dark situations you should avoid driving and/or operating heavy machinery. Airline pilots will not be able to continue their job while on isotretinoin and are advised to discuss this with their employer before starting the medication, and check with current Civil Aviation guidelines. These vision changes may be permanent in extremely rare circumstances.
Increased fat levels in the blood, and mild liver inflammation can occur but are usually not of clinical significance; these will be monitored by blood tests during the course of treatment. If you have had problems with your liver or kidneys, or suffer from high cholesterol or diabetes, you should discuss this with your doctor prior to starting the medication.
Peanut or soya allergy
Roaccutane contains soya oil. Occasionally, patients with soya allergy might react to the trace levels of soya proteins in soya oil. Exceptionally rarely, patients with peanut allergy might have a cross reaction to soya proteins in soya oil. You should inform your doctor and pharmacist if you think you may have an allergy to soya or peanut.
What are the rare side effects of Roaccutane?
A number of more serious side effects may occur although these are fortunately rare. Roaccutane can lead to changes in mood and/or behaviour and less commonly, unusual experiences including thoughts of self-harm and suicide. There have also been reports of patients attempting suicide. If you have ever had low mood, suicidal ideas or any other mental health problem, please discuss this with your doctor before starting treatment. If you have a history of depression your dermatologist may ask a psychiatrist to see you before starting Roaccutane to determine if it is safe for you to take. If you or your friends/relatives feel that your mood or behaviour is changing, or if you start having thoughts of self-harm whilst taking isotretinoin, please inform your doctor and stop taking it immediately. Your doctor will then discuss it with you and advise if it is safe to take in the future.
Rarely, inflammation of the liver or pancreas may occur. Very rarely, increased pressure in the brain may present with morning headaches and disturbance of vision. Sexual side effects, such as erectile dysfunction and decreased libido, may also occur but these are understood to be rare. If you do suffer from a side effect then stopping or reducing the dose of isotretinoin may resolve the problem. Please talk to your doctor or nurse before making any changes to your medication. The list of side effects is not exhaustive, and if you do develop any new problems while taking isotretinoin please inform your doctor or nurse.
May I drink alcohol whilst taking Roaccutane?
Ideally alcohol should be avoided completely, as this can cause inflammation of the liver.
Can I take other medications at the same time as Roaccutane?
Most drugs can be taken safely with Roaccutane but some medications may interact. It is important that you tell your doctor and pharmacist what you are currently taking before taking any new prescription or over-the-counter medications. Medications to avoid while taking Roaccutane include: • Tetracycline antibiotics • Methotrexate This is not a complete list and it is important that you always inform your doctor and pharmacist that you are taking Roaccutane, and read the in-pack leaflet. Vitamin supplements containing vitamin A should be avoided during a course of Roaccutane.
Are there any other precautions whilst taking Roaccutane?
You must never share your tablets, especially with women. Do not donate blood whilst taking isotretinoin and for a month afterwards in case the blood is given to a pregnant woman.
There has been no known adverse effect on the pregnancy if a man taking Roaccutane fathers a child. However, as Roaccutane is present in semen, it may be a sensible precaution to use a condom to avoid transmission of any of the drug to females. Women should not breast-feed while taking Roaccutane.
Why is there concern about women taking Roaccutane and pregnancy?
If a pregnant woman takes Roaccutane there is a high risk that the unborn baby will be harmed. There is an increased risk of miscarriage and babies may have severe and serious defects (such as abnormal appearance or intellectual disability). For this reason: • Roaccutane should not be taken during pregnancy. • You must not become pregnant whilst taking Roaccutane, or for at least one month after stopping Roaccutane. • You should not breast-feed whilst taking Roaccutane, or for one month afterwards. • If you do become pregnant, or suspect that you may be pregnant, you must stop the medication immediately and contact your doctor, so you may be referred to a specialist pregnancy clinic.
What happens next?
If you would like to ask our Medical Director & Nurse Consultant, Sue Ibrahim a message, by all means do. We provide a responsive service that aims to set your mind at ease and ensure you are fully informed before booking your consultation. At Elan Medical Skin Clinic in Essex, all new patients receive a thorough consultation and medical assessment prior to treatment.
How do I book an appointment?
You can either call Elan Medical Skin Clinic on 01268 770660 between 9.30am and 5pm Monday to Saturday or you can click here to book online and one of our reception team will contact you by phone or email, whichever you prefer. You will be asked to pay your initial consultation fee by credit or debit card on confirming your appointment.