9 replies to this topic

[AutonomousOne1980]

1: Br J Dermatol. 1994 Sep;131(3):360-3. Links
Long-term safety of isotretinoin as a treatment for acne vulgaris.
Goulden V,
Layton AM,
Cunliffe WJ.
Department of Dermatology, General Infirmary at Leeds, U.K.
We assessed possible long-term side-effects of isotretinoin therapy in 720 patients who had received one or more courses of treatment, and had a mean follow-up period of 4.9 years (range 2-12 years). Most patients (442) had received a total cumulative dose of 120-200 mg/kg body weight. One hundred and sixty-two patients received a cumulative dose of < 120 mg/kg body weight, and 116 received a cumulative dose > 200 mg/kg. Fifty-two patients (7.2%) reported persistent symptoms during the follow-up period. No correlation was found between age, sex, cumulative dose, or number of courses of isotretinoin and occurrence of reported possible side-effects. The reported symptoms were predominantly musculoskeletal (2%) or mucocutaneous (4.8%), and were mild in all cases. Xeroderma, dry eye syndrome, arthralgia, and possible exacerbation of eczema, were considered to be infrequent but probable long-term side-effects. The findings of this study indicate that isotretinoin in the treatment of acne is a safe drug, with no serious long-term side-effects.

[Danno]

^ Cool

No mention of Roscea though? Maybe that isn't a long term side effect at all.

That made me feel a lot better man, thanks for the post. I'll feel even better when I'm done with all this shit!

[mx123]

Good to hear that.

[AutonomousOne1980]

what i find peculiar is that 442 out of the 720 patients were given a cumulative dose of at least 120mg/kg to as much as 200mg/kg which is about twice the dosage of what is recommended these days. This probably corelates with the idea of how people that took the drug when it first came out usually took it once and were cured for a long time, as opposed to many people these days having many more relapses and going on the drug much more often. Maybe it has something to do with repeat business? or more likely side effects that higher doseges endure or perhaps initial breakout which could cause more scarring. interesting though.

[Zoilo]

what i find peculiar is that 442 out of the 720 patients were given a cumulative dose of at least 120mg/kg to as much as 200mg/kg which is about twice the dosage of what is recommended these days. This probably corelates with the idea of how people that took the drug when it first came out usually took it once and were cured for a long time, as opposed to many people these days having many more relapses and going on the drug much more often. Maybe it has something to do with repeat business? or more likely side effects that higher doseges endure or perhaps initial breakout which could cause more scarring. interesting though.

Unless I'm misunderstanding what you've written, I don't think you have it right.

The current studies say that maximum long term effects are achieved by a minimum cumulative dose of 120 mg/kg and there is no benefit seen from cumulative doses exceeding 150 mg/kg. In otherwords, the recoomended target is 120-150.

Your first sentance mentions cumulative doses in the study of 120 - 200. I don't see how you get that this is twice as much as currently recommended. If the doses were twice as much as what is currently recommended, it would be a range of 240 - 300. Compared to that, 120-200 is actually pretty much the same as 120-150 and I'll bet it is considered as such by researchers.

You imply that doctors tend to prescribe less than in the past. In my personal experience, doctors actually tend to prescribe higher cumulative doses nowadays compared to in the past, not lower - exactly because of these studies that show the importance of cumulative dose. They may or may not prescribe higher daily doses, but my opinion is that current cumulative doses are more consistent, and higher, than 10 - 15 years ago.

I have never seen any studies that support your opinion that in the past people were more likely to have permanent cure compared to now. Is there somthing out there that shows this? Why do you think this?

My opinion therefore is exactly the opposite to what you've written: current prescribing tendancies are higher doses which makes it LESS likely that there will be relapses compared to in the past.

I took two courses of accutane a long time ago and was given only half of what is currently recommended - because I had a relatively mild condition and the conventional wisdom at the time was: "milder condition, less med needed". I had good results, but definitely not permanent. When starting my current course, both doctors I talked to said that they would prescribe the entire cumulative dosage regardless of my (relatively) milder condition. The both told me that they thought it would have better long term results than what I took before. In the past, both would have prescribed a much lower dose because of the milder condition.

[DanMan1]

what i find peculiar is that 442 out of the 720 patients were given a cumulative dose of at least 120mg/kg to as much as 200mg/kg which is about twice the dosage of what is recommended these days. This probably corelates with the idea of how people that took the drug when it first came out usually took it once and were cured for a long time, as opposed to many people these days having many more relapses and going on the drug much more often. Maybe it has something to do with repeat business? or more likely side effects that higher doseges endure or perhaps initial breakout which could cause more scarring. interesting though.

Unless I'm misunderstanding what you've written, I don't think you have it right.

The current studies say that maximum long term effects are achieved by a minimum cumulative dose of 120 mg/kg and there is no benefit seen from cumulative doses exceeding 150 mg/kg. In otherwords, the recoomended target is 120-150.

Your first sentance mentions cumulative doses in the study of 120 - 200. I don't see how you get that this is twice as much as currently recommended. If the doses were twice as much as what is currently recommended, it would be a range of 240 - 300. Compared to that, 120-200 is actually pretty much the same as 120-150 and I'll bet it is considered as such by researchers.

You imply that doctors tend to prescribe less than in the past. In my personal experience, doctors actually tend to prescribe higher cumulative doses nowadays compared to in the past, not lower - exactly because of these studies that show the importance of cumulative dose. They may or may not prescribe higher daily doses, but my opinion is that current cumulative doses are more consistent, and higher, than 10 - 15 years ago.

I have never seen any studies that support your opinion that in the past people were more likely to have permanent cure compared to now. Is there somthing out there that shows this? Why do you think this?

My opinion therefore is exactly the opposite to what you've written: current prescribing tendancies are higher doses which makes it LESS likely that there will be relapses compared to in the past.

I took two courses of accutane a long time ago and was given only half of what is currently recommended - because I had a relatively mild condition and the conventional wisdom at the time was: "milder condition, less med needed". I had good results, but definitely not permanent. When starting my current course, both doctors I talked to said that they would prescribe the entire cumulative dosage regardless of my (relatively) milder condition. The both told me that they thought it would have better long term results than what I took before. In the past, both would have prescribed a much lower dose because of the milder condition.

Are you done taking it? or currently on?

[AutonomousOne1980]

what i find peculiar is that 442 out of the 720 patients were given a cumulative dose of at least 120mg/kg to as much as 200mg/kg which is about twice the dosage of what is recommended these days. This probably corelates with the idea of how people that took the drug when it first came out usually took it once and were cured for a long time, as opposed to many people these days having many more relapses and going on the drug much more often. Maybe it has something to do with repeat business? or more likely side effects that higher doseges endure or perhaps initial breakout which could cause more scarring. interesting though.

Unless I'm misunderstanding what you've written, I don't think you have it right.

The current studies say that maximum long term effects are achieved by a minimum cumulative dose of 120 mg/kg and there is no benefit seen from cumulative doses exceeding 150 mg/kg. In otherwords, the recoomended target is 120-150.

Your first sentance mentions cumulative doses in the study of 120 - 200. I don't see how you get that this is twice as much as currently recommended. If the doses were twice as much as what is currently recommended, it would be a range of 240 - 300. Compared to that, 120-200 is actually pretty much the same as 120-150 and I'll bet it is considered as such by researchers.

You imply that doctors tend to prescribe less than in the past. In my personal experience, doctors actually tend to prescribe higher cumulative doses nowadays compared to in the past, not lower - exactly because of these studies that show the importance of cumulative dose. They may or may not prescribe higher daily doses, but my opinion is that current cumulative doses are more consistent, and higher, than 10 - 15 years ago.

I have never seen any studies that support your opinion that in the past people were more likely to have permanent cure compared to now. Is there somthing out there that shows this? Why do you think this?

My opinion therefore is exactly the opposite to what you've written: current prescribing tendancies are higher doses which makes it LESS likely that there will be relapses compared to in the past.

I took two courses of accutane a long time ago and was given only half of what is currently recommended - because I had a relatively mild condition and the conventional wisdom at the time was: "milder condition, less med needed". I had good results, but definitely not permanent. When starting my current course, both doctors I talked to said that they would prescribe the entire cumulative dosage regardless of my (relatively) milder condition. The both told me that they thought it would have better long term results than what I took before. In the past, both would have prescribed a much lower dose because of the milder condition.

nice.

i just thought that the goal was 120, so 200mg/kg wouldve been almost double. Im not THAT sharp on the facts, it was just a quick thought more or less, but i see your point in that a double dosage wouldve been much greater range.

and no i havent read any studys that support the theory of much higher dosages in the past, this was just based on what i have read of people that took the drug when it came out. people have said that high dose at a shorter period of time have generally cleared them longer then moderate or low dose over a longer period of time. so its basically hearsay.

[beentheredonethat]

My opinion therefore is exactly the opposite to what you've written: current prescribing tendancies are higher doses which makes it LESS likely that there will be relapses compared to in the past.

I see just the opposite based on what is reported by users in this forum. Many derms seem to be scared to take people even as high as 1.0mg/kg for their daily dose which used to be the gold standard. I see a lot of people on relatively low dose courses now. As far as my personal experience, my first course was high dose and lasted 9 months, compared to my more recent course which was a much lower dose, for 6 months, and i didn't even come close to that 120-125mg/kg target, while i far surpassed it my first time and got a 10 year remission out of it. Who knows how long this one will last?

[Zoilo]

I took two courses of accutane a long time ago and was given only half of what is currently recommended - because I had a relatively mild condition and the conventional wisdom at the time was: "milder condition, less med needed". I had good results, but definitely not permanent. When starting my current course, both doctors I talked to said that they would prescribe the entire cumulative dosage regardless of my (relatively) milder condition. The both told me that they thought it would have better long term results than what I took before. In the past, both would have prescribed a much lower dose because of the milder condition.

Are you done taking it? or currently on?

I took the two previous courses (1/2 current recommended cumulative dose) in the mid-80s and mid-90s. I got 5-6 "perfect" years and 4-5 years of gradual return of acne after each course, in otherwords 10 years between courses. Not a "cure", but I was very happy with the results.

I just finished 3rd course, in which I took a full 133 mg/kg cumulative dose. I'll let you know in 5+ years if it worked better long term. I have been completely clear since about 5 weeks in - but that was true the first two times also.

[AutonomousOne1980]

i thought people might be interested in this thread again.

if they are interested in the long term risks of taking accutane.