I thought I would post a log since I haven't seen many on a higher dosage. I won't post too often but thought I would try to capture my experience every week or two at the least and include some bloodwork information as I go along (I'll be getting blood work monthly).
Background: I'm 35 and had mild acne as a teen. I used lots of acne products like "Oxy" as a teen which has caused my face to always be oily yet still dry and cracking to the point that I use moisturizer daily. In my late 20's, I started to get back, forehead, head, and neck acne which I never got when younger. It's become painful and difficult to manage. Probably considered moderate acne. After a year of trying other things, my derm has put me on accutane. I have full baseline bloodwork which is all very normal.
I'm a bigger guy (260#, 6'6") and as I understand it, my doc doesn't want me on the stuff for more than 20 weeks and wants me at about 150mg/kg total (worst case). So the goal was 2 weeks at 80mg and then 120mg until 10/25.
Currently on Day 14 and switched to the 120mg dose today.
First two weeks have been battling dry cracking skin on my face and head. Second most annoying has been the dry lips. After about day 4 I realized that I would need better moisturizers....I was severely under-equipped. Those second couple of days were the worst for me.
The following regimen has been working OK:
- Wash face in AM with CeraVe Hydrating Cleanser.
- Using a Clinique unscented moisturizer my wife has that works but doesn't leave much of a glare.
- Using Aquaphor on the lips.
- Using both moisturizer and the aquaphor at work throughout day. It's a challenge to manage the excess oil so I don't have that oily look.
- Carry around Blistex Complete in my pocket.
- At night, I use Cetaphil on my face, head, neck and generous amounts of Aquaphor
I have not yet experienced the dreaded breakout (at least nothing worse than what I normally get) and I've noticed my whiteheads\blackheads on my nose and cheeks have become smaller. Forehead and head acne has improved. Back and neck has not.
No other symptoms yet. Next bloodwork should be on the 19th or thereabouts. Will try to post in a week after I get a feel for this 120mg change.
If I took 40mg, I'd have to take it for 443 days before I'd reach the 150mg/kg cumulative dose lol. I'm a tall guy with a big frame so I just don't have many options. I can't imagine being on this stuff more than a few months!
Did your back pain and hair loss start pretty soon after you started your course or closer to the 25 day mark?
Thanks for the reply. Staying positive and managing sides is an important part of this indeed!
Mate, I'm on 100mg a day (feel free to have a look at my thread) and I'm nearly half way through (I hope). I'd like to say that it gets better, and for you I truly hope it does, but for me the symptoms have reached a peak and stayed there. Your regime is very similar to mine---I think I'd have packed this stuff in long ago where it not for Cetaphil and Aquaphor as they are about the only things I've tried that control the side effects to a degree.
You've been lucky to miss the Initial Breakout so stick it out and best of luck. I've seen too many success stories to stop now but there have been times for me where this drug has just made me not want to leave the house. Gotta man up and ride it out I guess...
If I took 40mg, I'd have to take it for 443 days before I'd reach the 150mg/kg cumulative dose lol. I'm a tall guy with a big frame so I just don't have many options. I can't imagine being on this stuff more than a few months!
Did your back pain and hair loss start pretty soon after you started your course or closer to the 25 day mark?
Thanks for the reply. Staying positive and managing sides is an important part of this indeed!
They started at the 1 week mark. I'm shedding hair all over my body,but it is really diffuse. From my head,i loose around 10-20 hair per day (when i never loosed in my life). My derm explained me that you usually loss hair at the beginning of the treatment (until hopefully your body get used to the drug and get pass the "shock" phase) or at the end of it (that is usually worse,since you freak out,because it shouldn't fall after you end it lol). Anyways if the hair loss worsens,my derm is stopping the treatment (so far is the same).
My back got progressively worse between week 1 and week 2. Pain is not unbearable,but hurts moderately when bending (specially when lying on the bed) for a couple of secs or when maintaining a bad posture.
Hair loss and back pain are included in the most common side effects,even more in high doses like yours,so please don't freak out if this happens to you ! Everyone reacts different to accutane !! Bests of lucks my man
Day 21 (Week 3 of 20)
First week at 120mg complete. It seems like sides have been progressively worse since Day 3 and I didn't have the feeling that the increased dose had a sudden sharp increase in sides. Overall, feeling pretty good all things considered, but have experienced multiple new sides:
Dry Skin - Still the worst problem and has spread to my extremities (arms, hands). My daily Cetaphil, Aquaphor, and Clinique stuff has been working well. I've found that a nice coating of Aquaphor when I'm going to be at home all day seems to really help.
Dry Lips - Hasn't been much of a problem. I use Aquaphor throughout the day. Some soreness but no dryness with Aquaphor.
Depression - I don't really have any, but I have noticed a "empty" feeling that could contribute when coupled with other life problems if you had them. The biggest problem is that this feeling has impacted work. I have less of an urge to get things done.
Back Pain - Lower back pain every now and then.
Joints - They are sore now and it has impacted my workouts.
Muscle Fatigue - Also sore now and impacting my workouts.
Eyes - Seem to be impacted by brightness a bit more. They don't feel dry but I know they must be so I use re-wetting drops twice a day now.
Digestive Tract - I've noticed several symptoms consistent with IBS. This is the most concerning side for me and something I want to talk further with my doc about.
The good news is that the acne is improving and I have had no real noticeable breakouts. Discomfort and pain has improved as well as some progress on clearing. Also blackheads\whiteheads\pores have shrunk and decreased considerably.
At this point, IBS symptoms are concerning and the rest is tolerable. I see my doc and get bloodwork on Thursday.
Day 28 (Week 4 of 20)
I'll summarize by saying things have improved since my last report on all fronts. Overall feeling pretty good. Acne is about the same as last week so I remain confident that it may be a couple months before further improvement.
Sides have subsided or are less noticeable. It's almost like the initial start at 80mg and the change to 120mg both caused about a week each of chaotic sides and then a week later, things have been much more tolerable. Skin, Lips, Pain, Fatigue, IBS related.....all much better.
Bloodwork came back fine...nothing was outside of normal. My Liver markers had all improved from baseline (strange!?!?) and the triglycerides had moved from 60 to 90 (all within normal reference range). Doc did not seem concerned yet about the IBS related symptoms but says that if things don't normalize by my next bloodwork appointment, we can consider adjustments.
Another week, another 0.84 grams of accutane closer to my cumulative total! Still a long way to go but I can do anything for 16 weeks.
Day 42 (Week 6 of 20)
The course is working really well for me. I seem to have really adjusted to the dose and sides have become less of a nuance albeit most are still there. And the best part is that I seem to be very clear with the exception of 1-2 small pimples a week or so. My skin is smoothing in the process which is kind of weird...If I run my hand down my arm, there is a point where the skin transitions from smooth to what my whole arm used to feel like.
Sides have been manageable. My skin\lips\etc still requires a strict regimen to moisturize. I still literally am applying lotions and aquaphor all day long. The biggest annoyances for me currently are that my workouts aren't as good as they could be. I get in an hour of weights and an hour of cardio every morning but my lifts are weaker and I'm more tired than usual and my post cardio limbs ache more than normal.
I had a bit of a rash going around my neck and I've noticed that when I'm sweating (cardio) that it becomes pretty uncomfortable, especially if I dry it with a towel. I've been using aloe on my neck which seems to have helped with the redness, but it still stings when I dry it with a towel.
Guess nothing more than that to add. My cumulative dose is right on track and I'm really looking forward to the end!
I wonder if docs ever shorten a cycle way below the minimum recommended cumulative dose if they see clearing for many weeks?!?
Hard to believe, but I'm about half way through my course I believe. I have taken 8.22 grams so far with the maximum course (150mg/kg) total required at 17.7 grams.
Nothing really new to report other than I've been pushing my workouts up a bit which has made me feel better and less focused on side effects. Aside from the occasional minor flair ups, beneficial effects have been very positive...so much so that it is hard to stay the full course when it "feels" like I'm finished.
Hopefully the second half goes as quick as the first has.