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I've been thinking for a while that we need a new Accutane FAQ. The one that's up there just isn't useful or properly comprehensive. I think we might get a few less repeat questions if we had a better FAQ - or at least we could refer them to the FAQ when they asked a common question. I'm hoping this might also reduce the Accutane questions so that people who want to talk about other prescriptions feel like this subforum is for them too. I have cleared it with Dan, so, without further ado!

Please submit questions/answers that are frequently asked to this thread. Also please submit links to any useful off-site resources that you are aware of. Bump the thread if it falls off the front page so everyone will have a chance to see it and contribute if they wish. I will compile/edit the questions/answers into something presentable as soon as i am able and will post it once Dan has approved it. I'm requesting that he stickies it and locks it. Feel free to submit answers that differ from those i primarily give - if they are well founded i have no problems including opposing viewpoints. But don't be a jerk about it, i won't be including anything that i think could open up Acne.org to litigation. So no advice on where to buy Accutane on the internet please. Feel free to copy anything in that you found useful that's in the current FAQ.

Isotretinoin (Accutane) FAQ - draft

What is isotretinoin?

Isotretinoin (13-cis-retinoic acid) is a naturally occuring derivative of Vitamin A used to treat acne vulgaris. When taken systemically, isotretinoin noticeably reduces the production of sebum and shrinks the sebaceous glands. It stabilizes keratinization and prevents comedones from forming. The exact mechanism of action is unknown, however it is known that it alters DNA transcription.

Under what brand names is isotretinoin sold under?

Isotretinoin is sold in the US by the original manufacturer under the name Accutane, and in Europe and Australia as Roaccutane. It is also available as generic brands - Claravis, Amnesteem, and Sotret are available in the US (what else is available in other places?)

Should i use the brand name (Roche) or is the generic just as good?

The reputable generic brand names which are available in the U.S. are just as effective as the Roche version at substantial savings. They contain the same active ingredient and have to demonstrate similar bioavailability. The only difference is the binders, capsule style, etc. There are other generics which may be available, but it's hard to know if they are really equivalent.

Who should take isotretinoin?

Isotretinoin is intended to treat severe, recalcitrant, nodular/cystic acne. However, it is effective against a wide range of keratinization-related skin disorders, so is often prescribed for off-label uses. It is also often prescribed for less severe acne which has not responded to conventional therapy.

People who have liver problems should not take isotretinoin. Women who are pregnant or may become pregnant should not take isotretinoin because it is a powerful teratogen causing serious birth defects in many exposed fetuses. If you are considering isotretinoin treatment you should dicuss it with your doctor and make sure that it's the best choice for you.

Who can prescribe isotretinoin?

U.S. rules - In the U.S., dispensation of isotretinoin is controlled via an F.D.A. program called iPLEDGE. iPLEDGE is an extremely complicated system ostensibly designed to prevent isotretinoin-exposed pregnancies. Female patients of childbearing potential must submit to two pregnancy tests before treatment, one each month during treatment, and one a month after treatment, as well as demonstrate knowledge of birth control each month via a web or phone entry system. When the prescription is written the patient has only seven days from the date of the office visit to fill it. If you miss this window you must wait at least 23 days and another blood test to get a new prescription. No exceptions.

Men and women with no childbearing potential are luckier - there is no waiting period for them, but i beleive they are still required to fill the prescription within 7 days.

Canada rules help me out, people!

UK rules (are these basically the same throughout Europe?) help me out, people!

Aussie/NZ rules help me out, people!

Anyone else i missed please submit your rules and where you are from!

Dosage

Doctors vary in their philosophy regarding dosage. Some take a low and slow approach, keeping patients on a low dose for a long period of time to minimize side effects. Some doctors opt for higher dose, shorter courses. The official dosing guidelines from Roche are as follows:

The recommended dosage for Accutane is 0.5 to 1mg per 1 kg (i.e. 2.2 pounds) of body weight divided into 2 doses taken with food daily. A typical course will last 15 to 20 weeks but it may last for longer or shorter. It is thought that, whilst all dosages should provide an initial clearing of acne, there was a greater need for retreatment with lower dosages. Patients with very severe acne and scarring or whose acne is primarily on the trunk may be prescribed as much as 2 mg per kilo of weight.

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I've been on and off this site all day and didn't see your post! I'll have a think. J

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I've been thinking for a while that we need a new Accutane FAQ. The one that's up there just isn't useful or properly comprehensive. I think we might get a few less repeat questions if we had a better FAQ - or at least we could refer them to the FAQ when they asked a common question. I'm hoping this might also reduce the Accutane questions so that people who want to talk about other prescriptions feel like this subforum is for them too. I have cleared it with Dan, so, without further ado!

Please submit questions/answers that are frequently asked to this thread. Also please submit links to any useful off-site resources that you are aware of. Bump the thread if it falls off the front page so everyone will have a chance to see it and contribute if they wish. I will compile/edit the questions/answers into something presentable as soon as i am able and will post it once Dan has approved it. I'm requesting that he stickies it and locks it. Feel free to submit answers that differ from those i primarily give - if they are well founded i have no problems including opposing viewpoints. But don't be a jerk about it, i won't be including anything that i think could open up Acne.org to litigation. So no advice on where to buy Accutane on the internet please. Feel free to copy anything in that you found useful that's in the current FAQ. To start the ball rolling, i'll give a few examples with abbreviated examples of answers. If you guys could write out your answers rather than abbreviating that would rock, but if not i'll get around to writing full answers.

Q. Will i lose my hair? Why is my hair shedding after my course is over? Etc.

A. I didnt, i seemed to grow a little more!

Q. How do i calculate my cumulative dosage? What is the recommended cumulative dosage?

A. suppose to be about 1mg per kg right. Well i weigh 70kg and was put on 80mg as I had severe cystic acne. Will depend on factors relatig to wight and more importantly how bad your acne is. the 1mg to kg is for people with serious acne, not these mild odd spot vanity lightweights lol. Oh and it is not recommended for people still going through puberty/ growth which can be up to like 20/21 as it may cause growth defects/ resulting in more chance of long term side effects, allegedly according to derms and professionals but hey what do they know...alot so listen to them!

Q. What dose should i be taking?

Depends on factors discussed/ weight/ age & severity of acne. Which must be medically determined by a professional

Q. What side effects should i expect? What, if anything, should i do to counter a side effect?

very very dry cracking peeling lips, dry flaking skin, more so in the first few months. initial outbreak and also more severe or painful new acne as skin is thinning and sensitive. Also in first weeks i experienced mild headaches, muscle aches (some still), fatigue. Lots of vaseline for the lips/ aqueas cream for dry areas of skin, but not too much of any moisturizer as it can cause clogged pores and more new acne. tane took over 3 monhs for me to see massive improvement which has maintained itself with next to no new acne.

Q. What should i take my dose with? I don't like milk, i'm scared of fat, etc.

I started taking milk with my tane after a few months when i learnt that it improves the absorption of tane. Then again a proper meal is good too, which I did with the milk. flax seed oil etc didnt touch

For me being on tane was all about patience and not giving up when things got rough, which they did, which is why these people with mild, next to no acne going on it is in my opinion just stupid.

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Great idea and thanks for undertaking this task!

Some information about iPledge would be helpful.

How much fat to take with your pills would be good to know.

How long does it take for side effects to diminish post-tane.

What about sun exposure while taking 'tane?

How do deal with the red face syndrome!

How to treat rashes!

Will fish oil pills really help muscle, joint, tendon pain?

Can I take antibiotics to avoid the IB?

Can I take my pills all at once or should I spread them throughout the day?

That's all I can think of for now!

P&W

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Great idea and thanks for undertaking this task!

Some information about iPledge would be helpful., what is ilpledge

How much fat to take with your pills would be good to know.

just with a regular meal, I drank a glass of full fat milk when taking tabs after meal

How long does it take for side effects to diminish post-tane.

onlyjust finished my course, see my other post, quite a few of the inital sideeffects go after the first few weeks. nearing the end of my course my skin flakes a lot less

What about sun exposure while taking 'tane?

a hour or 2 at most a day is not bad for you, it has helped me nearer the end of the course even out the scars and marks a little

How do deal with the red face syndrome!

face didnt get too red, used mainly water to wash face and left it if it went red, applying moisturizer used to make it go redder and more blotchy, also sometimes causing new acne

How to treat rashes!

non acne red bumpy rashes, with aqeaus cream, on one occasion used fucidin h giving by my doc, which is a steroid cream. only has the odd red or itchy rash, nothing severe

Will fish oil pills really help muscle, joint, tendon pain?

in reality probably not, just another health food fad, waste of time in my opinion, just eat a healthy balanced diet

Can I take antibiotics to avoid the IB?

No you shouldnt, especially not any cyclines, be patient its the only way

Can I take my pills all at once or should I spread them throughout the day?

i was on 80 mg a day, i took 40 in morn with breakfast and 40 in evening with dinner/supper

That's all I can think of for now!

P&W

see answers again

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OK i'm glad there is some interest after all. I'm going to try to work out an outline first (i will just keep editing the first post) so we can get all our questions in some sort of organized form. Anyone know if there is some sort of spoiler tag on this board so users can open and close sections of the FAQ? Hmmm. (Edit - nope, must just be a vbulletin thing) Maybe it could be an html document on acne.org with a post that links to the different sections. Anyways!

Some information about iPledge would be helpful.

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Recommended dosage for Accutane

The recommended dosage for Accutane is 0.5 to 1mg per 1 kg (i.e. 2.2 pounds) of body weight divided into 2 doses taken with food daily. A typical course will last 15 to 20 weeks but it may last for longer or shorter. It is thought that, whilst all dosages should provide an initial clearing of acne, there was a greater need for retreatment with lower dosages. Patients with very severe acne and scarring or whose acne is primarily on the trunk may be prescribed as much as 2 mg per kilo of weight.

An example of the dose you may be prescribed if you weigh 40 kgs (or 88 pounds) is:

20mg per day (if using a recommended dose of 0.5mg/kg);

40mg per day (if using a recommended dose of 1mg/kg); or

80mg per day (if using a recommended dose of 2mg/kg).

Similar figures for different body weights are set out below:

50kgs (110 pounds) - 25mg / 50mg / 100mg

60kgs (132 pounds) - 30mg / 60mg / 120mg

70kgs (154 pounds) - 35mg / 70mg / 140mg

80kgs (176 pounds) - 40mg / 80mg / 160mg

90kgs (198 pounds) - 45mg / 90mg / 180mg

100kgs (220 pounds) - 50mg / 100mg / 200mg

Source: www.fda.gov/foi/label/2005/0186625056lbl.pdf

You wanted info on the rates of occurrence of certain side effects. There is an article by Dr. Jeve Mammino and Dr Robert Rosen from the American Osteopathic College of Dermatology that is posted on www.beauty4skin.com/accutane-isotretinoin which gives some figures. Another site also quotes some figures - see www.cosmeticcop.com/learn/article.asp?PAGETYPE=ART&REFER=SKIN&ID=73. It quotes research by Journal of Cutaneous Medical Surgery. Unhelpfully, the figures don't match!

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A few I thought of were:

Should I follow a special diet on Accutane?

Accutane has worked for me, what shall I do post my Accutane course to maintain the results

Accutane hasn't worked for me, what should I do now.

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most of the questions seem to be "can I use _________ while I'm on accutane?", where this blank seems to be filled with alllllll different meds & OTC products.

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In reply to the earlier post about which medications (otc) are safe on Accutane...I was wondering if it is safe to take a diet pill?? I am trying to clear up my skin and lose 15-20 pounds for my HS reunion. Thanks.

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I wouldn't risk using an unregulated diet pill with Accutane, but you're going to have to check with your doctor on that one if you really want to go that route. Keep in mind that many people (myself included) report that Accutane itself suppresses their appetite and it's not uncommon to lose weight during treatment without any help from other substances.

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Bump of the day.

I'm going to try to work on this over the weekend, so bear with me and don't forget to add anymore frequently asked questions that you can think of. Thanks.

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I don't agree with AndD's response regarding antibiotics on Tane. I don't think the rules about tetracyclines necessarily apply to other antibiotics. I myself was prescribed an antibiotic with Accutane by a derm and others on this forum have been too.

I think that the following from http://www.fda.gov/CDER/DRUG/infopage/accu...cationguide.htm is a useful starting point

"Do not take Accutane with antibiotics unless you talk to your prescriber. For some antibiotics, you may have to stop taking Accutane until the antibiotic treatment is finished. Use of both drugs together can increase the chances of getting increased pressure in the brain."

I also found the following on drugs.com/Accutane

What other drugs will affect Accutane?

- Do not take any of the following medicines while taking Accutane:

- vitamin supplements containing vitamin A; or

- a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin, Panmycin, Robitet, others), minocycline (Minocin, Dynacin, Vectrin), doxycycline (Doryx, Monodox, Vibramycin, Vibra-Tabs), demeclocycline (Declomycin), or troleandomycin (TAO).

- Taking any of the drugs listed above during treatment with Accutane may be dangerous.

- Before taking Accutane, tell your doctor if you are taking carbamazepine (Tegretol, Carbatrol, Epitol). You may require a dosage adjustment or special monitoring during treatment.

- Do not use other acne medications unless otherwise directed by your doctor. They may interfere with the treatment or increase irritation of the skin.

- Do not take birth control pills that do not contain estrogen ("minipills") during treatment with Accutane. They may not work while taking Accutane.

- Drugs other than those listed here may also interact with Accutane. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

If I was answering the question as to whether antibiotics can be taken with Accutane to reduce an initial breakout, I would say something like:

"Do not take Accutane with antibiotics unless you talk to your prescriber. Use of a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin, Panmycin, Robitet, others), minocycline (Minocin, Dynacin, Vectrin), doxycycline (Doryx, Monodox, Vibramycin, Vibra-Tabs), demeclocycline (Declomycin), or troleandomycin (TAO) with Accutane can increase the chances of getting increased pressure in the brain. However, a small number of forum members have found that dermatologists are willing to prescribe other antibiotics with Accutane in order to minimise the initial breakout."

I try to find out what other antibiotics have been described.

BTDT - is any of this any help? If not I'll shut up and go away!

OK - I did a check. Jen121 responded to a thread I created on this subject. She was prescribed Erthromycin. I took Klacid MR.

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Uh, yeh that's not the only thing i disagree about - i'm a firm beleiver in the benefits of fish oil while on Accutane.

And you are right, it's only the -cyclin type antibiotics which are contraindicated.

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I definitely think reiterating the consumption of too much vitamin A on top of Accutane should be noted. It caused me to have major heart palpitations during my course. (Ovaltine was the culprit.)

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Bumpity!

I'm actively working on the questions/answers now. I still need some info - from a current iPLEDGE user of each gender, info on the prescribing rules for various countries, what brands are available where, etc.

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I don't agree with AndD's response regarding antibiotics on Tane. I don't think the rules about tetracyclines necessarily apply to other antibiotics. I myself was prescribed an antibiotic with Accutane by a derm and others on this forum have been too.

I think that the following from http://www.fda.gov/CDER/DRUG/infopage/accu...cationguide.htm is a useful starting point

"Do not take Accutane with antibiotics unless you talk to your prescriber. For some antibiotics, you may have to stop taking Accutane until the antibiotic treatment is finished. Use of both drugs together can increase the chances of getting increased pressure in the brain."

I also found the following on drugs.com/Accutane

What other drugs will affect Accutane?

- Do not take any of the following medicines while taking Accutane:

- vitamin supplements containing vitamin A; or

- a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin, Panmycin, Robitet, others), minocycline (Minocin, Dynacin, Vectrin), doxycycline (Doryx, Monodox, Vibramycin, Vibra-Tabs), demeclocycline (Declomycin), or troleandomycin (TAO).

- Taking any of the drugs listed above during treatment with Accutane may be dangerous.

- Before taking Accutane, tell your doctor if you are taking carbamazepine (Tegretol, Carbatrol, Epitol). You may require a dosage adjustment or special monitoring during treatment.

- Do not use other acne medications unless otherwise directed by your doctor. They may interfere with the treatment or increase irritation of the skin.

- Do not take birth control pills that do not contain estrogen ("minipills") during treatment with Accutane. They may not work while taking Accutane.

- Drugs other than those listed here may also interact with Accutane. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

If I was answering the question as to whether antibiotics can be taken with Accutane to reduce an initial breakout, I would say something like:

"Do not take Accutane with antibiotics unless you talk to your prescriber. Use of a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin, Panmycin, Robitet, others), minocycline (Minocin, Dynacin, Vectrin), doxycycline (Doryx, Monodox, Vibramycin, Vibra-Tabs), demeclocycline (Declomycin), or troleandomycin (TAO) with Accutane can increase the chances of getting increased pressure in the brain. However, a small number of forum members have found that dermatologists are willing to prescribe other antibiotics with Accutane in order to minimise the initial breakout."

I try to find out what other antibiotics have been described.

BTDT - is any of this any help? If not I'll shut up and go away!

OK - I did a check. Jen121 responded to a thread I created on this subject. She was prescribed Erthromycin. I took Klacid MR.

My derm said she would keep me on cephalexin for a while after I start accutane

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