Jump to content
Acne.org
Search In
Find results that contain...
Find results in...
nikki333

Accutane 2 times, did it work??

Recommended Posts

I went on accuatne about a year ago (was on only 3 months), it worked beautiful for 7 months, now i started breaking out again. the last time i was on 20 mg, then got a rash so my doc put me on 10 mg. I just started it again snd my doc put me on 80 mg, my skin is moderate, only about 2 or 3 cysts on face and 3 on back, wanna stop it before it gets worse, but this 80 mg is killing me , i have arash again my lips are beyond chapped. it was not this bad last time and i am breaking out worse, only been on 3 weeks, did this ever happoen to anyone, is dosage to high, i am 110lbs? my question is did it ever work for anyone after the 2nd time, permanetly or at least for about 3 or 4 years??? please let me know thanks, do not know if this is worth it for just 7 months, a few years maybe

Share this post


Link to post
Share on other sites

Taking a second course greatly increases the chances of remission. Your first course probably shouldn't even count as a course since you took such a low dose for such a short period of time. Yes, the side effects are much more intense on higher doses. If you really just can't stand it, ask for a reduction in dose. But try to stick it out if you can.

For your lips - ask your pharmacist to order you Dr. Dan's Cortibalm. It is a lipbalm with hydrocortisone in it that reduces inflammation and helps heal stubborn cracks in the lips. Then slather something like Aquaphor on top. Moisturize to prevent rashes - you can try an over the counter 1% hydrocortisone cream on your current rash, it should go away. If it doesn't ask your doctor to prescribe something.

Share this post


Link to post
Share on other sites

Thanks,

It is just so hard getting through every day like this, I know I am gonna stick with it, wanna be clear for summer =), just the breakouts getting worse is killing me. i know it gets worse before it gets better, happened last time to, but how long does it get worse for. It has been 3 weeks, anytime soon?

I just really hope that this time it lasts, I wish I knew someone that it lasted for.

Share this post


Link to post
Share on other sites

i really hope you clear up for summer...it sucks ass to have bad acne in the summer...believe me, i spent alot of summer cooped up in my room cause i was ashamed of my skin.

i just got off accutane for the third time and i hope it can last forever!

Share this post


Link to post
Share on other sites

i really hope you clear up for summer...it sucks ass to have bad acne in the summer...believe me, i spent alot of summer cooped up in my room cause i was ashamed of my skin.

i just got off accutane for the third time and i hope it can last forever!

how long did it last when you took it the 2nd time?

It's impossible to say how long your initial breakout will last. It depends on your individual reaction and how much junk you had in your pores that's being purged.

thanks for all the help, such a fustrating thing!! my doc now said he only wants to put me on for 3 months also and he is a different doctor, do u think everyone has to stay on longer

Share this post


Link to post
Share on other sites

If you only weigh 110 lb, your MAXIMUM dose should be around 100 mg per day (which makes it about 2 mg per kilo).

If you were on 20mg last, why would the derm START you at nearly your maximum? It doesn't make sense in the light of the latest recommendation to start patients at a LOW dose (from 0.1 mg to 0.5 mg per kilo) and go slowly up.

This is from an article in Pediatric Dermatology but the same principles work for all patients:

Quote

Typical dosing guidelines for isotretinoin are:

Full dose: 0.5-2 mg/kg per day for 15-20 weeks

Initial dose should be no more than 0.5 mg/kg per day

Only rarely is a dose of 2 mg/kg per day required. In addition, doses of 0.1-0.5 mg/kg per day are also effective in clearing severe acne. However, in a standard 20-week course, when these doses were compared with 1 mg/kg per day, it was found that recurrence was twice as frequent when the lower doses were employed. Therefore, in a standard 20-week course, the 1 mg/kg per day dose is preferred.

In Europe, the daily dose is thought to be less important than the total dose. As long as a total dose of 120-150 mg/kg was reached, recurrence was not greater with the lower daily doses. Of course, the treatment course must be longer to achieve the appropriate final total doses if lower daily doses are used. This could mean greater risk of pregnancy in women of child-bearing potential.

In the past, the full 1 mg/kg per day dose was started initially, but most clinicians now advocate beginning therapy with a reduced dose of no more than 0.5 mg/kg per day, and frequently even as low as 10-20 mg per day for at least the first 3 weeks. Starting slowly helps prevent the occasional severe flare that may accompany abrupt full-dose onset. Dr. Shalita begins counting the 20-week course only after he has reached the full 1 mg/kg dose.

Share this post


Link to post
Share on other sites

"Dr. Shalita begins counting the 20-week course only after he has reached the full 1 mg/kg dose."

That is absurd! So if you weigh 80kgs and start 80mg in month 4...you have another 5 months to go???

Share this post


Link to post
Share on other sites
That is absurd!

I guess it depends on your definition of "absurd." If your derm ( and you) are willing to take the risk of a severe flare/scarring in hopes of getting done with the course faster, that is of course a decision for you and your derm to make. No one is able to predict how exactly a given individual is going to respond to isotretinoin. And no, the bloodtests say nothing about that.

Personally, I like the cautious approach. With drugs, "less is more" usually holds: if you can kill your headache with one aspirin, you don't throw a bottle at it.

With friendly (motherly) greetings

Share this post


Link to post
Share on other sites

I had 2 different derms, the last one started me off on 20 then knocked me to 10 the new one started me with 80 my skin was not that bad now it is breaking out one after another, should i just take 1 pill till i see him that will be 40, do you tink the breakout will be alittle less?

but another way to look at it would be if you start off slow and gradually go up dont you risk having that breakout every time your dose is increased?

Share this post


Link to post
Share on other sites

You should not adjust your own dose. Do as your derm tells you unless you don't trust your derm, in which case you need a new one.

i know i shouldnt adjust my own dose but the sides of my outh are so cracked and red it looks like two big sore pathches on each side of my mouth i took 40 for 2 days and that got better, im gonna go to my derm but until then it sucks ya know

its just the worse phase that is killing me

anyone have any tips on what to do during the worse stage, even just to get it the way it was before i went on the pill, any tips let me know

Share this post


Link to post
Share on other sites

Ask your pharmacist to order you some Dr. Dan's Cortibalm. I know of nothing else that will heal those cracks in the corners. Put that on directly on the lips (it has hydrocortisone so it reduces inflammation and heals those cracks) and then put something moisturizing like Aquaphor on top. Use a good moisturizing body lotion for the rest of you - stick with sensitive skin formulas. I like Aveeno's deily moisturizing lotion. You will probably need eye drops - especially if you start feeling abnormally tired or headachy.

Share this post


Link to post
Share on other sites

This is from the same article I quoted above:

Acne Recurrence After Isotretinoin Therapy

Recurrences after full isotretinoin courses are seen commonly in patients with very early onset of severe acne or in patients with hormonal abnormalities. In addition, patients with acne less severe than nodular disease frequently experience recurrences after treatment. In these patients, lower isotretinoin doses with longer courses (up to 1 year) may be more effective.

Share this post


Link to post
Share on other sites

It really doesn't, unless you take it for a very long period of time. Even then, the jury is out unless you can take it indefinitely, and unless you are a Hollywood starlet, you probably can't.

Share this post


Link to post
Share on other sites

This if from the FDA opinion re a new formulation (NF) of Accutane that Roche is trying to get approved.

The current recommended dosage range for AC (Accutane) for the treatment of severe recalcitrant

nodular acne is 0.5 to 2.0 mg/kg/day given with food in two divided doses. The

dosage of AC used in the clinical trial in this application was 1 mg/kg with food.

According to the Sponsor, it is likely that patients who received AC in the

therapeutic study had approximately 240% higher exposure to isotretinoin than

the subjects who received NF. Since therapeutic equivalence was demonstrated

in the adequately powered total trial population, it would appear that the currently

recommended dosing range for Accutane® may be too high. This is of

considerable clinical importance because many of the side effects of isotretinoin

are dose-dependent. Even those that would appear to be “non-serious� (e.g.

mucocutaneous effects, transient moderate hypertriglyceridemia) can lead to

treatment discontinuation for patients who might otherwise greatly benefit by

completing a course. Available dose-ranging studies for Accutane® do not

definitively establish that even the lower end of the currently labeled dosage is

the minimum effective dose.

Share this post


Link to post
Share on other sites

I went back to derm today. Asked him a thousand questions. he said for me to stay on the 80mg for the duration, he is not going to change my dose. The reason for this is he believes with such a high dose the whole time i will only have to be on tane for 3 months. i know everyone says 3 months is not long enough but he advised that being on such a high dosage the whole time there is no reason to be on much longer and if i would like i can be on a lower dosage for 5 months, i guess when you think about it if it comes out to be same total mg in 3 months or five months should be the same, i guess it depends on how severe your acne is, i basically just get a few cysts on my back and just reg normal breakout on face. What donyou guys think should i see another derm???

for my liosnhe gave me aquaphor ever use it?

Share this post


Link to post
Share on other sites

The side effects depend on the dose PER DAY. You are on a pretty high dose for your weight. Your derm is -- how should I put it politely-- rather aggressive in the way he is treating your acne. Sure, you can get to the total of 150 mg per kilo of body weight in a shorter period of time (3 months instead of five) but the maximum dosing PER DAY guidelines are there for a reason. Taking his approach to its logical conclusions--why not take the entire 150 mg at one go--kill the glands and be done with it? Why try to spread it out over several months at all?

The answer to that should be obvious: because Isotretinoin is a serious drug. Vitamin A and its derivatives are toxic to the body in high doses. That's why you get the side effects-- the higher the dose, the more likely it is you'll have some pretty impressive side effects to show.

Personally, I would change derms/get a second opinion but that is, of course, your call. I tend to err on the cautious side.

Share this post


Link to post
Share on other sites

If you weigh 110lbs, that's approximately 50kg. A 60mg a day dose is only 1.2mg/kg. It's much easier to get a 60mg a day dose, since a 50mg a day dose (which would be almost exactly 1.0mg/kg) requires a 30mg pill which is only made by one manufacturer and is difficult to find). That's not really an agressively high dose, it's a moderate dose. 2mg/kg would be aggressive, .5mg/kg would be cautious. 1.2 is not "pretty much near the maximum for your weight". There's nothing wrong with dosing like this except that side effects will be more pronounced. However, three months of that will only get you to 108mg/kg total. You should really try to hit 125mg/kg total for the best chance of remission, so you'd really need an extra couple weeks at that dose, or one more month at half that dose. Although you can still get a remission with a lower total dosage, it's just that statistically you have the best chance if you reach at least 125.

Really you need to ask yourself if you trust your derm. If you do, then stick with the derm's recommendations. If not, find another one.

Share this post


Link to post
Share on other sites

If you weigh 110lbs, that's approximately 50kg. A 60mg a day dose is only 1.2mg/kg. It's much easier to get a 60mg a day dose, since a 50mg a day dose (which would be almost exactly 1.0mg/kg) requires a 30mg pill which is only made by one manufacturer and is difficult to find). That's not really an agressively high dose, it's a moderate dose. 2mg/kg would be aggressive, .5mg/kg would be cautious. 1.2 is not "pretty much near the maximum for your weight". There's nothing wrong with dosing like this except that side effects will be more pronounced. However, three months of that will only get you to 108mg/kg total. You should really try to hit 125mg/kg total for the best chance of remission, so you'd really need an extra couple weeks at that dose, or one more month at half that dose. Although you can still get a remission with a lower total dosage, it's just that statistically you have the best chance if you reach at least 125.

Really you need to ask yourself if you trust your derm. If you do, then stick with the derm's recommendations. If not, find another one.

The devil is in the details. The original poster was on put on an 80 mg dose ( 1.6 mg per kilo of body weight-- not 60 mg and 1.2 like you say) right at the beginning. Most doctors now recommend starting with a low dose (MAX 0.5) to see how an individual responds to the drug. Moreover, 2 mg per body weight is not "aggressive" like you say but the maximum the manufacturer recommends/has tested -- and something that the derm I quoted said is "seldom needed."

And, like the research/FDA files I quoted show, a lot about isotretinoin dosing is still being debated/not definitively proven by reliable studies/statistics.

Share this post


Link to post
Share on other sites

Hey beentheredonethat (long name lol)

Your pretty good at figuring out that dose stuff... can you tell me if mine would be good? I am 105 pounds and my derm is giving me 40mg for 5 months... does that fufill the requirement to avoid another relapse.. this is my second time and i dont want a number 3! THANKS a lot!

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Personalized Advice Quiz - All of Acne.org in just a few minutes

×