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childofthenight

What is more important?

I take a dose below my the mg/kg but not too much below only 13mg-15mg. But if I finish my treatment in a 6 month period, I'll have a cumulative dose well in 120-150mg/kg. What's more important cumulative dose or 1mg/kg? Oh and I have moderate severe acne.

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13mg-15mg?

To what are you referring?

Accutane comes in pill strengths of (I think 10mg), 20mg, 40mg, and I think a few larger.

How much do you weigh? Convert the lbs. to kg.

The dosage of mg/kg means that the dose matches your weight approximately, as close to it as possible, but a little higher.

So if you weigh 68kg, for example, the suggested target dose would be approximately 68mg. However, it does not come in that strength. Your Derm. may go with a conservative 60mg daily, in this case, or go up to 80mg daily to treat more aggressively.

I'm not sure what you mean by cumulative dose of 120-150mg. Are you referring to adding all the months up together? I don't think the Dermatologists think along those lines with regard to dosage. But, there is a cumulative effect of treating with Accutane (at any dose) during a length of time. It also stays in your system for months following treatment -- obviously not maintaining those levels, but tapering off as time passes.

If I remember correctly, you said in another thread that your doctor hasn't ordered a blood test for you. Are you going to a General Practitiner for this treatment as opposed to a Dermatologist? It seems to me, that you need far better medical advice than you are getting from your current doctor. Dosage varies from patient to patient and is very individual on a case by case basis. There are many factors to consider when the doctor increases or decreases dosage -- there is no standard one dosage fits all. What works well for one person may not work for another, or even be an option. What causes one person side effects may not effect another. Side effects themselves are unique to the individual. The levels in your blood tests play a big part in treatment.

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I'm not sure what you mean by cumulative dose of 120-150mg. Are you referring to adding all the months up together? I don't think the Dermatologists think along those lines with regard to dosage.

Yes, they do. http://www.skintherapyletter.ca/stl/download/stl_9_3.pdf

Acne therapy is usually initiated at a dose of 0.5mg/kg daily for the first 2-4 weeks and then increased to 1.0mg/kg/day for the remainder of the 20 week course. Upon initial introduction in 1982, lower dosages of 0.1-0.5mg/kg/day were given for severe acne with data analysis showing increased rates of recurrence compared to the dosages recommended today.1 The minimum total cumulative dose associated with long term, permanent remission is 120mg/kg. Some patients requiring re-treatment after relapse or partial response may require doses of 1.5-2.0mg/kg/day.14 Dermatologists often continue treatment until the patient is clinically clear, although there is controversy regarding benefits beyond 150mg/kg.1 Doses must be adjusted in some cases of concomitant systemic disease. (See Table 1).

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I'm being treated by a dermatologist. I don't know why he does blood test every 3 months, truthfully I would want to change him, he seems to be a idiot, but I have this shity city insurance and I have to go through a bunch of hassle to change a specialist, and most of them are in hospitals where you wait like the whole day to see them but anyways...

I weigh 73kg (162lbs) and am on 80/40mg a day (3rd month). First 2 months was 40mg. This month I have definitely noticed a good deal less outbreaks but the existing ones don't heal faster then pre-tane, I don't think I'm really benefiting from tane or maybe my dose is not enough.

For the cumulative dose, yeah I meant the one you add up with all the months, so if I stay on this dose for the next 3 months, I'll be in the 120-150mg/kg range.

**And beentheredonethat just stated from a fact that the 20 week course starts from 1mg/kg. Well if that's the case I have a very long time to go, so I think that is bull. I'm already 3 months done it'll be insane to go another 5 months on this lol.

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I'm being treated by a dermatologist. I don't know why he does blood test every 3 months, truthfully I would want to change him, he seems to be a idiot, but I have this shity city insurance and I have to go through a bunch of hassle to change a specialist, and most of them are in hospitals where you wait like the whole day to see them but anyways...

I weigh 73kg (162lbs) and am on 80/40mg a day (3rd month). First 2 months was 40mg. This month I have definitely noticed a good deal less outbreaks but the existing ones don't heal faster then pre-tane, I don't think I'm really benefiting from tane or maybe my dose is not enough.

For the cumulative dose, yeah I meant the one you add up with all the months, so if I stay on this dose for the next 3 months, I'll be in the 120-150mg/kg range.

That's great that you are using a professional to help you with your journey to clear skin. Remember to do your own research as well. This is a great place to talk about the issues that you are coming across. I wish you the best of luck.

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**And beentheredonethat just stated from a fact that the 20 week course starts from 1mg/kg.

When did i say that?

**Acne therapy is usually initiated at a dose of 0.5mg/kg daily for the first 2-4 weeks and then increased to 1.0mg/kg/day for the remainder of the 20 week course.

Sorry meant no offense, you didn't state it, you put down a quote that had it in, I think that would be insane, since not everybody needs a 1mg/kg in their treatment, some go 0.5mg/kg throughout the whole treatment and do fine.

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It says usually. Different doctors have different approaches for different patients. And the usual 20 weeks is all-inclusive, it doesn't start counting at 1.0mg.

Ok I feel better, like I said I weigh 73kgs so I could handle up to 80mg, and I started 80/40mg on month 3, that would be crazy to start 20 weeks from month 4 lol. But just to get this right now and I see you understand this well, even if I never reached a 1mg/kg a day but I hit a cumulative dose of at least 120mg/kg should I be fine?

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There are several schools of thought. Some doctors hold that the cumulative dose is more important. Some beleive the daily dose is. Either way i don't see a problem with your dosage unless your acne is very severe, and even then it could be sufficient.

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I'm being treated by a dermatologist. I don't know why he does blood test every 3 months, truthfully I would want to change him, he seems to be a idiot, but I have this shity city insurance and I have to go through a bunch of hassle to change a specialist, and most of them are in hospitals where you wait like the whole day to see them but anyways...

I weigh 73kg (162lbs) and am on 80/40mg a day (3rd month). First 2 months was 40mg. This month I have definitely noticed a good deal less outbreaks but the existing ones don't heal faster then pre-tane, I don't think I'm really benefiting from tane or maybe my dose is not enough.

For the cumulative dose, yeah I meant the one you add up with all the months, so if I stay on this dose for the next 3 months, I'll be in the 120-150mg/kg range.

**And beentheredonethat just stated from a fact that the 20 week course starts from 1mg/kg. Well if that's the case I have a very long time to go, so I think that is bull. I'm already 3 months done it'll be insane to go another 5 months on this lol.

Well, aside from the fact that the guy isn't monitoring your blood levels, he is taking a more conservative approach to your treatment. But given your weight, he should go up a little higher for the last three months. Another question: you said 80/40mg a day.....do you mean an average of 60mg a day (I had to do that as there is no 60mg pill) or 80mg a day? Anyway, if it's 60mg a day, ask him to increase it to 80mg a day. If it's 80mg a day, it could be increased barring any problems, but it could just as easily stay put and still treat you effectively.

When do you see your doctor next?

There are several schools of thought. Some doctors hold that the cumulative dose is more important. Some beleive the daily dose is. Either way i don't see a problem with your dosage unless your acne is very severe, and even then it could be sufficient.

I don't recall my doctor's focus on cumulative, however, he could have been and that just wasn't emphasized. What would be the purpose of obsessing on the cumulative? I mean, if each patient is different in size, weight, type of acne, resistancy or compliancy to treatment, complications or lack thereof, etc., what point is there to focus on the total cumulative amount? Especially if some individual's course lasts longer or has to be stopped and started again or goes on long term low dose following -- then wouldn't that target range of cumulative amounts be completely thrown out the window?

What do you think, in your own opinion, is more important? (Taking into account variances for individual cases)

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Well, aside from the fact that the guy isn't monitoring your blood levels, he is taking a more conservative approach to your treatment. But given your weight, he should go up a little higher for the last three months. Another question: you said 80/40mg a day.....do you mean an average of 60mg a day (I had to do that as there is no 60mg pill) or 80mg a day? Anyway, if it's 60mg a day, ask him to increase it to 80mg a day. If it's 80mg a day, it could be increased barring any problems, but it could just as easily stay put and still treat you effectively.

When do you see your doctor next?

Well first of all I have moderate severe acne on my face and mild acne on my back and moderate on my shoulders. I'm on 80mg on one day, and 40 the other (alternating dose). Since those 3 months, my back is almost completely clean and smooth, just a couple of zits across. My right shoulder is mostly clean and my left is kinda getting there. My face I only have some stuff left on my upper cheecks and sides. The part where my beard grows and chin is completely clean and nice, except I do have a good amount of little blackheads on my shoulders and face, but my derm said only some of those will go on accutane so I can't fret about those.

I was thinking that I should stay on this dose for month 4+5 and then do 80mg a day for good ridance. If I do that I'll have a cumulative dose of 138mg/kg which seems good enough.

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What would be the purpose of obsessing on the cumulative?

There is apparently data (although i haven't seen the study) that indicates that the statistically best chance of long-term or permanent remission comes when you reach a cumulative dosage of 120-125mg/kg.

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Well first of all I have moderate severe acne on my face and mild acne on my back and moderate on my shoulders. I'm on 80mg on one day, and 40 the other (alternating dose). Since those 3 months, my back is almost completely clean and smooth, just a couple of zits across. My right shoulder is mostly clean and my left is kinda getting there. My face I only have some stuff left on my upper cheecks and sides. The part where my beard grows and chin is completely clean and nice, except I do have a good amount of little blackheads on my shoulders and face, but my derm said only some of those will go on accutane so I can't fret about those.

I was thinking that I should stay on this dose for month 4+5 and then do 80mg a day for good ridance. If I do that I'll have a cumulative dose of 138mg/kg which seems good enough.

Oh, okay. Yeah, I had to alternate the 80/40 thing too -- to get that average of 60mg a day. But I only weigh 105lbs (approx 47.7kg), I had moderate acne, mild if none on my back/chest. He would have put me at 80mg daily for the 3rd and 4th month but I had some slight increases in my liver enzyme levels (sgot and sgpt) so we stuck with the conservative 60mg. That being said, you are obviously much bigger than me and I'm guessing slightly worse acne, so assuming everything is all good with your health and liver, 80mg a day would be good treatment for you, because 60mg daily is below the mg/kg target. That being said, there may be a reason he is being conservative with you, so ask him and talk about a higher dose if possible.

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There is apparently data (although i haven't seen the study) that indicates that the statistically best chance of long-term or permanent remission comes when you reach a cumulative dosage of 120-125mg/kg.

Heh? I thought it was somewhere between 120mg-150mg/kg??

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There is apparently data (although i haven't seen the study) that indicates that the statistically best chance of long-term or permanent remission comes when you reach a cumulative dosage of 120-125mg/kg.

Okay. So, the idea is to take at least that cumulative amount. Does that mean that a higher cumulative amount over a longer period of time just adds to the efficacy (long term low dose) or is that what my Derm meant that there just isn't enough long term information?

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I have seen repeated references in the literature (but no links to the actual data) which indicates that low dose, long-term courses can be as effective as high dose, short-term courses with less side effects. I have also seen references indicating that this approach leads to a greater need for retreatment - that link was posted here a long time ago but i don't have it.

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There are other important factors, such as family history of acne, whether you have body acne (the more the worse) and when you first got (serious) acne (the younger the worse).

So cumulative dosage of 100-120 mg/kg can be fairly enough.

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There are other important factors, such as family history of acne, whether you have body acne (the more the worse) and when you first got (serious) acne (the younger the worse).

So cumulative dosage of 100-120 mg/kg can be fairly enough.

Family history of acne: My father (outgrow it at 18), uncle had a lot (outgrow it at 20-21), mother (very mild in her teens (since then never acne again) only my sister still has acne as an adult but only on her chin, she had a lot in her teens

Body acne: Got it at 17, it was mild-to moderate now I'm 19 1/2 and it became mild

Since when I got acne: At the age of 10 I started getting blackheads and whiteheads and I was naturally cleared at 13, at 14 acne started to come and at 15 it became severe, now it was only moderate severe (I guess I got older it got better, heck maybe in a few years I would outgrow it but I'm tired of waiting)

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