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isotretinoin
Accutane, Roaccutane‡

Pregnancy Risk Category X

How supplied
Capsules:
10 mg, 20 mg, 40 mg

Action
Unknown. Thought to normalize keratinization, reversibly decrease size of sebaceous glands, and alter composition of sebum to a less viscous form that is less likely to cause follicular plugging.

Indications & dosage
Severe recalcitrant nodular acne unresponsive to conventional therapy--

Adults and adolescents:
0.5 to 2 mg/kg P.O. daily in two divided doses for 15 to 20 weeks.

Adverse reactions
CNS:
headache, fatigue, pseudotumor cerebri.
EENT:
conjunctivitis, corneal deposits, dry eyes, visual disturbances, epistaxis, dry nose.
GI:
nonspecific GI symptoms, nausea, vomiting, anorexia, abdominal pain, dry mouth, gum bleeding and inflammation.
Hematologic:
anemia, elevated platelet count.
Hepatic:
elevated AST, ALT, and alkaline phosphatase levels.
Metabolic:
hypertriglyceridemia, hyperglycemia, altered uric acid levels.
Musculoskeletal:
musculoskeletal pain.
Skin:
cheilosis, rash, dry skin, facial skin desquamation, peeling of palms and toes, petechiae, nail brittleness, thinning of hair, skin infection, photosensitivity, cheilitis, pruritus, fragility.
Other:
drying of mucous membranes.

Interactions
Drug-drug.
Carbamazepine: decreased carbamazepine levels. Monitor levels.
Tetracyclines:
increased risk of pseudotumor cerebri. Avoid concomitant use.
Vitamin A, products containing vitamin A:
increased toxic effects of isotretinoin. Don't use together without doctor's permission.
Drug-food.
Any food: enhanced absorption of drug. Administer drug with milk, a meal, or shortly after a meal.
Drug-lifestyle.
Alcohol use: increased risk of hypertriglyceridemia. Avoid concomitant use.
Sun exposure:
increased photosensitivity reactions. Avoid prolonged or unprotected exposure to sun.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to parabens, which are used as preservatives, vitamin A, or other retinoids. Also contraindicated in woman of childbearing age unless patient has had a negative serum pregnancy test within 2 weeks before beginning therapy, will begin drug therapy on second or third day of next menstrual period, and will comply with stringent contraceptive measures for 1 month before therapy, during therapy, and for at least 1 month after therapy.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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