Accutane is a medicine that is used to treat a severe type of acne called nodular acne, this is when you have acne with red, swollen and tender lumps in the skin.  It should only be used if your acne has not improved using other acne treatments including antibiotics.

Accutane is the brand name of the drug isotretinoin, there are now other brands of isotretinoin available called Absorica, Amnesteem, Caravis, Myorisan Sotret and Zenatane.  It is also available under the generic name of isotretinoin.  

What are the more common side effects of Accutane?

All medicines have side effects that affect some people,  these are the most common side effects of Accutane:

• dry skin
• bone or joint pain
• irritated eyes with burning, redness and itching
• nosebleeds
• inflamed dry, red scaling lips
• skin infection or rash
• headache
• stomach upset
• thinning hair

Mild side effects of Accutane 

These are side effects that do not usually require immediate medical attention:

• dry eyes (use lubricating drop or ointment)

• dry nose that may lead to nosebleeds. 

Serious side effects of Accutane

These unwanted effects are serious and require immediate medical attention:

• Birth defects if you become pregnant
• Mental health issues depression, psychosis, aggressive behaviour and suicide ideation and attempts
• Increased pressure in the brain
• Serious skin problems
• Severe stomach chest or bowel pain
• Muscle and joint pain
• Hearing or vision problems
• Increase in cholesterol levels and/or blood sugar levels
• Lowering of red and white blood cells
• Serious allergic reactions (anaphylaxis)

Side Effects in more detail

Accutane, the brain and mental health issues

Accutane may cause serious mental health issues as a side effect. If you have any of the symptoms below it is important to call a doctor immediately: 

• Feeling sad more than you usually do
• Sleep problems of wanting to sleep more or having trouble sleeping
• Being more irritated, aggressive or angry
• Appetite changes or change in your body weight
• No longer want to spend as much time with friends or family.
• Less interest in your usual activities that you once enjoyed
• Feeling tired often
• Feeling worthless
• Thoughts or plans of harming yourself or someone else
• Having impulsive thoughts actions that could be dangerous
• Seeing things or hearing things that you know are not real

A rare side effect of Accutane is that it can increase the pressure in your brain which can cause loss of eyesight and very rarely death.  It is important you call your doctor immediately if you have any symptoms of increased brain pressure, symptoms include: 

• bad headache 
• vision is blurry
• feeling dizzy 
• unexplained nausea or vomiting 
• seizures (convulsions)
• stroke 

Allergic reactions 

Accutane can rarely cause a serious allergic reaction (anaphylaxis) which is a medical emergency and you should call 911 for immediate medical attention. Symptoms of anaphylaxis can include:

• Wheezing, trouble breathing, cough or shortness of breath
• Lips or tongue swelling, having trouble swallowing or tightening of the throat
• Rash, hives, itching or swelling
• Dizziness, lightheadedness, fainting or confusion

Another form of serious allergic reaction is a skin reaction which may include:

• blisters or peeling on legs, arms or face
• sores in your mouth, throat, nose, eyes 

If you have any of these symptoms you should stop the medicine and call your doctor.

Accutane and pregnancy

Accutane should not be used in pregnancy or if you are trying to become pregnant, it can cause birth defects, miscarriage, babies to be born very early and death of the baby.  There is a high risk of severe birth defects even if Accutane is taken in a small amount for a short period of time.

Accutane can only be prescribed under a special restricted distribution program approved by the Food and Drug Administration. This program is called iPLEDGE™.

If you are a female who can become pregnant you must:

• Agree not to become pregnant one month before starting Accutane, while on Accutane and for one month after completing Accutane.
• Have a negative pregnancy test before starting Accutane then monthly while taking Accutane, a test at the end of treatment and a final test one month after completion of the entire course of Accutane.
• Agree to use two forms of contraception while using Accutane, unless the patient has chosen to not have intercourse with a male while being treated, or you have had a hysterectomy.
• If you become pregnant you must see a Doctor who is an Obstetrician-Gynecologist experienced in reproductive toxicity for further evaluation and counseling.

Accutane and skin side effects.

Mild side effects of dry skin, chapped lips and dry nose are quite common and can often be treated with a quality lip balm, moisturizer and gentle cleansing products. Discuss with your doctor which products they recommend for your skin condition.

Severe skin reactions can be life threatening, require hospitalization and even may result in death.  If you develop a fever and rash with blisters on your face, arms, legs, mouth, throat, nose or eyes, it is important to seek medical attention immediately. 

Bone and muscle side effects

Accutane can cause pain in your muscles and joints.

You should tell your doctor if you get: 

• Back pain
• Joint pain
• Broken bone (tell your doctor you are  taking Accutane) 
• Inform your doctor if you will be doing hard physical activity while you are taking Accutane
• If you have muscle weakness with pain or without pain this can be a sign of serious damage to muscle and you should stop Accutane and call your doctor.

Accutane may cause long bone growth to stop in teenagers who are still growing.

Hearing and vision side effects

Some people taking this medicine develop ringing in their ears or their hearing gets worse, if this happens to you then you should stop taking Accutane and call your doctor.

Accutane can cause dry eyes which may respond well to lubricating eye drops and ointment. 

Contact lens wearers may develop an intolerance to wearing their contact lenses.

You should stop Accutane and see your doctor or have an ophthalmological examination if :

• your vision is not as clear as usual
• it is harder to see in the dark
• your eyes are constantly dry or painful
• you develop red or inflamed eyes (conjunctivitis) 

Change in blood tests

Before you start Accutane you may get a baseline blood test to check your levels of cholesterol,  triglyceride, glucose, transaminase, platelets and red and white blood cells, this way you know what your levels are to begin with.

Accutane can cause an increase in cholesterol, triglyceride, transaminase and glucose levels and can cause a decrease in red blood cells, white blood cells and an increase or decrease in platelet levels.

You should contact your doctor if you have any of these symptoms:

• increase thirst 
• increase in urination
• feeling faint, weakness or tiredness
• trouble with breathing
• increase in number of infections
• fever

Abdomen or tummy side effects

Sometimes Accutane can cause symptoms that mean there is damage to an organ in your abdomen, which could include your liver, pancreas, stomach, intestines or your esophagus. If you have any symptoms below you should stop taking Accutane and call your doctor:

• severe pain in your chest, stomach or bowel
• painful or difficulty in swallowing
• heartburn that is new or worse than normal
• bleeding from your anus
• your skin or the white of your eyes become yellow
• urine is dark