Isotretinoin capsules for acne

About isotretinoin

Acne is the common cause of spots. Most people with acne are aged between 12 and 25 years, but some older and younger people are affected too. Small sebaceous glands lie just under your skin surface and make an oil (sebum) that keeps your skin supple and smooth. Tiny pores on your skin allow the sebum to come on to the surface of your skin. In acne, some of these pores become blocked, causing inflamed spots.

Isotretinoin belongs to a group of medicines known as retinoids, which are substances related to vitamin A. It is used to treat acne which is severe, or which has not got better with other treatments such as oral antibiotics or skin treatments. It works by reducing the production of your skin's natural oil. It is also thought to reduce inflammation. Isotretinoin capsules will be prescribed for you by a skin specialist doctor.

Isotretinoin is also available as a rub-on (topical) skin treatment. There is more information about topical isotretinoin in a separate leaflet called Isotretinoin gel for acne.

Before taking isotretinoin

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking isotretinoin it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding. This is very important because isotretinoin is harmful to babies.

• If you have diabetes (diabetes mellitus).

• If you have a dry eye condition.

• If you have been told you have high levels of fats (lipids) in your blood.

• If you have ever had a mental health problem such as a depressive illness, or if you have ever had suicidal thoughts.

• If you know you have a condition where there is too much vitamin A stored in your body, called hypervitaminosis A.

• If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.

• If you have ever had an allergic reaction to a medicine, or if you are allergic to soya or peanuts.

• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. It is particularly important that your doctor knows if you are taking a tetracycline antibiotic, or a vitamin supplement.

How to take isotretinoin

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack of capsules and any additional information you are given by the doctor. These will give you more information about isotretinoin and will provide you with a full list of the side-effects which you may experience from taking it.

• The capsules are for you - it is very important that you do not share isotretinoin with anyone else.

• Take isotretinoin exactly as your doctor tells you to. There are several strengths of isotretinoin capsules available: 5 mg, 10 mg, 20 mg, and 40 mg. Your dose will be calculated from your weight - each dose may be a combination of different strengths of capsule. Isotretinoin is taken once or twice each day. Your doctor will tell you how many capsules of which strengths to take for each dose, and what time(s) of the day to take the doses. This information will also be printed on the label of the packs to remind you about what the doctor said to you.

• Take the capsules with food; during a meal is ideal. It is best to swallow the capsules with a drink of water. Do not open or chew the capsules.

• If your doctor thinks it necessary, your dose may be adjusted during the course of your treatment. If this happens, make sure you follow carefully the instructions that your doctor gives to you.

• You will be prescribed a course of treatment that lasts for 4-6 months. Only one course of treatment is usually needed.

• If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case take the next dose when it is due and leave out the forgotten dose). Do not take two doses together to make up for a missed dose.

Getting the most from your treatment

• It is important that you keep your regular appointments with your doctor. This is so your doctor can check on your progress. You will need to have some tests before and during the treatment. The tests will check a number of things: that your liver and blood remain healthy, that the amount of fat in your blood stays within normal amounts, and (in women) that you are not pregnant.

• Your doctor will explain to you the dangers of isotretinoin on an unborn baby. If you are a woman, you will be given advice on which types of contraception are suitable for you. One or preferably two forms of contraception are needed during the time from at least one month before you start taking isotretinoin, during the whole course of the treatment, and for at least one month after you stop taking isotretinoin. If at any time during this period you think you may be pregnant, you must speak with your doctor straightaway.

• Some people find that their acne gets worse when they first start taking isotretinoin. This can happen, but it usually resolves quickly within 7-10 days.

• Isotretinoin is likely to make your skin feel very dry. Many people find that using a moisturiser and a lip balm regularly from the day that the treatment starts helps to reduce this.

• You may find that your eyes feel drier than normal. Ask a pharmacist or optician to recommend some suitable lubricating eye drops for you to use. If you normally wear contact lenses, you may prefer to wear glasses instead for a while.

• Your skin will become more sensitive than normal to sunlight and UV light while you are on isotretinoin. Do not use sunbeds and try to avoid direct sunlight. It is recommended that you use a sunblock and a lip balm with a sun protection factor (SPF) of at least 15 before you go out into the sun.

• Do not use treatments such as hair removal waxing, chemical dermabrasion, or laser treatments. You should wait for at least six months after you've finished isotretinoin before having any of these types of treatments.

• Prescriptions for isotretinoin must be dispensed within seven days of being prescribed by a doctor. Wherever possible, it should be on the same day. Each time you are given a new prescription, please take it to your pharmacy to be dispensed straightaway.

• Do not take any vitamin supplements which contain vitamin A while you are on isotretinoin. If you buy any over-the-counter medicines or vitamin supplements, check with a pharmacist that they are suitable for you to take. Also, do not use or take any other anti-acne treatments.

• If you are a blood donor, do not donate blood while you are taking isotretinoin or for at least one month after your treatment has stopped.

• Rarely, some people taking isotretinoin have become depressed and have experienced some mood changes. It is important that you let your doctor know straightaway if you feel 'low' or anxious, or if you start having thoughts about harming yourself.

Can isotretinoin cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with isotretinoin. The best place to find a full list of the side-effects which can be associated with the capsules, is from the manufacturer's printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to isotretinoin, speak with your doctor or pharmacist for further advice.

How to store isotretinoin

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

• Do not keep out-of-date or unwanted capsules. Return them to your local pharmacy which will dispose of them for you.

Important information about all medicines