Daniel Buchen, MD
Dermatology and Cosmetic Surgery in New York and New Jersey
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Isotretinoin


   
 

Isotretinoin (Accutane) The statements below are my opinions that I have come to after years of personal experience with isotretinoin. For more information, please consult www.ipledgeprogram.com and your doctor.

Given all the hysteria about isotretinoin (accutane) in the news (internet, TV and radio), I though it would be useful to clarify some of the myths and misconceptions about this very useful drug.

The following statements are TRUE.

  1. The only way to obtain isotretinoin is through the iPledge™ program, www.ipledgeprogram.com. In my office, I am pleased to have now a registered nurse practitioner, Diana DaSilva, RNP who will manage all our isotretinoin patients. Patients needing isotretinoin must be seen by myself (Daniel Buchen, MD) and then will be referred to the RNP who will guide patients through their isotretinoin course.
  2. The principle objective of the program is to eliminate fetal exposure to the medication. Isotretinoin can cause serious birth defects if a pregnant woman takes the medication.
  3. The program requires patient, doctor and pharmacy participation.
  4. Prior to taking, while on the medication and for one month after you have completed treatment, you must come in every month for blood tests (pregnancy test, liver function and triglyceride levels) and evaluation. The usual length of treatment is eight months from start to finish.
  5. Women of child bearing potential must use two separate methods of birth control for one month prior to initiating treatment, during the entire treatment course, and for one month after the medication has been discontinued. Before treatment, two negative pregnancy tests must be documented. The first one can be ordered when the doctor decides that the drug is appropriate for your acne. The second test must be done during the first five days of your menstrual period immediately before you start the medication.
  6. You must have completed all blood work prior to coming in for the appointment. Failure to complete blood work in a timely manner may delay your prescription or may require that your status be reconfirmed in the iPledge program. You will be charged a $50 fee for reconfirmation.
  7. Fill your prescription within seven days at the pharmacy. Bring your prescription and your iPledge card to the pharmacy. Your prescription may not be honored by the pharmacy after one week.
  8. During your treatment, all patients will experience very dry lips. This is normal and expected. You should apply Aquaphor Healing Ointment, an over-the-counter Vaseline like emollient, throughout the day to the lips. This can also be applied intranasally (in the nose) to prevent excessive drying of the nasal mucosa which can lead to nose bleeds. The eyes will also feel dry and those patients who wear contacts may need to use eye drops. The skin on the body, especially the hands, will also become dry. Aquaphor is also useful for the hands.
  9. During your first month or two of treatment, your acne may look worst before it looks better. Some patients will misinterpret this apparent worsening of acne and inappropriately stop the medication. In fact, the best approach is to continue with the medication. With time, you will eventually see your acne improve.
  10. Rarely, the medication can cause joint pains. If they are severe, the medication can be stopped and the joint pains will resolve.
  11. While you take the medication and for one month after completing it, you must not donate blood.

The following statements are FALSE.
(The statements in italic are false. After each false statement, an explanation (truth) in regular font appears.)

  1. The medication may damage your liver. In fact, the liver is very rarely affected by the medication.
  2. You must be on a special, low fat diet when you take the medication. The drug almost always leads to an increase in plasma triglycerides, a fat in the blood. This elevation is normal and anticipated. Very rarely, the rise in triglycerides can lead to pancreatitis, an inflammation of the pancreas (an organ in your abdomen). You do not need to alter your diet when you take isotretinoin.
  3. Isotretinoin causes scarring. What causes scarring is cystic acne, and that, of course, is why you are taking the medication. The drug does not cause scarring.
  4. Isotretinoin cannot be taken when patients spend time outside and are exposed to significant sun. Though there are random reports on the Internet about phototoxicity and isotretinoin, I have not seen any problems when the medication is taken in summer.
  5. The medication cannot be taken by athletes. I am not sure where this myth came from, but it is simply not true.
  6. Isotretinoin causes depression. Every few months, another study comes out regarding the connection or lack of connection between the drug and depression. My experience has been that the drug inevitably improves a patient’s mood. Human nature is such that as patients look better, they feel better.