Accutane

Isotretinoin is a high-dose vitamin A relative taken as a capsule. It has been available since 1982 for severe acne that has not responded to antibiotics. It is now also used for less severe acne that scars, causes real distress, or keeps returning after other treatments. It is the most effective acne treatment available, and the only one given as a defined course aiming at long-term remission rather than ongoing control.

Isotretinoin shrinks the oil glands, sometimes dramatically, and keeps them small long after the course ends. Less oil means less to clog and less for bacteria to feed on. It also normalizes how cells shed inside the pore and reduces inflammation. It is the only acne drug that acts on all four causes of acne at once. The gland shrinkage is why the effect lasts. Other drugs suppress a process that resumes the moment they stop. Isotretinoin changes the gland itself, and regrowth is slow and often incomplete.

Each grade is the same one shown on that condition’s page.

Capsules, commonly 10 mg, 20 mg, 30 mg and 40 mg. Standard capsules need a fatty meal to be absorbed properly. There is also a formulation designed to absorb well without food, sold at lower listed strengths because more of it gets in. Which version you have changes how you take it, so check the label.

Dose is calculated by body weight, and the total amount over the whole course matters more than the amount on any given day.

When to take it: With a meal containing fat, unless you have the formulation designed to work without food. Absorption of standard capsules roughly doubles with a fatty meal, so taking them on an empty stomach effectively lowers your dose. Splitting the daily amount into two doses with meals is common.

If you miss a dose: Take it with your next meal if it is the same day. If not, skip it. Do not double up. A missed dose here is not a crisis, because the total over months is what counts, and it is simply added to the end of the course.

Liver enzymes and blood fats, especially triglycerides, are checked before starting and again during the course, most often in the early months and after any dose increase. Cholesterol and triglycerides commonly rise and usually settle afterwards.

Anyone who can become pregnant is enrolled in iPLEDGE, a federal safety program. It requires two forms of contraception or documented abstinence, a pregnancy test before starting and monthly pregnancy tests during, and prescriptions collected within set time windows. Missing a window means starting that month's process again.

Long term, this is not a drug people stay on. The course ends. What matters afterwards is that the effect on the oil gland is durable, so most people need nothing more than a topical retinoid, and a smaller group needs a second course.

There is no withdrawal and no taper. The course simply ends once the target total dose is reached. Dryness clears over weeks to a couple of months, and skin often keeps improving for three to six months afterwards. Relapse is the real question. Most people stay clear or much improved. Around one in five needs a second course, and the risk is higher in those who started in early adolescence, who had very oily skin, who have hormonal acne, or who stopped before reaching the cumulative target. Pregnancy precautions continue for one month after the last capsule.

Generic isotretinoin is widely available and moderately priced. The formulations designed to absorb without food cost considerably more. The main practical obstacles are not cost but the iPLEDGE requirements, monthly appointments and pharmacy pickup windows, which need planning around travel and work.