Isotretinoin: serious side effects

Isotretinoin: serious side effects

Isotretinoin is an active ingredient used to treat acne. However, it is only approved for the treatment of severe acne. This is because the active ingredient can have significant side effects. These include skin rashes and inflammation of the skin, eyes and mouth. Since taking it can cause birth defects in the foetus, taking it during pregnancy is not permitted. Find out more about the effects, side effects and dosage of isotretinoin here.

effects of isotretinoin

Isotretinoin belongs to the group of acne remedies – more precisely to the retinoids. These are substances that are related to  vitamin A  (retinol). By using the remedy, the sebaceous glands become smaller and less sebum is produced. In addition, isotretinoin has an anti-inflammatory effect and normalizes the growth of (mucous membrane) cells. This can effectively relieve acne.

The active ingredient can be applied both topically and systemically. When applied topically, the agent only acts locally on the diseased area. In systemic therapy, the active ingredient is taken in the form of tablets and thus unfolds its effect throughout the body.

Due to its significant side effects, isotretinoin is usually only used in severe cases. In addition, the active ingredient is usually only used if another treatment – for example local acne or antibiotic therapy – has not worked.

Side Effects of Isotretinoin

Whether and if so which side effects occur during treatment with isotretinoin depends heavily on how the active ingredient is used. When applied locally, there are usually fewer side effects than when the active ingredient can be distributed throughout the body. Especially in this case, the drug shows a number of side effects.

Very often, side effects on the skin occur during use: These include inflammation, scaling, skin rash, increased skin vulnerability and  itching . The skin becomes drier and inflammation of the mucous membranes and  nosebleeds  can occur. In addition, the skin reacts more sensitively to the sun. This should be considered especially in summer.

In addition, the following side effects also occur very frequently during treatment: decrease in the number of  red blood cells  (somewhat more rarely also in  white blood cells ), changes in the number of blood platelets, dry mucous membranes and inflammation in the area of ​​the eyes and mouth, back pain, muscle and  joint pain  and increase in blood fat levels. It can also cause headaches, hair loss and an increase in blood sugar levels.

effects on the psyche

Presumably, isotretinoin also affects the psyche of some patients. In rare cases, side effects such as mood swings, anxiety and increased aggressiveness have been observed. In addition,  depression  can occur or an existing depression can be aggravated.

Very rarely, the treated patients can also have suicidal thoughts and, in the worst case, even attempt suicide. For this reason, patients should be closely monitored not only by the doctor treating them, but also by relatives or friends. This is particularly important at the beginning of treatment.

For a detailed list of all side effects, please refer to the information leaflet that came with your medication.

Dosage of isotretinoin

Isotretinoin is a prescription drug that can only be purchased at the pharmacy with a doctor’s prescription. The acne remedy is not available without a prescription. In principle, the active ingredient is available for local application in the form of ointment, cream or gel. There are tablets for internal use. These usually contain 10 or 20 milligrams of the active ingredient.

Isotretinoin tablets should be taken once or twice daily with some liquid with meals. Depending on the dose, treatment usually lasts 16 to 24 weeks. At the beginning of therapy, adults and children over 12 years of age should receive 0.5 milligrams of isotretinoin per kilogram of body weight. Later, the dose can be increased up to 1 milligram as needed. In the case of impaired kidney function, the dose must be correspondingly lower.

Overdose of acne remedy

If you have taken too much isotretinoin, please contact your doctor or go to the nearest hospital immediately. However, if you miss a dose, make up for it as soon as possible. However, do not take it if it is already time for the next dose. So don’t take double doses!

Do not interrupt or stop treatment with isotretinoin without a valid reason without first consulting your doctor. An exception is the possibility of pregnancy. In this case, you must not continue to use the active substance. You should also stop taking it immediately if you experience any of the following symptoms:

  • Nausea  and vomiting coupled with upper abdominal pain
  • Nausea and vomiting coupled with headache and/or visual disturbances
  • Severe abdominal pain and bloody  diarrhea

If you have an allergic reaction, you should stop taking it immediately. This can manifest itself in the form of skin rashes, itching, breathing problems, swelling or circulatory disorders.


Products with isotretinoin should not be used if there is hypersensitivity to the active ingredient. In addition, the active substance is also contraindicated in the following diseases:

  • Elevated blood fat levels
  • Impaired liver function
  • Increased vitamin A concentration in the body

In addition, the active ingredient may only be used with particular caution in the case of certain visual disorders, depression, kidney dysfunction,  diabetes , obesity, increased intracranial pressure and chronic inflammatory bowel diseases. When used locally on the skin, no skin areas affected by acute  eczema , perioral dermatitis or rosacea should be treated.

pregnancy and breast feeding period

Isotretionin should not be used during pregnancy and lactation. Women of childbearing potential must use reliable  contraception  and carry out a pregnancy test before starting treatment. Pregnancy tests are usually carried out at regular intervals during treatment.

Contraception must be started four weeks before treatment and continued until four weeks after treatment. Stop treatment immediately if there is a possibility that you are pregnant. Otherwise, serious malformations in the unborn child or a  miscarriage  can occur.

Because of the dangerous side effects, women of childbearing age may only receive prescriptions that are sufficient in the amount prescribed for 30 days. The prescription must also be redeemed within seven days of being issued – otherwise it will expire.


If you take other medications in addition to isotretinoin, interactions may occur. It is therefore essential that you inform your doctor about medications that you use regularly. Antibiotics ending in -cyclin must not be taken during treatment with the acne remedy  . Likewise, no vitamin A preparations may be added to the body.

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