Roaccutane

What is it?

A retinoid preparation for hospital use only, available as red/ white gelatin capsules in 2 strengths containing 5mg and 20mg of isotretinoin, marked R5 and ROA20, respectively.

Medical Uses

Acne, especially severe forms unresponsive to antibiotics.

Dosage

Adults, start with 0.5mg per kg of body weight each day, either as 1 or 2 doses with food, for 4 weeks. Then adjusting depending upon response within the range 0.1 to 1.0mg per kg of body weight for an additional 8 to 12 weeks. Should not normally be repeated.

Special Care

Specialist hospital use only, exclude pregnancy; effective female contraception necessary 1 month before and up to 4 weeks after treatment. Check liver function and blood lipids regularly - drug may need to be stopped if tranaminase or triglyceride levels are high or if signs of pancreatitis occur. Previous depression - monitor all patients for depresion or thoughts of suicide. Previous gastrointestinal disorders - drug should be withdrawn if severe diarrhoea occurs. Certain skin treatments must not be carried out for at least 6 months - ongoing supervision required.

Avoid Use

Children, pregnancy, breast- feeding, liver or kidney disease.

Possible Drug and Food Interactions

Tetracyclines, high doses of vitamin A.

Known Side Effects

Hair loss, dryness (monitor for keratitis if eyes are dry), mucosal erosion, nausea, headache, muscle and joint pains, neurological changes, psychiatric disorders, drowsiness, sweating, fits, menstrual disorders, mood changes, rise in liver enzymes and blood levels of triglycerides, blood and protein in urine (reversible). Risk of fatal pancreatitis. Sometimes, hearing loss, thrombocytopenia, (decline in blood platelets causing bleeding), alllergic vasculitis, disturbance of vision - patients should be warned and eyes examined regularly. In rare cases, acne fulminans, hairiness, pigmentation of face, lymphadenopathy (disease/damage of lymph system).