Isotretinoin is a medication more commonly known by its brand name of Accutane, when taken orally, or Isotrex when used as an ointment. Isotretinoin is derived from Vitamin A, and is used most commonly in the treatment of very severe acne. It tends not to be the first line drug recommended for the treatment of acne because it can have serious side effects, including either severe birth defects or fetal death among pregnant women.
Isotretinoin was developed and first released as a prescription medication after noting that some patients who took high levels of vitamin A seemed to have reduced problems with acne. This was particularly true when the vitamin A was derived from animal livers, instead of vegetable sources.
A high vitamin A treatment had side effects and isotretinoin was thought to deliver better results with fewer side effects. Unfortunately early patients taking isotretinoin had little idea that severe birth defects could result from taking the medication. Now it is well known that both high doses of fat-soluble vitamin A and isotretinoin are indicated in severe birth defects.
Acne often is associated with teenagers, and teenagers with unplanned pregnancy. Thus to cut down on risking pregnancy while taking isotretinoin, prescription of the medication is controlled through the program called iPLEDGE in the US, as per FDA recommendations.
Under iPLEDGE, prescribing doctors must be registered to prescribe the medication. Further, isotretinoin is not given refills. Patients must get a new prescription of isotretinoin every 30 days in order to continuously take the medication. This system is still imperfect and has proved inconvenient for some patients.
Isotretinoin has proven an effective medication for fighting significant acne but it does have side effects other than its tetragenic ones. Some may note more acne at first, drying of the skin, and sensitivity to the sun. Infrequently isotretinoin has been linked to raised glucose levels, and mood changes. Rarely isotretinoin may cause cataracts, difficulty with night vision and extreme depression.
Since this medication is associated with numerous negative effects, it is important to weigh risk versus benefits and thoroughly discuss all options with a competent dermatologist. Further, women who are sexually active and do not use birth control should not take this medication. Women who are sexually active are advised to practice at least two birth control methods to prevent pregnancy, such as condoms and the birth control pill.