1. About isotretinoin capsules
Isotretinoin capsules are a very effective treatment for severe acne (spots).
This medicine can have serious side effects, however, so it must be prescribed and supervised by a specialist doctor.
Isotretinoin capsules are also known by the brand names Roaccutane and Rizuderm.
2. Key facts
- Isotretinoin capsules start to work after a week to 10 days. They work very well - 4 out of 5 people who use them have clear skin after 4 months.
- You will a have blood test before you start taking isotretinoin and regular blood tests during your treatment.
- Your skin may become very dry and sensitive to sunlight during treatment. Using lip balm and moisturisers will help.
- It's very important not to become pregnant while using isotretinoin capsules and for at least 1 month after stopping. This is because isotretinoin can harm an unborn baby. Women will be given a reminder card about this.
- If you become depressed or think about harming yourself while taking isotretinoin, stop taking the medicine and tell your doctor straight away.
3. Who can and can't take isotretinoin capsules
Isotretinoin capsules are for teenagers and adults with severe acne. Do not give isotretinoin capsules to children under the age of 12 years or before puberty.
Isotretinoin capsules aren't suitable for some people.
Do not take isotretinoin capsules if you:
- have had an allergic reaction to isotretinoin, soya (the capsules contain soya) or any other medicines in the past
- have an inherited digestive disorder called fructose intolerance (the capsules contain sorbitol)
To make sure isotretinoin capsules are safe for you, tell your doctor if you:
- have had a mental health illness like depression
- are pregnant or think you could be, or you're breastfeeding
- have ever had an allergic reaction to isotretinoin or any other medicine
- have liver or kidney disease
- have high levels of cholesterol or other fats in your blood
- have high levels of vitamin A
- have Crohn's disease or ulcerative colitis
If you have diabetes, talk to your doctor before beginning treatment with isotretinoin capsules. You may need extra monitoring while you take isotretinoin capsules as this medicine can cause a rise in blood sugar levels.
4. Side effects
Like all medicines, isotretinoin capsules can cause side effects, although not everyone gets them. Side effects will usually go away when you stop treatment.
Dry skin and lips are very common side effects. For safety, do not have any waxing, dermabrasion, or laser skin treatment while you're taking this medicine and for at least 6 months after you stop, as this could cause scarring or skin irritation.
Common side effects
The common side effects of isotretinoin capsules happen in more than 1 in 10 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:
- skin becoming more sensitive to sunlight
- dry eyes
- dry throat
- dry nose and nosebleeds
- headaches and general aches and pains
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Stop taking isotretinoin capsules and call a doctor straight away if you get:
- anxiety, aggression and violence, changes in mood, or suicidal thoughts - these can be signs of depression or other mental health problems
- severe pain in your stomach with or without diarrhoea, feeling or being sick (nausea or vomiting) - these can be signs of a serious problem called pancreatitis
- bloody diarrhoea – this may be a sign of gastrointestinal bleeding
- a serious skin rash that peels or has blisters - the skin rash may come with eye infections, ulcers, a fever, and headaches
- difficulty moving your arms or legs, and painful, swollen or bruised areas of the body, or dark pee - these can be signs of muscle weakness
- yellow skin or the whites of your eyes turn yellow, difficulty peeing, or feeling very tired - these are signs of liver or kidney problems
- a bad headache that doesn't go away and makes you feel sick or be sick
- sudden changes in eyesight, including not seeing as well at night
It's very rare, but isotretinoin capsules can sometimes cause depression or make it worse, and even make people feel suicidal.
Tell your doctor straight away if you become depressed or think about ending your life while taking isotretinoin capsules.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to isotretinoin capsules.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of isotretinoin. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
5. How to cope with side effects
What to do about:
- dry skin or lips - apply a moisturiser and lip balm often (the best type of moisturiser is an oil-free face moisturiser for sensitive skin). Try to keep your showers shorter than 2 minutes, using lukewarm water rather than hot.
- skin becoming more sensitive to sunlight - stay out of bright sun and use a high factor, oil-free sun cream (SPF 15 or above) even on cloudy days. Do not use a sunlamp or sunbeds.
- dry eyes - ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and these become uncomfortable, you might have to wear glasses instead while you're taking this medicine.
- dry mouth or throat - try chewing sugar-free gum or sweets.
- dry nose and nosebleeds - try applying a thin layer of Vaseline to the inside edges of your nose.
- headaches and joint, muscle and back pain - ask your pharmacist to recommend a painkiller. Light exercise shouldn't be a problem, but try to avoid heavy exercise as it may make joint or muscle pain worse.
6. How and when to take it
It's important to take the capsules as instructed by your doctor.
As a general rule, the starting dose is 0.5mg per kilogram body weight per day (0.5 mg/kg/day). So if you weigh 60kg, your dose will usually start at 30mg a day.
Usually, you take isotretinoin capsules once or twice a day. Each capsule contains a dose of 10mg or 20mg of isotretinoin.
The dose of isotretinoin capsules varies from person to person, and depends on your weight.
Swallow the capsules whole with a drink of water. It's best to take them straight after a meal or snack to make sure they work properly.
What if I forget to take it?
If you take the capsules once a day and remember you've missed a dose on that day, take it as soon as you remember. If it's the next day when you remember, skip the missed dose and take the next capsule at the usual time.
If you take the capsules twice a day and forget to take a dose, take it as soon as you remember, unless this is within 2 hours of your next dose. In this case, skip the missed dose and take the next capsule at the usual time.
Never take a double dose. Never take an extra dose to make up for a missed one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Urgent advice: Call your doctor or go to A&E straight away if you take too much isotretinoin - even if you have no symptoms
If you need to go to your nearest A&E department, take the isotretinoin packet or leaflet inside it plus any remaining medicine with you.
Will the dose I take go up or down?
After a few weeks, your doctor may change your dose of capsules. You may need a higher dose if your acne isn't getting better. You may need a lower dose if you have side effects that bother you.
7. Advice for women
This medicine is likely to harm a baby. It also increases the risk of miscarriage.
If you become pregnant during treatment with isotretinoin capsules, stop taking the capsules and tell your doctor as soon as possible.
It's very important that you do not get pregnant while you're taking isotretinoin capsules. You'll be asked by your doctor to follow strict rules to prevent pregnancy during treatment and for 1 month afterwards.
Before starting treatment with isotretinoin capsules, women who are able to become pregnant must agree to:
- use at least 1, and ideally 2, reliable methods of contraception for 1 month before starting isotretinoin capsules, and for 1 month after treatment has stopped - the second contraceptive should be a barrier method of contraception (for example, a condom), but you shouldn't use barrier methods on their own
- have a pregnancy test before, during, and 5 weeks after the end of treatment - some doctors may ask you to have monthly pregnancy tests
Your doctor will give you a patient reminder card for isotretinoin. Read this card and the information leaflet that comes with your medicine before you start taking the capsules.
Do not breastfeed while you're using isotretinoin capsules. This medicine can get into breast milk and harm your baby.
Do not take isotretinoin capsules if you think you're pregnant, you know you're pregnant, or if you're breastfeeding.
Men and isotretinoin capsules
Men can safely take isotretinoin capsules if they and their partner are trying for a baby, or their partner is pregnant.
Isotretinoin capsules don't seem to damage sperm. Only tiny amounts of isotretinoin get into semen, which is too little to harm the unborn baby.
8. Cautions with other medicines
Some medicines and isotretinoin capsules can interfere with each other, and make it more likely that you'll have side effects.
Tell your doctor if you're taking these medicines before you start treatment with isotretinoin capsules:
- supplements that contain vitamin A
- tetracycline antibiotics such as doxycycline, oxytetracycline, minocycline, and lymecycline
- other acne medicines (using both together may make skin irritation worse)
Mixing isotretinoin capsules with herbal remedies or supplements
There's very little information about taking herbal remedies and supplements while you use isotretinoin capsules.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How do isotretinoin capsules work?
Isotretinoin capsules are only for severe acne. This is acne with lots of pus-filled spots that may affect the back and chest, as well as the face.
Isotretinoin capsules help severe acne by reducing the amount of natural oil made by your skin so blocked pores are less likely. The medicine also kills the bacteria that cause acne, and relieves redness and soreness.
How long does it take to work?
Your acne may get worse when you first start treatment with isotretinoin capsules, but will then normally start to improve after 7 to 10 days.
How long will treatment last?
A treatment course of isotretinoin capsules usually lasts for 16 to 24 weeks (around 4 to 6 months). Acne will normally keep improving for up to 8 weeks after stopping treatment.
Most people have clear skin after that time, but a few will need another round of treatment.
Are there other acne treatments?
Isotretinoin capsules are usually only used for people whose acne doesn't improve with other treatments.
But there are other options for some people with severe acne, for example, treatments that use lasers, and other light devices and chemical peels.
Why is isotretinoin no longer available as a gel?
Isotretinoin used to also come as a gel, known by the brand name Isotrex. In 2017 GSK stopped manufacturing Isotrex gel. This medicine is no longer available in the UK.
However there is a gel containing isotretinoin and erythromycin (brand name Isotrexin). There are also other gels that contain tretinoin or adapalene. These work in a similar way to isotretinoin gel.
Ask your specialist or a pharmacist for advice about suitable alternatives and the best treatment for your condition.
Will it affect my fertility?
There's no firm evidence to suggest that taking isotretinoin capsules will reduce fertility in either men or women.
However, women are advised not to take isotretinoin capsules if they're pregnant or trying for a baby. This medicine can harm a baby.
It's safe for women to try for a baby from 5 weeks after their treatment with isotretinoin capsules has finished. A pregnancy test will be done after you stop your treatment.
Can I donate blood while taking isotretinoin?
Do not donate blood while taking isotretinoin capsules and for at least 1 month after stopping. If your blood is given to a pregnant woman, it may harm her unborn baby.
Can I drive or ride a bike?
Isotretinoin capsules can make you feel sleepy and dizzy. You also may not see as well at night. If this happens to you, do not drive, cycle, or use machinery or tools until you've stopped treatment.
Can I drink alcohol with it?
It's best to avoid alcohol while taking isotretinoin capsules, or at least keep the amount you drink to a minimum. This is because there's a risk of damage to your liver - and that your cholesterol levels will increase.
If you do drink, try not to drink more than the recommended guidelines of up to 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking isotretinoin capsules.
Can lifestyle changes help my acne?
These lifestyle changes may help with your acne:
- try not to wash affected areas of skin more than twice a day - too much washing can irritate your skin and make spots worse
- wash spotty skin with a mild soap or cleanser and lukewarm water - very hot or cold water can make acne worse
- never "clean out" blackheads or squeeze spots - this can make them worse and cause permanent scars
- do not use too much make-up or cosmetics - use water-based products described as non-comedogenic (this means the product is less likely to block the pores in your skin)
- remove make-up before going to bed
- use a fragrance-free, water-based moisturiser if dry skin is a problem
- shower as soon as possible after exercising, as sweat can irritate acne
- wash your hair regularly, and try to stop letting your hair fall across your face
- use an oil-free sunscreen