- Isotretinoin is the prescription acne medication better known as Accutane.
- It can cause some side effects that seem totally unrelated to your skin, like dry eyes, nosebleeds, or thinning hair.
- Most people tolerate isotretinoin very well, a dermatologist told INSIDER.
- If you’re struggling with side effects, your doctor can adjust your dose.
Isotretinoin – the prescription acne pill better known by the now-defunct brand name Accutane – is well-known for its ability to clear severe, treatment-resistant acne. Many patients who take the medicine, typically for a four- to five-month course, experience a prolonged (sometimes permanent) disappearance of their blemishes.
Just like any medication, though, isotretinoin can cause side effects, including some that you might not expect – like muscle pain and dry eyes – given that it’s a medicine for the skin.
The presence of side effects doesn’t mean isotretinoin isn’t worth taking. Just about every acne treatment has benefits and drawbacks, and for a lot of acne patients, isotretinoin’s side effects are worth the results.
“It’s very well tolerated, and in many cases is going to be the only treatment that’s going to put patients’ acne into remission,” dermatologist Dr. Kathleen Suozzi, assistant professor of dermatology at Yale School of Medicine, told INSIDER.
Still, side effects are a reality of undergoing the powerful therapy. Here are nine that are possible while taking the drug.
(Note: This isn’t an exhaustive list of possible side effects. You can find a more complete list at the US National Library of Medicine website.)
1. Dry skin and chapped lips
Sebum, the oily substance secreted by small glands attached to your hair follicles, keeps skin from drying. But an excess of sebum contributes to acne by making dead skin cells stick together inside pores, promoting to the clogs that lead to zits, according to the American Academy of Dermatology.
One of the ways the isotretinoin fights acne is by dramatically reducing the amount of sebum the skin produces, Suozzi explained to INSIDER.
This means that dry skin and chapped lips are “almost a guaranteed side effect,” of the drug, she said. So it’s important for isotretinoin patients to slather their skin and lips in moisturizers and emollients. Some cases, however, may require extra intervention.
“If [chapped lips] are severe, I will sometimes prescribe an ointment that contains hydrocortisone,” Suozzi said. “That will help decrease the discomfort.”
2. Dry eyes
Suozzi explained that isotretinoin can affect the Meibomian glands – tiny glands along the eyelid that secrete an oily, lubricating substance. That’s why the medicine may cause dry eyes, too.
“Some patients that are on isotretinoin might find that their eyes are too dry to even use contact lenses because they don’t have that proper lubrication,” she said.
Isotretinoin can also have a drying effect on your nasal mucosa – a.k.a. the tissue that lines your nasal cavity. That dryness may result in nosebleeds.
“Your mucosal skin is just like your regular skin, it’s just slightly different in its structure,” Suozzi said. “[Isotretinoin] affects the thickness of the skin and how it matures. And so the barrier is thinned a bit, which can also contribute to its fragility. The reason you get nosebleeds is because of that dry nasal mucosa.”
4. Thinner, more fragile nails
Suozzi previously explained to INSIDER that your nails could temporarily become thinner and more fragile during the course of treatment, too.
“Think about the nails as an appendage of your skin,” she said. “The area that makes the nail, called the nail matrix, is a type of epithelial tissue just like your skin. So it’s all potentially affected [by isotretinoin].”
5. Thinning hair
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It’s also possible to experience some hair thinning while on isotretinoin, dermatologist Dr. Joshua Zeichner previously told INSIDER. But he added that this effect is typically mild and goes away once the medication is stopped.
- Getty Images / Phil Walter
Isotretinoin patients may also experience muscle pain and, more rarely, joint pain. But experts still don’t know exactly why this happens, according to Suozzi.
“It’s more common to have the muscle pain in patients that have more physical activity,” she said. “Those seem to be the patients that are a little bit more at risk. It’s certainly something that we screen for every time we see a patient for follow up on isotretinoin … If a patient is having true weakness because of the muscle pain, then you might discontinue the medication.”
7. Vision changes
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Taking isotretinoin can temporarily affect your vision, making it harder to see at night.
“It probably has to do with rhodopsin, which is an important compound in the eye,” Suozzi said. (More specifically, it’s a protein found in the light-sensitive retina, and it’s needed for vision, particularly in low-light environments.) “And retinoids [like isotretinoin] probably interfere with its formation, which can lead to night vision [issues].”
She added that some patients have also reported other vision changes, like sensitivity to glare or changes in color perception, but these are not common.
8. High triglycerides
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A short-term increase in triglycerides – a type of fat found in the blood – happens in 25% to 50% of isotretinoin patients, Suozzi said.
“We tolerate some level of elevation because it’s so common, but if it’s getting very high – like, above 800 mg/dL, when normal is 200 mg/dL or less – then you could consider discontinuing therapy,” she added.
Transient bumps in triglycerides typically don’t present major issues, Suozzi explained, but someone with very high levels may be at risk for pancreatitis, which can lead to life-threatening organ failure. High triglycerides can also increase the risk of heart disease.
This is why doctors have isotretinoin patients come back for follow-up blood tests to monitor triglyceride levels.
9. Birth defects
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This isn’t a side effect that directly affects people on isotretinoin, but it’s important to know that the medication can cause severe birth defects, miscarriages, and pre-term births if you get pregnant while on the drug.
For this reason, in the US, isotretinoin patients who can get pregnant must take a pregnancy test at their doctor’s office every month before they can pick up their next monthly supply of pills. They also need to verify that they’re using two forms of birth control. It’s all part of a mandatory program called iPledge that was developed to cut down on the number of isotretinoin-related birth defects.
This birth defect risk is also why you can’t donate blood during a course of isotretinoin (and for 30 days after you take the last pill). If you donated blood and it was given to a pregnant woman, her fetus could be harmed.
If your side effects are really harsh, your doctor can adjust your dose
- Sarah Schmalbruch/INSIDER
If isotretinoin side effects are really bothersome, adjusting your daily dose could help.
“The goal for isotretinoin is not a specific dose that you’re getting daily, it’s a total cumulative dose,” Suozzi said. “The higher the daily dose, the fast you’ll get to your total cumulative dose, but you’ll have likely more side effects.”
But a dermatologist can adjust your daily dose to make it lower and make side effects more tolerable, she explained. The only downside is that it’ll take a bit longer to reach your cumulative dose, which is based on weight.
In general, isotretinoin is well-tolerated
- Sarah Schmalbruch/INSIDER
Suozzi said that, in general, isotretinoin’s safety profile is “very high.”
You may have heard or read stories about a link between isotretinoin and suicide or depression, but there’s still no evidence that the drug causes these things to happen, as INSIDER previously reported. Still, doctors prescribing it practice caution.
“If a patient has a history of course of suicidal ideation or active depression, you want to discuss with their psychiatrist and have them monitored closely if they’re going to be on the mediation,” Suozzi said.
Plus, patients return to their doctors for frequent follow-up visits (including the aforementioned pregnancy and blood tests), providing opportunities to address concerning side effects.
“The key is to make sure you’re being treated by an experienced dermatologist, and that you are aware of all the side effects so that you can report them as soon as you are experiencing them,” Suozzi said. “And then your doses can be adjusted or the medication can be discontinued if necessary.”
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