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This site complies with the HONcode standard for trustworthy health information: verify here. Discontinuation of isotretinoin therapy may be insufficient; further evaluation by a mental health professional may be necessary. Patients should be warned against driving or operating machinery at night while taking isotretinoin.
Decreased night vision and other visual disturbance have been reported during isotretinoin therapy; onset of visual changes may be sudden. Patients may experience decreased tolerance to contact lenses during and after isotretinoin therapy. All visual problems reported during isotretinoin treatment should be carefully monitored.
All patients experiencing visual difficulties should discontinue isotretinoin therapy and have an ophthalmologic examination. Isotretinoin therapy has been associated with cases of pseudotumor cerebri benign intracranial hypertension , some of which involved the concomitant use of systemic tetracyclines.
Concurrent use of isotretinoin with systemic tetracyclines should be avoided. Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances.
Patients with these symptoms should be screened for papilledema and, if present, they should be told to discontinue isotretinoin therapy immediately and be referred to a neurologist for follow-up and treatment. Hearing impairment, which continued after discontinuing the drug, has been reported in patients taking isotretinoin.
Patients who experience tinnitus or hearing impairment should discontinue isotretinoin treatment and be referred to for further follow-up.
Retinoids may cause photosensitivity. Patients should avoid prolong sunlight UV exposure while receiving isotretinoin. Appropriate protective clothing e. Wax epilation and skin resurfacing procedures e. Neutropenia and rare cases of agranulocytosis have been reported during isotretinoin therapy. Isotretinoin should be discontinued in patients show develop clinically significant leukopenia or neutropenia.
Isotretinoin has been associated with an extremely high risk of birth defects if taken during pregnancy in any amount even for a short period of time. Discuss reproductive risk with the patient prior to initiation of therapy. Isotretinoin must not be initiated in females of childbearing potential, regardless of whether they are sexually active, until negative results from 2 urine or serum pregnancy tests are confirmed and the patient or her guardian completes the consent form; the interval between the 2 tests should be at least 19 days.
Monthly pregnancy testing during isotretinoin therapy is also required. Discuss contraception requirements with the patient before beginning treatment and monthly during treatment. Women who are, or might become, sexually active with a male partner must select and use 2 forms of effective contraception simultaneously for at least 1 month before beginning, during, and for 1 month following discontinuation of therapy, even when there has been a history of infertility, unless due to hysterectomy.
Low-dose progestins may be an inadequate method of contraception during isotretinoin therapy. In addition, females who are using hormonal contraception as a primary form of birth control should not take St. John's Wort, as it may decrease the effectiveness of hormonal contraceptives.
Adapalene; Benzoyl Peroxide: Moderate Benzoyl peroxide will cause additive irritant and drying effects with concomitant oral isotretinoin use. Reduction in the dose or temporary discontinuation of the benzoyl peroxide product may be needed until skin irritation resolves.
Azelastine; Fluticasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. Beclomethasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Benzoyl Peroxide: Moderate Benzoyl peroxide will cause additive irritant and drying effects with concomitant oral isotretinoin use.
Benzoyl Peroxide; Clindamycin: Moderate Benzoyl peroxide will cause additive irritant and drying effects with concomitant oral isotretinoin use.
Benzoyl Peroxide; Erythromycin: Moderate Benzoyl peroxide will cause additive irritant and drying effects with concomitant oral isotretinoin use. Benzoyl Peroxide; Sulfur: Moderate Benzoyl peroxide will cause additive irritant and drying effects with concomitant oral isotretinoin use.
Betamethasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Budesonide: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
Budesonide; Formoterol: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Budesonide; Glycopyrrolate; Formoterol: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
Cholestyramine: Moderate Cholestyramine can bind with and possibly decrease the oral absorption of isotretinoin. To minimize drug interactions, administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of cholestyramine. Ciclesonide: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Colestipol: Moderate Colestipol can bind with and possibly decrease the oral absorption of isotretinoin.
Administer other drugs at least 1 hour before or at least 4 to 6 hours after the administration of colestipol. Therefore, it is critically important for women of childbearing potential to select and commit to use 2 forms of contraception simultaneously, at least 1 of which must be a primary form, unless absolute abstinence is the chosen method or the patient has undergone a hysterectomy.
Corticosteroids: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Cortisone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Deflazacort: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
These reports are more frequent for women who use only a single method of contraception. Dexamethasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Minor L-methylfolate and isotretinoin should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with isotretinoin. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together.
Eravacycline: Major Avoid the concomitant use of isotretinoin and eravacycline due to the potential for increased cranial pressure and an increased risk of pseudotumor cerebri benign intracranial hypertension. Early signs and symptoms include papilledema, headache, nausea, vomiting, and visual disturbances.
Ethanol: Minor Alcohol consumption can increase the risk for isotretinoin-related hypertriglyceridemia; patients experiencing hyperlipidemia while on isotretinoin should be advised to limit their alcohol intake. Fludrocortisone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
Flunisolide: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Fluticasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Fluticasone; Salmeterol: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
Fluticasone; Umeclidinium; Vilanterol: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Fluticasone; Vilanterol: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Formoterol; Mometasone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Fosphenytoin: Minor Long-term use of fosphenytoin has been associated with osteomalacia.
No formal clinical studies have been conducted to assess if there is an additive or interactive effect on bone loss between fosphenytoin and isotretinoin therapy. Patients receiving fosphenytoin or other anticonvulsants that may affect the bone should receive isotretinoin therapy with caution. Hydrocortisone: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Levomefolate: Minor L-methylfolate and isotretinoin should be used together cautiously.
Lomitapide: Moderate Caution should be exercised when lomitapide is used with other medications known to have potential for hepatotoxicity, such as isotretinoin. The effect of concomitant administration of lomitapide with other hepatotoxic medications is unknown. More frequent monitoring of liver-related tests may be warranted. Methotrexate: Major Concomitant use of systemic retinoids, such as isotretinoin, and methotrexate could increase risk of liver-related side effects of methotrexate and such patients should be monitored closely during methotrexate therapy.
If concurrent use is necessary, closely monitor patients for signs or symptoms of skin toxicity. Isotretinoin can't be used by people who are pregnant because it causes severe birth defects. The drug also increases the risk of miscarriage and premature birth. People taking isotretinoin who can get pregnant must first register with a program called iPledge Program.
The goal of this program is to prevent fetal exposure to isotretinoin. The requirements include using two methods of contraception or practicing complete abstinence during treatment, having negative pregnancy tests each month for people of childbearing potential , seeing a healthcare providermonthly, and submitting to regular blood tests as needed.
Although they have very similar-sounding names, isotretinoin and tretinoin are very different medications. Your dermatologist will help you decide if either is the right treatment option for your acne. There are many other acne treatments available , too. These can be just as effective and may be a better fit in your case. The bottom line, though: If you need help treating acne, call a dermatologist. There are many treatment options that can help you get clearer skin.
Dealing with acne can be frustrating. Our free guide provides expert tips to help you take control. Sign up and get yours today. UW Health. Retinoids: defining the difference. Updated Tretinoin topical. Updated March 15, Updated August 15, Your Privacy Rights.
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