NationMaster - Encyclopedia: Isotretinoin

Isotretinoin (INN) (pronounced /aɪsoʊtrɨˈtɪnoʊɨn/ or /ˌaɪsoʊtrɨˈtɪnoʊɨn/^[1]) is a medication used for the treatment of severe acne. It is sometimes used as a chemotherapy medication for prevention and treatment of certain skin cancers. In some cases, it is used to treat Harlequin type ichthyosis. It is a retinoid, meaning it derives from vitamin A and is found in small quantities naturally in the body. Oral isotretinoin is marketed under various trade names, most commonly Accutane (Roche), Amnesteem (Mylan), Claravis (Barr), Decutan (Actavis), Isotane (Pacific Pharmaceuticals), Sotret (Ranbaxy), Oratane (Genepharm Australasia) or Roaccutane (Roche); while topical isotretinoin is most commonly marketed under the trade names Isotrex or Isotrexin (Stiefel). In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body. ... An International Nonproprietary Name (INN) is the official non-proprietary or generic name given to a pharmaceutical substance, as designated by the World Health Organization. ... This article does not cite any references or sources. ... Harlequin-type ichthyosis (also harlequin ichthyosis, ichthyosis congenita, or keratosis diffusa fetalis), a skin disease, is the most severe form of congenital ichthyosis, characterized by a thickening of the keratin layer in fetal human skin. ... First- and second-generation retinoid compounds The retinoids are a class of chemical compounds that are related chemically to vitamin A. Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth. ... The structure of retinol, the most common dietary form of vitamin A Vitamin A is an essential human nutrient. ... Hoffmann-La Roche, Ltd. ... Mylan Laboratories Inc. ... Barr Pharmaceuticals, Inc. ... Actavis is a leading international pharmaceutical company founded in 1956 as Pharmaco. ... Ranbaxy Laboratories Limited is an Indian company incorporated in 1961. ... Hoffmann-La Roche, Ltd. ...

History

Prior to the development of isotretinoin, the mainstay treatment of moderate to severe or persistent acne was oral antibiotics such as the tetracyclines and erythromycin. While these drugs have proven efficacy, they worked against only one contributing factor of acne – the Propionibacterium acnes bacteria. The antibiotics gradually became less effective over time as more resistant strains of the bacterium became prominent. An antibiotic is a drug that kills or slows the growth of bacteria. ... This article deals with the group of antibiotics known as the Tetracyclines . ... Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. ... Binomial name (Gilchrist 1900) Douglas & Gunter 1946 Propionibacterium acnes is a relatively slow growing, typically aerotolerant anaerobic gram positive bacterium that is linked to the skin condition acne; it can also cause chronic blepharitis and endophthalmitis, the latter particularly following intraocular surgery. ...

An early, effective treatment of acne was high doses of the fat-soluble vitamin A. At these dose levels (sometimes 500,000 IU per day) effects such as reduced production of sebum and dry hair could be noticed^{[citation needed]}. However the vitamin also had many other prominent side effects which inhibited its widespread use^{[citation needed]}. In pharmacology, the International unit (IU, alternatively abbreviated UI, from French unitÃ© internationale) is a unit of measurement for the amount of a substance, based on measured biological activity (or effect). ... The sebaceous glands are glands found in the skin of mammals. ...

Increasingly higher dosages of isotretinoin will result in higher toxicity, resembling vitamin A toxicity (the higher the dosage, the more pronounced the side effects will be). The "upper limit" for Vitamin A (Retinol) is 3 milligrams (10,000 IU). This is the dosage at which the scientific community agrees there are no side effects for Vitamin A. Isotretinoin is available in 2.5mg capsules (as well as 5mg, 10mg, 20mg, 40mg). However, isotretinoin is more teratogenic (causes birth defects) than vitamin A at the same dosage^{[citation needed]}.

The development of the retinoic acid derivative isotretinoin (13-cis-retinoic acid), and its release in 1982 by Hoffmann-La Roche, was a great step forward in the treatment of acne. The synthetic compound provided better therapeutic benefit than vitamin A, while also producing fewer adverse effects. In February 2002, Roche's patents for isotretinoin expired and there are now many other companies selling cheaper generic versions of the drug. Retinoic acid, or Retin-A or vitamin A acid, is a carotenoid organic compound that is a component of visual pigments. ... Year 1982 (MCMLXXXII) was a common year starting on Friday (link displays the 1982 Gregorian calendar). ... Hoffmann-La Roche, Ltd. ... In medicine, an Adverse effect is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as a result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...

Because of a 1984 study funded by Roche, high dosages of the drug became mainstream in treatment. Lower dosages were found to be effective in treatment by independent research (see dosage section of this article), but Roche's dosage recommendations still continue to be used.^{[citation needed]}

Currently, isotretinoin continues to be used only after other acne treatments fail to produce results. Treatment of acne begins with topical medications (e.g. benzoyl peroxide, adapalene, etc), followed by oral antibiotics (or a combination) and finally isotretinoin therapy. This is because other treatments, while less effective than isotretinoin, are thought to be associated with fewer adverse effects and lower cost. The higher cost is due to the medical supervision required in taking a toxic dosage. The cost of the medicine is also a factor (example: taking 5, 10, or even 20mg daily is far less expensive than taking 80mg daily). R-phrases , , S-phrases , , , Autoignition temperature 80Â°C RTECS number DM8575000 Except where noted otherwise, data are given for materials in their standard state (at 25 Â°C, 100 kPa) Infobox disclaimer and references Tube of Basiron, a water-based 5% benzoyl peroxide preparation for the treatment of acne. ... Adapalene is a topical retinoid primarily used in the treatment of acne and is also used (off-label) to treat keratosis pilaris as well as other skin conditions. ...

From the time of its introduction the drug was known to have teratogenic potential, and pregnancies with the drug were strongly discouraged. When they occurred, they were found to have approximately 30% rates of congenital malformation, versus a 3-5% baseline risk.^[2] Beginning in 1998, prescriptions of the drug came under scrutiny, as fewer than half of prescribers were testing for pregnancy, usually relying on less sensitive urine tests.^[3] On the grounds that pregnancies by women taking the drug had been underreported by the manufacturer between 1982 and 2000, and that once generic manufacturers entered the market risk management was no longer centralized, the FDA instituted restrictions on prescribing and dispensing the drug, first with the "System to Manage Accutane Related Teratogenicity" (SMART) in 2000, and subsequently the iPLEDGE program in 2006. A retrospective cohort study recently found that pregnancy rates were quite high during the period (1 per 30 women per year), but 84% of pregnancies were ended by induced abortion.^[2] Teratology (from the Greek (genitive ), meaning monster, or marvel and , meaning word, speech) as early as 17th century referred to a discourse on prodigies and marvels, of anything so extraordinary as to seem abnormal. ... The correct title of this article is iPledge. ...

In countries that do not restrict distribution of isotretinoin, pharmacists recommend 5mg or 10mg daily^{[citation needed]}, since at lower dosages the adverse side effects are diminished. Isotretinoin in topical form is also prescribed.

Isotretinoin is available over the internet from countries where it can be dispensed without a prescription. It is an ongoing problem for governments where a prescription is required^{[citation needed]}, as it is mailed illegally across borders.

Pharmacodynamics

Isotretinoin's exact mechanism of action is unknown. However it is known that, like other retinoids, the drug alters DNA transcription.^[4] This effect decreases the size and output of sebaceous glands, making the cells that are sloughed off into the sebaceous glands less sticky, and therefore less able to form comedones. Isotretinoin noticeably reduces the production of sebum and shrinks the sebaceous glands. It stabilizes keratinization and prevents comedones from forming. This combined impact on several of the contributory factors in acne distinguishes isotretinoin from alternative remedies such as antibiotics and accounts for its greater efficacy in severe, nodulocystic cases. Wikipedia does not yet have an article with this exact name. ... First- and second-generation retinoid compounds The retinoids are a class of chemical compounds that are related chemically to vitamin A. Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth. ... In genetics, transcription is the first of the two-step protein biosynthesis process. ... The sebaceous glands are glands found in the skin of mammals. ... The sebaceous glands are glands found in the skin of mammals. ... Epidermis is the outermost layer of the skin. ... A black head (technically known as a comedo) is a yellowish, reddish (with white cap) or blackish bump or plug on a skin. ...

Pharmacokinetics

Isotretinoin, when administered orally, is best absorbed when taken after a high fat meal, as it has a high level of lipophilicity. In a crossover study, it was found that the peak plasma concentration more than doubled when taken after a high fat meal versus a fasted condition. Isotretinoin is primarily (99.9%) bound to plasma proteins, mostly albumin. At least three metabolites have been detected in human plasma after oral administration of isotretinoin. These are 4-oxo-isotretinoin, retinoic acid and 4-oxo-retinoic acid. Isotretinoin also oxidises, irreversibly, to 4-oxo-isotretinoin. The metabolites of isotretinoin are excreted through both urine and feces. The mean elimination half-life is 21 hours, with a standard deviation from this mean of 8.2 hours. ... This article is about the urine of animals generally. ... Horse feces Feces, faeces, or fÃ¦ces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... The elimination half-life of a drug (or any xenobiotic agent) refers to the timecourse necessary for the quantity of the xenobiotic agent in the body (or plasma concentration) to be reduced to half of its original level through various elimination processes. ...

Clinical use

Indications

Isotretinoin is indicated for the treatment of severe cystic acne vulgaris.^[5]^[6] It is also effective for hidradenitis suppurativa and some cases of severe acne rosacea.^[6] It can also be used to help treat harlequin ichthyosis, and is used in xeroderma pigmentosum cases to relieve keratoses.
Although extremely rare, isotretinoin has been used as a treatment for Fibrodysplasia Ossificans Progressiva. This article is about a skin disease commonly found during adolescence. ... Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. ... Erythematotelangiectatic rosacea, the mildest form of the condition, is characterized by persistent facial redness. ... Harlequin-type ichthyosis (also harlequin ichthyosis, ichthyosis congenita, or keratosis diffusa fetalis), a skin disease, is the most severe form of congenital ichthyosis, characterized by a thickening of the keratin layer in fetal human skin. ... Xeroderma pigmentosum, or XP, is an autosomal recessive genetic disorder of DNA repair in which the bodys normal ability to remove damage caused by ultraviolet (UV) light is deficient. ... Keratosis is a growth of keratin on the skin. ...

Prescribing restrictions

In the United Kingdom, this drug may only be prescribed by, or under the supervision of, a consultant dermatologist.^[7] Because severe, cystic acne has the potential to cause permanent scarring over a short period, restrictions on isotretinoin's more immediate availability have proved contentious.^[8] Similar restrictions are common in most Australian states – in New South Wales and Victoria, for instance, the prescriber must be a Fellow of the Australasian College of Dermatologists (FACD).^[9] Dermatology is a branch of medicine dealing with the skin, its structure, functions, and diseases (from Greek derma, skin), as well as its appendages (nails, hair, sweat glands). ... NSW redirects here. ... VIC redirects here. ... It has been suggested that this article be split into multiple articles accessible from a disambiguation page. ...

In New Zealand, isotretinoin can be prescribed by any doctor but is subsidised only if prescribed by a skin specialist/dermatologist. As New Zealand General Practitioner visits are subsidised it is usually cheaper for the patient to buy their isotretinoin with a GP prescription than to pay to see a dermatologist. Dermatology is a branch of medicine dealing with the skin, its structure, functions, and diseases (from Greek derma, skin), as well as its appendages (nails, hair, sweat glands). ...

Since 1 March 2006, the dispensing of isotretinoin in the United States has been controlled by a FDA-mandated website called iPLEDGE – dermatologists are required to register their patients before prescribing and pharmacists are required to check the website before dispensing the drug. The patient must visit the iPLEDGE website or call the hotline number in order to log in with his or her ID code to answer the iPLEDGE questionaire. The prescription may not be dispensed until all three parties have complied. A physician may not prescribe more than a 30-day supply. A new prescription may not be written for at least 30 days. Pharmacies are also under similar restriction. There is also a 7-day window in which the medication must be picked up at the pharmacy. If the original prescription is lost, or pick-up window is missed, the patient must re-qualify to have another prescription written. Doctors and pharmacists must also verify written prescriptions in an online system before patients may fill the prescription. is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... FDA redirects here. ... The correct title of this article is iPledge. ...

In Mexico, this drug is of restricted use, and an official identification and patient signature is required by the pharmacies.

Dosage

The dose of isotretinoin a patient receives is dependent on their weight and the severity of the condition. High dose treatments are administered between 0.5 mg/kg/day to 2 mg/kg/day (usually at 0.5 to 1 mg/kg/day^[10], divided into two doses), for a total treatment of 4–6 months. A second course may be used two months following the cessation of the initial course if severe acne recurs. Efficacy appears to be related to the cumulative dose of isotretinoin taken, with a total cumulative dose of 120–150 mg/kg used as a guideline.^[5]^[6] High dose treatments should only be used as a last resort due to adverse side effects. Image File history File linksMetadata Size of this preview: 800 Ã— 600 pixel Image in higher resolution (1280 Ã— 960 pixel, file size: 665 KB, MIME type: image/jpeg) Authors own picture. ... Image File history File linksMetadata Size of this preview: 800 Ã— 600 pixel Image in higher resolution (1280 Ã— 960 pixel, file size: 665 KB, MIME type: image/jpeg) Authors own picture. ...

Other studies show that lower dosage treatments are just as effective.^[11]^[12] In these experiments, subjects used 20mg/day, which is 0.25 mg/kg/day for an 80 kg (176 pounds) person.

Preparations

Isotretinoin is marketed under many brand names by various manufacturers. It is typically available as 5 mg, 10 mg, 20 mg, 30mg and (in the USA) 40 mg capsules. Some brands of oral isotretinoin include: Accure (Alphapharm), Accutane and Roaccutane (Roche), Aknenormin (Hermal), Amnesteem (Mylan), Ciscutan (Pelpharma), Claravis (Barr), Clarus (Prepharm), Isohexal (Hexal Australia), Isotane (Pacific Pharmaceuticals), Isotroin (Cipla), Oratane (Douglas Pharmaceuticals), and Sotret (Ranbaxy). // Company Overview Alpharma is a producer of specialty antibiotics, animal health feed additives for poultry and livestock, and vaccines for farmed fish. ... Hoffmann-La Roche, Ltd. ... Mylan or Mylan Labs is the second largest generic drug maker in the United States. ... Barr Pharmaceuticals, Inc. ... Hexal Australia is a large pharmaceutical manufacturer, formed in 1995 with Hexal AG Germany. ... Cipla is an Indian pharmaceutical company, best-known for manufacturing cheap anti-AIDS drugs. ... // Top 50 pharmaceutical companies The following is a list of the top 50 pharmaceutical and biotech companies ranked by healthcare revenue. ... Ranbaxy Laboratories Limited is an Indian company incorporated in 1961. ...

It is also available as a 0.05% topical preparation, marketed by Stiefel under the trade name Isotrex or Isotrexin (with erythromycin).. In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, nasopharynx, or the eye. ... Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. ...

Adverse effects

Increasingly higher dosages will result in higher toxicity, resembling vitamin A toxicity. Adverse drug reactions associated with isotretinoin therapy include:^[5] An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted, negative consequences associated with the use of given medications. ...

The following adverse effects have been reported to persist, even after discontinuing therapy: alopecia (hair loss), arthralgias, decreased night vision, inflammatory bowel disease,degenerative disc disease, keloids, bone disease. High dosages of isotretinoin have been reported to cause rosacea (a disease of severe facial skin redness and irritation). An infection is the detrimental colonization of a host organism by a foreign species. ... This article needs to be cleaned up to conform to a higher standard of quality. ... Cheilitis is a medical condition involving inflammation of the lip. ... Photosensitivity is the amount to which an object reacts upon receiving photons of light. ... Nosebleed as a result of fracture through a rugby impact. ... A soft contact lens A contact lens (also known as contact, for short) is a corrective or cosmetic lens placed on the cornea of the eye atop the iris. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... This article does not cite any references or sources. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... Night-vision is seeing in the dark. ... Human eye cross-sectional view, showing position of human lens. ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... Menstrual cycle In the female reproductive system, the menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age females. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Pancreatitis is inflammation of the pancreas. ... Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ... The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eyes optical power [1]. Together with the lens, the cornea refracts light and, as a result, helps the eye to focus. ... Papilledema is optic disc swelling that is caused by increased intracranial pressure. ... Idiopathic intracranial hypertension (IIH), sometimes called benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC) is a neurological disorder that is characterized by increased intracranial pressure (ICP), in the absence of a tumor or other intracranial pathology. ... For other uses, see Skeleton (disambiguation). ... Hyperostosis is an excessive growth of bone. ... Dystrophic calcification is the mineralization of soft tissue without a systemic mineral imbalance. ... For other uses, see Psychosis (disambiguation). ... Alopecia is a set of disorders ranging from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... A keloid is a special type of scar which results in an overgrowth of tissue at the site of a healed skin injury. ... Rosacea (IPA: ) is a common but often misunderstood condition that is estimated to affect over 45 million people worldwide. ...

Erectile dysfunction in the form of difficulty in maintaining erection was reported in several patients in a clinical study. The impotence may have been caused by the psychiatric side effects of isotretinoin.^[13] Despite this, sexual dysfunction is not acknowledged as a side-effect in the official literature accompanying the medication.
Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ... The erection of the penis, clitoris or a nipple is its enlarged and firm state. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Psychiatry is a branch of medicine that studies and treats mental and emotional disorders (see mental illness). ...

While vitamin E supplements have been advocated by some to reduce the toxicity of high-dose retinoids without reducing drug efficacy, test results have proven this to be false (though no indication of what form of vitamin E was used).^[14] The Î±-tocopherol form of vitamin E. Main articles: tocopherol and tocotrienol Vitamin E is the collective name for a set of 8 related tocopherols and tocotrienols, which are fat-soluble vitamins with antioxidant properties. ...

Patients receiving isotretinoin therapy are not permitted to donate blood during and for at least one month after discontinuation of isotretinoin therapy due to reported birth defects to unborn children.

Patients that get a tattoo while on this medication might get scarring on the tattoed area, and also rejection of the ink^{[citation needed]}.-1...

Teratogenicity (Birth Defects)

Isotretinoin is a teratogen and is highly likely to cause birth defects if taken during pregnancy. A few of the more common birth defects that this drug can cause are hearing and visual impairment, missing earlobes, facial dysmorphism, and mental retardation. Isotretinoin is classified as FDA Pregnancy Category X and ADEC Category X, and use is contraindicated in pregnancy.^[6] Teratogenesis is a medical term from the Greek, literally meaning monster making. ... FDA redirects here. ... The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother. ... The Australian Drug Evaluation Committee or ADEC, is a committee that provides independent scientific advice to the Australian Government regarding therapeutic drugs. ...

The manufacturer recommends that pregnancy be excluded in female patients two weeks prior to commencement of isotretinoin, and that they should use effective contraception (sometimes two simultaneous forms are recommended) at least one month prior to commencement, during, and for at least one month following isotretinoin therapy.^[15]

In the U.S. more than 2,000 women have become pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion or miscarriage. About 160 babies with birth defects were born. Consequently, the iPLEDGE program was introduced by the U.S. Food and Drug Administration on 12 August 2005 in an attempt to ensure that female patients receiving isotretinoin do not become pregnant – as of 1 March 2006, only prescribers registered and activated in iPLEDGE are able to prescribe isotretinoin, and only patients registered and qualified in iPLEDGE will be able to have isotretinoin dispensed. For other uses of terms redirecting here, see US (disambiguation), USA (disambiguation), and United States (disambiguation) Motto In God We Trust(since 1956) (From Many, One; Latin, traditional) Anthem The Star-Spangled Banner Capital Washington, D.C. Largest city New York City National language English (de facto)1 Demonym American... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ... The correct title of this article is iPledge. ... FDA redirects here. ... is the 224th day of the year (225th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ...

Depression

Several studies have suggested a possible link between isotretinoin and clinical depression.^[16]^[17] However, no conclusive evidence has been produced. Despite this, the argument that isotretinoin caused depression and suicide has won a few lawsuits, and is partially responsible for the strict control of the drug, especially in the United States. Various case reports of depression, suicidal ideation, suicide attempt, and suicide in patients treated with isotretinoin have been reported to the U.S. FDA Adverse Events Reporting System, with 431 cases reported between 1982 and May 2001 – of these 37 patients had committed suicide.^[18] While analyses have suggested an association between isotretinoin therapy and depression, no causal relationship has been established and further studies are required.^[19]^[20] On the Threshold of Eternity. ...

Studies have shown that patients with acne, the population group eligible to receive isotretinoin therapy, have an increased risk of clinical depression compared with the general population.^[21]^[22] Chee Hong describes Isotretinoin-related depression as "an idiosyncratic side-effect", claiming, often anxiety can bring on acne and depression, creating more anxiety.^[23] Correspondingly, treatment of severe acne with isotretinoin has been shown to reduce anxiety and depression, for tests have shown acne to be a main depressant in most tested patients' lives.^[24]^[25] There are very few or no other articles that link to this one. ...

One study utilising positron emission tomography (PET) showed functional brain imaging changes in patients treated with isotretinoin, however the clinical relevance of this finding is unclear.^[26] Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ...

U.S. Representative Bart Stupak (D-MI) is known for his distrust of Accutane. He believes unadvertised psychological side effects from the drug drove his teenage son, Bartholomew Thomas "B.J" Stupak Jr., to commit suicide in 2000. Bartholomew Thomas Bart Stupak (born February 29, 1952), American politician, has been a Democrat in the United States House of Representatives since 1993, representing Michigans 1st congressional district (map). ... Year 2000 (MM) was a leap year starting on Saturday. ...

Psychological effects

In addition to possible anxiety, several studies have shown that male patients taking isotretinoin show increased sensitivity to testosterone, and related psychological effects such as unusual irritability, over-inflated self-confidence and increased sexual desire. It should be noted that none of these symptoms have been known to last more than one month after the end of the treatment. Am J Psychiatry 2007;122(5):996-67. PMID 16363402 The American Journal of Psychiatry (AJP) is the most widely read psychiatric journal in the world. ...

Crohn's Disease and Ulcerative colitis

Several scientific studies have posited that Accutane is a probable cause of Crohn's Disease and Ulcerative colitis in some individuals. Three cases in the United States have gone to trial thus far, with all three resulting in multi-million dollar judgements against the makers of isotretinoin; there are an additional 425 cases pending. [1] [2] [3] [4] [5] Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. ...

Drug interactions

The concurrent use of isotretinoin with tetracycline antibiotics or vitamin A supplementation is not recommended. Concurrent use of isotretinoin with tetracyclines significantly increases the risk of idiopathic intracranial hypertension. Concurrent intake of Vitamin A supplementation increases the risk of vitamin A toxicity.^[6] This article deals with the group of antibiotics known as the Tetracyclines . ... The structure of retinol, the most common dietary form of vitamin A Vitamin A is an essential human nutrient. ... Idiopathic intracranial hypertension (IIH), sometimes called benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC) is a neurological disorder that is characterized by increased intracranial pressure (ICP), in the absence of a tumor or other intracranial pathology. ... The structure of retinol, the most common dietary form of vitamin A Vitamin A is an essential human nutrient. ...

Concurrent use of isotretinoin with methotrexate increases the risk of hepatotoxicity and may increase methotrexate levels. The combination is used with caution and close monitoring of adverse effects and liver function tests.^[5] Amethopterin redirects here. ... Hepatotoxicity (from hepatic toxicity) implies chemical-driven liver damage. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ...

See also

Tazarotene (marketed as TazoracÂ®, AvageÂ® and ZoracÂ®) is a prescription topical retinoid sold as a cream or gel. ... Hypervitaminosis A syndrome is a condition that is caused by excessive intake of vitamin A or vitamin A analogs. ...

References

^ isotretinoin - Definitions from Dictionary.com
^ ^a ^b Bérard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D (2007). "Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective". British journal of clinical pharmacology 63 (2): 196-205. doi:10.1111/j.1365-2125.2006.02837.x. PMID 17214828.
^ Holmes SC, Bankowska U, Mackie RM (1998). "The prescription of isotretinoin to women: is every precaution taken?". Br. J. Dermatol. 138 (3): 450-5. doi:10.1046/j.1365-2133.1998.02123.x. PMID 9580798.
^ DrugBank database - Isotretinoin (APRD00140), 12 November 2006, University of Alberta, accessed January 2007
^ ^a ^b ^c ^d Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
^ ^a ^b ^c ^d ^e Klasco RK, editor. Drugdex system, vol. 128. Greenwood Village (CO): Thomson Micromedex; 2006.
^ Joint Formulary Committee. British National Formulary. 47th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain. ISBN 0-85369-584-9
^ James M. Isotretinoin for severe acne. Lancet 2006;347(9017):1749-1750. PMID 8656912
^ Pharmaceutical Services Branch. Guide to poisons and therapeutic goods legislation for medical practitioners and dentists. Sydney: NSW Department of Health; 2006.
^ United States Pharmacopeia Staff. Consumer Reports Complete Drug Reference. Yonkers, NY: Consumer Reports Books, 1995. Pg 998.
^ Amichai B, Shemer A, Grunwald M (2006). "Low-dose isotretinoin in the treatment of acne vulgaris". J Am Acad Dermatol 54 (4): 644–6. doi:10.1016/j.jaad.2005.11.1061. PMID 16546586. Summary of study results
^ Seukeran D, Cunliffe W (1998). "Acne vulgaris in the elderly: the response to low-dose isotretinoin". Br J Dermatol 139 (1): 99–101. doi:10.1046/j.1365-2133.1998.02321.x. PMID 9764156.
^ Tirado Sánchez A; León Dorantes G. (Nov-Dec 2005). "[Erectile dysfunction during isotretinoin therapy]". Actas urologicas españolas. 29 (10): 974-6. PMID 16447596.
^ Kus S, Gün D, Demirçay Z, Sur H. Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris. Int J Dermatol 2005;44(3):248-51. PMID 15807739
^ Roche Products Pty Ltd. Roaccutane (Australian Approved Product Information). Dee Why (NSW): Roche; 2005.
^ O'Donnell J. Overview of existing research and information linking isotretinoin (accutane), depression, psychosis, and suicide. Am J Ther 2003;10(2):148-59. PMID 12629595
^ Bremner JD. Does isotretinoin cause depression and suicide? Psychopharmacol Bull 2003;37(1):64-78. PMID 14561949
^ Wysowski DK, Pitts M, Beitz J. An analysis of reports of depression and suicide in patients treated with isotretinoin. J Am Acad Dermatol 2001;45(4):515-9. PMID 11568740
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The New Zealand Dermatological Society is a medical organization best known outside New Zealand for its DermNet website, which provides photographs and descriptions of many skin conditions. ... A section of the Anatomical Therapeutic Chemical Classification System. ... In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, nasopharynx, or the eye. ... Azelaic acid is a saturated dicarboxylic acid found naturally in wheat, rye, and barley. ... R-phrases , , S-phrases , , , Autoignition temperature 80Â°C RTECS number DM8575000 Except where noted otherwise, data are given for materials in their standard state (at 25 Â°C, 100 kPa) Infobox disclaimer and references Tube of Basiron, a water-based 5% benzoyl peroxide preparation for the treatment of acne. ... Glycolic acid (or hydroxyacetic acid) is the smallest Î±-hydroxy acid (AHA). ... Bright light therapy is a common treatment for seasonal affective disorder. ... Salicylic acid (from the Latin word for the willow tree, Salix, from whose bark it can be obtained) is a beta hydroxy acid (BHA) with the formula C6H4(OH)CO2H, where the OH group is adjacent to the carboxyl group. ... Tea Tree Oil (Melaleuca Oil) Tea tree oil is an extraction from the Melaleuca tree. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ... Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. ... Sulfacetamide is a sulfonamide antibiotic. ... This article deals with the group of antibiotics known as the Tetracyclines . ... Trimethoprim is a bacteriostatic antibiotic mainly used in the prophylaxis and treatment of urinary tract infections (cystitis). ... For other uses, see Hormone (disambiguation). ... An antiandrogen, or androgen antagonist, is any of a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens, male sex hormones, on normally responsive tissues in the body (see androgen insensitivity syndrome). ... First- and second-generation retinoid compounds The retinoids are a class of chemical compounds that are related chemically to vitamin A. Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth. ... Adapalene is a topical retinoid primarily used in the treatment of acne and is also used (off-label) to treat keratosis pilaris as well as other skin conditions. ... Tazarotene (marketed as TazoracÂ®, AvageÂ® and ZoracÂ®) is a prescription topical retinoid sold as a cream or gel. ... Tretinoin is the acid form of vitamin A and so also known as all-trans retinoic acid or ATRA. It is a drug commonly used to treat acne vulgaris and keratosis pilaris. ...

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