What is isotretinoin used for?

isotretinoin is evaluated for the following indications with varying evidence strength: Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of isotretinoin?

Common side effects of isotretinoin (≥ 1 in 100): Dry skin, lips and mucous membranes, Cheilitis, Conjunctivitis and dry eyes, Epistaxis, Myalgia and arthralgia, Elevated transaminases. See the Safety section for uncommon and serious reactions.

Who should not take isotretinoin?

isotretinoin is contraindicated in: Pregnancy and lactation; Hypersensitivity to isotretinoin, peanut oil or soya; Severe hepatic impairment; Hypervitaminosis A; Severe hyperlipidaemia. Full list in the Safety section.

FDA category X. FDA Category X. Isotretinoin is among the most potent teratogens: first-trimester exposure carries >30% risk of major malformations (microtia, CNS and cardiac defects). Since 1988 AEMPS has run a Pregnancy Prevention Programme: monthly pregnancy tests, double contraception, signed consent. Therapy stops at least 1 month before planned pregnancy.

Anti-aging and longevity

Not recommended

Isotretinoin is an oral retinoid. It is prescribed for severe nodular acne vulgaris and for moderate acne unresponsive to other treatments ( 2020, 2023, AEMPS Ficha Técnica). In anti-aging practice, isotretinoin is prescribed for anti-aging of the skin and for occasional inflammatory acne lesions without confirmed moderate-to-severe disease. In people with mild acne, the risk profile is not justified. The drug has serious risks: severe teratogenicity ( boxed warning, mandatory iPLEDGE program with dual contraception for women of reproductive age), hepatotoxicity, hyperlipidemia, skin and mucosal xerosis, cheilitis, depression and described suicidal-ideation risk, and impaired night vision. If isotretinoin was prescribed for mild eruptions or anti-aging, consider seeking a second opinion.

Major

Carbamazepine

Antiepileptics. Carboxamide derivatives

Mechanism

Carbamazepine is a CYP3A4 inducer. It lowers isotretinoin plasma levels, which can cause acne therapy failure. Additionally: both drugs are teratogens, absolutely contraindicated in pregnancy.

Symptoms

Recurrence of acne, no response to isotretinoin. In pregnancy on combination: severe foetal malformations (both drugs are teratogens).

Management

Avoid the combination. Alternative anticonvulsants without induction: levetiracetam, lamotrigine. Alternative acne therapy: antibiotics (doxycycline, azithromycin), topical retinoids, spironolactone in women. In women of reproductive age, mandatory dual contraception.

Sources

FDA: Accutane (isotretinoin) boxed warning (2010)

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Major

Doxycycline

Tetracyclines

Mechanism

Both drugs cause benign intracranial hypertension (pseudotumor cerebri). Additive risk with classic presentation: headache, diplopia, visual disturbance, optic disc oedema.

Symptoms

Persistent pressing headache (not relieved by analgesics), diplopia, transient visual disturbances, tinnitus. Examination: optic disc oedema, blind spot enlargement. Symptoms appear several weeks into combination.

Management

The combination is not prescribed. Alternative antibiotic for acne on isotretinoin: azithromycin (short course) or topical retinoids. If headache with diplopia appears, stop both drugs immediately and refer to ophthalmology.

Sources

FDA: Accutane (isotretinoin) boxed warning (2010)

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Moderate

Budesonide

Inhaled corticosteroids (ICS)

Mechanism

Dual immunomodulation. Isotretinoin is teratogenic and affects liver function and skin barrier. Systemic budesonide suppresses immunity and raises infection risk. No direct pharmacokinetic interaction.

Symptoms

On long-term combination: increased infection susceptibility (bacterial sinusitis, pneumonia, candidiasis). Skin and mucosal dryness intensifies. Cases of intestinal mucosal ulceration on the combination have been reported.

Management

Systemic budesonide and isotretinoin are not co-prescribed without strong indication. In inflammatory bowel disease (Crohn's) with severe acne, options: treat acne topically and with adapalene, or start isotretinoin after inflammation remits and glucocorticoids are stopped. Inhaled budesonide with isotretinoin is safe.

Sources

FDA: Pulmicort (budesonide) prescribing information (2010)

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Contraindications

Pregnancy and lactation
Hypersensitivity to isotretinoin, peanut oil or soya
Severe hepatic impairment
Hypervitaminosis A
Severe hyperlipidaemia
Co-administration with tetracyclines (pseudotumor cerebri risk)

Serious adverse effects

Teratogenicity in pregnancy
Depression, suicidal ideation (requires monitoring)
Inflammatory bowel disease
Pseudotumor cerebri
Hypertriglyceridaemia with pancreatitis
Severe cutaneous reactions (Stevens-Johnson, toxic epidermal necrolysis)

Common adverse effects

Dry skin, lips and mucous membranes
Cheilitis
Conjunctivitis and dry eyes
Epistaxis
Myalgia and arthralgia
Elevated transaminases

Uncommon adverse effects

Depression and suicidal ideation
Inflammatory bowel disease
Pseudotumor cerebri
Hypertriglyceridaemia with pancreatitis
Severe cutaneous reactions (Stevens-Johnson, TEN)

PregnancyFDA X

FDA Category X. Isotretinoin is among the most potent teratogens: first-trimester exposure carries >30% risk of major malformations (microtia, CNS and cardiac defects). Since 1988 AEMPS has run a Pregnancy Prevention Programme: monthly pregnancy tests, double contraception, signed consent. Therapy stops at least 1 month before planned pregnancy.

Breastfeeding

Not compatible. Hale L5. No human milk transfer data; highly lipophilic and accumulates in tissues. AEMPS contraindicates isotretinoin during breastfeeding.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

isotretinoin

Mechanism of action

Marketing claims without evidence base

Anti-aging and longevity

Drug–drug interactions

Carbamazepine

Doxycycline

Budesonide

Check interaction with another drug

Official sources

Safety

Contraindications

Serious adverse effects

Common adverse effects

Uncommon adverse effects

PregnancyFDA X

Breastfeeding

Frequently asked