Accutane side effects are so common as to be considered a normal part of therapy for most patients using Accutane fixed treatment of severe recalcitrant and nodular acne. Because of the common side effects and because of the absolute importance and not using Accutane during pregnancy Accutane use is restricted to physicians in a distribution program called iPLEDGE. Physicians are required to dispense Accutane only to patients who meet all iPLEDGE requirements. In addition distribution of brand name Accutane has been discontinued in the United States and other brands such as Sotret, Amnesteem, and Claravis are used today.
Accutane side effects: Accutane is used for the FDA approved indications of severe recalcitrant nodular acne. Is generally prescribed by dermatologists who take care of large numbers of patients on Accutane in order to monitor for Accutane side effects and comply with the iPLEDGE requirements. Accutane dosage is usually 0.5 to 1 mg per kilogram per day divided into two equal doses. It is usually given with food and typical course of Accutane therapy is 15 to 20 weeks. The maximum daily dose is 2 mg per kilogram per day for very severe disease. There is a toll-free number 1-866-495-0654 to obtain additional information on the iPLEDGE program.
Common Accutane side effects: dermatologic Accutane side effects occur in almost every patient using Accutane and include dry skin, fragile skin, cheilitis which is dryness and cracking of the corners of the mouth, itching, dry mouth and nose bleeds, dry eyes and conjunctivitis, hair loss and hair thinning, fingernail and toenail changes, and photosensitivity. Other common acting side effects include muscle pains and joint pains, hypertriglyceridemia which can be very severe at times even lead pancreatitis, elevation of liver transaminases, intolerance of wearing contact lenses, ringing in the ears, back pain, and depression.
Serious Accutane side effects: the list of serious Accutane side effects is extensive and should be discussed in detail with your dermatologist prior to initiating therapy with Accutane. Use in pregnancy will be discussed below but is absolutely contraindicated and excellent contraception is needed in women of childbearing age who use Accutane. Psychologic Accutane side effects can be very serious and suicidal ideation is a concern. These include aggression and violent behavior, frank psychosis, and depression. Central nervous system acting side effects include stroke, seizures, and pseudotumor cerebri. Other serious Accutane side effects can include osteoporosis, hepatotoxicity, severe allergic reaction including anaphylaxis and hypersensitivity vasculitis, hearing impairment, corneal opacities and cataracts, inflammatory bowel disease, pancreatitis, and other blood clots the vascular system. Severe dermatologic Accutane side effects can include erythema multiforme as severe as Stevens-Johnson syndrome and toxic epidermal necrolysis. Agranulocytosis, neutropenia, and other hematopoietic Accutane side effects have been noted. When Accutane is used before the end of puberty premature epiphyseal closure has been noted.
Cautions and contraindications: the list of cautions contraindications to Accutane use is so extensive that they really need to be discussed in detail with the prescribing dermatologist prior to consideration of Accutane therapy. Pregnancy and breast feeding are at the top of the list. Use of Accutane in patients with psychiatric disorder any type of metabolic bone disorder, hyperlipidemia or pancreatitis, diabetes mellitus, anorexia nervosa, and sensitivity to any drugs this class are contraindicated. The use of Accutane with tetracyclines, vitamin A, or any medications in the retinoid class of drugs should be avoided if possible. Accutane therapy may need special monitoring or modification in combination with carbamazepine. Caution is advised with many herbal products including black cohosh, kava, and others. Use with topical acne medications requires careful observation and use with the phenytoin anticonvulsants requires special monitoring of phenytoin levels.
Accutane Metabolism: Accutane is generally excreted in both the urine and feces with a serum half-life of about 21 hours. In the liver Accutane metabolism occurs in the CYP 450 pathway especially the CYP 2C8, CYP 2C9, and CYP 3A4 substrate pathways.
Pregnancy and lactation: Accutane is pregnancy category X meaning it uses absolute contraindicated. Refer to the iPLEDGE restrictions and guidelines for detailed but severe fetal abnormalities have been noted in humans when Accutane is use during pregnancy. Accutane is considered unsafe for use during lactation.
Special considerations: in general when used in women of childbearing age both formal and very contraception should be used in combination to give the best possible contraception and to absolutely avoid conception while using Accutane. One of the desired effects of Accutane is long-term control of severe acne. Accutane is been extremely helpful to some patients where scarring and permanent skin damage has occurred and continues to occur from severe nodular acne. That stated the risk-benefit ratio of use of Accutane versus continued severe acne needs to be discussed in detail with experienced provider in order to the side effects teen therapy is appropriate for an individual.
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