Isotretinoin: Price, Dosage & Where to Buy

Isotretinoin is an oral retinoid prescribed for the treatment of severe recalcitrant nodular acne in patients 12 years of age and older who have not responded to conventional therapy, including systemic antibiotics. It requires a prescription in the United Kingdom. Generic isotretinoin has been available since November 2002.

Isotretinoin is indicated for severe recalcitrant nodular acne in non-pregnant patients aged 12 years and older with multiple inflammatory nodules measuring 5 mm or greater in diameter. Because of significant adverse reactions associated with its use, isotretinoin is reserved for patients with severe nodular acne who are unresponsive to conventional therapy, including systemic antibiotics. The medicine addresses a form of acne that has not improved with other treatments and is characterised by large, inflamed nodules.

Isotretinoin is a retinoid, a derivative of vitamin A chemically known as 13-cis-retinoic acid. Retinoids work by affecting the growth and differentiation of skin cells. In acne, isotretinoin reduces the size and activity of sebaceous glands, which produce the oily substance called sebum.

By decreasing sebum production, isotretinoin helps prevent pores from becoming blocked. It also has anti-inflammatory properties and influences the way skin cells are shed, reducing the formation of comedones and nodules. The exact mechanisms are complex and involve multiple pathways in skin cell regulation.

The label lists capsules in the following strengths: 8 mg, 10 mg, 16 mg, 20 mg, 24 mg, 25 mg, 30 mg, 32 mg, 35 mg, and 40 mg. The usual starting dose is 0.5 to 1 mg per kg per day given in two divided doses with or without meals for 15 to 20 weeks. The label lists dosage adjustments based on response and tolerability.

Adult patients whose disease is very severe with scarring or primarily manifested on the trunk may require dosage adjustments up to 2 mg per kg per day in divided doses, as tolerated. The label states that once daily dosing has not been established and is not recommended.

Capsules should be swallowed whole with a full glass of liquid to decrease the risk of oesophageal irritation. The label advises not to split, crush, chew, or suck on the capsules.

The label states that if a dose of isotretinoin is missed, just skip that dose. Do not double the dose to make up for the missed one.

The label advises never to use two doses of isotretinoin at the same time. Because isotretinoin is prescribed as part of a course lasting 15 to 20 weeks, missing an occasional dose is unlikely to affect the overall outcome, but patients should contact their prescriber or pharmacist if they have questions about managing missed doses.

Isotretinoin is contraindicated in pregnancy because it can cause fetal harm. There is an extremely high risk of life-threatening birth defects if pregnancy occurs while using any amount of isotretinoin, even for short periods. Major congenital malformations documented following isotretinoin exposure include malformations of the face, eyes, ears, skull, central nervous system, cardiovascular system, and thymus and parathyroid glands.

An increased risk of spontaneous abortion and premature births has been reported. If pregnancy occurs during treatment, isotretinoin must be stopped immediately and the patient referred to an obstetrician-gynaecologist experienced in reproductive toxicity.

There are no data on isotretinoin in human milk. Breastfeeding is not recommended during treatment and for at least 8 days after the last dose.

The label lists storage at 20 to 25 degrees Celsius (68 to 77 degrees Fahrenheit), with excursions permitted to 15 to 30 degrees Celsius (59 to 86 degrees Fahrenheit). The label states to protect isotretinoin from light. Capsules should be kept in their original packaging to maintain quality and stored out of reach of children.