Accutane (Isotretinoin) Appetite & Cravings Changes: What the Evidence Says

Does isotretinoin reduce appetite?

The Absorica label lists decreased appetite, weight fluctuation, and alterations in blood sugar as adverse reactions, and it also lists weight loss [1]. The older Accutane label lists weight loss, nausea and alterations in blood sugar [2].

The labels do not say why appetite might change. Isotretinoin is a retinoid that inhibits sebaceous gland function and keratinization, and the exact mechanism of its acne effect is unknown [1][2].

Are food cravings a known side effect?

Neither the Absorica nor the Accutane adverse-reaction list includes food cravings or food preference [1][2]. The labels do list alterations in blood sugar and increased fasting blood glucose [1][2].

What the label says about triglycerides and lipids

The Accutane label reports marked elevations of serum triglycerides in approximately 25% of patients in clinical trials; about 15% developed a decrease in high-density lipoprotein and about 7% had an increase in cholesterol [2]. Cheilitis and hypertriglyceridemia are dose related [1][2].

A retrospective cohort of 13,772 patients aged 13 to 50 found a 44% cumulative incidence of a new triglyceride abnormality, 31% for total cholesterol and 11% for transaminase among patients with normal baseline values [3]. Moderate to severe lipid and transaminase abnormalities were generally transient and reversible [3].

These are monitoring findings rather than appetite findings. The labels call for a fasting lipid profile and liver function tests before treatment, with lipid and liver monitoring during treatment [1][2].

Could appetite loss be a sign of depression?

The Accutane label includes changes in weight or appetite among signs of depression and lists depression, mood disturbance, psychosis, and aggression among psychiatric concerns [2].

A 2017 systematic review and meta-analysis of 31 studies found no significant difference in depression-score change between isotretinoin and alternative treatment in controlled studies (standardized mean difference -0.334, 95% CI -0.680 to 0.011) [4]. The prevalence of depression after treatment declined (relative risk 0.588, 95% CI 0.382-0.904) [4]. The review included no randomized controlled trials and noted large variation between studies [4].

Does food affect the drug or nausea?

The Accutane label says Accutane should be taken with food and that failing to do so will significantly decrease absorption. In 74 healthy adults given a single 80 mg dose, a high-fat meal more than doubled exposure, with AUC 10,004 vs 3,703 ng*h/mL [2]. The Absorica label says Absorica can be taken with or without meals [1]. Both labels list nausea as a reaction, but neither says that a meal pattern treats nausea or appetite loss [1][2].