Accutane (Isotretinoin): What to Expect Week by Week, First Month

Is There a Week-by-Week Pattern?

No established week-by-week pattern is available. The isotretinoin labeling gives no onset week for dryness, no week when a flare peaks and no week when clearing begins [1][2].

What the Label Lists as Common

Reactions reported in 5% or more of patients include dry lips, dry skin, back pain, dry eye, arthralgia, epistaxis, headache, chapped lips, dermatitis, increased creatine kinase, cheilitis, musculoskeletal discomfort, upper respiratory tract infection and reduced visual acuity [1]. Cheilitis and hypertriglyceridemia are the two the label calls dose related [1]. No onset timing is given. The older-format label reports that about 16% of patients in a clinical trial developed musculoskeletal symptoms, including arthralgia [2].

The 4-Week Lipid Checkpoint

The Absorica label requires a fasting lipid profile and liver function tests in all patients before starting [1]. The Accutane label says lipid determinations should be done before treatment and then at intervals until the lipid response is established, which usually occurs within 4 weeks [2]. In clinical trials, marked serum triglyceride elevations were reported in approximately 25% of patients, about 15% developed a decrease in HDL and about 7% an increase in cholesterol, and the effects were reversible on stopping [2].

Dose, iPLEDGE and What to Avoid

Absorica may be taken with or without meals; the older-format label says to take it with food because fasting significantly decreases absorption [1][2]. Adults with very severe disease may go to 2 mg/kg/day of Absorica as tolerated, and once-daily dosing is not recommended [1]. Neither the Absorica label nor the older Accutane-format label states a cumulative mg/kg target [1][2].

Every patient is enrolled in iPLEDGE. Patients who can get pregnant follow the pregnancy testing and prevention rules, and patients who cannot get pregnant must not share the drug or donate blood; pharmacies dispense a maximum 30-day supply with no refills [1]. The label says to avoid vitamin A supplements and tetracyclines, to avoid prolonged exposure to UV rays or sunlight, and to avoid wax epilation and skin resurfacing during treatment and for at least 6 months afterward [1][2].