Accutane is a naturally occurring derivative of vitamin A and is detectable in the bloodstream of all people. Vitamin A in large doses has the same effects as Accutane, both good and bad, but quickly becomes poisonous (Important: Don't take any vitamin A while on Accutane). Accutane is formed naturally in the body from the Vitamin A present in the bloodstream. This is why large amounts of Vitamin A taken during pregnancy cause the same birth defects that Accutane does. Fortunately, because it is a naturally occurring product, the body is able to quickly remove Accutane from the bloodstream. It is gone from the blood within five days and has no lasting effect on future pregnancies.

Accutane "cures" about half of those people who take it so that they never need to do anything else for acne. In the first few weeks of treatment, about one in five patients gets a little worse, and one in 500 patients gets much worse. The rest either get much better, or better for a while.  There is nothing else in the world that comes close to being this effective for severe acne. The usual patient takes it for 4 to 6 months, but some need more and must be "re-treated" for an additional 4 to 6 months. 

The more Accutane you take, the greater the chance you will be cured. In clinical studies comparing dosages of 10, 40 and 80 milligrams daily, all 3 dosages resulted in initial clearing of acne. disease but there was a greater need for re-treatment with the smaller doses (about 40, 20, and 10% of the patients, respectively, required a second course of therapy).  

Unfortunately, side effects depend on the dose also. At the lowest doses, there are almost no side effects at all. At the highest, everyone get rather nasty side effects. The dose need to be adjusted to strike a balance between effectiveness and side effects.

The common side effects of Accutane result from the drug decreasing the amount of oil produced by the bodies oil glands. The most important oil glands are in the skin (Sebaceous glands), but other oil glands in the body are affected and are the reason for the side effects the drug produces.  

Side effects that are common are listed here. Frequency-the percent of people who get the particular side effect is listed in parenthesis. Chapped lips (90%, countered by a using Vaseline as a moisturizer and taking 800 IU of Vitamin E daily), Intestinal symptoms (5%), Urinary symptoms (5%), Dry skin and itching (80%), Headache (5%), Rash (7%), Decreased night vision (<1%, occurs when Accutane pushes out Vitamin A from the eye-we think this can be reversed by eating carrots), Dryness of nose, mild nosebleed (80%, helped by "AYR nasal gel"), Temporary hair thinning (10%), Irritation of the eyelids and eyes (40%), Joint and muscle pains (15%), Increased sensitivity to sun (5%), Depression, thoughts of suicide (<1%).  

Accutane may increase the level of blood fats, sometimes to risky levels. Occasionally it may affect the liver. That's why regular blood tests are necessary when you are taking Accutane; these tests must be done when you have fasted for 12 hours (no breakfast), so that the blood fat determinations are reliable. If they are done without fasting and are completely normal, that's OK too.

A baseline blood chemistry test is needed before you begin Accutane. There is little risk of any damage if these precautions are followed. The most damaging side effect of Accutane is serious birth defects if taken during pregnancy.

It is critically important for women not to take Accutane while pregnant, and not to become pregnant while taking it. Women who are, or might be, sexually active while taking Accutane must use an effective method of birth control. We cannot always trust the answer of a teenage girl sitting next to her dad in our office to accurately describe her sex life. This usually means oral contraceptive pills.

Oral contraceptive pills do rarely fail, so an additional method of birth control such as a condom for the male partner or a spermicidal foam or sponge is also needed. A woman who does get pregnant while on Accutane should be prepared to have an abortion and must state that in writing before many physicians will prescribe it for her. None of my patients have ever become pregnant while on Accutane, and I plan to keep it that way.

Because the birth defects caused by Accutane are so serious, it's important not to share the pills with others. It doesn't appear that Accutane taken by men can cause birth defects, but its best not to get a woman pregnant while taking it.

Some people develop headaches while on Accutane. These respond to Advil or Tylenol. If you develop a persistent headache while on Accutane, call your physician right away. A persistent headache, which will does not go away could be dangerous and you should stop the medication.

Accutane rarely causes depression and thoughts of suicide. If this were to occur stop the medicine and immediately and call your physician. Avoid extremely vigorous exercise, as you tend to develop aches.