Isotretinoin

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Administration

  • Type:
  • Dosage Forms:
  • Routes of Administration: IV, PO
  • Common Trade Names: Accutane

Adult Dosing

  • Acne: 0.25 mg/kg twice daily x 1 month, then 0.5 mg/kg twice daily as tolerated; continue until a total cumulative dose of 120 to 150 mg/kg is reached
  • Cutaneous T cell lymphoma/other cancers IV doses vary

Pediatric Dosing

  • Used for acne, neuroblastoma

Special Populations

Pregnancy Rating

  • X

Lactation risk

  • unknown

Renal Dosing

  • No adjustment

Hepatic Dosing

  • No adjustment

Contraindications

  • Allergy to class/drug
  • Pregnancy

Adverse Reactions

Serious

  • Hearing impairment
  • Bone mineral density loss leading to fractures/delayed fracture healing, skeletal hyperostosis/premature epiphyseal closure
  • Erythema multiforme, SJS, TEN
  • Agranulocytosis, neutropenia
  • Hepatitis
  • Hypersensitivity reactions (anaphylaxis, allergic vasculitis)
  • IBD, ileitis
  • Rhabdomyolysis
  • Visual impairment, corneal opacities
  • Pancreatitis
  • Pseudotumor cerebri
  • Psychiatric effects (depressed mood/suicidal ideation, psychosis)
  • ATRA syndrome

Common

  • Increased triglycerides, decreased HDL, increased CPK
  • Increased LFTs
  • Arthralgia, back pain
  • Decreased bone mineral density
  • Photosensitivity

Pharmacology

  • Half-life: 5-38h
  • Metabolism: Hepatic via CYP2B6, 2C8, 2C9, 3A4
  • Excretion: Urine and feces

Mechanism of Action

  • Induces apoptosis in certain cells, including those of the sebaceous glands

Comments

See Also

References