Isotretinoin

Question 1

Drug Class

Answer 1

Retinoids

Question 2

Active

Answer 2

Isotretinoin

Question 3

Indications

Answer 3

• Cystic acne
• Keratinisation
• Plaque psoriasis (T azarotene)

Question 4

Dose Range

Answer 4

ORAL:

• Initially, up to 0.5 mg/kg each day as a single dose or in 2 divided doses.
• Dosage may be increased to 1 mg/kg after 4 weeks according to response and tolerance.

TOPICAL:
- Apply once a day at bedtime

Question 5

SE’s

Answer 5

Both topical and oral:

• Acne flare
• erythema
• peeling
• irritation
• skin dryness
• burning
• itch

Oral:

• dryness of skin, lips, eyes and mucous membranes
• flushing
• photosensitivity
• nose bleeds
• raised LFTs
• headache (raised intracranial hypertension)
• mood changes
• fatigue

Question 6

Counselling

Answer 6

Labels: 8, B, D

• During the first few weeks, your acne may get slightly worse. This is temporary and is not a reason to stop treatment.
• Do not squeeze or pick at pimples as increases risk of scaring.

ORAL:

• This medicine is absorbed best if taken with food.
• Report promptly any nausea, headaches or visual changes (including poor night vision or blurring) to your doctor.
• This medicine often causes dry lips, mouth, skin and eyes. Use lip balm, lubricating eye drops and moisturising lotions whilst taking this medication. Tell your doctor if you are unable to manage dry skin, dry lips or dry eyes, or if during the initial treatment period your contact lenses become uncomfortable.
• Tell your doctor if you notice a change in your moods.
• Avoid taking vitamin A supplements.
• Protect skin from sunlight with protective clothing or a broad spectrum sunscreen. Avoid sunlamps and tanning beds.
• Avoid waxing and dermabrasion during, and for 6 months after stopping, treatment as they could scar or irritate your skin.
• Do not share medication with others.
• Do not donate blood during, or for 1 month after stopping, treatment.
• Female patients, it is important that you use adequate contraception before, during and for 1 month after, treatment, because birth defects can occur during this time.

TOPICAL:

• Before applying, wash with mild soap or soap substitute and warm water; rinse and gently pat dry. To reduce irritation, wait until skin is completely dry (usually 20–30 minutes) before applying. Apply enough to cover affected areas and rub in gently.
• Do not apply to eyes, lips or in nostrils.
• Protect treated areas from sunlight with protective clothing or broad spectrum sunscreen, preferably 30+, containing a physical barrier (eg. titanium dioxide). Avoid sunlamps and tanning beds.
• Cosmetics may be used but wash them off before applying medication at night.
• Avoid topical anti-acne preparations as local irritation may increase.

Question 7

Monitoring

Answer 7

• liver function and lipids (at baseline)
• psychological symptoms (depression, attempted suicide)
• Acne