Isotretinoin - Side Effects And Treatment Of Side Effects

Click here to view the A-Detail™ on Accutane®.

Most people have minor Isotretinoin (Accutane®) side effects that disappear within 2 weeks after stopping the medication. Almost everybody gets dry lips, and blood work to monitor the liver and blood fats (lipids) must be done periodically. Possible side effects are numerous and well documented, most side effects are dose related which means they get worse as the dose gets higher.

Your patient may experience some side effects from Isotretinoin that will require some medical attention while on this acne treatment. The side effects that typically require treatment are aggravated skin, dry eyes, dry nose and sun damage on their lips.

Side Effects That May Be Noticed By The Patient:

Aggravated skin:
Overcleansing their skin can cause irritation that may aggravate their acne as well as encourage them to use other products that will grease up their skin. This may then complicate their skin care in that they will need to use a toner to remove the oil, which in turn may irritate their skin further.

Skin Cleansers Can Be Grouped As:

Dry Lips And Skin:

Dry lips are the most common side effect of Isotretinoin (Accutane®). If your patient is on a course of Accutane® and their lips are not dry, then they are either not using the drug, or they are not taking the medication with fatty food. Sticky ointments are best for relieving this dryness and may prevent cracking, these products must be used multiple times a day. Occasionally, patients may get a secondary bacterial infection on their lips, this will usually respond to topical antibiotics. Some physicians will advise a few days of mild cortisone ointment for their patients if they have significant inflammation on and around their lips.

With dry skin, you may see this most often on the back of your patient's hands and forearms. Dryness may cause a secondary bacterial infection in their skin, their skin may become fragile and the healing of their skin may slow down.

We often forget about protecting our lips from chronic sun damage, long term exposure will often produce "actinic cheilitis", which describes changes such a loss of a distinct lip line, and white patches on the lower lip called leucoplakia. These changes are precancerous and we should take care to protect our lips to reduce this occurrence. Those who are prone to cold sores may get them more frequently after sunexposure. Those taking Accutane® will have dry lips that are more sensitive to sunburn.

Regular sunscreens are not entirely satisfactory for lip protection, and a number of lip sunscreens have been developed.

Examples:

Dry Eyes And Vision:

Rarely, night vision problems have been reported, they are mostly transient, but could be permanent. Loss of visual acuity is uncommon but if your patient does experience this, an ophthalmologist should assess them. Dry gritty eyes, contact lenses may have to be discontinued, use of artificial tears is encouraged and in most cases can be very helpful.

Dry eyes are a common problem. There are multiple contributing factors and a spectrum of severity. The film of tears over your eyes is composed of oil, water and mucin. These are produced in the meibomian glands, lacrimal glands and goblet cells. Your tears are then spread by your eyelids to coat your eyeballs which helps to moisten them. The tears drain away through a tear duct that is found in the inner part of your lower eyelid. If this is blocked it will produce excess tears and lead to watery eyes.

Many disease conditions, trauma and/or environmental conditions may play a part in causing symptoms of dry eyes such as burning, grittiness and blurry vision. It is also known that a low level of inflammation that is often not seen (subclinical) can produce dry eyes. Accutane® (Isotretinoin) will cause dry eyes in some individuals. Your patient may find this to be a problem, particularly if they wear contact lenses. They may need to stop wearing them temporarily, but frequent use of artificial tears may allow the patient to continue using their lenses.

Artificial tears have active ingredients that may contain various methylcellulose compounds, polyvinyl alcohol and polyethylene glycol.

Examples:

Nasal Dryness:

Patients may have a dry nose or nose bleeds due to dryness and subsequent cracking of the inner lining of their nose, frequent use of lubricants is recommended.

Dryness of the inner linings of the nose can be caused by a variety of factors. Allergic conditions, viral infections, chronic irritation, sinus inflammation, dry climates and postnasal discharge as well as oxygen therapy, can change the moisture content of the nasal lining. Accutane® (Isotretinoin) will often cause dry nose, which may in turn produce cracking and consequent nosebleeds. Lubricating their nose can minimize or prevent this side effect.

Nose lubricants that are most often used are in the form of a gel. These will often contain polyethylene glycol and propylene glycol.

Examples:

Hair:

Thirteen percent of people taking Accutane® experience thinning hair, though this is usually temporary.

Photosensitivity:

Patients may sunburn more easily, this can be a problem particularly during vacations and recreational activities. While taking Accutane® alcohol based sunscreens may be too drying.

Fatigue: (15-20%)

Headaches: (5-16%)

A rare side effect of this drug is benign intracranial hypertension, which is an increase in pressure of the fluid surrounding your brain. If patients have persistant headaches that are present in the morning on waking and ware off through the day, the patient should be evaluated by a doctor.

Clindoxyl® Gel

Close | Move

INTRODUCTION
Clinical experience confirms what has been shown in clinical trials, that Clindoxyl Gel is effective and well tolerated Once daily application of topical that combines two active anti-acne agents may well increase patient compliance... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Moderate comedonal and papulo-pustular acne Approved in Canada as a once daily topical for moderate Acne in December 2000... | Read more ...

PATIENT PROFILE
Any patient who has inflammatory acne can be treated with Clindoxyl Gel Acne patients with comedones only are best treated by topical retinoids Patients with cystic acne usually require systemic therapy... | Read more ...

DOSING
Once daily application of Clindoxyl Gel is recommended The product needs to be applied to the whole region of skin that is affected with acne. In other words... | Read more ...

EFFICACY
The following figures show pooled data from randomized, controlled double-blind trials involving 673 patients with acne... | Read more ...

COMPLIANCE
Three factors to consider for good compliance of Clindoxyl Gel are: Well tolerated by most patients, results are often seen within 2 weeks... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Overall tolerance was rated as excellent in 94% of patients. Potential side effects expected in some patients... | Read more ...

COST OF TREATMENT
This is a cost effective product. Reducing inflammation can reduce the risks of scarring... | Read more ...

View the entire Clindoxyl® Gel presentation.

Diane-35^®

Close | Move

INTRODUCTION
There are limitations for regulators, pharmaceutical companies and pharmaceutical sales representatives to present clinical evidence following development of product monograph and drug approval... | Read more ...

CLININCAL EXPERIENCE
Diane-35® (2mg cyproterone acetate and 0.035mg ethinyl estradiol) is approved for use in Canada to treat women with severe acne who are unresponsive to other available treatments and who have associated symptoms of androgenization, such as seborrhea and mild hirsutism. In addition to treating acne, Diane-35® also provides reliable contraception... | Read more ...

INDICATIONS
Used to treat women with severe* acne and its associated symptoms of androgenization, including seborrhea and mild hirsutism.. | Read more ...

PATIENT PROFILE
Women who have acne associated or not with signs of hyperandrogenism. Any woman who has acne that is not controlled with topical medication... | Read more ...

DOSING
Diane-35® is sold in blister pack units containing 21 tablets. Each tablet contains 2mg of cyproterone acetate and 0.035mg of ethinyl estradiol. Each cycle consists of 21 days on the medication and a 7-day interval without it... | Read more ...

EFFICACY
Improvements in seborrhea are generally seen after 2 to 3 months. Improvements to acne are generally seen after 3 to 4 months. Numerous studies have proven the efficacy of hormonal therapy in treating acne over 6 or more months of use... | Read more ...

COMPLIANCE
Patients should take Diane-35® at the same time each day with liquid... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Side effects are typical of most oral contraceptives and can include breast tenderness, headache, nausea, breakthrough bleeding, ankle swelling and weight gain. These side effects are typically mild and tend to resolve by the second or third cycle of therapy... | Read more ...

COST OF TREATMENT
Diane-35 is sold to pharmacy wholesalers at a cost of $19.00 per cycle... | Read more ...

View the entire Diane-35^® presentation.