Last Updated on August 7th, 2019
Accutane (also known as isotretinoin or 13-cis-retinoic acid) is sometimes a miracle drug for cystic acne, but the benefits of the medication1 come at the cost of side effects. Just a few of the potential side effects of Accutane include:
Some of these side effects may become permanent. There is a well-known increased risk of suicide among users of Accutane, and about 10% of women who use Accutane during the first trimester of pregnancy bear children with facial birth defects5. Using lower doses of Accutane, many researchers have reasoned, ought to reduce the risk of side effects. But would lower doses of Accutane control acne as well?
Accutane comes in 10 mg (pink), 20 mg (red), and 40 mg (yellow) pills. American doctors, in particular, tend to prescribe the 40 mg dosage. American acne sufferers have to pay out of pocket for their medications, and the various sizes of the drug cost about the same. Many expect to get their money’s worth by taking the highest available dose of the medication.
Many of the dosing recommendations that appear in English-language medical journals include studies of patients who were not being treated for acne. Accutane is also used as a treatment for certain kinds of cancer6. Cancer treatment requires much higher doses of the drug, but these dosages were included in the recommendations recorded in the medical literature for dosing Accutane for treating acne. It is entirely possible that decades-old dosage recommendations are simply too high, but have become standard medical procedure in the USA.
In Italy, there is no incentive to prescribe a higher dosage of the drug. Researchers in Italy conducted a clinical study to see if dosage really makes a difference.
In the Italian study, 114 people with “mild” acne and 36 people with “moderate” acne were given about 75% of the dosage usually prescribed, 30 mg a day (one pink pill and one red pill). Essentially all of the patients in the group studied by the researchers went into remission from acne during the study. Only about 10% relapsed after they were taken off medication after taking the lower dose of the drug.
These results are consistent with the results of a study of the 30 mg daily dosage conducted in Germany in the 1990’s. German researchers found that about 1/3 of patients given 30 mg of Accutane a day instead of 40 mg of Accutane a day needed a second course of treatment, on average a little under 8 months after they first came off the drug. The German doctors only had one person who failed to respond at all to taking just 30 mg of Accutane a day.
In another study, Korean researchers studied7 60 people who had “moderate” acne. They were given either a regular dosage of Accutane, a low dose, or intermittent Accutane treatment, taking Accutane only one week per month. In the regular dosage group, 12% relapsed when they were taken off the drug. In the low-dose group, 18% relapsed after being taken off the drug. In the one-week-a-month group, however, 50% had their acne come back when they stopped taking Accutane. Taking Accutane once a week was apparently enough to control acne but not enough to cure it.
It seems that lower (30 mg) doses of Accutane are about as likely to cure acne as higher (40 mg) doses of Accutane if they are taken regularly. Taking a vacation from Accutane treatment for 3 weeks out of the month results in relapses soon after the drug is discontinued.
The reality is, however, that many people take Accutane on an intermittent or occasional schedule even though their doctors tell them to take it every day. Some people don’t take all the Accutane they are prescribed because they cannot afford it. Some people don’t take all the Accutane they are prescribed because they find side effects to be intolerable. And some people don’t take all the Accutane they are prescribed because the simply forget to take their pills.
Many doctors are sold on Accutane. It’s the only oral medication for acne that both opens the skin and shrinks the oil glands that become inflamed at the base of pores. It shrinks cysts as it opens the skin above them, and it treats blackheads and whiteheads by peeling skin that covers them, too. Some studies suggest8 that Accutane is also anti-inflammatory and anti-bacterial if it is taken in the right dose.
Probably the best time to ask your doctor about taking the smallest dose of Accutane is when it is first prescribed. Ask your doctor if he or she thinks that a 10 mg dose might be as effective for you as 20 mg or 40 mg—and why. Be especially sure to ask about lower doses if you have any history of inflammatory bowel disease, as this sometimes life-threatening condition can be aggravated by taking the drug.
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