Isotretinoin capsules are a very effective treatment for severe acne (spots).

This medicine can have serious side effects, however, so it must be prescribed and supervised by a specialist doctor.

Isotretinoin capsules are also known by the brand names Roaccutane and Rizuderm.

• Isotretinoin capsules start to work after a week to 10 days. They work very well - 4 out of 5 people who use them have clear skin after 4 months.
• You will a have blood test before you start taking isotretinoin and regular blood tests during your treatment.
• Your skin may become very dry and sensitive to sunlight during treatment. Using lip balm and moisturisers will help.
• It's very important not to become pregnant while using isotretinoin capsules and for at least 1 month after stopping. This is because isotretinoin can harm an unborn baby. Women will be given a reminder card about this.
• If you become depressed or think about harming yourself while taking isotretinoin, stop taking the medicine and tell your doctor straight away.

Isotretinoin capsules are for teenagers and adults with severe acne. Do not give isotretinoin capsules to children under the age of 12 years or before puberty.

Isotretinoin capsules aren't suitable for some people.

Do not take isotretinoin capsules if you:

• have had an allergic reaction to isotretinoin, soya (the capsules contain soya) or any other medicines in the past
• have an inherited digestive disorder called fructose intolerance (the capsules contain sorbitol)

To make sure isotretinoin capsules are safe for you, tell your doctor if you:

• have had a mental health illness like depression
• are pregnant or think you could be, or you're breastfeeding
• have ever had an allergic reaction to isotretinoin or any other medicine
• have liver or kidney disease
• have high levels of cholesterol or other fats in your blood
• have high levels of vitamin A
• have Crohn's disease or ulcerative colitis

If you have diabetes, talk to your doctor before beginning treatment with isotretinoin capsules. You may need extra monitoring while you take isotretinoin capsules as this medicine can cause a rise in blood sugar levels.

Like all medicines, isotretinoin capsules can cause side effects, although not everyone gets them. Side effects will usually go away when you stop treatment.

Dry skin and lips are very common side effects. For safety, do not have any waxing, dermabrasion, or laser skin treatment while you're taking this medicine and for at least 6 months after you stop, as this could cause scarring or skin irritation.

Common side effects

The common side effects of isotretinoin capsules happen in more than 1 in 10 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:

• skin becoming more sensitive to sunlight
• dry eyes
• dry throat
• dry nose and nosebleeds
• headaches and general aches and pains

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Stop taking isotretinoin capsules and call a doctor straight away if you get:

• anxiety, aggression and violence, changes in mood, or suicidal thoughts - these can be signs of depression or other mental health problems
• severe pain in your stomach with or without diarrhoea, feeling or being sick (nausea or vomiting) - these can be signs of a serious problem called pancreatitis
• bloody diarrhoea – this may be a sign of gastrointestinal bleeding
• a serious skin rash that peels or has blisters - the skin rash may come with eye infections, ulcers, a fever, and headaches
• difficulty moving your arms or legs, and painful, swollen or bruised areas of the body, or dark pee - these can be signs of muscle weakness
• yellow skin or the whites of your eyes turn yellow, difficulty peeing, or feeling very tired - these are signs of liver or kidney problems
• a bad headache that doesn't go away and makes you feel sick or be sick
• sudden changes in eyesight, including not seeing as well at night

It's very rare, but isotretinoin capsules can sometimes cause depression or make it worse, and even make people feel suicidal.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to isotretinoin capsules.

These are not all the side effects of isotretinoin. For a full list see the leaflet inside your medicines packet.

What to do about:

• dry skin or lips - apply a moisturiser and lip balm often (the best type of moisturiser is an oil-free face moisturiser for sensitive skin). Try to keep your showers shorter than 2 minutes, using lukewarm water rather than hot.
• skin becoming more sensitive to sunlight - stay out of bright sun and use a high factor, oil-free sun cream (SPF 15 or above) even on cloudy days. Do not use a sunlamp or sunbeds.
• dry eyes - ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and these become uncomfortable, you might have to wear glasses instead while you're taking this medicine.
• dry mouth or throat - try chewing sugar-free gum or sweets.
• dry nose and nosebleeds - try applying a thin layer of Vaseline to the inside edges of your nose.
• headaches and joint, muscle and back pain - ask your pharmacist to recommend a painkiller. Light exercise shouldn't be a problem, but try to avoid heavy exercise as it may make joint or muscle pain worse.

It's important to take the capsules as instructed by your doctor.

As a general rule, the starting dose is 0.5mg per kilogram body weight per day (0.5 mg/kg/day). So if you weigh 60kg, your dose will usually start at 30mg a day.

Usually, you take isotretinoin capsules once or twice a day. Each capsule contains a dose of 10mg or 20mg of isotretinoin.

The dose of isotretinoin capsules varies from person to person, and depends on your weight.

Swallow the capsules whole with a drink of water. It's best to take them straight after a meal or snack to make sure they work properly.

What if I forget to take it?

If you take the capsules once a day and remember you've missed a dose on that day, take it as soon as you remember. If it's the next day when you remember, skip the missed dose and take the next capsule at the usual time.

If you take the capsules twice a day and forget to take a dose, take it as soon as you remember, unless this is within 2 hours of your next dose. In this case, skip the missed dose and take the next capsule at the usual time.

Never take a double dose. Never take an extra dose to make up for a missed one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Will the dose I take go up or down?

After a few weeks, your doctor may change your dose of capsules. You may need a higher dose if your acne isn't getting better. You may need a lower dose if you have side effects that bother you.

This medicine is likely to harm a baby. It also increases the risk of miscarriage.

If you become pregnant during treatment with isotretinoin capsules, stop taking the capsules and tell your doctor as soon as possible.

It's very important that you do not get pregnant while you're taking isotretinoin capsules. You'll be asked by your doctor to follow strict rules to prevent pregnancy during treatment and for 1 month afterwards.

Before starting treatment with isotretinoin capsules, women who are able to become pregnant must agree to:

• use at least 1, and ideally 2, reliable methods of contraception for 1 month before starting isotretinoin capsules, and for 1 month after treatment has stopped - the second contraceptive should be a barrier method of contraception (for example, a condom), but you shouldn't use barrier methods on their own
• have a pregnancy test before, during, and 5 weeks after the end of treatment - some doctors may ask you to have monthly pregnancy tests

Your doctor will give you a patient reminder card for isotretinoin. Read this card and the information leaflet that comes with your medicine before you start taking the capsules.

Do not breastfeed while you're using isotretinoin capsules. This medicine can get into breast milk and harm your baby.

Men and isotretinoin capsules

Men can safely take isotretinoin capsules if they and their partner are trying for a baby, or their partner is pregnant.

Isotretinoin capsules don't seem to damage sperm. Only tiny amounts of isotretinoin get into semen, which is too little to harm the unborn baby.

Some medicines and isotretinoin capsules can interfere with each other, and make it more likely that you'll have side effects.

Tell your doctor if you're taking these medicines before you start treatment with isotretinoin capsules:

• supplements that contain vitamin A
• tetracycline antibiotics such as doxycycline, oxytetracycline, minocycline, and lymecycline
• other acne medicines (using both together may make skin irritation worse)

Mixing isotretinoin capsules with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements while you use isotretinoin capsules.