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Aching joints accutane. Side effects of isotretinoin capsules
Accutane Side Effects: What Are They? - Common side effects
Isotretinoin has a wide spectrum of side effects, including multiorgan systems such as reproductive, mucocutaneous, ocular, neurological, musculoskeletal and hepatic systems. It may also cause several musculoskeletal side effects such as arthralgia, myalgia, back pain, spondyloarthropathy-related symptoms and sacroiliitis [ 1 , 2 , 3 ].
Other uncommon musculoskeletal disorders related with isotretinoin are hyperostosis, extraspinal calcifications, enthesitis, arthritis, costochondritis, osteoporosis, growth retardation, premature epiphyseal closure in children and as well as gout [ 3 , 6 , 7 , 8 ]. In the literature, there are only a few original studies investigating the musculoskeletal side effects of isotretinoin [ 1 , 2 , 9 , 10 ]. Furthermore, there are many case reports or case series indicating the musculoskeletal side effects of isotretinoin [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].
The majority of the recently performed studies are the case studies regarding with isotretinoin-induced sacroiliitis [ 11 , 13 , 16 , 18 , 20 ]. To the best our knowledge, there is no controlled study investigating the presence of isotretinoin-related musculoskeletal side effects with a wide spectrum such as arthralgia, myalgia, low back pain, sacroiliitis, tendinopathy and enthesopathy.
In previous studies, the incidence of sacroiliitis and back pain were the most detected parameters [ 1 , 2 , 10 ].
The primary aim of this study was to evaluate and emphasize the musculoskeletal side effects of systemic isotretinoin treatment in patients with acne vulgaris and to compare them with healthy controls. The second aim was to elucidate clinicians regarding with isotretinoin-induced musculoskeletal symptoms.
A total of 94 patients with moderate to severe acne vulgaris treated with systemic isotretinoin and sex- and age-matched controls who were admitted to Ankara Training and Research Hospital, Department of Dermatology, between September and April were enrolled in this cross-sectional study.
The local ethics committee approved the study. All participants were informed about the study and their written consent form was obtained. Isotretinoin group included the patients under isotretinoin treatment for acne vulgaris, but had no history of rheumatologic syndromes.
The control group was selected from among health professionals who had received a routine medical checkup in the hospital. Exclusion criteria for this study were the presence of any chronic rheumatological, dermatological diseases or any patients with a history of mechanical back pain, inflammatory back pain, sacroiliitis, enthesitis, before starting isotretinoin, history suggestive of spondyloarthropathies reactive arthritis, ankylosing spondylitis, inflammatory bowel disease, and psoriasis , or systemic autoimmune disorders.
Also, the patients with depression or similar psychiatric diseases, had renal and liver function disorders, those who were pregnant or using any systemic drugs for other diseases, were not included. All participants were firstly evaluated by a dermatologist and questioned carefully about the musculoskeletal symptoms.
Only the patients who had musculoskeletal symptoms such as myalgia, arthralgia, back pain were determined and enrolled in the study. They were referred to the physical medicine and rehabilitation department and examined by a specialist. Sociodemographic information, including age, sex, history of drug use dose and duration , history of chronic diseases were recorded.
A detailed anamnesis was obtained and a careful dermatological and physical examination was performed by both of the specialists. It was queried that whether myalgia, arthralgia and low back pain occurred after starting isotretinoin treatment. Data were recorded on a standardized pre-prepared evaluation form.
The pain severity of the participants was evaluated by visual analog scale VAS based on a chart numbered from 0 no symptom to 10 maximum severity. According to GAGS, the body was divided into six regions -forehead, nose, each cheek, chin and back. In each region, each type of lesion is given a number: zero for no lesion, one for comedones, two for papules, three for pustules and four for nodules.
It was investigated that whether there was a enthesitis by a detailed clinical examination. The following entheses were examined for tenderness and swelling bilaterally: common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, tibial tuberosity, knee medial collateral ligament, Achilles tendon, and plantar fascia insertion on the calcaneus [ 23 ].
If there was a swelling and erythema, it was considered as inflammatory enthesitis. The absence of swelling or erythema was considered to be mechanical enthesitis. The ASAS criteria consist of commencement under the age of 40, insidious onset, relief with exercise, no relief with rest and nocturnal pain improving with rising up from bed. These 4 items are essential in diagnosing inflammatory low back pain. The various imaging modalities, including conventional radiography, computed tomography CT , magnetic resonance imaging MRI and bone scintigraphy are used for investigation of inflammatory changes at the sacroiliac joints.
In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs may be normal. Inflammatory back pain is not a specific indicator of sacroiliitis. Therefore, there is need for valuable imaging methods.
Scintigraphy lacks specificity. CT is a very good method for visualization of established bony destruction or ossification. MRI can identify both inflammation and structural changes, localise different degrees of inflammation and bone marrow edema, and differentiate a possible septic sacroiliitis. MRI is the most sensitive and specific modality for sacroiliitis by directly imaging changes in the synovium, articular cartilage, and subchondral bone [ 26 , 27 , 28 ].
In our study, the patients meeting ASAS criteria for inflammatory back pain were evaluated in detail and requested both sacroiliac radiography and sacroiliac MRI. Sacroiliac MRI was performed on 1. At least 12 slices of coronal oblique T1-weighted turbo spin-echo and short tau inversion recovery STIR sequences of the sacroiliac joints were acquired.
This images were interpreted by the same reader who had received standardized training and were blinded with regard to the study groups. In addition, laboratory blood tests including rheumatoid factor RF , erythrocyte sedimentation rate ESR and c-reactive protein CRP values were requested.
Anti-nuclear antibody ANA was ordered to rule out other connective tissue diseases. Data were analyzed using SPSS software version The normality of the data was tested by Kolmogorov-Smirnov test. For the comparison of the paired groups, the independent samples t-test normal distribution and the Mann-Whitney U test non-normal distribution were used for the quantitative data. Chi-squared test was used to evaluate whether there was a difference in terms of musculoskeletal symptoms between the study groups.
This case-control study included 94 71 women, 23 men patients with acne vulgaris receiving isotretinoin and 74 women, 26 men age- and sex-matched controls. The age and sex distributions of the study and control groups are presented in Table 1. All of the tendinopathies were mechanical feature, swelling or erythema was not observed. The flow chart of the participants was presented in Fig.
The median duration of treatment was 3 min. There was a total of 66 patients The clinical characteristics of both isotretinoin group and healthy controls can be seen in Table 2. The median duration of treatment was 3 IQR: 3, min. The comparison of the patients who had musculoskeletal symptoms or not in isotretinoin group regarding as total cumulative dose of drug were given in Table 3.
The results of linear regression analysis between the age, sex, duration of treatment and cumulative dose of drug with musculoskeletal side effects were shown in Table 4. The sacroiliac radiography was normal in all of the patients with inflammatory back pain. In sacroiliac MRI, sacroiliitis was observed in 11 Semicoronal short tau inversion recovery STIR images show hyperintense lesions arrows consistent with bone marrow edema in bilateral sacroiliac joints.
Semicoronal T1-weighted spin-echo image shows signal loss arrows in sacroiliac joints consistent with sacroiliitis. The patients who developed rheumatologic symptoms during isotretinoin usage were called to follow-ups by monthly. They were evaluated by a specialist and physical examination was performed at each time they came to control.
VAS scores of the patients were also assessed at each follow-up. In addition, routine biochemical blood tests were acquired from all of the patients in isotretinoin group.
The patients who developed musculoskeletal symptoms such as mechanical back pain, arthralgia, myalgia or tendinopathy, except for sacroiliitis were initiated a nonsteroidal antiinflammatory drugs NSAID and continued a lower dose of isotretinoin.
In patients who were diagnosed as sacroiliitis, the drug was discontinued immediately and a NSAID was prescribed. We observed that the complaints of these patients were resolved within a month after cessation of the drug and VAS scores were also decreased dramatically. The symptoms were mostly disappeared by the third month. All the patients with sacroiliitis were completely symptom free at the sixth month of the discontinuation of the drug.
Isotretinoin, or cis retinoic acid, is a vitamin A derivative used for severe recalcitrant acne since Although isotretinoin is a very effective drug, it may have many side effects.
It is essential that the clinician should be careful about the various side effects of the drug [ 30 ]. In this study, we focused on the musculoskeletal side effects of isotretinoin.
Ninety-four patients treated with isotretinoin suffering from musculoskeletal pain were included. The patients were then examined in detail. They were also compared with healthy controls. Isotretinoin has been associated with various musculoskeletal side effects in the recent literature.
Some of these are original studies, while most of them are sporadic case reports [ 1 , 2 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The onset of the musculoskeletal symptoms of the patients in these case reports was in the first few months. They have found myalgia in Acute sacroiliitis was determined in 8. The authors concluded that the incidence of sacroiliitis in patients receiving isotretinoin is quite high [ 1 ]. In our study, the percentages of myalgia and sacroiliitis were similar to this study, however, the frequency of back pain was noticeably higher in isotretinoin group.
This was one of the most important results of this study. Other musculoskeletal side effects were not found to be statistically significantly related with the total cumulative dose of isotretinoin.
The patients with low back pain using isotretinoin should be asked about the dosage and duration of their drug, and if necessary, the dose should be reduced. On the other hand, it is an interesting finding that sacroiliitis is not related with the total cumulative dose of the drug.
In their study, Alkan et al. In the isotretinoin group, No inflammatory back pain was observed in tetracycline group 32 patients. They found unilateral sacroiliitis only in one patient in the isotretinoin group that included a total of 42 patients. A gynecologist can then give you further evaluation and counseling.
Because of the risks it carries for pregnancies, isotretinoin can be prescribed only under a special restricted distribution program called iPLEDGE. This program is approved by the Food and Drug Administration. Both males and females who take isotretinoin need to discuss this program with their doctor. Doctors who prescribe isotretinoin and pharmacies that dispense isotretinoin must be registered and activated with the iPLEDGE Program. The second pregnancy test must be done in a lab specified by your doctor.
The program also requires females to choose and agree to use two forms of effective birth control at the same time. This precaution goes along with the third requirement. That is, you must agree not to become pregnant while using isotretinoin and for one month before or after treatment.
At least one of the birth control methods must be a primary form of birth control. Examples of these forms are tubal ligation having your tubes tied , an IUD, and hormonal birth control.
Another approach is for your partner to have a vasectomy. The only exceptions to this requirement are if you have chosen not to have intercourse with a male abstinence or have had a hysterectomy surgery to remove your uterus. As you can see, there are many risks linked with isotretinoin use. If you have more questions about these side effects, talk with your doctor. Questions you may ask include:. Your doctor can help you decide if isotretinoin is the right drug for you.
They can also help you manage any side effects you have. Isotretinoin belongs to a class of drugs called retinoids. Less oil on your skin gives the acne-causing bacteria less to feed on.
With fewer clogged pores, bacteria have fewer places to grow. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Accutane was the brand name of a drug for severe acne treatment called isotretinoin.
Understanding the risks and knowing the signs of common STDs is crucial for men who are sexually active. Learn how to spot the main symptoms. While some types of acne scarring are best treated by a dermatologist, others may benefit from over-the-counter topical products. Ice therapy is routinely used for injuries.
But can ice facials help reduce puffy eyes and acne? Learn more about its purported benefits and how to…. Nodules, pustules, whiteheads, and more. Here's what you need to care for it all. Differin Gel uses retinoid to clear up acne and scarring. Here's everything you need to know about the over-the-counter medication.
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Teenagers tend to experience breakouts and acne due to hormonal changes. There are treatments and skin care habits that can help. What can you do about acne scars? Back to Isotretinoin capsules Roaccutane. Like all medicines, isotretinoin capsules can cause side effects, although not everyone gets them. Side effects will usually go away when you stop treatment. These common side effects of isotretinoin capsules happen in more than 1 in people. There are things you can do to help you cope with them:.
Apply a moisturiser cream or ointment and lip balm regularly speak to a pharmacist or your doctor about the best type to use. Avoid using exfoliating products or anti-acne products.
Try applying a thin layer of Vaseline to the inside edges of your nose. 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. You may notice your skin becoming more fragile and getting redder, and it may be more sensitive to sunlight.
Metrics details. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Isotretinoin is an effective treatment option for severe acne. The aim of this study was to evaluate musculoskeletal side effects of systemic isotretinoin treatment. Ninety-four patients with acne vulgaris and sex- and age-matched controls were enrolled in this study. Only the patients who had musculoskeletal symptoms were evaluated in this study. All participants were firstly assessed by a dermatologist.
The patients were asked whether they had any musculoskeletal symptoms after isotretinoin treatment, if so, the feature and duration of the symptoms were recorded. The dosage of the drug, treatment duration, incidence of arthralgia, myalgia, low back pain, sacroiliitis and tendinopathy and laboratory test results were noted.
The severity of pain was assessed by visual analog scale VAS. Of the 94 patients, 71 were female and 23 were male. Bone marrow edema consistent with sacroiliitis was detected by sacroiliac MRI in 11 patients with inflammatory back pain. Low back pain is one of the very common complications of isotretinoin.
It can be mostly mechanical or inflammatory. Isotretinoin-induced low back pain is dose-related, and inflammatory back pain without sacroiliitis is also frequent. The clinicians should be aware of the back pain may be a reflective of sacroiliitis during isotretinoin usage. Peer Review reports. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit with multifactorial etiology [ 1 ].
Isotretinoin is an effective treatment option for severe acne vulgaris. Isotretinoin has a wide spectrum of side effects, including multiorgan systems such as reproductive, mucocutaneous, ocular, neurological, musculoskeletal and hepatic systems.
It may also cause several musculoskeletal side effects such as arthralgia, myalgia, back pain, spondyloarthropathy-related symptoms and sacroiliitis [ 123 ]. Other uncommon musculoskeletal disorders related with isotretinoin are hyperostosis, extraspinal calcifications, enthesitis, arthritis, costochondritis, osteoporosis, growth retardation, premature epiphyseal closure in children and as well as gout [ 3678 ].
In the literature, there are only a few original studies investigating the musculoskeletal side effects of isotretinoin [ 12910 ]. Furthermore, there are many case reports or case series indicating the musculoskeletal side effects of isotretinoin [ 11121314151617181920 ].
The majority of the recently performed studies are the case studies regarding with isotretinoin-induced sacroiliitis [ 1113161820 ]. To the best our knowledge, there is no controlled study investigating the presence of isotretinoin-related musculoskeletal side effects with a wide spectrum such as arthralgia, myalgia, low back pain, sacroiliitis, tendinopathy and enthesopathy. In previous studies, the incidence of sacroiliitis and back pain were the most detected parameters [ 1210 ].
The primary aim of this study was to evaluate and emphasize the musculoskeletal side effects of systemic isotretinoin treatment in patients with acne vulgaris and to compare them with healthy controls. The second aim was to elucidate clinicians regarding with isotretinoin-induced musculoskeletal symptoms.
A total of 94 patients with moderate to severe acne vulgaris treated with systemic isotretinoin and sex- and age-matched controls who were admitted to Ankara Training and Research Hospital, Department of Dermatology, between September and April were enrolled in this cross-sectional study. The local ethics committee approved the study. All participants were informed about the study and their written consent form was obtained.
Isotretinoin group included the patients under isotretinoin treatment for acne vulgaris, but had no history of rheumatologic syndromes. The control group was selected from among health professionals who had received a routine medical checkup in the hospital. Exclusion criteria for this study were the presence of any chronic rheumatological, dermatological diseases or any patients with a history of mechanical back pain, inflammatory back pain, sacroiliitis, enthesitis, before starting isotretinoin, history suggestive of spondyloarthropathies reactive arthritis, ankylosing spondylitis, inflammatory bowel disease, and psoriasisor systemic autoimmune disorders.
Also, the patients with depression or similar psychiatric diseases, had renal and liver function disorders, those who were pregnant or using any systemic drugs for other diseases, were not included. All participants were firstly evaluated by a dermatologist and questioned carefully about the musculoskeletal symptoms.
Only the patients who had musculoskeletal symptoms such as myalgia, arthralgia, back pain were determined and enrolled in the study. They were referred to the physical medicine and rehabilitation department and examined by a specialist. Sociodemographic information, including age, sex, history of drug use dose and durationhistory of chronic diseases were recorded.
A detailed anamnesis was obtained and a careful dermatological and physical examination was performed by both of the specialists. It was queried that whether myalgia, arthralgia and low back pain occurred after starting isotretinoin treatment. Data were recorded on a standardized pre-prepared evaluation form. The pain severity of the participants was evaluated by visual analog scale VAS based on a chart numbered from 0 no symptom to 10 maximum severity. According to GAGS, the body was divided into six regions -forehead, nose, each cheek, chin and back.
In each region, each type of lesion is given a number: zero for no lesion, one for comedones, two for papules, three for pustules and four for nodules. It was investigated that whether there was a enthesitis by a detailed clinical examination. The following entheses were examined for tenderness and swelling bilaterally: common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, tibial tuberosity, knee medial collateral ligament, Achilles tendon, and plantar fascia insertion on the calcaneus [ 23 ].
If there was a swelling and erythema, it was considered as inflammatory enthesitis. The absence of swelling or erythema was considered to be mechanical enthesitis. The ASAS criteria consist of commencement under the age of 40, insidious onset, relief with exercise, no relief with rest and nocturnal pain improving with rising up from bed.
These 4 items are essential in diagnosing inflammatory low back pain. The various imaging modalities, including conventional radiography, computed tomography CTmagnetic resonance imaging MRI and bone scintigraphy are used for investigation of inflammatory changes at the sacroiliac joints.
In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs may be normal. Inflammatory back pain is not a specific indicator of sacroiliitis.
Therefore, there is need for valuable imaging methods. Scintigraphy lacks specificity. CT is a very good method for visualization of established bony destruction or ossification. MRI can identify both inflammation and structural changes, localise different degrees of inflammation and bone marrow edema, and differentiate a possible septic sacroiliitis.
MRI is the most sensitive and specific modality for sacroiliitis by directly imaging changes in the synovium, articular cartilage, and subchondral bone [ 262728 ]. In our study, the patients meeting ASAS criteria for inflammatory back pain were evaluated in detail and requested both sacroiliac radiography and sacroiliac MRI.
Sacroiliac MRI was performed on 1. At least 12 slices of coronal oblique T1-weighted turbo spin-echo and short tau inversion recovery STIR sequences of the sacroiliac joints were acquired.
This images were interpreted by the same reader who had received standardized training and were blinded with regard to the study groups. In addition, laboratory blood tests including rheumatoid factor RFerythrocyte sedimentation rate ESR and c-reactive protein CRP values were requested. Anti-nuclear antibody ANA was ordered to rule out other connective tissue diseases. Data were analyzed using SPSS software version The normality of the data was tested by Kolmogorov-Smirnov test.
For the comparison of the paired groups, the independent samples t-test normal distribution and the Mann-Whitney U test non-normal distribution were used for the quantitative data. Chi-squared test was used to evaluate whether there was a difference in terms of musculoskeletal symptoms between the study groups.
This case-control study included 94 71 women, 23 men patients with acne vulgaris receiving isotretinoin and 74 women, 26 men age- and sex-matched controls. The age and sex distributions of the study and control groups are presented in Table 1. All of the tendinopathies were mechanical feature, swelling or erythema was not observed.
The flow chart of the participants was presented in Fig. The median duration of treatment was 3 min. There was a total of 66 patients The clinical characteristics of both isotretinoin group and healthy controls can be seen in Table 2.
The median duration of treatment was 3 IQR: 3, min. The comparison of the patients who had musculoskeletal symptoms or not in isotretinoin group regarding as total cumulative dose of drug were given in Table 3. The results of linear regression analysis between the age, sex, duration of treatment and cumulative dose of drug with musculoskeletal side effects were shown in Table 4. The sacroiliac radiography was normal in all of the patients with inflammatory back pain.
In sacroiliac MRI, sacroiliitis was observed in 11 Semicoronal short tau inversion recovery STIR images show hyperintense lesions arrows consistent with bone marrow edema in bilateral sacroiliac joints.
Semicoronal T1-weighted spin-echo image shows signal loss arrows in sacroiliac joints consistent with sacroiliitis. The patients who developed rheumatologic symptoms during isotretinoin usage were called to follow-ups by monthly.
They were evaluated by a specialist and physical examination was performed at each time they came to control. VAS scores of the patients were also assessed at each follow-up. In addition, routine biochemical blood tests were acquired from all of the patients in isotretinoin group.
The patients who developed musculoskeletal symptoms such as mechanical back pain, arthralgia, myalgia or tendinopathy, except for sacroiliitis were initiated a nonsteroidal antiinflammatory drugs NSAID and continued a lower dose of isotretinoin.
In patients who were diagnosed as sacroiliitis, the drug was discontinued immediately and a NSAID was prescribed. We observed that the complaints of these patients were resolved within a month after cessation of the drug and VAS scores were also decreased dramatically. The symptoms were mostly disappeared by the third month.
All the patients with sacroiliitis were completely symptom free at the sixth month of the discontinuation of the drug. Isotretinoin, or cis retinoic acid, is a vitamin A derivative used for severe recalcitrant acne since Although isotretinoin is a very effective drug, it may have many side effects. It is essential that the clinician should be careful about the various side effects of the drug [ 30 ].
In this study, we focused on the musculoskeletal side effects of isotretinoin. Ninety-four patients treated with isotretinoin suffering from musculoskeletal pain were included. The patients were then examined in detail.
Questions about Accutane and joint pain, with answers from board-certified doctors. Get all of your questions answered on RealSelf. Joint and muscle pain. Experts estimate that body aches and pains impact about 20% of people taking isotretinoin. In fact, a small study. Week four. ONE MONTH DOWN!!!Hey guys! I survived week three of Accutane for my mild acne/enlarged pores/overproduction of oil. NHS medicines information on side effects of isotretinoin capsules and what you can do to cope. Back pain and aches and pains in muscles or joints. Isotretinoin may cause bone or muscle problems, including joint pain, muscle pain or stiffness, or difficulty moving. You may get hurt more. Use two forms of effective birth control to keep from getting pregnant 1 month before beginning treatment, while you are using this medicine even if the medicine is temporarily stoppedand for at least 1 month after you stop taking the medicine. Contraception must be continued during the period of treatment, which is up to 20 weeks, and for 1 month after isotretinoin is stopped. The brand is no longer available in the United States. Check with your doctor right away if you or your child have hearing loss, a continuing ringing or buzzing, or any other unexplained noise in the ears. Anonymous patient. Do not drink too much alcohol.Drug information provided by: IBM Micromedex. Isotretinoin is used to treat severe, disfiguring nodular acne. It should be used only after other acne medicines or antibiotics have been tried and have failed to help the acne. Isotretinoin may also be used to treat other skin diseases as determined by your doctor.
Isotretinoin must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and have failed. Isotretinoin must not be taken during pregnancy because it causes birth defects in humans.
If you are able to bear children, it is very important that you read, understand, and follow the pregnancy warnings for isotretinoin. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do.
This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of isotretinoin in children younger than 12 years of age. Safety and efficacy have not been established. This medicine should be used with caution in teenagers, especially those with bone problems or diseases.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of isotretinoin in the elderly.
However, elderly patients are more likely to have serious unwanted effects, which may require caution in patients receiving isotretinoin. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.
Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.
The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. Isotretinoin comes with a patient information form and Medication Guide.
It is very important that you read and understand this information. Be sure to carefully follow these instructions and ask your doctor if you have any questions. Be sure to ask your doctor if you have any questions about this program. It is very important that you understand and follow all of the requirements. You will not get another prescription unless you follow the instructions for the program. Swallow the capsule whole with a full glass 8 ounces of water or other liquid.
Do not crush, break, chew, or suck the capsule. It is very important that you take isotretinoin only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
To do so may increase the chance of side effects. It is very important that you not share this medicine with anyone else because of the risk of birth defects and other serious side effects. Different brands may not work the same way.
If you refill your medicine and it looks different, check with your pharmacist. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Do not take extra medicine to make up for a missed dose. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Keep from freezing. It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects. Isotretinoin causes birth defects in humans if taken during pregnancy. If you suspect that you may have become pregnant, check with your doctor right away. Using this medicine while you are pregnant can cause very serious birth defects. Use two forms of effective birth control to keep from getting pregnant 1 month before beginning treatment, while you are using this medicine even if the medicine is temporarily stopped , and for at least 1 month after you stop taking the medicine.
The most effective forms of birth control are hormone birth control pills, patches, shots, vaginal rings, or implants, an IUD, or a vasectomy for men. One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap. Isotretinoin must not be taken by women of reproductive age who may become pregnant unless 2 effective forms of birth control have been used for at least 1 month before the start of treatment.
Contraception must be continued during the period of treatment, which is up to 20 weeks, and for 1 month after isotretinoin is stopped. Be sure that you have discussed this information with your doctor. If you are a woman who is able to have children, you must have 2 pregnancy tests before beginning treatment with isotretinoin to make sure you are not pregnant. The second pregnancy test must be taken at least 19 days after the first test and during the first 5 days of the menstrual period immediately before beginning treatment.
In addition, you must have a pregnancy test each month while you are using this medicine and 1 month after treatment is completed. Do not take vitamin A or any vitamin supplement containing vitamin A while using this medicine, unless otherwise directed by your doctor. During the first 3 weeks you are taking isotretinoin, your skin may become irritated. Also, your acne may seem to get worse before it gets better.
Check with your doctor if your skin condition does not improve within 1 to 2 months after starting this medicine or at any time your skin irritation becomes severe.
Full improvement continues after you stop using isotretinoin and may take up to 6 months. Your doctor can help you choose the right skin products to reduce skin dryness and irritation.
You or your child should not donate blood to a blood bank while using isotretinoin or for 30 days after you stop using it. This is to prevent a pregnant patient from receiving blood that contains the medicine. In some patients, isotretinoin may cause a decrease in night vision. This problem may occur suddenly. If it does occur, do not drive or do anything else that could be dangerous until you know how this medicine affects you. Also, check with your doctor.
Isotretinoin may cause dryness of the eyes. If you or your child wear contact lenses, your eyes may be more sensitive to them during the time you are using isotretinoin and for up to 2 weeks after stopping it. To help relieve dryness of the eyes, check with your doctor about using a lubricating solution, such as artificial tears. If eye inflammation occurs, check with your doctor right away.
Isotretinoin may cause dryness of the mouth and nose. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist.
Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections. Avoid overexposing your skin to sunlight, wind, or cold weather. Your skin will be more prone to sunburn, dryness, or irritation, especially during the first 2 or 3 weeks of treatment. However, you or your child should not stop using this medicine unless the skin irritation becomes too severe.
Do not use a sunlamp or tanning beds. To help isotretinoin to work properly, use sunscreen or sunblock lotions with a sun protection factor SPF of at least 15 on a regular basis.
Also, wear protective clothing and hats. Isotretinoin may cause some people to be agitated, irritable, or display other abnormal behaviors.
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