6 Things That Can Happen When Taking Isotretinoin

If you've been prescribed isotretinoin—the high-dose vitamin A pill that treats acne and is more widely known by its former brand name Accutane—there are many side effects to using this drug. The side effects range from temporary ones like increased breakouts and hair changes to severe ones like causing birth defects and miscarriages.

Here are six things that can happen to your body when taking isotretinoin.

What Is Accutane?

Accutane was introduced in the United States in 1982 to treat severe acne, but it was taken off the market in 2010 because of safety concerns. Isotretinoin, the generic name for Accutane, is a pill prescribed when other medications have not been effective. Isotretinoin belongs to a group of medications known as retinoids.

As of 2021, isotretinoin is sold under the brand names Absorica, Absorica LD, Claravis, Amnesteem, Myorisan, and Zenatane.

Serious Side Effects

Pregnancy side effects are the most severe side effects of taking isotretinoin. If a pregnant person takes this drug, it can cause severe birth defects, miscarriage, and stillbirth.

A federal program called iPLEDGE Risk Evaluation and Mitigation Strategy (REMS) was created to ensure that pregnant people do not take anything containing isotretinoin and that people do not become pregnant while taking anything containing this drug. The program is meant to inform healthcare providers, pharmacists, and people about to be prescribed isotretinoin the risks of taking this drug.

To be prescribed isotretinoin, anyone who could become pregnant will be required to take two pregnancy tests. People who could become pregnant are also required to take monthly pregnancy tests and agree to use two forms of birth control one month prior to beginning isotretinoin while on the drug and one month after stopping the drug.

Other Side Effects

Breakouts

"This can happen because the drug brings out all the acne that's underneath the skin," Debra Jaliman, MD, a New York-based dermatologist, told Health.

However, this effect should be temporary. The drug can make your acne worse for one to two months before your skin clears up.

Dryness

Dry lips, skin, mouth, and eyes are the most common side effect.

"Almost everyone experiences it," Arielle R. Nagler, MD, associate professor of dermatology at the NYU Grossman School of Medicine in New York, told Health. That's because the drug reduces the production of sebum—the oily secretions from the sebaceous glands in your skin.

"Sebum is what's necessary to create acne," explained Dr. Nagler. "By decreasing oil production, isotretinoin is one of the only medications we have that can cure acne in many cases."

Apply a generous amount of moisturizer in the morning and night to keep skin hydrated. Remember to apply sunscreen to your face daily because isotretinoin increases your sensitivity to the sun.

Stock up on lip balms, especially those that contain cortisone, to moisturize your lips. The dryness can also extend to the nasal passages, causing nose bleeds. Apply petroleum jelly to the inside of the nose and use a humidifier to prevent nose bleeds. Use artificial tears to soothe dry eyes.

Hair Changes

"People say their hair gets less oily, and they have to wash it less," said Dr. Nagler. "That's likely related to the decrease in sebum production on the scalp." 

About 3.2% to 5.7% of people on isotretinoin experience hair loss, with a higher frequency at higher doses. Luckily, there's no evidence that hair loss may continue after discontinuing the medication.

Your hair may also become thin. This side effect is also temporary, and your hair should return to normal after stopping the medication.

Stiffness and Joint Pain

People taking isotretinoin may feel aches and pains in different parts of the body but most commonly in the lower back. "Isotretinoin can affect the muscles and cause tenderness and soreness," noted Dr. Jaliman.

"I see isotretinoin patients with joint pain and some with headaches, too," added Dr. Nagler. "But if you are getting headaches on the medication, you definitely want to be seen by your [healthcare provider] since, in rare cases, the drug can cause an increase in pressure in the brain."

Again, these side effects should disappear when you stop taking the medication.

A Quick Review

There are several myths and misconceptions regarding the side effects of isotretinoin. Although experiences using the acne treatment may vary from person to person, side effects of isotretinoin include:

• Dry skin, mouth, and lips
• Muscle or joint aches and pains
• Sensitivity to the sun (use an SPF of at least 30 daily to protect yourself against sun exposure)
• Thinning hair
• Vision problems at night
• Worsening acne
  

However, these side effects are usually temporary and subside over time. They will also go away if you stop taking isotretinoin.

Consult a healthcare provider before starting or stopping isotretinoin. Do not use the acne treatment if you are pregnant or plan to become pregnant because isotretinoin may cause birth defects, miscarriage, or stillbirth.