Isotretinoin: what it does and who should consider it

One pill can clear severe acne for many people — but isotretinoin also comes with real risks. If you’ve tried antibiotics and topical treatments without luck, isotretinoin (known by brands like Accutane or Roaccutane) may be the next step. It’s mainly for stubborn cystic or nodular acne that impacts skin scarring or quality of life.

How isotretinoin works, dose, and what to expect

Isotretinoin reduces oil production, shrinks oil glands, and calms inflammation. Typical dosing is 0.5–1 mg per kg of body weight per day, for about 4–6 months. Doctors often target a total cumulative dose around 120–150 mg/kg to lower the chance of relapse. You might see your skin worsen for a few weeks before it gets better — that’s common. Stick with the full course unless your prescriber tells you otherwise.

Practical tips while on treatment: use a gentle cleanser, heavy moisturizer, and regular SPF. Expect dry lips, dry skin, nosebleeds, and some sensitivity to sunlight. Lip balm and a non-irritating moisturizer really help. If you get muscle aches or joint pain, report them — dose changes or breaks are sometimes needed.

Risks, monitoring, and strict pregnancy rules

Isotretinoin is strongly linked to severe birth defects. If you can get pregnant, you must follow strict rules: use two reliable forms of birth control, have documented negative pregnancy tests before starting and during treatment (monthly in many programs), and continue contraception for at least one month after stopping. Many countries use registration programs (like iPLEDGE in the U.S.) to enforce this. Never donate blood while taking isotretinoin and for one month after.

Your doctor will usually check liver function tests and fasting lipids before treatment and again during the course. Heavy alcohol use raises the risk to your liver; cut back while on the drug. Avoid taking vitamin A supplements — combining them can cause overdose symptoms. Also avoid certain procedures (like aggressive skin resurfacing) until your skin has recovered, as healing can be abnormal.

Mood changes have been reported with isotretinoin. The link isn’t fully clear, but you should tell your doctor if you feel unusually sad, anxious, or have thoughts of self-harm. Keep a trusted friend or family member in the loop so changes are noticed early.

Thinking of buying isotretinoin online? Only use a licensed pharmacy that requires a prescription from a licensed prescriber. Avoid sites that sell without a prescription, offer unrealistic low prices, or lack clear contact details. Look for HTTPS, verifiable pharmacy credentials, and reviews. When in doubt, ask your local pharmacist or prescriber for help — safety matters more than a fast sale.

If isotretinoin is on your radar, talk openly with a dermatologist. They’ll explain benefits, run baseline tests, and set up the right monitoring so you get the best result with the least risk.