How Many Times Can You go on Accutane
I was on Accutane 3 years ago and I absolutely loved it. I had no significant side-effects while I was on it (just chapped lips, which I sued Aquaphor for and my skin never looked so good. I constantly received compliments about my skin. Now I'm starting to breakout again. Nothing too bad, but after not having any zits in 3 years, I absolutely can't stand the sight of them popping up again! Can I go on Accutane again?
In our New Jersey practice we have had similar situations with patients having success for a period of a few years, then requiring repeat treatment. In general, 80% of patients treated properly with accurate weight and duration of treatment will be in remission of their acne with Isotretinoin (formerly known as the brand Accutane). Relapsing, however, is still possible especially when the older guidelines for treatment were used. To date, the AAD (American Academy of Dermatology) recommends that for patients with severe and/or recalcitrant acne be treated in a dosage of 0.5mg/kg/day and increase to 1.0mg/kg/day for a cumulative dose (meaning over the course of the approximate 5 months of treatment a total amount of medication has been taken) of 220mg/kg or more. Following these dosing recommendations typically gives the lowest relapse rates (with the AAD’s caveat that more studies are recommended to confirm this to be true).
If all of that made you a bit dizzy, I’ll give you an example of what those guidelines would mean for an average weight patient:
A 150lb (68.0kg) patient with severe nodular acne would start at about 35mg/day, increasing to about 70mg/day overtime. By the end of therapy, according to the guidelines, they should reach about 15,000mg total over the course of their treatment to reach the cumulative dose.
It is important to keep in mind that the “practice” of medicine affords providers the ability to adjust these protocols based on additional studies, case studies, historical evidence, and other information gathered from reliable sources. In addition, a multitude of studies have looked at low-dose Isotretinoin for moderate acne having similar success rates as higher dosing for severe acne. The bottom line is, researchers are still trying to figure out the best dosing for each scenario, so it is not unlikely that it gave you only partial remission.
If you’re able to remember, or even consult with your dermatology group or pharmacy, about the prior dosing you had 3 years ago, compare that example above with what your weight and treatment was over time. Did you reach that cumulative dose recommended by the AAD? It is possible then, after the treatment course was completed, you may not have reached that total dose and therefore were at a higher risk for relapse.
With that said, it is not typical in our practice that we would jump right back into Isotretinoin. Instead, following a cleansing and prescription regimen would be more appropriate, especially when the acne is mild and/or intermittent. For example, using a nighttime topical retinoid +/- a clindamycin/benzoyl peroxide topical is usually a good start. There are situations, however, that a patient’s acne does require repeat treatment, but this is more often seen with severe cases.
So the long and short of answering your question is yes, you can go on “Accutane” (Isotretinoin) multiple times, but it all depends on your provider, your health situation, your current acne state, and your willingness to comply with all the associated requirements when taking this medication.
Dr. Jeanine Downie
Hey - I've been on Accutane three times and it wasn't until my third dose that my acne stopped. The first two times I was on too low of a dose for my body weight. I'm 6'1" and 204 lbs, and my doctor had me on 40 mgs a day. Granted I didn't have cystic acne, but still, I didn't expect my acne to come back a year after each dose. On the third try, I was put on the right dose for my weight and switched from Claravis to Absorica. My dermatologist told me scientific studies had shown Absorica absorbed better than Claravis. I think it had something to do with the fact that Claravis needs to be taken with a fatty meal and Absorica has some sort of fat binding molecule already in it.
What is your height, weight and what dose/brand were you on? Is your acne cystic?
When you say you took 20mgs a day, did you take 1-10mg pill in the morning and one at night? If so, that sounds way too low to me. You should speak with your dermatologist about upping your dosage to 30 mgs twice a day. Refer them to this Accutane dosage guideline study. You should also ask about trying Absorica, instead of Claravis or another generic. I know from personal experience that my body didn't absorb the Claravis as well (You're supposed to always take Claravis with a fatty meal). Absorica doesn't need to be taken with a fatty meal, so many people absorb it better. I hope this info helps you and don't give up! My acne finally went away on the third attempt when I switched to Absorica.
What Sdot said is absolutely true. You can go on Accutane multiple times. There are a number of people who don't have much success with their first acne treatment, usually due to dosing issues (e.g. took too low of a dose for too short of a period). I've also personally had and have heard from others, that Absorica works better than Claravis, which is the most frequently prescribed Accutane generic brand.
You can absolutely go on Accutane again. I did it two times. Both times I was on a relatively low dose for my body weight, but as long as you're willing to get blood tests every month and responded well to it the first time, most physicians won't have an issue putting you back on Accutane. My second dose of Accutane was 5 years ago and I have not had acne since. Accutane was the absolute best decision I've ever made. I think the negative press about it is overhyped. Having horrible acne is much more depressing than being on Accutane. This drug was a life changer for me. Best decision I ever made.