What is the proper Accutane dosage for a 17 year old girl?
I am trying to do as much research as I can on Accutane before allowing my daughter to take it. She has struggled with acne her entire life and it breaks my heart seeing her so upset. We have tried everything under the sun and nothing seems to work. If I do agree to let her take Accutane, what is the proper dosage for her to take. She is 17 years old - 5 ft 5" and 130 lbs. Thanks!
The decision to prescribe isotretinoin is always a difficult one. Prior to initiating therapy I generally require my patients to exhaust other common treatment options. These medications include benzoyl peroxide, tazarotene, clindamycin, doxycycline, tretinoin and other available acne treatments.
Accutane, originally manufactured by Hoffmann-La Roche, was pulled from the market in 2009 after the company was sued for millions of dollars in the United States over claims the drug was linked to inflammatory bowel disease. Since 2017 isotretinoin has been available as a generic preparation under multiple brand names like Absorica and Claravis.
Isotretinoin has many other potentially serious issues too numerous to list here, but they include birth defects, changes in blood cholesterol and lipid levels, potentially serious drug interactions and the potential for premature epiphyseal closure in teens.
It’s the potential for birth defects (FDA pregnancy risk category X) that’s most concerning for young women. Dermatologists in the US are legally required to register female patients of childbearing-age with the iPledge system in order to mitigate the risk of pregnancy during Isotretinoin treatment.
I can't give you any direct medical advice without an examination and personal consultation, but the typical starting dosage is .5 mg/day taken in two separate doses for 15 to 20 weeks, or until the acne lesions decrease by 70% -- at which point treatment is stopped. There is little information available on long term treatment even at a lower dose so exceeding 20 weeks is generally inadvisable. If your daughter or anyone in your family has a history of inflammatory bowel disease, depression, psychiatric disorders or suicide attempts be sure to communicate that to your physician and inquire about low-dose treatments.
With all of the negatives associated with the Accutane/isotretinoin, you may be wondering why it's prescribed at all. The reason is that isotretinoin is extremely effective and considered a miracle drug by many acne sufferers. It addresses all four of the major pathogenic factors that cause acne: follicular hyperkeratinization, excessive sebum production, bacterial infection and inflammation. Despite its very serious drawbacks, it remains one of the most effective treatments for teen and adult acne that we have.
I suggest you consult with an experienced board-certified dermatologist and be very clear with your daughter about the risks and benefits of isotretinoin.
Doing careful research on Accutane (oral isotretinoin) is advisable because as you probably know, Isotretinoin has some extremely serious potential adverse effects to be aware of.
Isotretinoin is an oral retinoid used for treating severe acne (cystic acne or nodular recalcitrant acne) that hasn't improved using traditional treatments. As you say, your daughter has already tried "everything under the sun" so I would cautiously agree that she may be a good candidate for Isotretinoin.
Please note, Isotretinoin is a prescription-only medication which should only be taken under the supervision of a physician.
I can't offer any specific advice without a clinical consultation, but a typical dosing formula would be 0.5mg per kilogram of body weight, divided into two daily doses. After the first month, that dose is often increased upon advisement of a dermatologist to 1.0 mg/kg of body weight.
Common side effects include dry lips, cheilitis, dry nose, nose bleeds, and inflammation of the mucous membranes of the eyes. More serious side effects include abnormal liver enzymes, and increased blood cholesterol, triglyceride and lipid levels.
Most importantly, Isotretinoin has been shown to cause serious birth defects if taken while pregnant. It cannot be stated strongly enough that women in their childbearing years who are taking Isotretinoin must not get pregnant.
Isotretinoin treatment is an excellent solution for treating severe nodular acne. For many acne patients the drug has wonderful, life-changing effects. In addition to a reduction of symptoms, patients often see positive improvements in confidence and self-esteem. However, given the potentially serious adverse effects, the decision to begin Isotretinoin therapy should be weighed seriously by the parents of teens before moving forward.
Prescribing isotretinoin is not something that should be done casually. The drug has serious potential side effects which must be weighed carefully along with the benefits of treatment.
For young women the most serious potential issue with isotretinoin is the potential for birth defects. Doctors who determine a patient is a good candidate for the drug are required to carefully communicate the risks associated with treatment and to register the patient online with the FDA iPledge system. The iPledge Program is a mandatory, FDA-required risk management program designed to reduce the risks of pregnancy and fetal exposure to teratogens.
As part of the iPledge system, patients are required to use two forms of birth control and take two in-office pregnancy tests over the course of two consecutive months.
To answer your question about dosage, if I determine a patient is a good candidate for isotretinoin, I typically start them on a dose of .5 mg/kg of body weight per day for the first month, with a target cumulative dose of 120-150 mg/kg.
Treatment is immediately discontinued in the event of headaches, vision changes, chest pain, hearing loss, or any other serious side effects.
For many patients, isotretinoin is close to being a miracle drug. It’s arguably one of the best weapons against severe cystic acne there is. But that acne-fighting power comes with the potential of serious side effects. Be sure to consult with an experienced, board-certified dermatologist who has experience managing isotretinoin therapy in teens and young women. Good luck with your daughter's treatment.
As a board certified dermatologist, prescribing Isotretinoin (formerly known as the brand name Accutane) is never a quick decision. Doing research on the medication is very important before initiating the therapy, so I commend you on your due diligence.
First, trying "everything under the sun" is important before discussing with your provider the option of moving forward with Isotretinoin therapy. Beyond the over the counter options, patients in my practice are typically expected to have tried topical prescriptions (like clindamycin +/- benzoyl peroxide, tretinoin, tazarotene, adapalene +/- benzoyl peroxide, dapsone, etc.) and oral medications (like short-course(s) of antibiotics such as doxycycline or minocycline).
Second, understanding the requirements (at least so far as they are implemented in the United States with the iPledge program) of the medication are paramount to avoiding unnecessary delays and issues with medication distribution. For females with the capability to get pregnant, certain timeframes are required by the program to start and continue therapy. Male or female patients are required to conduct monthly blood work (usually just before their monthly visit when possible) that check for variations in hemoglobin, liver enzymes, kidney function, cholesterol, etc. With proper monitoring and discussions with patients prior to and during treatment, variations in blood work are minimized as well as risks with taking the medication.
Third, once a thorough discussion and consent process has been completed (and as a female the 30-day waiting period required by iPledge), the patient can initiate therapy. As you so intelligently noted, typical dosing guidelines are based on weight and gender. Depending on the provider, certain dosing alterations are made on historical evidence within their practice as well as consideration for guidelines. According to Absorica's (branded isotretion) treatment guidelines, 0.5-1.0mg/kg/day dosing for a duration of 15-20 weeks is advised. With that noted, your daughter would likely be given approximately 30-60mg/day and the medication is provided as twice daily dosages (so the daily value is split in half). Adjustments based on clinical practice and preferences are typically made throughout the treatment process and can be discussed with your provider before initiating therapy.
Best of luck to you and your daughter, and remember to wear sunscreen (especially if she starts an isotretinoin regimen - she will have increased sun sensitivity due to the medication).
All the best,
Jeanine Downie, MD