Accutane (isotretinoin): A dermatologist’s guide for patients

Dr. Trowbridge says that while Accutane comes with potential side effects, it is often a life-changing treatment for those struggling with severe acne that has not responded to other treatments.

• Highly effective – Studies show that Accutane (isotretinoin) is the most powerful acne treatment, with up to 70 – 85% of patients achieving long-term clear skin after one course^{5 6}.
• Prevents scarring – By reducing severe breakouts, it helps prevent permanent acne scars.
• Shrinks oil glands – Significantly reduces oil (sebum) production, making skin less oily and less prone to breakouts.
• Works when other treatments fail – Ideal for those with severe, cystic, or treatment-resistant acne that hasn’t responded to antibiotics or topical medications⁷.
• Reduces inflammation – Helps clear red, swollen, and painful acne lesions, improving overall skin texture.
• May improve skin texture – Can make pores appear smaller and skin smoother over time.

The Pros and Cons of taking Accutane

Common generic brands of isotretinoin 

• Claravis
• Amnesteem
• Absorica (includes Absorica LD, a lower-dose version)
• Myorisan
• Zenatane

How does Accutane (isotretinoin) work?

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What is the right Accutane (isotretinoin) dosage for acne?

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Dr. Trowbridge says that the typical Accutane (isotretinoin) dose prescribed for acne patients depends on your weight, the severity of your acne, how well you tolerate the medication, and what your goals and risk tolerance is. 
The AAD recommends starting at doses of 0.5 mg to 1 mg per kg of body weight per day, ideally split into two doses, but Dr. Trowbridge says often higher doses are needed to achieve the recommended goal total dose. Also, some patients may start at even lower doses to reduce side effects¹⁰. The AAD recommends aiming for a total goal of  cumulative dose of 120 to 150 mg per kg over the entire treatment course, but some evidence suggests higher doses may decrease the risk of relapse without a clear increase in risk^{11 12}. Your dermatologist will adjust the dose based on your response to the medication trying to maximize effectiveness while minimizing side-effects.

Can you take a low dose of Accutane (isotretinoin)?

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Dr. Trowbridge says that although low-doses of Accutane have been studied, numerous large, rigorous, and standardized trials have not been done, nor is there FDA approval for low-dose courses. However, in the appropriate context, and when understanding the trade-offs compared to conventional dosing, it may be reasonable.  

Low-dose isotretinoin (0.1-0.5 mg/kg/day) achieves high clearance rates (80-95%), but relapse rates are higher compared to standard-dose isotretinoin (0.5-1.0 mg/kg/day).  Furthermore, intermittent regimens (1 week per month) result in higher relapse rates (~30-50%) compared to continuous low-dose regimens (~10-30%).  It may take combination therapy (e.g., isotretinoin + azithromycin/clindamycin oral antibiotic) to reduce relapse rates.Higher cumulative doses (>120 mg/kg) remain the most important predictor of lower relapse rates, which are difficult to achieve with low dose regiments^{13 14}.  Finally, the AAD guidelines caution against low-dose regimens.

How long is Accutane (isotretinoin) treatment?

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Dr. Trowbridge says that he usually prescribes isotretinoin between 5 to 6 months, depending on the dosage and severity of acne, however some patients may need to stay on the medication longer if their acne doesn’t clear after 6 months or they may need a second round of treatment, and some with more mild acne may only require 4 months of treatment Treatment is usually stopped once a cumulative dose is reached and ideally after the skin has been clear for 30-60 days, which lowers the risk of relapse. Studies show that up to 85% of patients get clear skin after treatment long-term after completing their course^{15 16}.

How long does Accutane (isotretinoin) take to work?

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Dr. Trowbridge says that Accutane (isotretinoin) typically starts showing improvement within 6 to 8 weeks. In fact, studies show that 85% of patients on 0.5 – 1.0 mg/kg/day achieve clear skin within 16 weeks, while 13% need 5–6 months of treatment and less than 1% may need to take the medication for up to 12 months¹⁷. Dr. Trowbridge also explains that some people may experience an initial acne flare-up in the first month before seeing clearer skin, that many refer to as the “Accutane purge”.

Accutane (isotretinoin) before and after

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Dr. Trowbridge says that most of his patients before starting Accutane, have severe, persistent acne, often with deep, painful cysts and nodules that have not responded to other treatments. Many of these patients experience oily skin, frequent breakouts, and inflammation, which in many cases leads to scarring. Some patients experience some initial worsening (20-30%), and in some cases it can be severe, requiring urgent dose reduction and addition of oral corticosteroids.  But the vast majority of patients report a steady improvement in their acne over the course of treatment. After completing a first round with Accutane, up to 70 – 85%  patients experience long-term clear skin after one course^{18 19}. Skin texture becomes smoother, and inflammation is reduced, although some redness may persist for a few months. In many cases, acne doesn’t return, or if it does, it’s much milder and easier to manage with topical treatments. Scars from past acne may still remain, but they often fade over time with the help of tretinoin and other treatments such as laser or micro needling.

Dr. Trowbridge says that Accutane (isotretinoin) is not available over the counter and requires a prescription from a dermatologist due to its potentially serious side effects, that include birth defects, which is why it is strictly regulated under the iPLEDGE program²⁰ in the U.S. This means patients must follow specific guidelines, including monthly evaluations, blood tests, and pregnancy prevention measures (for those who can get pregnant).

Can you buy Accutane (isotretinoin) online?

Dr. Trowbridge says you can buy Accutane (isotretinoin) online, but only with a valid prescription from a certified iPLEDGE healthcare provider. In the U.S. it must be purchased through an approved pharmacy after meeting all safety requirements, including monthly evaluations and pregnancy tests (if applicable). To safely get Accutane online, use trusted telemedicine services (like Miiskin) and pharmacies that comply with FDA regulations.

How much is Accutane (isotretinoin)?

The cost of isotretinoin varies based on insurance, pharmacy, and whether you choose a brand-name or generic version. Without insurance, generic isotretinoin costs between $40 to $200 per month, while brand-name isotretinoin can range from $300 to $700 per month using medication coupons. With insurance, co-pays typically range from $25 to $60 per month, but this depends on your plan and your type of insurance*

* Miiskin is not responsible for medication prices as we do not sell any pharmaceuticals. Prices may vary depending on your state, pharmacy, coupons used and/or your insurance policy.  

Is Accutane (isotretinoin) worth it​?

Dr. Trowbridge says research shows Accutane (isotretinoin) is the most effective medication for treating severe, persistent, or nodular acne, with up to 70 – 80% of patients experiencing long-term benefits after one course of treatment²¹. While it comes with potential side effects like dry skin, sun sensitivity, and the need for strict pregnancy prevention, its ability to eliminate deep, cystic acne and prevent scarring makes it worth it for many people. If other treatments such as topical medications or oral antibiotics haven’t worked for you and acne is affecting your quality of life, Accutane can be a life-changing option, but it’s important to discuss risks and treatment requirements with your dermatologist.

Dr. Trowbridge says Accutane (isotretinoin) has a half-life of about 10 to 20 hours, meaning it takes around 5 days for most of the drug to leave your system after your last dose and traces may remain in your body for up to a month.  This is why women must wait at least one month after stopping Accutane before trying to get pregnant, as the drug can cause severe birth defects²². While isotretinoin clears from the bloodstream relatively quickly, its impact on oil production and acne can last for months or even years after treatment²³.

Teratogenicity (Birth defects id taken while pregnant)

Dr. Trowbridge emphasizes that females of childbearing potential must not get pregnant while taking this medication or for one month after stopping it, as it can cause serious birth defects^{25 26}. After one month off the medication, there is no effect on fertility or fetal health.

To prevent pregnancy, you must practice 100% strict abstinence or use two forms of birth control—no exceptions unless pregnancy is physically impossible (absence of a uterus or ovaries).Additionally, some reports suggest a possible risk of birth defects in babies conceived by male partners taking isotretinoin. Therefore, males on this medication are also advised to use birth control with their partners²⁷.

Depression and suicide

There have been reports of patients taking isotretinoin who become depressed and/or committed suicide. However, the connection between taking this medication and developing depression or committing suicide has not been substantiated. In fact, a review in 2017 concluded that isotretinoin treatment for acne does not appear to be associated with an increased risk of depression; moreover, the treatment of acne appears to reduce depressive symptoms²⁸. There are numerous studies on this topic, with the vast majority corroborating the safety of isotretinoin^{29 30 31}. 

The misconception may arise from the higher suicide rate in the age group that most commonly takes isotretinoin, as well as the potential impact of acne on mood and social interactions, which can contribute to depression. However, everyone can react differently to medications, and there are some that still have concerns³², so if you experience any new changes in mood or thoughts of suicide, stop the medication immediately and contact your dermatologist, primary care doctor, or mental health professional for discussion.

Inflammatory bowel disease

Dr. Trowbridge says that Accutane (isotretinoin) has been questioned as a potential trigger for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. However, the data remains mixed, with no clear evidence linking the medication to IBD. A large study found no increased risk of either condition³³. Studies that have suggested a possible link concluded that the absolute risk of developing IBD after taking isotretinoin is likely very small—comparable to the risk in patients using only topical acne treatments^{34 35 36 37}. This suggests that the connection may be due to underlying inflammation in individuals with severe acne, who are also more likely to take isotretinoin, rather than the medication itself.

Side effects of Accutane that are uncommon and bothersome

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Dry skin

The most common side effect of isotretinoin is dryness of the skin, lips, and eyes. To  manage this symptom, Dr. Trowbridge recommends a consistent routine of thick moisturizers and lip balm. Apply moisturizer at least twice daily to both the face and body. Additionally, carry an ointment-based lip balm for frequent application throughout the day. (Links to recommended products will be provided later.)

Muscle or joint aches

Some patients experience mild muscle or joint discomfort, which is typically temporary and not serious. Rarely, abnormal bone growth has been reported, but this is generally seen with high doses over extended periods for conditions other than acne. If you develop exercise-induced pain, stop the medication and notify your doctor.

Headache

While rare, severe headaches can occur. If you experience a persistent or intense headache, stop the medication immediately.

Abnormal menstrual bleeding

Some patients report changes in their menstrual cycle while on isotretinoin. This is usually not harmful and resolves after stopping the medication.

Important Notice: Only the most common or serious side effects of isotretinoin have been described in this article. For the full list of side-effects that may be caused by isotretinoin, read the patient leaflet on your medication.

Accutane (isotretinoin) is processed by the liver and can increase triglyceride levels (fat in the blood). In rare cases, it may also affect blood cell counts. To monitor for these potential side effects, dermatologists usually recommend checking liver function and triglycerides through lab work. However, Dr. Trowbridge says that new studies show that significant lab abnormalities are extremely rare and may not be necessary for healthy patients^{38 39} as they typically resolve on their own without needing to stop the medication.

For his patients, Dr. Trowbridge checks lab tests before starting treatment and again after two months. If results are normal, no further testing is needed⁴⁰. He also mentioned that women of childbearing potential MUST take a pregnancy test every month.

If a patient does get pregnant while taking isotretinoin, they are usually strongly advised to terminate their pregnancy. Isotretinoin is also not recommended for use by breastfeeding women.

Pregnancy risk

Accutane is highly teratogenic, which means  there is about a 20–60% risk for congenital defects or neurocognitive impairment in infants exposed to the drug in utero⁴¹.  Due to this high risk,  women of childbearing age should use strict birth control methods to avoid  becoming pregnant while taking isotretinoin. If a patient does get pregnant while taking isotretinoin, they are usually strongly advised to terminate their pregnancy.

Mental health monitoring

Although rare, some patients may experience mood changes, depression, or anxiety while on Accutane. If you notice mood symptoms, contact your doctor immediately.

Sun sensitivity

Accutane makes your skin highly sensitive to UV rays, so avoid tanning beds, limit sun exposure, wear sunscreen SPF 50 in face and body or use protective UV-protective clothing and sunglasses.

Do not donate blood

Do not donate blood while taking isotretinoin and for at least 1 month after stopping to prevent harm to a pregnant recipient.

Skip alcohol

Drinking alcohol while on Accutane can increase liver strain and cholesterol levels, so it’s best to avoid or limit consumption.

What to avoid while on Accutane?

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While on Accutane, certain medications, foods, and activities should be avoided to prevent side effects and complications.

Medications to avoid while taking isotretinoin:

• Vitamin A supplements and retinoid products (risk of toxicity).
• Tetracycline antibiotics (e.g., doxycycline, tetracycline) due to the risk of increased brain pressure.
• Other acne treatments, including strong topical products that may cause irritation.
• St. John’s Wort, which can interfere with birth control effectiveness.
• Progestin-only birth control pills, as they may be less effective while on Accutane.

Foods to avoid while taking isotretinoin:

• Foods high in vitamin A (e.g., fish, dark leafy greens, carrots) to prevent vitamin A toxicity.

Activities to avoid while taking isotretinoin:

• Tanning beds and prolonged sun exposure, as Accutane increases sun sensitivity.
• Cosmetic skin procedures (e.g., waxing, laser treatments, chemical peels) due to the risk of skin irritation and scarring.

Other avoid while taking isotretinoin:

• Consult your doctor before taking any new medications or supplements.
• Stay well-hydrated, get enough rest, and maintain a balanced diet.
• Do not breastfeed while taking Accutane or for one month after stopping the medication.

Following these guidelines can help reduce side effects and improve treatment effectiveness while on Accutane. Always check with your dermatologist for personalized advice.

Who cannot take Accutane?

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You should not take Accutane (isotretinoin) if you:

• Are under 12 years of age
• Are pregnant, trying to conceive, or breastfeeding (it causes severe birth defects).
• Have a history of liver or kidney disease.
• Have severely high cholesterol or triglycerides.

Following these guidelines can help reduce side effects and improve treatment effectiveness while on Accutane. Always check with your dermatologist for personalized advice.

Accutane Alternatives

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If you are wondering if there are some Accutane Alternatives available in the market, Dr. Amit Om, board-certified dermatologist, gives you a few options if you don’t want to use this medication.

Accutane (isotretinoin) vs Tretinoin

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If you are wondering whether if tretinoin and isotretinoin are the same thing, you are not alone. Click on the article to see a thorough comparison between these two medications.