Isotretinoin (often known by brand names like Accutane) can clear severe cystic acne when other treatments fail. It works deep in the oil glands to shrink them and lower oil production, so pimples stop forming. That makes it extremely effective, but also powerful — it has real risks you need to understand before starting.
Doctors usually recommend isotretinoin for nodular or scarring acne, or acne that hasn’t responded to antibiotics and topical retinoids. Typical dosing ranges from about 0.5 to 1 mg per kg of body weight per day, often for 4–6 months. Many patients reach a cumulative dose (total over the course) around 120–150 mg/kg for best long-term results. Your prescriber will pick a dose based on severity, weight, and side effects.
Key safety points: isotretinoin is highly teratogenic — it can cause severe birth defects. Pregnancy must be avoided before, during, and after treatment. In the U.S., patients of childbearing potential enroll in a mandatory safety program (like iPLEDGE) with pregnancy tests and strict contraception rules. Outside the U.S., similar safeguards exist; follow your clinic’s program exactly.
Before starting, most doctors order a baseline lipid panel and liver tests because isotretinoin can raise triglycerides and affect liver enzymes. They may repeat tests at 4–8 weeks and as needed. Ask your prescriber about mental health monitoring — some people report mood changes; keep an eye on mood, thoughts, or sleep and tell your doctor immediately if things change.
Common, predictable side effects include dry lips, dry skin, nosebleeds, and sun sensitivity. Use gentle cleansers, thick lip balm, and daily SPF. Avoid waxing, laser, and strong facial peels while on treatment — your skin becomes fragile. Don’t take vitamin A supplements or high-dose fish oil without checking with your doctor; too much vitamin A increases risk. Avoid tetracycline antibiotics (doxycycline, minocycline) together with isotretinoin because of rare risk of raised intracranial pressure.
If you plan to donate blood, stop — most programs ask you not to donate while taking isotretinoin and for at least one month after the last dose because of pregnancy risk to recipients.
Buying and prescriptions: isotretinoin requires a prescription from a licensed provider. Beware of online sites that sell without valid prescriptions or skip safety checks. Verify the pharmacy is licensed, read recent reviews, and confirm they require a prescription and safety enrollment. If you’re unsure, ask your doctor for a trusted pharmacy recommendation.
Isotretinoin can be life-changing for people with severe acne, but it needs respect. Talk openly with your prescriber about goals, side effects, and monitoring plans. With careful checks and sensible self-care, many people finish a course and enjoy clear, long-lasting skin.
