Accutane was the original brand name of the chemical compound isotretinoin. Even though multiple preparations of isotretinoin have been formulated and are sold today through prescription, the name Accutane has stood the test of time.
Accutane is a modified version of vitamin A that shrinks the oil glands in the skin leading to remarkable clearance of acne, and often permanent cure. Accutane is soluble in fat but not water. This means that for Accutane to be properly absorbed, it must be taken simultaneously with fat. Otherwise less Accutane will be absorbed and there will be a much greater risk of recurrence of acne in the future. So if you take the generic preparation of Accutane without adequate fat, you will most likely relapse with acne.
In the original studies of Accutane absorption, the participants consumed 50 g of fat simultaneously while taking accutane. How much is 50 g of fat? Well, simply put, this would be equivalent to a baconator from Wendy’s. Or it would be equivalent to two eggs, pancakes with syrup and butter, two strips of bacon and toast with butter .
Would Accutane still be properly absorbed if one consumed half this amount of fat? We don’t know the answer to this question. However, in an effort to reduce the need for fat intake, Sun pharmaceuticals developed Absorica, their own brand of Accutane. This is a lipid coated version with much better absorption on an empty stomach.
The patent for Absorica expired, and now it is made by several pharmaceutical companies in a generic version. Mayne and Teva both make a generic version of Absorica. This generic version of Absorica is still better absorbed with some fat, but you don’t need to take nearly as much fat as in the studies.
Look on the box for it to say Isotretinoin (ABSORICA).
Then a couple years ago, the next generation called Absorica LD (Lidose) was developed, and this proved to be the holy grail of Accutane. With this preparation absorption is perfect on a empty stomach.
In the state of Michigan, hardly any patients that I have treated have been able to get the branded Absorica LD due to lack of insurance coverage This is a point of contention, but at this time, most of my patients are unable to obtain the preparation absorbed without food.
The generic version of the original Absorica made by Sun pharmaceuticals, is available in the state of Michigan, however, most patients will pay $65 for 30 tablets. At some point during the treatment, most people take two tablets a day which means that the cost of generic Absorica for the month will be $130. – This is cost prohibitive for many.
- Therefore, most of you will receive a generic version of Accutane. The prescription box will be labeled Isotretinoin and will be made by various manufacturers and will go by various names such as:
- Amnesteem
- Claravis
- Myorisan
- Sotret
- Zenatane
If you fall into this group, you must take your Isotretinoin with an adequate amount of fat.
I recommend that you take the Isotretinoin with the largest meal and include either 8 ounces of WHOLE milk OR a tablespoon of peanut butter PLUS other fat such as meat, eggs, ice cream, avocado, butter, bacon , etc.
Please bring your Accutane prescription with you to your next appointment so we can confirm which preparation you have received and we can advise you regarding the need for fat intake.
How to avoid common side effects of Accutane
The major side effect of Accutane is extreme dryness of the skin, lips, nose and eyes. The lips, however, are the prime area for extreme dryness. To prevent cracking and splitting of the lips, you will need to apply lip balm multiple times an hour. There are number of options, my favorites include aquafor ointment, Cerave ointment, and Dr. Dan’s Cortibalm which contains 1% hydrocortisone. Other people prefer Chapstick Blistex and Carmex. But the important thing to remember is to always keep lip balm with you and apply frequently.
The nasal passages can also become dry with some dried blood or even nosebleeds. We therefore recommend saline nasal spray as well as some Vaseline or aquafor inside the nostrils to reduce cracking of the blood vessels.
Approximately 15% of people will experience blepharitis or eyelid inflammation if they do not apply eyedrops. Even if your eyes do not feel dry, you must purchase an eyedrop and use it morning and night. My favorite is Systane ultra. If you wear contact lenses, you will need to apply lubricant eyedrops three times a day. Most people are still able to wear their contact lenses during accutane.
The skin on your hands, arms and body will become dry. Therefore, you should use gentle skin cleansers such as Cetaphil, Cerave or Dove and you need to apply a moisturizing cream. Examples include Cerave Cetaphil, Eucerin and Aveeno. Again make sure you purchase a cream, not a lotion. Creams or Ointments are much better moisturizers and they are usually found in a jar. Whereas lotions our water-based and are somewhat trying to the skin and are usually are found in a pump.
Most of the dryness side effects are dose-dependent, meaning that at the lower doses you will not feel so dry, but at the higher doses of Accutane you will feel very dry.
We recommend that you increase your intake of water as well.
It is important to stop all previous topical acne medications as these will irritate your skin. You should also stop any oral antibiotics unless specifically recommended by Dr. Singer.
You may experience some achiness of your muscles or bones, particularly lower back pain at the higher doses. This is normal and you may take ibuprofen or Tylenol.
If you start developing any significant headaches, please contact our office immediately.
You will be very sensitive in the sunlight, and you will burn five times faster in the sun. Therefore you need to wear protective clothing and hats as well as sunscreen which needs to be applied 20 minutes before you go outside, and every two hours thereafter.
Be prepared for the acne to become a little worse in the beginning. If you are experiencing severe flaring, please contact our office immediately. It will take several months for you to see results. But once you do you will be so much happier.
Good luck.
