What is Accutane?
Dr. Gerardo Sison, Pharm.D.
Acne is a problem that most people have had to deal with at some point in their lives. While the occasional pimple is not something to worry about, the physical and emotional discomfort caused by acne can be significant. More than 50 million Americans suffer from acne, and according to the American Academy of Dermatology, 85 percent of people between the ages of 12 and 24 have some form of minor acne. Acne can occur on different parts of the body, like the face, neck, arms, back and chest. Acne usually starts at puberty, but there is no age limit for the onset of acne. Recently, children as young as the age of seven are being treated for acne and it can be a persistent problem for some people well into adulthood, affecting individuals even after the age of 50 or 60.
When does acne need to be treated? This will largely depend on the severity of the problem. Everyone has different skin and the causes of acne can vary for different people. Acne is caused when glands and hair follicles of the skin produce excess oil, which can clog pores causing pustules and lesions. Getting prompt treatment for acne can prevent other problems like permanent scarring, dark spots and emotional and mental distress. Depression and anxiety are increasingly reported in people with acne, but treating the problem can allow an individual to live a happier and healthier life.
How is acne treated? Dermatologists evaluate the symptoms and severity of the acne to find the right treatment option for an individual. Acne is commonly treated with topical medications that are applied to the affected area. Some topical medications like benzoyl peroxide are effective in treating mild to moderate acne. For more severe acne, oral medications are prescribed. One of the best oral acne medications on the market is Accutane, or isotretinoin.
What is Accutane?
Accutane is a vitamin A derivative that belongs to the class of retinoids used to treat severe acne. What makes Accutane stand out compared to other types of acne medication is that it has the reputation of being effective against all kinds of breakouts. Notably, it is effective for clearing up cystic and nodular acne. Cystic acne is the most serious type of acne that is the hardest to treat. It is caused by cysts that develop deep under the skin due to accumulation of oil, bacteria and old skin cells that get trapped there. Cystic acne appears larger and deeper than other kinds of acne and it can sometimes appear to be pus-filled. Cystic acne also occurs in areas other than the face, like chest, neck and back. Besides being painful, cystic acne can leave permanent scars.
Accutane is prescribed when acne does not respond to other modes of treatment like antibiotics. It is usually taken once or twice a day for four to five months. Remarkably, Accutane has the ability to completely clear up even severe acne within this duration of treatment. Some individuals have to take another course of Accutane again, but in most cases Accutane completely resolves acne regardless of its cause or severity. Often, topical acne treatment methods are recommended following Accutane treatment to prevent the recurrence of pimples.
History of Accutane
Accutane was developed by pharmaceutical giant, Hoffman-La Roche in the early 1960’s as the compound, 13 cis-retinoic acid. It was later FDA-approved for treating acne in 1982 after conducting clinical trials. The patent expired in 2002, and due to the rapid availability of multiple generic forms of Accutane on the market, Roche discontinued making Accutane in 2009. Today, although isotretinoin is referred to as Accutane, the drug is sold as different generic brand names like Absorica, Claravis, Sotret and Amnesteem. These generic brands have the same active ingredient as Accutane.
How does Accutane work?
Isotretinoin works by shrinking the sebaceous glands of the skin that produce oil. Excess oil production can mix with dirt and bacteria that can clog pores and lead to acne. By shrinking these glands, Accutane decreases oil production in the skin and stops acne from forming. Unlike other acne treatments, since it shrinks the oil glands, only one course or at most two courses are needed to be effective.
Risks of Accutane
Since Accutane is vitamin A taken at very high doses, it has some serious side effects and risks associated with it. Build-up of vitamin A in the tissues of the body can be very dangerous, so you should never take vitamin A supplements while on Accutane. Some of the major risks associated with taking Accutane are as follows:
During early studies of Accutane by Roche, it was discovered that the drug can cause serious birth defects if taken while pregnant. Therefore, the drug is classified as a potent ‘teratogen’ and has a black box warning for pregnancy. Some birth defects that have been reported include missing eyes, hearing loss, congenital heart defects, cleft palate, underdeveloped brain (microcephaly), buildup of fluid in the brain (hydrocephaly), small eyes, and small or missing thymus gland. It can also cause premature births, miscarriage and death of the fetus. Even a single dose of Accutane can harm the unborn fetus.
Due to the severity of these effects on the developing fetus, women who take Accutane must enroll in a program developed by the FDA called the iPledge program. This program works to minimize the risk of fetal exposure to Accutane by monitoring the pregnancy status of women who take the drug. In this program, women must either use two forms of contraception or practice 100 percent abstinence while taking the drug, take monthly pregnancy tests that are negative, and submit blood tests every month in order to receive the medication. These results are verified by the prescribing doctor and pharmacist to ensure that patients abide by the program guidelines before they can take the drug.
Accutane must not be taken for one whole month before becoming pregnant in order to be sure that it will not cause harm to the fetus.
Mental Health problems
Accutane can cause mental health problems like depression, psychosis and suicidal thoughts in some patients who take it. The reason for this is still unclear and most patients on Accutane never experience any difference in their mental health. However, in rare cases, this can happen in people who have never taken Accutane before, so it is important to be aware of any signs of declining mental health while on the drug. Letting your friends or family know that you are taking Accutane can help them monitor your wellbeing while on the drug and report the first signs of any changes in mental health to your doctor.
Other common side effects
Most often, Accutane is accompanied by less serious side effects like chapped lips, photosensitivity, muscle aches, nosebleeds, headaches, decreased night vision and thinning skin and hair. These side effects are temporary and usually go away once you stop taking the drug. Your doctor will monitor how your body reacts to the drug through monthly blood tests. These are crucial in making sure that you are responding to the drug safely with no adverse effects to your body. It is also important that you report any unwanted symptoms to your doctor.
How to take Accutane
Accutane must be taken exactly as prescribed by your doctor. It is extremely important to follow up with the regular blood tests and measures to prevent pregnancy while taking this drug. This medication is not right for everyone, so an appointment with your dermatologist can help you find out if it could help your problem.
How much does Accutane cost? If you suffer from cystic or nodular acne and are considering whether to take Accutane, chances are that you have already gone through several treatment regimens that were ineffective. Accutane is known for being very expensive. One of the reasons why Accutane is so expensive is that there are no other drugs on the market that can match its ability to resolve severe acne. Even though generics are available and the original brand of Accutane does not exist anymore, the price of the drug has not decreased over the years. Currently, the list cash price of Accutane is in the range of over $700. This is the cost without health insurance, and certain insurance plans can help reduce the co-pay of this drug. How much Accutane will cost you after you apply health insurance will depend on the specific plan.
You can save on the cost of Accutane through prescription discount cards. This is one way to reduce the amount that you pay for the drug even if you do not have health insurance, or if your plan does not cover Accutane. Since Accutane is not a drug that is taken long-term, you only have to shell out the money one time, or at most twice if a repetitive course is needed. One good option for a prescription discount card is available from USA Rx. Signing up for the card is easy and takes just a few minutes. Present the card at your pharmacy when filling your prescription to apply savings. The discount card can be applied at almost any pharmacy across the nation, so you are not limited to purchasing it from a specific location.