CautionRoaccutane

Isotretinoin

Oral retinoid

Extreme teratogen — Pregnancy Prevention Programme mandatory.

Oral

First-line for

Severe recalcitrant nodulocystic acne (specialist)

Mechanism

Vitamin A analogue → ↓ sebaceous gland activity, keratinisation modulation, anti-inflammatory.

"Roaccutane = 1 pregnancy = catastrophic"

MHRA PPP: two contraceptives + monthly PPT
Do NOT donate blood during or 1 month after
MHRA 2023: mental health and sexual dysfunction warnings

Dosing

Adult: 0.5–1 mg/kg/day divided; cumulative dose 120–150 mg/kg per course

Contraindications

AbsolutePregnancy — retinoid embryopathy
AbsoluteBreastfeeding
AbsoluteConcurrent tetracyclines (raised ICP)
AbsoluteHepatic impairment, hypervitaminosis A

Side effects

Cheilitis, dry skin/eyes
Photosensitivity
↑ LFTs, ↑ triglycerides
Depression, suicidal ideation (rare, monitor)
Sexual dysfunction (MHRA 2023)

Fetal & maternal notes

• Retinoid embryopathy: craniofacial, cardiac (conotruncal), thymic, CNS (hydrocephalus)
• Effective contraception 1 month before, during, and 1 month after

Key interactions

Tetracyclines
Avoid
Idiopathic intracranial hypertension
Vitamin A supplements
Avoid
Additive toxicity
Micro-progestogen contraception (POP)
Caution
Considered insufficient alone

Clinical pearls

💡 Always double-contraception advice + monthly PPT before dispensing
💡 Baseline + monthly lipids and LFTs

Content last reviewed: REPLACE_ME (e.g. 2026-07)

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