Accutane Side Effects
Accutane (isotretinoin) is a powerful medication prescribed to treat severe, difficult to control acne. Roche stopped selling that product in the United States, but you can still find generic versions or other brand names (Absorica, Amnesteem, Claravis, Myorisan, Zenatane). Isotretinoin can cause severe birth defects, mental health problems, and stomach issues. The common, less serious side effects include dry skin, chapped lips, dry eyes, and dry nose.
Birth defects are among the most serious side effects of Accutane. Taking isotretinoin during pregnancy may also result in miscarriage, premature birth, and infant death.
Women of childbearing potential must enroll in a special pregnancy prevention program (iPLEDGE) before being prescribed isotretinoin because of the drug’s risks. Men and women without reproductive potential who use isotretinoin must also participate in the iPLEDGE program.
Side effects of the medication have led to more than 7,000 lawsuits against the manufacturer of Accutane.
- Birth defects
- Premature birth
- Infant death
- Other mental health problems (psychosis)
- Suicidal thoughts or behavior
- Aggressive or violent behavior
- Increased brain pressure (pseudotumor cerebri)
- Serious skin reactions
- Acute pancreatitis
- Lipid abnormalities
- Hearing impairment
- Liver toxicity
- Inflammatory bowel disease
- Skeletal abnormalities
- Vision impairment
Birth defects from isotretinoin can range from miscarriages to babies born with slits where ears should be.
Since 1985, isotretinoin’s label has contained a black box warning detailing its “extremely high risk” of “severe birth defects.” The label warns female patients who are or may become pregnant to avoid taking isotretinoin.
The boxed warning also lists possible birth defects that can happen with isotretinoin. These birth defects include anything from ear, eye and other face-related abnormalities to abnormal skull development.
Birth defects from isotretinoin can also affect the central nervous system, immune system (thymus gland), certain hormones (parathyroid), and heart.
Isotretinoin and Pregnancy
About half of Accutane users are women of childbearing age. This makes birth defects associated with Accutane-use a significant concern.
From 1982 to 2006, more than 2,000 isotretinoin users became pregnant. These pregnancies resulted in many spontaneous or elective abortions.
As a result, Roche initiated a pregnancy prevention program (iPLEDGE).
The iPLEDGE program is required for isotretinoin users. This program requires women to take monthly pregnancy tests at a doctor’s office. Men and women without reproductive potential who use isotretinoin must also participate in the iPLEDGE program.The iPLEDGE program has decreased, but not completely stopped, birth defects from isotretinoin.
Results of one study showed an average of three pregnancies for every 1,000 patients taking isotretinoin.
Gastrointestinal Disorders: Crohn’s Disease and Ulcerative Colitis
Studies link Accutane to two types of gastrointestinal disorders: Crohn’s disease and ulcerative colitis (UC).
Both Crohn’s and UC are inflammatory bowel diseases (IBD), but the conditions affect patients in different ways.
Crohn’s can occur anywhere in the digestive tract but most often affects the lower end of the small intestine. UC more commonly affects the lining of the large intestine (colon) and the rectum.
Symptoms common with both conditions include abdominal pain and cramping, weight loss, diarrhea, fever, fatigue, mouth sores, joint pain and swelling, and blood in the stool.
Crohn’s cannot be cured. UC can only be cured with surgery to remove the large intestine. Both conditions can be managed with medications.
Accutane and Inflammatory Bowel Diseases (IBD)
A study released in 2009 found Accutane users had almost double the chance of developing a serious bowel disorder than those who never took Accutane.
Researchers at the University of North Carolina Chapel Hill presented evidence confirming that a link exists between isotretinoin and IBD.
They compared 8,189 cases of IBD with 21,832 healthy individuals. The results of the study showed people taking isotretinoin had a 1.68 times higher risk of developing IBD than people who did not use the drug.
This number increased to 2.67 times the risk among patients who filled four or more prescriptions of Accutane.
Patients who use isotretinoin are 4.36 times more likely to develop UC than patients who don’t take the drug.
Studies published since 2013 refute a link between isotretinoin and IBD. Some authors have instead proposed a link between severe acne and a predisposition to IBD. Both conditions involve inflammation.
The studies also conclude that the occurrence of IBD in patients taking isotretinoin may be coincidental based on the person’s age. IBD usually begins around 19 years of age. This is around the same age that a patient might experience severe acne and start taking isotretinoin.
Still, isotretinoin’s most recent drug label includes a warning about the possibility of developing IBD.
Depression and Suicide
Studies also linked Accutane to psychiatric disorders.
From 1982 to May 2000, the FDA received hundreds of reports linking isotretinoin use to depression.
These reports included 37 suicides, 110 hospitalizations for depression or suicidal behavior, and 284 cases of non-hospitalized depression.
Isotretinoin and Depression
Roche responded to the reports of depression and suicide in 1998 by adding a warning to the medication’s label. The warning stated that isotretinoin could cause mental health disorders.
Before 2005, reports of depression and suicide linked to the use of isotretinoin accounted for the fourth-highest number of adverse reactions occurring in the U.S.
Researchers still don’t understand how isotretinoin causes mental health events. Definitive proof of an association between depression and isotretinoin is still lacking.
A 2017 study in the Journal of the American Academy of Dermatology concluded that there may not be an association between isotretinoin and depression at all.
The study was a meta-analysis, or evidence-based examination, of published literature. It included all literature regarding the relationship between isotretinoin and depression up to Sept. 30, 2016.
Results showed no apparent association between isotretinoin and an increased risk for depression. This study, and others, have shown that treating acne could actually reduce symptoms of depression.
Please seek the advice of a medical professional before making health care decisions.