What is Isotretinoin?
Isotretinoin is a retinoid for the systemic treatment of cystic nodules and conglobate acne and severe skin rashes that have not responded to complete treatment for systemic antimicrobial agents or cause skin rashes with nerve problems. In addition, the drug is used to treat skin rashes in women who are usually resistant to treatment with antibiotics.
It is one of the most dangerous drugs during pregnancy.
Isotretinoin reduces the size of sebaceous glands and inhibits their activity, resulting in the secretion of sebum. In addition, it has anti-keratinizing and anti-inflammatory effects. Isotretinoin is an isomer of tretinoin.
The drug is rapidly absorbed from the gastrointestinal tract and metabolized in the liver and possibly the intestinal wall. The half-life of isotretinoin and its major metabolite is 10-20 hours. The time required to reach the maximum plasma concentration is about 3 hours.
Contraindications to the use of Isotretinoin
This drug is strictly forbidden during pregnancy and may lead to death or organ failure. This drug is part of group X.
The drug should not be used in breastfeeding, cases of hepatic or renal impairment, vitamin A increase and hyperlipidemia.
Side effects of Isotretinoin
Endocrinology and metabolism: increase in serum triglyceride (more than 800 mg / dL), increase in creatine phosphokinase in blood samples, decrease in HDL cholesterol
Liver: Increased liver enzymes
Nervous, musculoskeletal: back pain, joint pain, muscle and bone disease
Endocrinology and metabolism: increase in serum cholesterol
Neuromuscular and musculoskeletal: Decreased bone mineral density, severe joint pain
Cardiovascular: Cerebrovascular accidents, chest pain, edema, hot flashes, palpitations, syncope, tachycardia, thrombosis, vasculitis
Skin: fulminant acne, hair loss, inflammation of the lips, sores and inflammation of the corners of the lips, contact dermatitis, dermatitis, increased sweating, eczema, redness of the skin, redness of the face, fragility of the skin, hair disease, nail disease, paronychia, itching, granuloma Pyogenation, scaling of the feet, dandruff, skin sensitivity to light, skin rash, sunburn, superficial peeling of the palm, urticaria, dry skin
Endocrinology and metabolism: changes in serum glucose, decreased libido, xanthoma lesions (yellow tumor), hirsutism (hair growth), increased gamma glutamyl transferase, increased lactate dehydrogenase, increased LDL cholesterol, increased serum glucose, increased uric acid, abnormalities , Weight Loss
Gastrointestinal: abdominal pain, colitis, constipation, loss of appetite, diarrhea, esophagitis, esophageal ulcer, gingival bleeding, gingivitis, ileal inflammation, inflammatory bowel disease, nausea, pancreatitis, vomiting, dry mouth
Genitourinary: erectile dysfunction, obvious blood in urine, microscopic blood in urine, protein in urine, pus in urine, sexual disorders
Hematology and oncology: anemia, bruising, decreased white blood cell count, increased erythrocyte sedimentation rate, lymphadenopathy, popura disease, severe neutropenia, elevated platelet count, thrombocytopenia
Hepatic: increase in serum alanine aminotransferase, increase in serum alkaline phosphatase, increase in serum aspartate aminotransferase, increase in serum bilirubin
Infectious: Herpes simplex infection (diffuse), infection
Central nervous system: aggressive behavior, anxiety, auditory hallucinations, depression, dizziness, drowsiness, unstable emotions, euphoria, fatigue, headache, idiopathic intracranial hypertension, insomnia, irritability, lethargy, lethargy, anger, eruption of anger Pain, panic attack, limb drowsiness, psychosis, seizures, suicidal ideation, suicidal ideation, violent behavior, voice disorder
Neuromuscular and musculoskeletal: laxity, arthritis, bone fractures, ligament calcification, tendon calcification, granulomatosis with polyangiitis (Wagner), arm and leg pain, muscle and bone pain, muscle pain, neck pain, osteopenia (decreased density) Bone), Osteoporosis, Premature epiphysis closure, Bone hyprastosis, Stiffness, Tendonitis
Ocular: eye fatigue, eyelid inflammation, blurred vision, cataracts, conjunctivitis, corneal opacity, decreased visual acuity, eye irritation, itchy eyes, eyelashes, increased tearing, keratitis (corneal inflammation), congestive heart disease, optic nerve inflammation, panic From light, change in color vision, visual impairment
Respiratory: bronchospasm, dry nose, nosebleeds, nasopharyngitis, respiratory tract infection, upper respiratory tract infection
Miscellaneous: Impairment of wound healing
Category X Interactions (Avoidance)
Aminoluvinolic acid (systemic), multivitamin / fluoride (containing vitamins A, D and E), multivitamin / mineral (containing vitamins A, D, E, K, folate and iron), multivitamin / mineral (containing vitamins A, E and without iron), tetracycline, vitamin A.
Reduce the effects of drugs by Isotretinoin
Progestin (contraceptive products)
Increased effects of drugs by Isotretinoin
Aminoluvinic acid (systemic and topical), Mipomersen, Porphyry, Vertporphine
Increased effects of isotretinoin by drugs
Alcohol (ethyl), multivitamin / fluoride (containing vitamins A, D and E), multivitamin / mineral (containing vitamins A, D, E, K, folate and iron), multivitamin / mineral (containing vitamins A) , Without iron), tetracycline, vitamin A.
Interference with food
The bioavailability of isotretinoin increases with food or milk.
- Isotretioninin is toxic drug and should only be prescribed by or under the supervision of a dermatologist this medicine has been used for at last 16 weeks and usually dose not need to be repeated.
- the drug is teratogenic and pregnancy shoud not occur at last one month before the start of one month after treatment.
- blood donation shuld be avoide during treatment and for at least one month after the end of treat ment .
- hepatic function and plasma fat levels should be assessed first and one month after the start of treatment and then once every three months.
- tetracycline, large amounts of vitamin A ( more than 4-5 thousand unites perday) and keratolytics should be avoided during druy.
- blood ylucose should be evaluated in diabetics as well as people with keratitis ( especially in people with dry eye syndrome).
Isotretinoin drug recommendations
If pregnancy is possible, the drug should be discontinued and a doctor should be consulted.
Concomitant use of vitamin A or other vitamin A supplements should be avoided unless prescribed by a physician.
In case of vision loss at night, driving and working with machines or similar items should be avoided and a doctor should be consulted.
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