Laboratory abnormalities:
One fourth of patients treated with accutane develop
elevated serum triglycerides during their four- to five- month
course of treatment for acne. Approximately one eighth have a
decrease in the HDL level and one sixteenth have elevated
chloresterol. These changes usually resolve after therapy is
discontinued. It is important to monitor blood lipids at the
onset of therapy and at intervals of two to four weeks until it
is seen that there are no significant changes. Minor elevations
in triglycerides are best treated by dietary maneuvres.
It is
not known what role the lipid abnormalities may play in the
production of coronary heart disease, but the risk is currently
thought to be low since abnormalities return to normal after
therapy is stopped. It is perhaps best that patients with high
triglyceride elevations be treated with the lowest effective
dosage of accutane for a shorter period of time.
Triglyceride
elevations of greater than 500 mg/dL necessitate discontinuation
of the drug, as these patients are at risk for developing acute
pancreatitis. A few patients develop mild leukopenia, anemia, or
thrombocytosis. Mild pyuria and liver function test abnormalities
occasionally occur. These changes appear to be reversible after
discontinuation of the drug and are usually not clinically
significant.
Accutane and pregnancy
The most serious side effect of accutane is its
teratogenicity. The drug should not be used by women who are
pregnant or those who plan to become pregnant during treatment.
Contraception is recommended for women taking the drug, beginning
one month before treatment, and continuing until one month after
discontinuation of treatment. Many physicians obtain a pregnancy
test within two weeks prior to starting therapy.
Reported fetal abnormalities include hydrocephalus,
microcephalus, abnormalities of the external ear (micropinna,
small or absent external auditory canals), Micropthalmia and
cardiovascular abnormalities. These abnormalities have occured
only in children born to mothers exposed to the drug during
pregnancy.
The package insert recommends that patients who become
pregnant discuss with their physician the desirability of
continuing the pregnancy. Since the half-life of accutane is
less than one to three days, it is believed that there is no risk
of teratogenicity during subsequent pregnancies occurring at
least one month after treatment has been stopped.
While no reproduction studies have been performed on humans
taking accutane, studies in rats have not revealed impaired
fertility. No significant changes have been seen in the number or
mobility of spermatazoa of human males receiving accutane. As
it is not known whether accutane is secreted into milk, it is
inadvisable to treat nursing mothers with the drug.
Wash the skin
Avoid oily substances
Shampoo the hair daily
Don`t "pop" pimples
Exercise regularly
Don't stop the acne medicine
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