A-Detail™ Fact Sheet (Canada)
Isotretinoin is approved for severe, recalcitrant nodular cystic
acne unresponsive to other first-line therapies; it is also used for
moderate acne and other indications including rosacea and
Grover’s Disease. Dermatologists are now using Isotretinoin
earlier in the acne process to reduce both the psychological
burden of chronic acne and also to prevent permanent scarring.
Patient selection, strict adherence to pregnancy prevention and
close monitoring of patients while on Isotretinoin make the
treatment a relatively safe experience.
Suitable candidates include patients with inflammatory acne
that has the potential to scar and where there are no obvious
contra-indications. Unsuitable candidates include patients with
significant hepatic or renal disease
PABA allergy (the 10mg caps do not contain PABA and
may be used in place of the 40mg caps for these patients)
depression (these patients need close monitoring and
possible co-management with a mental health professional.
Some patients have experienced improvement in mood
subsequent to successful treatment outcome.)
pretreatment elevation in
liver function tests or
Women who are pregnant, breastfeeding or of childbearing age
and unwilling to comply with mandatory contraceptive
measures are also unsuitable candidates.
Initial oral dosing of 40mg daily for 2-4 weeks is recommended.
Maintenance doses are 1mg/kg per day.
A minimum total cumulative dose of 120mg/kg is generally
required. Many dermatologists treat until the patient is clinically
clear resulting in total cumulative doses of 120-150mg. Forty
percent of patients respond to initial therapy and do not require
any further anti-acne treatment. Twenty percent keep acne
under control with topical therapy only and 20 percent of
patients need a further course of treatment. Adult onset acne in
women appear to relapse more often.
Side Effects, Risks, Compliance & Monit