Isotretinoin (Roaccutane): severe acne treatment and safety rules

Isotretinoin is a capsule medicine reserved for severe acne. The NHS says it is used when other prescription medicines have failed, and that it is prescribed by dermatology specialists. Roaccutane is the brand named.

Because of how serious some of its risks are, it sits well beyond ordinary acne care such as washes, benzoyl peroxide and antibiotic courses.

The NHS lists several reasons it may not be suitable. Tell the specialist if you have liver problems, have had an allergic reaction to isotretinoin or other medicines, are allergic to soya or peanuts, have raised cholesterol, or have a history of mental health problems such as depression, mood disorders or thoughts of self-harm.

Breastfeeding is not compatible with isotretinoin, so feeding should be stopped before treatment.

This is the most important safety rule. The NHS says you must use contraception while taking isotretinoin if there is any chance you could become pregnant, because the medicine causes miscarriage and developmental abnormalities in babies. Contraception should begin 1 month before treatment and continue for 1 month after stopping.

Specialists will discuss this at the start and at follow-up visits. If you think you might be pregnant at any point, speak to your specialist straight away.

Capsules are swallowed whole with food, once or twice a day, and the NHS describes treatment as lasting approximately 3 months. Your specialist sets the dose, and the length may vary; follow what your prescriber tells you rather than a general figure.

Regular check-ups and blood tests are part of treatment. A missed dose should be skipped, not doubled.

Common effects are dry or itchy skin, a rash, sun sensitivity, muscle and joint pain, easy bruising, headaches, soreness of the eyes, nose and throat, more infections and sexual difficulties.

Serious effects include anaphylaxis, pancreatitis, seizures, breathlessness and mental health problems such as psychosis and suicidal thoughts. Let your doctor know about any past mental health condition.

• Call 999 for signs of a severe allergic reaction, a seizure, or if you or someone else is in immediate danger.

• Speak to your specialist or NHS 111 promptly about low mood, hallucinations or thoughts of self-harm.

• Report suspected side effects through the Yellow Card scheme.

The NHS names tetracycline-type antibiotics including doxycycline, vitamin A supplements, other acne treatments, and anticoagulants such as enoxaparin and dalteparin as medicines to mention. Tell your specialist about everything you take.

It is best not to drink alcohol while taking isotretinoin because it could cause liver problems. Driving is generally fine unless you feel dizzy.

For milder acne, topical treatments such as benzoyl peroxide are tried first. Isotretinoin is considered when a range of prescription treatments has not worked. Our acne guides explain the steps that usually come before it, including scarring prevention.