Isotretinoin (Accutane) can improve severe acne, but it can also have adverse effects, such as headaches, eye inflammation, and joint problems. It may also increase the risk of depression and sexual problems.

Isotretinoin is a retinoid, which is a class of drugs similar to vitamin A.

According to the British Association of Dermatologists, about 90% of people taking a course of Accutane find that their acne improves significantly, though it may worsen in the short term.

Accutane has a range of side effects, including severe ones. According to the Food and Drug Administration (FDA), people should only take isotretinoin under a healthcare professional’s close supervision.

This article will examine some of the side effects of Accutane. It will also look at the medication’s long-term side effects and provide guidance on when to seek advice from a doctor.

Accutane pills in a blister pack that may cause side effectsShare on Pinterest
Accutane has several potential side effects.

Before taking Accutane, and at regular intervals afterward, people will undergo blood tests to check their liver and kidney function, as well as their levels of fats and cholesterol.

Some common side effects of Accutane include:

  • dry, cracking, or peeling skin
  • dry or inflamed eyes
  • chapped lips
  • a dry nose, perhaps with nosebleeds
  • headaches
  • aches and pains

People taking Accutane may also have increased sensitivity to UV light, so they should use sun protection and avoid direct sunlight as much as possible.

Current advice says that people taking Accutane should also avoid waxing or other carrying out cosmetic skin procedures while taking the drug and for 6 months afterward. This is to prevent scarring.

However, one 2017 review found no evidence to support delaying cosmetic procedures after using Accutane or products containing isotretinoin. That said, people should only perform such procedures with the advice of an experienced physician.

People sometimes mention weight gain or weight loss when talking about Accutane. However, the FDA do not currently list weight change as a side effect of this drug.

Risks in pregnancy

It is very important that anyone who is pregnant, who is planning to become pregnant, or who may become pregnant accidentally does not take Accutane.

This is because Accutane may cause:

  • miscarriage
  • congenital disabilities
  • premature labor
  • death in babies

These effects are severe and not unusual. For example, the Genetic and Rare Diseases Information Center say that around 20–35% of fetuses may develop malformations if they have exposure to retinoids during pregnancy.

Different countries have introduced various regulatory procedures to prevent fetal exposure to this medication, including asking people to use two contraception methods during and after retinoid treatment and to take regular pregnancy tests.

The United States introduced iPLEDGE in 2006 to try to eliminate fetal exposure to isotretinoin through a restricted distribution program.

One 2019 analysis reported that although the number of pregnancies, miscarriages, and fetal defects in people taking isotretinoin has decreased since then, they do still happen.

Anyone who is breastfeeding should also not take Accutane.

Allergic reactions

Some people may have an allergic reaction to the ingredients in Accutane.

Fats and cholesterol

Accutane may also increase the levels of blood cholesterol and fats in the body. Undergoing regular blood tests allows doctors to monitor these.

Red and white blood cells

Taking Accutane may lead to a reduction in the number of red and white blood cells. Anemia may affect more than 1 in 10 people taking Accutane.

The following sections will discuss the potential long-term side effects of Accutane in more detail.

Sexual function and fertility

Accutane does not appear to affect fertility. However, scientists have found a link between Accutane and sexual side effects, such as:

  • erectile dysfunction
  • loss of libido
  • genital numbness

Mental health problems

There are some serious mental health issues associated with Accutane.

For example, Accutane may cause:

  • depression
  • psychosis
  • suicidal thoughts

These severe but rare side effects may also persist after a person stops taking Accutane, so follow-up care is essential.

Neurological problems

Taking Accutane may increase the pressure inside a person’s brain. This could lead to permanent sight loss and, in rare cases, death.

Damage to internal organs

Organ damage is another possible side effect of Accutane. Accutane may damage the:

  • pancreas
  • bowel
  • esophagus
  • liver

Bone, muscle, and joint problems

Accutane may affect the:

  • bones
  • muscles
  • ligaments
  • joints

People should discuss any exercise they do with their doctor before starting this drug.

Accutane may stop long bone growth in teenagers who are still growing.

Blood sugar control and diabetes

Accutane may increase the levels of sugar in the blood and, rarely, lead to diabetes.

Vision problems

People may experience a loss of night vision (sometimes permanently) and other severe eye problems from taking Accutane.

This medication can also make it hard to wear contact lenses, and this difficulty may continue after treatment.

Serious skin problems

As well as the more common, minor skin side effects, people have reported severe skin conditions with the use of Accutane.

These include:

  • erythema multiforme
  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis

Some of the long-term side effects may persist after a person has stopped taking Accutane. These may even cause permanent problems, such as scarring, vision loss, or internal organ damage.

Some people had sexual side effects appear or become significantly worse after they had stopped treatment, according to one 2018 review.

Meanwhile, a 2010 study found an increased risk of suicide for up to 6 months after Accutane treatment had stopped. However, the risk of attempting suicide was higher before treatment started. For this reason, it is not possible to confirm any additional risk due to Accutane.

People who are about to take Accutane should talk to their doctor about any other medications or herbal supplements they take.

In particular, people taking Accutane should avoid:

  • vitamin A supplements
  • tetracycline antibiotics
  • corticosteroids
  • any other acne treatments
  • alcohol (or keep it to a minimum)
  • phenytoin (Dilantin)
  • strong sunlight and sunbeds
  • cosmetic skin procedures, such as waxing or laser treatment

Accutane may reduce progestin-only birth control pills’ effectiveness, so people taking these should talk to their doctor. Likewise, taking St. John’s Wort may mean that birth control pills are less effective.

People taking Accutane should see a doctor if any of the minor side effects persist and are causing them difficulty.

Other symptoms can indicate a serious condition. These include:

  • symptoms of depression or psychosis
  • indications of an increase in brain pressure, such as:
    • bad headaches
    • blurred vision
    • dizziness
    • nausea
    • vomiting
    • seizures
    • stroke
  • a severe rash that may blister or peel, sometimes with flu-like symptoms, conjunctivitis, or sores in the mouth, eyes, nose, or throat
  • possible abdominal problems or organ damage symptoms, such as:
    • nausea
    • vomiting
    • bad stomach pains
    • diarrhea
    • bleeding from the rectum
    • chest or bowel pain
    • the skin or whites of the eyes turning yellow
    • dark urine or difficulty urinating
  • muscle weakness and pain
  • swelling or bruising on some areas of the body
  • difficulty moving the arms and legs
  • ringing in the ears or worsening hearing
  • problems with vision or dry eyes that hurt
  • an allergic reaction
  • dark urine

If anyone notices these symptoms while taking Accutane, they should stop taking the medication immediately and call a doctor.

Those with back or joint pain should also seek medical advice.

Also, anyone who breaks a bone should tell the doctor treating them that they are taking Accutane.

Accutane is an effective treatment for severe acne, but it has some serious side effects, including mental health problems and risks associated with pregnancy.

Anyone who is considering taking this medication should have a detailed conversation with their doctor about the risks and how to reduce them.