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Accutane and acne

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Accutane and acne

Posted by Kristie Bradshaw on August 08, 2001 at 19:42:12:

I am a 15 year old female. I have been on Accutane for a little over a year now. Before Accutane, I had tryed every Neutrogena and Clearisil stuff on the market. I then decided to go to the dermatologist. He tryed almost every topical cream and three different oral medications. None of this stuff worked at all. He then put me on Accutane 10mg. It has had great results and I haven't had any side effects at all. But it seems like every time I return to the dermatologist he tries to reduce my dosage which results in my face breaking out again. He then has to move the dosage back to normal. I take Accutane every other day, and if it is the "ONLY" thing that has worked and that ever will work, then why is the dermatologist persitant about taking me off of it? I could understand if I was expericening bad side effects but it has worked perfectly. Is there a legal limit to how long you can be on Accutane, even if full results don't continue unless I am on it every other day?



Re: Accutane and acne

Posted by
thessa on August 09, 2001 at 07:35:30:

In Reply to: Accutane and acne posted by Kristie Bradshaw on August 08, 2001 at 19:42:12:

Hi Kristie,
Even though you don't have any side effects, your doc probably doesn't want to take his chances with this time bomb... Be glad you at least have an allopath who is somewhat sensitive to these warnings below. here's an extract I found from the Roche site:

CONTRAINDICATIONS AND WARNINGS: Accutane must not be used by females who are pregnant or who may become pregnant while undergoing treatment. Although not every fetus exposed to Accutane has resulted in a deformed child, there is an extremely high risk that a deformed infant can result if pregnancy occurs while taking Accutane in any amount even for short periods of time. Potentially any fetus exposed during pregnancy can be affected. Presently, there are no accurate means of determining after Accutane exposure which fetus has been affected and which fetus has not been affected.

Accutane is contraindicated in females of childbearing potential unless the patient meets all of the following conditions:

must have severe disfiguring nodular acne that is recalcitrant to standard therapies (see INDICATIONS AND USAGE for definition)

must be reliable in understanding and carrying out instructions

must be capable of complying with the mandatory contraceptive measures required for Accutane therapy and understand behaviors associated with an increased risk of pregnancy

must have received both oral and written warnings of the hazards of taking Accutane during pregnancy and exposing a fetus to the drug

must have received both oral and written information on the types of contraceptive methods and warnings about the rates of possible contraceptive failure, and of the need to use two separate, effective forms of contraception simultaneously, unless abstinence is the chosen method, or the patient has undergone a hysterectomy and has acknowledged in writing her understanding of the information and warnings and of the need for using two contraceptive methods simultaneously

must have had a negative urine or serum pregnancy test with a sensitivity of at least 50 mIU/mL when the patient is qualified for Accutane therapy by the prescriber, and must have had a second negative urine or serum pregnancy test on the second day of the next normal menstrual period or at least 11 days after the last unprotected act of sexual intercourse, whichever is later

must understand and agree that her prescriber will issue her a prescription for Accutane only after she has contacted the prescriber to confirm that she has obtained a negative result for the second urine pregnancy test which is to be conducted on the second day of the next normal menstrual period or at least 11 days after the last unprotected act of sexual intercourse, whichever is later

must have received instruction to join the Accutane Survey and have watched a videotape, provided by Roche to her prescriber, that provides information about contraceptive methods, possible reasons for contraceptive failure, and importance of using effective contraception when taking teratogenic drugs.

Major human fetal abnormalities related to Accutane administration have been documented: CNS abnormalities (including cerebral abnormalities, cerebellar malformation, hydrocephalus, microcephaly, cranial nerve deficit); skull abnormality; external ear abnormalities (including anotia, micropinna, small or absent external auditory canals); eye abnormalities (including microphthalmia); cardiovascular abnormalities; facial dysmorphia; cleft palate; thymus gland abnormality; parathyroid hormone deficiency. In some cases death has occurred with certain of the abnormalities previously noted. Cases of IQ scores less than 85 with or without obvious CNS abnormalities have also been reported. There is an increased risk of spontaneous abortion. In addition, premature births have been reported.

It is strongly recommended that a prescription for Accutane should not be issued by the prescriber until a female patient has had negative results from two urine or serum pregnancy tests, one of which is performed in the prescriber's office when the patient is qualified for Accutane therapy, the second of which is performed on the second day of the next normal menstrual period or 11 days after the last unprotected act of sexual intercourse, whichever is later. It is also recommended that pregnancy testing and counseling about contraception and behaviors associated with an increased risk of pregnancy be repeated on a monthly basis. To assure compliance, the prescriber should not issue a prescription for a female patient, until after the second negative pregnancy test result is obtained. In addition, the prescriber should prescribe no more than a 1-month supply of the drug for all Accutane patients and no automatic refills should be permitted. Roche will supply urine pregnancy test kits for female Accutane patients for the initial, second, and monthly testing during therapy.

Effective contraception must be used for at least 1 month before beginning Accutane therapy, during therapy, and for 1 month following discontinuation of therapy even where there has been a history of infertility, unless due to hysterectomy. The patient must be counseled about and understand the limitations of any chosen contraceptive method. The patient must also understand the risks associated with not using two contraceptive methods, even when one of the chosen methods is a hormonal contraceptive method.

Any birth control method can fail. Therefore, it is critically important that women of childbearing potential use two effective forms of contraception simultaneously, unless absolute abstinence is the chosen method, even when one of the forms is a hormonal contraceptive method. Although hormonal contraceptives are highly effective, there have been reports of pregnancy from women who have used oral contraceptives, as well as injectable/implantable contraceptive products. These reports are more frequent for women who use only a single method of contraception. It is not known if hormonal contraceptives differ in their effectiveness when used with Accutane.

If a pregnancy does occur during treatment, the prescriber and patient should discuss the desirability of continuing the pregnancy. Prescribers are encouraged to report all cases of pregnancy with specific information about the contraceptive forms used during Accutane therapy and for 1 month following therapy, either to the Roche Medical Services @ 1-800-526-6367 or to the Food and Drug Administration MedWatch Program @ 1-800-FDA-1088.

Accutane should be prescribed only by prescribers who have special competence in the diagnosis and treatment of severe recalcitrant nodular acne, are experienced in the use of systemic retinoids, and understand the risk of teratogenicity if Accutane is used during pregnancy.

Prescribers who prescribe Accutane should use the Pregnancy Prevention ProgramSM kit provided by Roche for the counseling of patients, should instruct the patient to participate in the Accutane Survey, and should receive medical education sponsored by Roche about effective contraception, the limitations of contraceptive methods and behaviors associated with an increased risk of contraceptive failure and pregnancy.

scary huh?



Re: Accutane and acne (Archive.)

Posted by Walt Stoll on August 10, 2001 at 09:40:25:

In Reply to: Re: Accutane and acne posted by thessa on August 09, 2001 at 07:35:30:

Thanks, thessa.

Namaste`

Walt

Follow Ups:


Re: Accutane and acne

Posted by Walt Stoll on August 10, 2001 at 09:41:24:

In Reply to: Accutane and acne posted by Kristie Bradshaw on August 08, 2001 at 19:42:12:

Hi, Kristie.

What have you learned from reading the acne archives?

Walt



Re: Accutane and acne

Posted by Kristie Bradshaw on August 13, 2001 at 09:07:30:

In Reply to: Re: Accutane and acne posted by Walt Stoll on August 10, 2001 at 09:41:24:

In reply to Walt:
I haven't really learned anything new. Some people see Accutane as a "time bomb" but then others see it as a miracle. And as of right now, I also see it as a miracle. Before Accutane I had no self-esteem whatsoever and now I do. So I guess that I will just see what happens and let my dermatologist make the final decision. Thanks.



Re: Accutane and acne

Posted by Raisa on August 13, 2001 at 10:21:13:

In Reply to: Re: Accutane and acne posted by Kristie Bradshaw on August 13, 2001 at 09:07:30:

Hi, Kristie - The only problem I see is that your acne keeps coming back unless you take a large dose of Accutane.
This would make me think that my acne was not getting better but that it was only acting like something like cortisone cream would to something - taking away the inflammation but not curing what is causing it.
I hesitate to mention this again, but since it cured my son's acne when he was your age (he was miserable), I will.
Please ask your dermatologist if you could try taking Tetracycline. Doctors used to prescribe this antibiotic regularly for acne. It totally cleared my son's acne up, which makes me think that his was caused by some kind bacteria which could be killed by the Tetracycline. I know that doctors do not like to give antibiotics randomly, but from what I have heard about Accutane, taking Tetracycline couldn't be any more harmful in the long run. My son is now 42 years old and has been able to take antibiotics for strep throats, etc. with no problem. Taking the Tetracycline for 6 months did no harm to him. Raisa



Re: Accutane and acne

Posted by Kristie Bradshaw on August 13, 2001 at 12:31:03:

In Reply to: Re: Accutane and acne posted by Raisa on August 13, 2001 at 10:21:13:

Raisa,
I have already tried Tetracycline. It had terrible effects on me. I was unable to go outside without breaking out into whelps. After Tetracycline, my dermatologist put me on Metronidazole and it didn't work either. Accutane was his last option. Accutane keeps my face completely clear and I am on the smallest possible dose. Thanks.



Really ? ...

Posted by Roy on August 13, 2001 at 12:55:20:

In Reply to: Re: Accutane and acne posted by Kristie Bradshaw on August 13, 2001 at 09:07:30:

You read the archives and didn't learn anything ? I've had acne for over 25 years, and I've never heard of a regimen like the one described here. ie. SR, WFD, exercise, EFA's (and B5 for some). Do you mind if I ask where you've heard that before ?



Re: Accutane and acne

Posted by Raisa on August 13, 2001 at 14:17:55:

In Reply to: Re: Accutane and acne posted by Kristie Bradshaw on August 13, 2001 at 12:31:03:

Kristie - Below is a link which is sort of encouraging (maybe it has been posted before, but it's very short).
It's encouraging, that is, as long as you are absolutely positive that there is no way that you could become pregnant until three months after you have finished taking it. It is results of a survey taken in Great Britain.
Is it at all possible that the dizziness you mentioned in your next post and nausea could be a belated side effect?
I hope not.
Good luck.



Re: Really ? ...

Posted by Kristie Bradshaw on August 13, 2001 at 14:42:04:

In Reply to: Really ? ... posted by Roy on August 13, 2001 at 12:55:20:

In reply Roy:
What are you talking about?? Where have I heard what before?

Follow Ups:


Re: Accutane and acne (Archive.)

Posted by Walt Stoll on August 14, 2001 at 10:16:49:

In Reply to: Re: Accutane and acne posted by Kristie Bradshaw on August 13, 2001 at 12:31:03:

Kristie,

As I have said many times before: The very worst complication of accutane is when it works with no side-effects. If you have read the archives like you said, you know what I mean.

Walt

Follow Ups:


Re: Accutane and acne

Posted by Raisa - to Kristie on August 14, 2001 at 10:31:28:

In Reply to: Re: Accutane and acne posted by Raisa on August 13, 2001 at 14:17:55:

Hi, Kristie - In my post about the British "survey" on Accutane, I meant to say "study" (of the long-term use of Accutane). Sorry. Raisa

Follow Ups:


Re: Accutane and acne

Posted by Kristie on August 17, 2001 at 08:32:58:

In Reply to: Re: Accutane and acne posted by thessa on August 09, 2001 at 07:35:30:

The only side effect even mentioned in that is the birth defect thing. I don't plan on getting pregnant for at least another 10 years. I read the British study that "Raisa" was kind enough to send me........take a look at it.

G200 -- 3/28/00

LONG TERM SAFETY OF ACCUTANE

Gabe Mirkin, M.D.

Isotretinoin, sold under the brand name Accutane, is the only drug that can cure acne, but it can cause horrible birth defects when taken by pregnant women. A recent report in the British Journal of Dermatology shows that Accutane otherwise is much safer than we used to think.

Acne is a condition in which normally colorless, liquid skin oils are converted to solid white material. Then the skin responds to the trapped solid oil by turning red and swelling. A three- or four-month course of Accutane damages the oil glands and markedly reduces the amount of oil that your skin produces, making Accutane the most effective drug to treat acne. Having less skin oil should not cause any serious side effects as its only known function is to keep you from feeling too cold in the winter, because it slows evaporation of sweat. Dry skin is associated with lack of water, and aging of skin is associated with lack of collagen, not with lack of oil.

In the British study, ninety-three per cent of the people taking Accutane reported no long-term side effects. The British researchers reported that two percent suffered muscle aches at follow up, and 5 percent suffered from dry mouth. Fewer than one percent claimed that they had dry eyes and skin and joint pains. Higher doses were not associated with more side effects. The authors concluded that their study showed that isotretinoin is a safe drug with no serious long-term side-effects. However, it causes birth defects when taken during pregnancy.

I insist that all women who take Accutane do nothing that could cause a pregnancy while they take it. Three months after stopping Accutane, a woman has no increased risk for birth defects.

I check liver tests and triglyceride levels and if normal, prescribe 40 mg of Accutane twice a day for 14 weeks. I check liver tests every four weeks and stop the drug immediately if the liver tests become abnormal. I repeat liver tests two weeks later, and if normal, restart Accutane. Eighty-two percent of those who follow this regimen are cured of acne for life. If the acne returns months or years later, I usually prescribe 40 mg of Accutane four times a day for one month.

1)V Goulden, AM Layton, WJ Cunliffe. Long-term safety of isotretinoin as a treatment for acne vulgaris. British Journal of Dermatology 1994(Sept);131(3):360-363. Most doctors prescribe 40 mg Accutane twice a day. You can take it with food. Get liver function and triglyceride blood tests before start and once a month while on Accutane. Do not get pregnant. Apply vaseline to your lips as often as possible. Stop at 14 weeks. Accutane is the only drug that can destroy oil glands.

2) Accutane blocks formation of dihydrotestosterone and does not affect other hormones. R Palatsi, A Ruokonen, A Oikarinen. Isotretinoin, tetracycline and circulating hormones in acne. Acta Dermato - Venereologica 77: 5 (SEP 1997):394-396.

3) C Leautelabreze, C Gautier, L Labbe, A Taieb. Infantile acne treated with oral isotretinoin. Annales de Dermatologie et de Venereologie 125: 2(FEB 1998):132-134. a 22-month-old boy, since 6 months of age.

Health Reports from The Dr. Gabe Mirkin Show and DrMirkin.com

Transcripts of segments of The Dr. Gabe Mirkin Show are provided as a service to listeners at no charge. Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.



Re: Accutane and acne

Posted by
Thessa on August 18, 2001 at 12:01:56:

In Reply to: Re: Accutane and acne posted by Kristie on August 17, 2001 at 08:32:58:

Kristie, hi there
I'm not saying that you should stop taking accutane. You are the one to decide that. I would just like to point out my perspective on the situation. When you make the choice to take accutane, you are making the choice to treat the symptoms of some underlying cause, instead of detecting the underlying cause and fixing that. Are you willing to take this approach with your health? When I read the article you posted, here is what jumped out at me from my perspective: 1. "A three- or four-month course of Accutane damages the oil glands ..." You have been on Accutane for 1 year. By taking this drug one chooses to destroy a part of their anatomy. I don't care about the side effects of this damage, I am talking about the concept of being willing to damage one's own body. (I myself have done it in the past)
2. "I insist that all women who take Accutane do nothing that could cause a pregnancy while they take it. Three months after stopping Accutane, a woman has no increased risk for birth defects." Now you are 15. If you take this drug for the next 10 years (unlikely I imagine) are you willing to not have sex with a man for the next 10 years and 3 months?
3. If accutane causes grave birth defects, would it be a far stretch to consider what it may do to a womb? With or without a child inside? Or even perhaps a 15 year old growing body?
4. "I check liver tests and triglyceride levels and if normal, prescribe 40 mg of Accutane twice a day for 14 weeks." This is a red flag to me that potentially your liver could become damaged. Not a far stretch since your liver has to process the drug and it has been doing it for a year already.
5. "In the British study, ninety-three per cent of the people taking Accutane reported no long-term side effects." Long-term? How long term? 3 months? a year? 5 years? any pregnancies after the study? any health issues at all in their 'long term'?

The reason this is important Kristie is because as Americans we are beginning to really find out that approaching dis-ease from the perspective of taking drugs to get rid of a symptom can really screw your whole body up. The generation before you is painfully figuring this out and for a 15 year old to start down the same path ignites a sense of urgency in me to preach to you! (so bare with my caring ;) For example, do you know the causes of acne? Do you know what is causing YOUR acne? Do you know that whatever is causing your acne is almost sure to morph into some other symptom, now or later when your oil glands are unable to produce the acne as a red flag to you? Do you know that the unanimous "it's just the puberty/hormone thing" may not be the whole story, and/or does not mean it can't be treated at the root?
I understand how painful/embarrassing acne can be. I realize you are growing emotionally and spiritually as well as physically. Hopefully this situation will put your insecurities at the top of the list of things to work on, and eventually acne or anything else won't be an issue of embarrassment. That's what happened with me but it took years.
Best to you girl, Thessa

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