Long Term Low Dose Isotretinoin

You have been advised to take isotretinoin (Roaccutane) in a low dose over a long term to try and improve the overall quality of your skin.

As explained this is an unlicensed use of the drug but many people find it produces considerable benefit. Isotretinoin is licensed to be used in a dose of one milligram per kilogram body weight a day for 16 weeks for the treatment of severe acne. In lower doses it can be used to reduce unwanted sebaceous gland activity and so improve the overall skin texture etc.

The principle of low dose treatment is to find the lowest dose of isotretinoin which controls the clinical problem and in the first instance maintain this dose for the period of time which equates to you taking the full dose over sixteen weeks.  In other words if you only have to take half the recommended licensed dose then we would continue the isotretinoin for twice the time (32 weeks).  If the problem relapses quickly then we can consider continuous long term treatment.

At the start of treatment the doctor will usually ask you to gradually increase the dose.  This is important as if you start at a high dose this may stimulate the glands and exacerbate the problem.  Normally the symptoms will come under control over six to eight weeks and then you can try and reduce the dose gradually to find the lowest dose which controls the symptoms.

Isotretinoin stays in the system for four weeks so if you change the dose too quickly the body may not have time to adapt.  I therefore suggest you reduce the dose by one capsule a week every fortnight.  After each reduction in dose a slight flare in symptoms may occur within a few days and then settle.  If it doesn’t settle then go back to taking the previous dose and stay on this for a month before trying to reduce again (see below).

It is important for females of child bearing potential to remember that even at low doses isotretinoin can seriously harm a baby in the womb and if you do become pregnant the pregnancy must be terminated.

Please contact us if you have any questions or concerns.

Example of treatment schedule

Weeks 1 – 6
Gradually increase dose as prescribed

Weeks 7-10
Continue on treatment as prescribed

Weeks 11-12

If skin stable omit one 20mg capsule a week (i.e. if taking 10 a week take 9)

Weeks 13-14

If skin stable omit one further 20mg capsule (i.e. reducing from 9 a week to 8)

Weeks 15-16

If all well reduce by a capsule a week (i.e. 8 to 7). Continue reduction as symptoms allow

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