Accutane (Isotretinoin)
Accutane (Isotretinoin)
Accutane is the brand name Roche uses to market the drug isotretinoin, a potent oral acne medication. Isotretinoin is chemically related to retinoic acid and retinol (Vitamin A), but don’t let this association confuse you. This is a strong synthetic drug, for removed from the relatively benign vitamin it is related to in base structure. Although its exact mode of action is unknown, isotretinoin works by inhibiting sebaceous gland functioning, which diminishes oil production in the skin and hinders acne development. Accutane is sold in many countries thoughout the world, and is largely regarded as one of the most effective medications over developed for treating severe acne. Bodybuilders are attracted to this agent for this same use, namely treating the ever so common side effect of anabolic/anadrogenic steroids use: acne.
Accutane is indeed a very effective medication for its intended use, displaying an excellent success rate with even some the strongest cases of clinical acne (acne vulgaris). For, example, a study was published that involved the treatment of 160 patients in Kuwait. There are many studies that could be referenced showing its high success rate, so this study is not intended to represent the “best” one (simply one of many). The study consisted of a 2 – 28 week treatment peroid, followed by regular checkup visits during the year after. Of the patents that finished the study (133), 127 of them noticed partial or complete clearance of acne during treatment. This was a success rate of over 95%, formidable for any drug. Nearly 60% of these patients were free of relapse a full year after Accutane therapy had been discontinued. This excellent long-term success rate exemplifies why this drug is so highly regarded, at least when it comes to effectiveness.
It isn’t all good for this drug, however. Accutane is extremely powerful, with many potential side effects. In fact, it can be such a serious drug that some might go so far as to call it controversial. Just ask one of the many Accutane action or victim groups. This drug has made front-page papers on many occasions, linked to birth defects, depression, and a string of patient suicides (among other things). The warnings on this product are numerous and very strong. Especially important is for any woman that potentially might become pregnant not use the drug. Even small exposure has been linked to very serious complications with fetal development. It also displays some hepatotoxicity, and can lead to inflammatory bowel disease, pancreatitis, suppressed HDL cholesterol, elevated triglyceride values, and hearing impairment. It may also be linked to a number of other peculiar side effects including psychosis, heart palpitations, hoarseness intracranial hypertension, and even nasal tip deformities when taken following cosmetic surgery. This is, indeed, one weird drug.
Although some researchers have contested the link to depression and suicide, the FDA approved literature on Accutane has warned of these risks for many years now. There seems to be reason, beyond the incidents and statistics alone, to take this very seriously. It appears that Accutane does definitely affect brain function to some degree. This was demonstrated in a study published in early 2005. Here, scientists began with the premise that in order for Accutane to effect depression and thoughts of suicide, it must affect the brain in some way. They set out to examine changes, if any, the drug would have on the various regions of the brain. Twenty-eight people participated in total, approximately half being treated with isotretinoin and the other half a topical antibiotic. Examinations were conducted before the drug was initiated, and after it had been used for 4 weeks. Using positron emisson tomography, they were able to demonstrate a 21% reduction in brain metabolism in the orbitofrontal cortex with Accutane use (there was a 2% increase with the antibiotic). This is a brain area known to mediate symptoms of depression, which suddenly gives this claim a lot more validity and understanding. More work will need to be done in this area before we know anything conclusive of course.
The typical method of using Accutane involves taking a dosage of .5 to 1mg/kg of bodyweight per day. This would equate to a maximum dosage of 100mg daily for a 220lb person. Very severe adult cases (with scarring perhaps) may require upwards adjustments in dosage later on, reaching as high as 2mg/kg/day. The daily dosage later on, reaching as high as 2mg/kg/day. The daily dose itself is divided into two equal doses, which are to be given at two seperate times of the day. Roche is very clear about this, stating that the safety of once daily dosing has not been established and, therefore, is not recommened. Accutane also should be taken with meals, not on an empty stomach, as food significantly aids in the absorption of this drug (high fat meals have the strongest benefit of bioavailability). One course of therapy is usually sufficient to clear up or at least control a patients condition.