Isotretinoin: What to Know Before You Start

Isotretinoin is the most powerful prescription for severe acne. For many people it clears nodules and cysts that never responded to antibiotics or topical creams. But it’s not a casual choice — it works well and carries serious risks, so you should know what to expect and how to stay safe.

How it works and who it helps

Isotretinoin is a vitamin A–derived drug that shrinks oil glands, reduces oil production, and slows clogged pores. That combo can dramatically reduce severe inflammatory acne and prevent scarring. Doctors usually consider it when other treatments—topicals, oral antibiotics, or hormonal therapy—haven’t worked or when acne is causing deep scarring.

Treatment courses typically last several months. Success depends on dose and total cumulative dose; many dermatologists aim for a total dose around 120–150 mg/kg spread over the course of treatment. Your doctor will pick a daily dose based on your weight, acne severity, and side effects.

Common side effects and safety checks

Dry skin and chapped lips are almost universal. Other common issues include dry eyes, nosebleeds, mild hair thinning, and sensitive skin. Blood tests can show higher cholesterol, triglycerides, or liver enzymes, so doctors often check blood work before starting and periodically during treatment.

Isotretinoin causes severe birth defects if taken during pregnancy. That’s non-negotiable: people who can get pregnant must follow strict pregnancy-prevention rules, including negative pregnancy tests before and during treatment and reliable contraception. Many countries require enrollment in a risk-management program before prescribing isotretinoin.

Mood changes and depression have been reported. The link isn’t fully proven, but you should tell your prescriber about any history of mental health issues and report new or worsening mood symptoms right away.

Avoid vitamin A supplements while on isotretinoin, since extra vitamin A raises the risk of toxicity. Also mention all medications and supplements to your doctor—some combinations are unsafe.

If you’re thinking about buying isotretinoin online, be careful. Legitimate pharmacies require a prescription and proper counseling. Check pharmacy credentials, look for verified contact information, and avoid sites offering prescriptions without a doctor consult. If a deal looks too good, it probably is.

Before starting, talk with your dermatologist about realistic expectations: improvement can take weeks, and a short flare-up may occur early in treatment. Ask about follow-up plan, lab checks, side-effect management (like lip balms and eye drops), and what to do if you miss a dose.

Isotretinoin can be life-changing when used correctly. Get clear guidance from a prescriber, follow safety checks, and report side effects early. That’s the best way to get the benefits while minimizing risks.