DOCTOR'S VIEW ARCHIVE
Accutane(isotretinoin) - Acne medicine linked to birth defects, depression and suicide
"Acne Drug Linked to Suicide Risk," was the headline over a Reuters story
last this year that began: "The US Food and Drug
Administration (FDA) issued a statement...advising
physicians and consumers about reports of "depression,
psychosis, and rarely suicidal thoughts and actions"
related to use of the acne drug isotretinoin (Accutane)."
Isotretinoin (Accutane) is now commonly used to combat
the cutaneous curse of adolescence, acne. Why?
The skin inflammation acne is in part due to increased
secretion from the sebaceous glands in the skin with
secondary irritation and subsequent scarring
(keratinization).
Accutane decreases the secretions and size of the
sebaceous glands, minimizing scarring from acne.
The FDA became particularly concerned about the
psychological side-effects of Accutane after it received
some two dozen reports of patients whose psychological
symptoms improved after they stopped the drug, but worsened
upon re-starting it. "To us that's an important clue that
something might be occurring," said Jonathan Wilkin,
director of the FDA's division of dermatologic drugs.
However, Accutane is not merely an anti-acne drug that
"may cause depression, psychosis and, rarely, suicidal
ideation, suicide attempts and suicide." It has effects
that can go well beyond the skin and psyche.
Do not forget that Accutane is a potent teratogen: an
agent capable of causing human congenital malformations.
To quote the March of Dimes Birth Defects Foundation:
"There is an extremely high risk of fetal malformations if
pregnancy occurs while taking Accutane in any amount, even
for short periods. Potentially all exposed fetuses can be
affected. Birth defects include hydrocephaly (enlargement
of the fluid- filled spaces in the brain); microcephaly
(very small head); mental retardation; small and malformed
ears and other facial abnormalities; and heart defects."
Accutane can cause these major malformations in the
early weeks of pregnancy soon after conception, a time when
many women may not yet know they are pregnant. Therefore,
MedicineNet (and many other sources) recommend that:
- Accutane must not be used by women who are pregnant,
plan on being pregnant, or have a chance of becoming
pregnant.
- Abstinence or effective birth control methods should be
used and pregnancy tests should be performed prior to
starting treatment and repeated monthly during
treatment.
- Pregnancy should be avoided until at least one month
after stopping Accutane. Nursing mothers should not use
Accutane.
- Any woman of child bearing age should seriously discuss
potential side effects with her doctor before using
Accutane.
Last Editorial Review: 2/4/2003