Effective therapy of various forms of acne continues to be an urgent problem for dermatovenereologists and cosmetologists, which is especially significant in severe clinical manifestations of dermatosis, when the process is widespread, recurrent, accompanied by the formation of scars and other post-partum symptoms.
In such cases, the method of choice is the administration of systemic Isotretinoin (Accutane), a drug that affects the main pathogenetic mechanisms of the development of acne. More than 30 years of experience in studying the use of this substance has shown that the drug is a highly effective medium for the treatment of moderate and severe forms of acne allowing to achieve complete regression of rashes in 85-95% of patients.
Is Accutane Really Effective?
Despite the wide clinical use of Isotretinoin for the treatment of acne, until recently the tactical issues of therapy have not been fully established: initial doses are discussed with various clinico-morphological forms of acne, rationality of the obligatory achievement of cumulative doses of the drug, duration of treatment, recommendations for the prescription of concomitant topical therapy, maintenance therapy after the termination of the course of the drug.
Earlier, it was reported that in 89-95% of patients after the completion of the standard course, the result of treatment with complete regression of the rashes was achieved, at present such rates are fixed in approximately 70% of patients with severe acne receiving the drug at a dose of 0.5 mg / kg / day. The analysis of publications showed that 21.5-26.0% of patients with acne treated with SI had a relapse within the first 4-6 months after the end of the course.
A retrospective analysis for a 10-year period of 17,351 patients with acne showed that among patients who had already received one course of SI, 7,100 (41%) had a relapse of rashes, and 4443 (26%) patients needed a repeated course of SI. According to I. Haryati, S.S. Jacinto (2005), among patients with acne with relapses of the disease, 17.5% needed external acne therapy, 3.3% received systemic antimicrobial drugs (AMP) and external treatment, and 19.6% of patients had readings for repeated courses of Isotretinoin.
The frequency of repeated exacerbations of acne after the course of SI is affected by: daily dose of SI, duration of therapy course, cumulative dose of the drug: so, among patients who needed re-therapy, the average cumulative dose was 103.5 mg / kg; the risk of recurrence of severe acne was 8.2 times higher in patients taking a cumulative dose of Isotretinoin less than 100 mg / kg, compared with those with a cumulative dose of more than 100 mg / kg. The appointment of repeated courses of Isotretinoin in relapses of the disease is a common practice.
During the therapy, it is necessary to take the following things into account in order to get the desired effect:
• Control the level of lipids, glucose, liver function. Patients with diabetes are encouraged to conduct more frequent monitoring of blood glucose.
• Women of reproductive age need to apply reliable contraceptive measures for 4 weeks before, during and for 1 month after the end of treatment. In case of pregnancy, it should be interrupted for medical reasons.
• In the event of colitis, visual impairment and symptoms of the pseudotumor, the treatment is stopped. If a pseudo-tumor of the brain is suspected, a neurologic examination is performed.
• Do not use Isotretinoin if receiving other drugs from the retinoid group (to avoid hypervitaminosis A).
• It is necessary to avoid high insolation, incl. UV therapy.
• In the treatment with Isotretinoin, a decrease in the tolerability of contact lenses is possible. Patients who wear contact lenses should wear eyeglasses in case of side effects.
• Do not apply ointment on the skin around the eyes and with severe acute inflammation; do not apply it to mucous membranes.
Is Accutane and Isotretinoin the Same Thing?
Isotretinoin is a drug against acne chemically associated with retinoic acid and retinol (vitamin A). The exact mechanism of action is not known, it blocks the sebaceous glands, reduces the production of fat in the skin, and thereby prevents the development of acne. It is sold in many countries of the world and is considered one of the most effective means of fighting acne. In one recent study, 160 volunteers used Accutane for a period of 2-28 weeks. Of 133 patients who remained at the end of the experiment, 127 patients noted complete or almost complete disappearance of acne. That is 95% efficiency, which is very important for any drug.
Also, 60% of the patients did not worry about pimples for a whole year after completing the Accutane. Bodybuilders use it for the same purpose to remove one of the most visible external side effects of using AAS-acne. Isotretinoin was developed by Hoffmann-La Roche, and was first put on the market in 1982. It was sold until 2002 under the patent name Accutane.
Now it is on the market under a lot of names. Isotretinoin is a licensed drug, but in recent years its sale has been regulated because of side effects. In particular, women need to make sure that they are not pregnant. The drug carries yellow stickers with a list of possible side effects. Isotretinoin is usually available in the form of gelatin capsules containing 10,20 or 40 mg of the drug.
Isotretinoin normalizes terminal differentiation of cells, inhibits the proliferation of the epithelium of the ducts of the sebaceous glands, the formation of detritus, facilitates its evacuation. It reduces production and facilitates the release of sebum. When administered, absorption is variable, bioavailability is low and variable; reception together with food increases bioavailability by 2 times. Tmax - 2-4 hours Binding to blood plasma proteins (mainly with albumin) - 99.9%. Metabolized with the formation of three major biologically active metabolites - 4-oxo-isotretinoin (the main metabolite), tretinoin and 4-oxo-retinoin, as well as less significant metabolites, including glucuronides.
Since in vivo isotretinoin and tretinoin are reversibly converted into each other, the metabolism of tretinoin is associated with the metabolism of isotretinoin. 20-30% of the dose of isotretinoin is metabolized by isomerization. In the pharmacokinetics of isotretinoin in humans, an important role may be played by enterohepatic circulation. In vitro studies have shown that isozretinoin metabolism involves isozymes CYP2C8, CYP2C9, CYP3A4 and CYP2B6 cytochrome P450. T1 / 2 isotretinoin - 19 hours, 4-oxo-isoretinoin - 29 hours. It is excreted by the kidneys and with bile in approximately equal amounts.
What are the Risks of Taking Accutane?
• On the part of the nervous system and sensory organs: excessive fatigue, headache, increased intracranial pressure (pseudotumor brain: headache, nausea, vomiting, impaired vision, edema of the optic nerve), convulsive attacks, xerophthalmia, isolated cases of visual impairment, photophobia, disturbance of dark adaptation (reduction of sharpness of twilight vision); rarely - depression, psychosis, suicidal thoughts, violation of color perception (passes after drug discontinuation), lenticular cataract, keratitis, blepharitis, conjunctivitis, eye irritation, optic neuritis; hearing impairment at certain audio frequencies.
• On the part of the digestive tract: dryness of the oral mucosa, bleeding from the gums, inflammation of the gums, nausea, diarrhea, inflammatory bowel disease (colitis, ileitis), bleeding, pancreatitis (especially with concomitant hypertriglyceridemia above 800 mg / dL). Rare cases of pancreatitis with fatal outcome are described, transient and reversible increase in hepatic transaminase activity and individual cases of hepatitis (in many of these cases, the changes did not go beyond the limits of the norm and returned to the baseline during treatment, however, in some situations, it was necessary to reduce the dose or cancel the drug ).
• On the part of the hematopoiesis system: anemia, a decrease in hematocrit, leukopenia, neutropenia, an increase or decrease in the number of platelets, an acceleration of the ESR.
• On the part of the respiratory system: rarely - bronchospasm (more often in patients with bronchial asthma in the anamnesis).
• On the part of the musculoskeletal system: muscle pain with elevated serum levels of CK in serum or without it, joint pain, hyperostosis, arthritis, calcification of ligaments and tendons, tendonitis.
• Skin: peeling of the skin of the palms and soles, rash, itching, face eruptions / dermatitis, sweating, pyogenic granuloma, paronychia, onychodystrophy, increased proliferation of granulation tissue, persistent thinning of hair, reversible hair loss, fulminant forms of acne, hirsutism, hyperpigmentation, photosensitization, slight trauma of the skin. At the beginning of treatment, there may be an exacerbation of acne, which lasts for several weeks.
• Effects caused by hypervitaminosis A: dry skin, mucous membranes, incl. lips (cheilitis), nasal cavity (bleeding), larynx and pharynx (hoarseness), eye (conjunctivitis, reversible corneal opacity and intolerance of contact lenses).
• Other: lymphadenopathy, hematuria, proteinuria, vasculitis (systemic hypersensitivity, glomerulonephritis, local or systemic infections caused by gram-positive pathogens (Staphylococcus aureus) hyperglycemia.
With external application: passing reddening of the skin, new rashes from the 2nd week of treatment, not requiring withdrawal of the drug, allergic reactions; possible (with prolonged use) - cheilitis, conjunctivitis, dryness and peeling of the skin.
The simultaneous use of isotretinoin with other retinoids (including acitretin, tretinoin, retinol, adapalen) increases the risk of hypervitaminosis A. Since tetracyclines increase the risk of increased intracranial pressure, concomitant use with isotretinoin is contraindicated (several cases of pseudotumor development have been reported).
Isotretinoin can weaken the action of progesterone, therefore, during the treatment with isotretinoin, contraceptives containing small doses of progesterone should not be used. Simultaneous use with drugs that increase photosensitivity (including sulfonamides, tetracyclines, thiazide diuretics) increases the risk of sunburn. The effect of the ointment is weakened by the simultaneous use of antibiotics of the tetracycline group, as well as the local application of glucocorticoids.
Do You Lose Weight with Accutane?
Accutane (Isotretinoin) - A-vitamin-like agent, which has anti-inflammatory, anti-acne, dermatoprotective and anti-seborrheic effect. The producer didn't have an intention to add an effect of losing weight taking Accutane. However, some patients admit that they start losing weight when taking Accutane regularly. In any case, it is not possible to use the drug with the aim to lose weight.
This is a drug for getting rid of acne and it can't be helpful for losing extra kilograms. Those who have reported their results of losing weight, admitted that the lost weight starts to come back quickly. Take this into account when using Accutane. It can't be taken as the method of losing weight because it has been developed with the aim to fight against acne.
How Much Does Accutane Cost?
The treatment with Accutane is intended for the long-term. Taking this into account, everyone wants to spend as little money as possible. The average cost of the treatment course may vary from $300-400, depending on the severity of the individual symptoms of the skin problem. However, the price may also depend on other factors. When buying the drug online, you can spend much less. For example, not $300 but $150. Buying without a prescription you save both time and money.
The medical insurance may not cover the treatment with retinoids. In this case, it is better to give preference to onlin drugstores, where you can purchase Accutane at a price $1.48 for Accutane 10 mg (10 pills per package). The price depends on the dosage. Accutane 40 mg costs more expensive. About $6 per 1 pill. Take this into account and choose the necessary dosage depending on the severity of acne manifestations.
In which tablets is Accutane sold in pharmacies?
Accutane is available in tablets of 5 mg, 10 mg, 20 mg, 30 mg, 40 mg. The doctor should prescribe the necessary dosage, or you can start with the minimal dosage and increase it gradually looking at the reaction of your skin until you find the best dosage that suits your skin condition. The optimal one is 10-20 if your condition isn't the lightest one and at the same time not severe.
The doctor usually prescribes taking capsules from 0.1 mg / kg per day. After about 4 weeks, he/she may specify the dose depending on the effectiveness and tolerability of the drug - in the range from 0.1 to 1.0 mg per 1 kg of body weight per day, not exceeding 2 mg / kg. The course of treatment lasts up to 16 weeks. Capsules are taken with food at a small dose 1 time per day, at large - in several receptions. If necessary, repeated courses of treatment are possible with a break of at least 8 weeks.
How to Buy Accutane online?
In order to buy Accutane online, you need just to choose the necessary dosage and place your order. There is nothing difficult. Before this, you are recommended to get acquainted with the instructions to know whether you have any contraindications or not. If you are sure that Accutane is what you need, if it is safe for you, add the requied dosage to the shopping cart and submit an order for the drug over the counter.
Before buying the drug, you can get the professional consultation online. The great advantage of online pharmacy is that you can ask any questions anytime as the customer support is at your disposal round the clock.