Isotretinoin: What to know before you start

If you have severe, stubborn acne that hasn’t improved with creams or antibiotics, your doctor may suggest isotretinoin. This drug can clear acne that ruined skin for years, but it also carries real risks. Read this to learn how it works, what to expect, and how to use it safely.

How isotretinoin works and what to expect

Isotretinoin shrinks oil glands in your skin and reduces the bacteria that cause acne. Most people start to see changes in 4–8 weeks, but a full course is usually 4–6 months. Typical dosing runs from 0.5 to 1 mg per kg of body weight per day. Doctors often aim for a total cumulative dose (around 120–150 mg/kg) to lower the chance acne returns.

Short-term side effects are common and usually manageable: dry lips, dry skin, nosebleeds, and increased sensitivity to sunlight. Your skin will likely flake and need simple care — gentle cleansers, fragrance-free moisturizers, and a strong lip balm help a lot. If you get an acne flare in the first month, that can be normal; don’t stop the medication without speaking to your prescriber.

Safety, monitoring, and practical tips

Pregnancy risk: isotretinoin causes severe birth defects. If you can become pregnant, you must use effective contraception and follow monthly pregnancy testing rules. Many places require enrollment in a pregnancy-prevention program before refill. Don’t donate blood while taking it and for at least one month after stopping.

Medical checks: doctors usually order baseline and periodic blood tests — liver function and blood lipids (cholesterol and triglycerides) are the main ones. If your labs go up, your doctor may lower the dose or pause treatment. Tell your doctor about other meds, especially vitamin A supplements and tetracycline antibiotics — some combinations are unsafe.

Mood and muscle effects: mood changes and rare reports of depression or suicidal thoughts exist. Pay attention to mood shifts and tell your prescriber immediately if you notice new or worsening mental health symptoms. Also report unexplained muscle or joint pain, and avoid heavy weightlifting if you have severe muscle aches.

Buying and follow-up: only use isotretinoin with a prescription and proper medical follow-up. Avoid sketchy online pharmacies that don’t require tests or doctor visits. If cost is a concern, ask your provider about generic options, patient assistance programs, or local pharmacy discounts.

Practical care: use sunscreen daily, moisturize frequently, avoid waxing and chemical skin peels while on treatment, and plan for a steady skincare routine rather than many new products at once. After you finish a full course, many people see long-term improvement, but some need a second, lower-dose course.

Have questions or concerns? Bring them up with your dermatologist. Isotretinoin can be life-changing for acne, but safe use means following rules, doing the tests, and keeping in touch with your doctor.