Should I request for a higher dose of isotretinoin if I am on a low dose isotretinoin regime?

Doctor's Answers 2

Isotretinoin is a drug that needs care on the part of the doctor when prescribing.

Firstly, it is teratogenic (causes malformed fetuses) thus a female patient CANNOT and MUST NOT get pregnant while on the pill (and 3-6 months thereafter to be safe).

Secondly, it has possible side effects. Disturbances of your lipid levels, renal and liver function may be possible and blood monitoring must be observed for safety’s sake.

Thirdly, it can cause really dry skin and mucous membranes (lips) etc.

All the above occur much more often in patients on a higher dose. Therefore, I can understand why your doctor is very cautious on the dosage. I would suggest for you to be patient and follow the doctor’s advice, if not, go for a second opinion.

Hi Anon – yes it’s true that in Sg doctors generally prefer giving lower dose – ie 10-20 mg, as opposed to in the UK where doctors tend to give 30-40 mg.

1. I reasoned with her that I wouldn’t mind taking a higher dose as I want to experience the break out asap

A breakout is actually not that common. I didn’t get one myself, neither did most of the patients I’ve started on Isotretinoin in the past. All doctors just tell you that it MAY happen as it’s a known side effect. Even if you do, don’t worry as your overall condition will rapidly improve over weeks.

2. What do you think of the low dose method?

Low dose works just as well for acne. It’s the cumulative dose that matters ie you have to take a total dosage of 1mg/kg at your bodyweight. Refer to this study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037971/

Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris. The benefits accrued to the society from using isotretinoin outweigh the risks, and thus low-dose isotretinoin can be used in the treatment of moderate to severe acne vulgaris as an effective modality of treatment, with a low incidence of severe side effects and at a lesser cost.

I understand why you may be keen on taking a higher dose and finishing the course sooner – but same with all other meds – doctors err on the side of giving a lower dose so the medication has minimal side effects.

Having said that, see point 3.

3. Should i go back to the dermatologist after a month to request for a much higher dosage?

Yes, I don’t see why not. As a general rule, I’d always encourage you to speak directly to your doctor about your concerns/queries. Ie tell your doctor straight up why you are keen on a higher dose of isotretinoin. If he doesn’t think it’s a good idea, he will explain to you why.

Cheers

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Should I request for a higher dose of Isotretinoin if I am on a low dose regime?

Pertaining to your isotretinoin dose, your dermatologist has done absolutely the right thing. I wouldn’t consider 30 mg low by any means. 10 – 15 mg is what’s normally considered to be in the “low range”. Even if you “shopped” around for a different doctor, I don’t think their dosage advice would differ too much from your dermatologist. Besides, it’s still relatively early days. 2 months in, and you are responding and improving. If I were you, I’d stick, rather than twist with the dose.

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How should I prevent Post-Accutane relapse, and advise on long term maintenance isotretinoin dose?

Hi S – 6 years is a long time to be on a course of isotretinoin, unless you were specifically prescribed a low dose, long term “maintenance” isotretinoin regime by your doctor. If you’ve been compliant to the dosage regime (at 120 mg/kg), 85% of patients only need one course to achieve complete remission of acne – this would take 4 – 6 months of treatment, depending on the dose administered. Relapse rates in patients after treatment with oral isotretinoin vary between 10% and 60%.

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