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Accutane (isotretinoin)

Side Effect Search

Underlined words or phrases provide helpful links to information in wikipedia.org and when moused over often give helpful definitions of the medical terms. Keywords

Accutane may cause the following symptom that is related to bleeding from the nose:

Nosebleeds

Medical Source Information
Yellow highlights indicate symptoms related to bleeding from the nose.

Dermatologic side effects have included cheilitis, severe mucosal drying, dry mouth, dry nose, dry skin, acne fulminans, flare of cystic acne, alopecia (persistent in some cases), epistaxis, eruptive xanthomas, erythema multiforme, skin fragility, hair abnormalities (including thinning of the hair), hirsutism, hyperpigmentation and hypopigmentation, infections (including disseminated herpes simplex), nail dystrophy, paronychia, palmoplantar desquamation, photoallergic/photosensitizing reactions, pyogenic granuloma, rash (including facial erythema, seborrhea, and eczema), Stevens-Johnson syndrome, increased sunburn susceptibility, sweating, toxic epidermal necrolysis, urticaria, abnormal wound healing (delayed healing or exuberant granulation tissue with crusting), and pruritus. Keloid formation and pyoderma gangrenosum have been reported.

Nervous system side effects have included lethargy, headache, dizziness, drowsiness, insomnia, paresthesias, seizures, stroke, syncope, weakness, pseudotumor cerebri, hearing impairment, tinnitus, and Guillain-Barre syndrome. At least one case of cerebral ischemia has been reported.

Areflexic tetraparesis necessitating ventilatory support, preceded by symptoms of lethargy, epistaxis, cough, arthralgias, paresthesia of the feet, and influenza-like symptoms (Guillain-Barre syndrome), was reported in two male patients, a 31-year-old man and a 13-year-old boy, after oral isotretinoin therapy. Both patients received IV immunoglobulin (2 g/kg) and were discharge from hospital within three months. Neither patient was rechallenged with oral isotretinoin. First patient continued to use topical isotretinoin gel without any adverse effects. A 30-year-old male experienced cerebral ischemia coincident with isotretinoin therapy. He had been given oral isotretinoin 45 mg per day for 3 months for treatment of severe acne. A cerebral computed tomography scan revealed hypodensity in the right middle cerebral territory corresponding to cerebral ischemia. No risk factors were determined. Isotretinoin was discontinued on admission and the adverse event resolved.

Side Effects to Watch
Watch closely for the following side effects and notify your physician immediately should any of these develop:

aggressive/violent behavior, psychosis/schizophrenia, depression or mood disturbances
Abnormal bruising or signs of bleeding such as bleeding from the gums, nose, digestive tract, vagina (females), faintness, dizziness, loss of consciousness, or rash (signs of problems with blood clot formation)

Lab and Diagnostic Tests
If certain symptoms develop, ask your physician whether you need the following lab tests or other diagnostic tests (if you've not already had them):

Monitor sugar, liver function tests and liver function tests
Hearing test (including tests for high frequency hearing loss) if hearing loss is suspected or if ringing of the ears occurs
Blood tests to assess normal clotting - in people who develop signs of bleeding such as abnormal bruising or signs of bleeding including bleeding from the gums, nose, digestive tract, vagina (females), faintness, dizziness, loss of consciousness, or rash

References

Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System. Bigby M, Stern RS J Am Acad Dermatol 1988;18:543-52.
Photoaggravated allergic reaction to isotretinoin. Auffret N, Bruley C, Brunetiere RA, Decot MC, Binet O J Am Acad Dermatol 1990;23:321-2.
Atypical facial scarring after isotretinoin therapy in a patient with previous dermabrasion. Katz BE, Macfarlane DF J Am Acad Dermatol 1994;30:852-3.
Atypical pyoderma as a side effect of isotretinoin. Elpern DJ J Am Acad Dermatol 1985;13:1045-6.
Granulomatous lesions appearing during isotretinoin therapy. Lane PR, Hogan DJ Can Med Assoc J 1984;130:550.
Mucosal denudation of the lips from isotretinoin therapy. Graham BS Arch Dermatol 1999;135:349-50.
Cerebral ischemia probably related to isotretinoin. Laroche ML, Macian-Montoro F, Merle L, Vallat JM Ann Pharmacother 2007;41:1073-6.
Acute depression from isotretinoin. Scheinman PL, Peck GL, Rubinow DR, DiGiovanna JJ, Abangan DL, Ravin PD J Am Acad Dermatol 1990;22:1112-4.
Isotretinoin: new therapy for severe acne. Perry MD, McEvoy GK Clin Pharm 1983;2:12-9.
Guillain-Barre syndrome seen in users of isotretinoin. Pritchard J, Appleton R, Howard R, Hughes RA BMJ 2004;328:1537.
Product Information. Accutane (isotretinoin). Anonymous Roche Laboratories, Nutley, NJ. PROD;
Uses and complications of isotretinoin therapy. Ellis CN, Krach KJ J Am Acad Dermatol 2001;45:S150-7.
Photosensitivity and isotretinoin therapy. McCormack LS, Turner ML J Am Acad Dermatol 1983;9:273-4.
Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders. Ward A, Brogden RN, Heel RC, Speight TM, Avery GS Drugs 1984;28:6-37.
Depression associated with isotretinoin therapy. Byrne A, Hnatko G Can J Psychiatry 1995;40:567.
Product Information. Accutane (isotretinoin). Anonymous Roche Laboratories, Nutley, NJ. PROD;
How safe is oral isotretinoin? Meigel WN Dermatology 1997;195:22-8.
Retinoid associated phototoxicity and photosensitivity. Ferguson J, Johnson BE Pharmacol Ther 1989;40:123-35.
Isotretinoin: new therapy for severe acne. Perry MD, McEvoy GK Clin Pharm 1983;2:12-9.
Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic. Tinoco MP, Tamler C, Maciel G, Soares D, Avelleira JC, Azulay D Int J Dermatol 2008;47:953-6.
Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System. Bigby M, Stern RS J Am Acad Dermatol 1988;18:543-52.
Acne fulminans with severe myalgia precipitated by isotretinoin therapy. Huston NR, Mules R N Z Med J 1985;98:821.
Long-term safety of isotretinoin as a treatment for acne vulgaris. Goulden V, Layton AM, Cunliffe WJ Br J Dermatol 1994;131:360-3.
Isotretinoin: a reappraisal. Conner CS Drug Intell Clin Pharm 1984;18:308-9.
Reversible melasma associated with isotretinoin. Burke H, Carmichael AJ Br J Dermatol 1996;135:862.
Analysis of common side effects of isotretinoin. McLane J J Am Acad Dermatol 2001;45:S188-94.
Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders. Ward A, Brogden RN, Heel RC, Speight TM, Avery GS Drugs 1984;28:6-37.
Excess granulation tissue responses associated with isotretinoin therapy. Robertson DB, Kubiak E, Gomez EC Br J Dermatol 1984;111:689-94.
Atypical keloids after dermabrasion of patients taking isotretinoin. Rubenstein R, Roenigk HH, Jr Stegman SJ, Hanke CW J Am Acad Dermatol 1986;15:280-5.

Multum version: 154.0 (Jun 16, 2010)

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