Indications for: ABSORICA
Severe recalcitrant nodular acne unresponsive to conventional therapy (eg, systemic antibiotics).
Limitations of Use:
Do not initiate second course of therapy (only if necessary) until ≥2 months after completing first course.
Do not substitute with other forms of isotretinoin. Swallow caps with a full glass of liquid. Give 0.5–1mg/kg/day in 2 divided doses; treat for 15–20 weeks or less if nodule count reduced by >70%; max 2mg/kg/day.
<12yrs: not established.
Pregnancy. Vitamin A allergy.
Must register patient in iPLEDGE program (see full labeling for restrictions and stipulations on use). Be fully familiar with drug's toxicity before use. Embryo-fetal toxicity: obtain 2 negative pregnancy tests prior to initiation of drug, monthly thereafter, and 1 month after treatment. Counsel patient about need for contraception; use 2 effective methods of contraception 1 month before, during, and 1 month after therapy; get written informed consent (see full labeling). Monitor blood lipids prior to treatment then at intervals until lipid response is known (usually within 4 weeks). Increased risk for hypertriglyceridemia (eg, diabetes, obesity, increased alcohol intake, lipid metabolism disorder or familial history of lipid metabolism disorder). History of psychiatric disorders; monitor and discontinue immediately if signs/symptoms develop. Discontinue and refer to specialist if papilledema or hearing disturbances occur. Discontinue if visual difficulties, severe skin reactions (eg, SJS, TEN), pancreatitis or hepatitis symptoms, abdominal pain, rectal bleeding, severe diarrhea, or uncontrolled hypertriglyceridemia occur. History of osteoporosis conditions (eg, osteomalacia, anorexia nervosa), fractures, or other bone metabolism disorders. Monitor bone growth, glucose, CPK, LFTs (at baseline, then periodically). Do not donate blood during and for 1 month after therapy. Aspirin hypersensitivity. Reduced tolerance to contact lenses. Max 1/℞. Nursing mothers: not recommended (during and ≥8 days after the last dose).
Avoid tetracyclines (increased risk of pseudotumor cerebri), Vit. A, or alcohol consumption (for ≥36hrs before lipid test). Caution with concomitant phenytoin. Avoid St. John's wort with hormonal contraceptives. Low-dose progestin-only contraceptives (eg, minipills) provide inadequate contraception. Caution with drugs that can disturb bone metabolism (eg, anticonvulsants, systemic corticosteroids).
Dry lips, skin, and eyes, back pain, arthralgia, epistaxis, headache, nasopharyngitis, chapped lips, dermatitis, blood creatinine kinase increased, cheilitis, musculoskeletal discomfort, upper respiratory tract infection, visual acuity reduced; auditory or lipid disturbances, skin reactions, pancreatitis, pseudotumor cerebri, hepatotoxicity, inflammatory bowel disease, psychiatric disorders, osteopenia, osteoporosis, hyperostosis, premature epiphyseal closure, reversible corneal opacities, decreased night vision, glucose intolerance.
Fecal, renal. Half-life: ~24 hours (32 mg), ~18 hours (40 mg).
Generic Drug Availability: