Nutrient Depletion Associated with Accutane (Isotretinoin)
Accutane (isotretinoin) primarily depletes vitamin E levels in the body, which may contribute to some of its side effects. 1
Confirmed Nutrient Depletions
Vitamin E
- Research has demonstrated that serum vitamin E levels decrease during isotretinoin treatment 1
- In a clinical study, mean serum vitamin E levels decreased from 20.22 mg/dl before treatment to 16.24 mg/dl after treatment 1
- This depletion occurred in nearly all patients studied (43 out of 46 patients) 1
Vitamin A Considerations
- Isotretinoin is structurally related to vitamin A and has similar pharmacology and toxicity profiles 2, 3
- Due to this relationship, patients are advised against taking vitamin supplements containing vitamin A to avoid additive toxic effects 4
- Concomitant administration of vitamin A supplements with isotretinoin should be avoided 5
Clinical Implications of Nutrient Depletion
Potential Consequences
- Some side effects of isotretinoin may be related to vitamin E depletion 1
- Mucocutaneous side effects (dry skin, cheilitis, etc.) are common during treatment and may be partially related to nutrient depletion
Supplementation Evidence
- Despite the documented depletion of vitamin E, one study found that supplementation with 800 IU/day of vitamin E did not reduce isotretinoin side effects 6
- More recent reviews suggest that various oral supplements may help mitigate isotretinoin-associated side effects, particularly mucocutaneous ones 7
Monitoring and Management
Laboratory Monitoring
- Regular monitoring of liver function tests and lipid panels is recommended during isotretinoin treatment 8
- C-reactive protein should be determined at the same time as any micronutrient analysis to account for inflammation's effect on nutrient levels 5
Contraindications for Supplementation
- Vitamin A supplementation should be strictly avoided during isotretinoin treatment 5, 4
- Patients should be advised against exceeding recommended daily intake of vitamin A (2400-3000 IU or 0.8-1 mg daily) 5
Special Considerations
Drug Interactions
- Tetracyclines should be avoided during isotretinoin treatment due to increased risk of pseudotumor cerebri 4
- Systemic corticosteroids may increase risk of osteoporosis when combined with isotretinoin 4
Patient Counseling Points
- Inform patients about the relationship between isotretinoin and vitamin A
- Advise against taking multivitamins containing high doses of vitamin A
- Consider discussing potential benefits of vitamin E supplementation, though evidence for efficacy is mixed
Conclusion
While vitamin E is the primary nutrient depleted during isotretinoin treatment, the clinical significance of this depletion and the benefit of supplementation remain uncertain. Careful monitoring and avoidance of vitamin A supplementation are essential aspects of managing patients on isotretinoin therapy.