What are the potential interactions between isotretinoin and sertraline (Zoloft), trazodone, rosuvastatin (Crestor), tadalafil (Cialis), Truvada (emtricitabine/tenofovir), and dexlansoprazole (Dexilant)?

Isotretinoin Drug Interactions

Based on available evidence, isotretinoin has no clinically significant pharmacokinetic interactions with sertraline, trazodone, rosuvastatin, tadalafil, Truvada, or dexlansoprazole, but important pharmacodynamic considerations and monitoring requirements exist for several of these combinations.

Sertraline and Trazodone (Psychiatric Medications)

Pharmacodynamic Concerns

• Both isotretinoin and SSRIs like sertraline can independently affect mood and psychiatric symptoms 1, 2
• Isotretinoin has been associated with mood changes in 1.4% of patients, though serious psychiatric events are rare 2
• Monitor closely for additive CNS effects including depression, mood changes, or behavioral alterations when combining isotretinoin with sertraline or trazodone 1, 2

Clinical Monitoring

• Assess mood and psychiatric symptoms at each visit, particularly during the first 8 weeks of combined therapy 2
• No dose adjustments are required for either medication based on pharmacokinetic interactions 3
• Educate patients to report symptoms of depression, suicidal ideation, or significant mood changes immediately 1

Rosuvastatin (Statin Therapy)

No Direct Interaction Expected

• Isotretinoin does not inhibit OATP1B1, BCRP, or CYP3A4 at clinically relevant concentrations, so no interaction with rosuvastatin is anticipated 3
• In vitro studies showed isotretinoin decreased OATP1B1 mRNA, but clinical evaluation using biomarkers demonstrated no actual effect on OATP1B1 activity in vivo 3

Monitoring Considerations

• Both isotretinoin and rosuvastatin can independently cause myalgia and elevated creatine phosphokinase (CPK) 1, 4
• Monitor CPK levels if muscle symptoms develop, as isotretinoin has been associated with CPK elevations up to 100 times normal in rare cases 1
• Advise patients to report unexplained muscle pain, tenderness, or weakness 1, 4

Tadalafil (PDE5 Inhibitor)

No Significant Interaction

• No pharmacokinetic or pharmacodynamic interaction is expected between isotretinoin and tadalafil 3
• Isotretinoin is not metabolized by CYP3A4 and does not significantly induce or inhibit this enzyme at therapeutic concentrations 3
• No dose adjustments or special monitoring required for this combination

Truvada (Tenofovir/Emtricitabine)

No Interaction Expected

• Isotretinoin has no effect on renal tubular secretion or P-glycoprotein transport, the primary elimination pathways for tenofovir and emtricitabine 5, 3
• Truvada components are not metabolized by cytochrome P450 enzymes, eliminating potential for metabolic interactions 5
• No dose adjustments required for either medication 5, 3

Standard Monitoring

• Continue routine monitoring of renal function for Truvada as clinically indicated, independent of isotretinoin use 5
• No additional monitoring required specifically for this drug combination

Dexlansoprazole (Proton Pump Inhibitor)

No Clinically Significant Interaction

• Isotretinoin absorption is not pH-dependent, unlike some other medications, so proton pump inhibitors do not affect isotretinoin bioavailability 6
• The evidence regarding pH effects on drug absorption relates to other compounds (velpatasvir, glecaprevir) but not to isotretinoin 6
• No dose adjustments or timing modifications needed for either medication

General Isotretinoin Precautions Relevant to This Regimen

Contraindicated Combinations (Not Present in This Regimen)

• Tetracyclines should be avoided due to risk of benign intracranial hypertension 6, 1
• Vitamin A supplementation exceeding 2400-3000 IU daily is contraindicated 6
• Methotrexate should be avoided due to additive hepatotoxicity risk 6

Baseline and Ongoing Monitoring

• Lipid profile and liver function tests monthly for first 3 months, then every 3 months 6
• CPK levels if muscle symptoms develop, particularly in physically active patients 1, 4
• Pregnancy testing as clinically indicated (isotretinoin is highly teratogenic) 6

Important Clinical Pearls

• Patients should avoid vigorous changes in exercise regimen while on isotretinoin due to potential for exercise-induced rhabdomyolysis 1, 4
• Lower doses of isotretinoin (<0.25 mg/kg/day) have significantly fewer adverse effects compared to higher doses 2
• Headache with nausea and visual changes requires immediate evaluation for benign intracranial hypertension 1, 2