From the Guidelines
The recommended dosing of Accutane (isotretinoin) for an adult with cystic acne is typically started at 0.5mg/kg/day and uptitrated to 1mg/kg/day as tolerated.
Important Considerations
- The goal of treatment is to achieve a cumulative dose of >220mg/kg to decrease the rate of relapse 1.
- Low-dose isotretinoin (0.2-0.4mg/kg/day) has been shown to be effective with reduced side effects, but this is typically used for mild to moderate acne 1.
- Treatment should be continued for at least two months after achieving no evidence of activity to decrease the frequency of relapse 1.
Monitoring and Precautions
- Monitoring of LFTs and lipids should be considered, but CBC monitoring is not needed in healthy patients 1.
- Pregnancy prevention is mandatory for persons of childbearing potential 1.
Treatment Duration and Relapse
- The treatment duration and cumulative dose should be individualized based on the patient's response and tolerance to the medication 1.
- Younger age at initial treatment and male gender are associated with an increased risk of relapse 1.
From the FDA Drug Label
5 to 1 mg/kg/day (see DOSAGE AND ADMINISTRATION), inhibits sebaceous gland function and keratinization. The recommended dosing of Accutane (isotretinoin) for an adult with cystic acne is 5 to 1 mg/kg/day.
- The dose should be taken with food to enhance absorption.
- The exact dose and duration of treatment should be determined by a healthcare professional. 2
From the Research
Recommended Dosing of Accutane (Isotretinoin) for Adult with Cystic Acne
The recommended dosing of Accutane (isotretinoin) for an adult with cystic acne is as follows:
- The usual oral dosage of isotretinoin for patients with cystic acne is 1-2 mg/kg/day in two divided doses, administered for 15-20 weeks 3
- A dose of 0.5 to 1.0 mg/kg/day is most effective for patients with acne who fail to respond to other forms of treatment, with virtually all patients responding to isotretinoin 4
- A higher dose of 1 mg/kg/day can reduce the relapse rate, especially in young patients and men with truncal acne and more severe disease 4
- High-dose isotretinoin, prescribed at 1.5 mg/kg/day or greater for 5-6 months, is safe and effective compared to current standard dosing practices, with a cumulative total dose of 290 mg/kg 5
- Lower dose regimens, such as 20 mg every alternate day, can also be effective and safe for mild to moderate acne, with fewer side effects 6
Factors Affecting Dosing
The following factors can affect the dosing of isotretinoin:
- Severity of acne: patients with severe acne may require higher doses or longer treatment durations 4, 5
- Age: younger patients may require higher doses to reduce the relapse rate 4
- Sex: men with truncal acne and more severe disease may require higher doses 4
- Presence of macrocomedones, ovarian dysfunction, or other underlying factors: these conditions may require additional treatments or adjustments to the isotretinoin dose 4