How Does Accutane Work? Plus, 6 More Accutane FAQs

Acne is a skin condition most people experience at some point in their life. While it commonly affects people between the ages of 12 and 24, older adults, and especially women, also deal with it. Several topical (applied to the skin) acne products exist. But sometimes, something stronger is needed to clear severe acne.

Accutane (isotretinoin) is the only FDA-approved medication for a type of severe acne called nodular acne. (The medication’s active ingredient is also available under the brand names Absorica, Claravis, and Myorisan.) With nodular acne, breakouts start deep under the skin and are hard and painful to the touch.

If you (or your teen) are prescribed Accutane, you may have several questions about the medication. In this article, we’ll answer seven frequently asked questions, including: How does Accutane work?

The brand-name product Accutane is no longer available, but many people know isotretinoin by this name. So we’ll use Accutane to refer to the medication throughout this article.

1. How does Accutane work?

Accutane comes from vitamin A. It’s part of a group of medications called retinoids. Researchers don’t know exactly how Accutane works. But it’s the only medication that addresses the four major causes of acne:   

1. Too much oil production

2. Inflammation

3. Clogged pores

4. Bacterial overgrowth

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2. How long does Accutane take to work?

You may see noticeable skin clearing as early as 4 weeks after starting treatment with Accutane. Most people need to keep taking it for 4 to 5 months to see significant improvement. However, if your skin clears more quickly than expected, you may be able to stop taking Accutane sooner.

And now a word of caution: During the first 1 to 2 months of Accutane treatment, your acne may temporarily worsen. This doesn’t always happen, but it’s important to know that it can. And it doesn’t mean Accutane isn’t working if it does.

3. How long do you have to take Accutane?

As mentioned above, a typical course of Accutane is 4 to 5 months long. But about 15% of people need more than one course of Accutane treatment for their skin to clear. Your dermatology care team can help you determine if you’d benefit from a second course.

Accutane courses need to be separated by at least 2 months. This is because your skin may continue clearing for several months even after you’ve stopped taking Accutane. Waiting at least 2 months between treatments ensures that the second course is truly needed. 

The skin-clearing effects of Accutane are often long term. And many people’s skin stays permanently clear.

4. Is Accutane safe?

Accutane is generally safe. It’s been on the market for more than four decades. And with more than 1 million prescriptions written each year, your dermatology care team is likely very familiar with using Accutane to treat acne. And they’ll only prescribe it to you after considering your unique risks and benefits, as well as your desire to take it.

Common side effects

Many Accutane side effects are caused by water loss in your mucous membranes. This can lead to dry lips, dry eyes, and nosebleeds. It can also cause dry, peeling skin. These side effects may be bothersome but they’re usually mild and can be managed with good moisturization. And they typically go away after you stop taking Accutane. 

Other potential side effects include muscle or joint aches and hair thinning. You may also notice increased sensitivity to sunlight. So wear sunscreen and consider additional methods of sun protection.

Serious side effects

More serious side effects are also possible, though rare. Examples include liver damage, increased cholesterol levels, and severe skin rashes. Vision loss has also been reported in people taking Accutane. 

Worsening depression and suicidal thoughts or actions have been reported in people taking Accutane. But so far, researchers haven’t found a definite link between Accutane and severe mood changes. Severe acne itself can make depression more likely, so it’s important to be aware and get help early if you or your teen is struggling.

Good to know: It’s important to give your prescriber and pharmacist a list of all of the prescription medications and over-the-counter products you take before starting Accutane. This will help them check for Accutane interactions.

5. Does Accutane cause birth defects?

Accutane can cause birth defects in up to 35% (or more) of children who are exposed to it in the womb. To avoid exposing unborn fetuses to Accutane, the FDA requires that the medication be prescribed under a Risk Evaluation and Mitigation Strategy (REMS) program. The REMS program for Accutane is called iPLEDGE. Anyone who prescribes, dispenses, or takes Accutane has to enroll in iPLEDGE.

If you could potentially become pregnant while taking Accutane, there are some specific requirements to fulfill. These include:

• Having a negative pregnancy test 1 month before and immediately before starting Accutane treatment

• Using two forms of birth control from at least 1 month before starting Accutane to 1 month after treatment stops

• Taking monthly pregnancy tests before receiving each Accutane prescription

• Not donating blood during treatment and for 30 days after the last dose (to ensure a pregnant person doesn’t receive blood with Accutane in it)

Let your dermatology care team know right away if you forget to take your birth control during Accutane treatment. And if you miss your period or become pregnant while taking Accutane, stop taking it and let your prescriber know immediately. You should also avoid becoming pregnant in the month following your last dose of Accutane. So let your prescriber know if you become pregnant during this time.

If following these safety precautions feels like too much to juggle, ask your dermatology care team whether an Accutane alternative might be worth considering.

6. Can you drink alcohol while taking Accutane?

It’s best to avoid drinking alcohol while taking Accutane. There are two main reasons for this:

1. Both substances can cause liver damage. About 15% of people have increased liver enzymes (proteins) during Accutane treatment. These changes are usually mild and go away after stopping treatment. But severe damage and inflammation can occur in rare cases. So it’s a good idea to stay away from alcohol, to decrease your risk of liver problems.

2. Accutane can increase some types of fat in your bloodstream, like triglycerides and cholesterol. Like Accutane, alcohol can increase triglycerides and cholesterol levels. High levels of these fats can raise your risk of heart attack, stroke, and liver disease.

7. Does Accutane cause hair loss?

It’s possible for Accutane to cause hair loss. Some research shows this can happen in up to 6% of people taking the medication.

If you do experience hair loss, it will most likely occur around 3 to 4 months after you start treatment. Taking a lower dosage for the shortest time needed may lower this risk. Though, keep in mind that hair loss with Accutane therapy is often temporary. 

How to save on Accutane

There are many ways to save on Accutane, which is available as both a brand-name and generic medication: 

• Save with GoodRx. GoodRx may be able to help you save over 60% off the average retail price of generic Accutane. With a free GoodRx coupon, a 1-month prescription may cost as little as $40.00 at some pharmacies.

• Save with a copay savings card. Some manufacturers offer savings programs for certain versions of isotretinoin. For instance, if you have commercial insurance, you may be eligible to pay as little as $20 for generic Absorica or $25 for brand-name Absorica with copay savings cards from the manufacturer.

Why trust our experts?

Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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