7 Accutane Interactions to Know About
Key takeaways:
Accutane (isotretinoin) is a medication that treats a severe type of acne. Avoid taking Accutane with supplements that contain vitamin A. This includes retinoid products such as Differin (adapalene), Retin-A (tretinoin), and Tazorac (tazarotene).
Many people will need to take hormonal birth control while taking Accutane. But several medications can lower the effectiveness of hormonal birth control. This includes St. John’s wort, seizure medications, and antiretrovirals. Taking these medications with Accutane could lead to an unintended pregnancy and birth defects.
Give your dermatologist and pharmacist a list of all the medications you take. Include over-the-counter items like supplements and skin care products. This will help them check for interactions.
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Table of contents
If you’ve ever experienced acne, you may have tried several products to help you get rid of it. If over-the-counter (OTC) products don’t work, your dermatologist may recommend prescription medications. One option for severe acne is an oral medication called Accutane (isotretinoin). It’s FDA approved to treat nodular acne, a severe form that happens deep within the skin.
Accutane is usually reserved for acne that doesn’t improve after trying other treatments. It can be very effective, but it has several interactions and side effects. Learning about these risks can help you know what to watch out for while taking Accutane. In particular, Accutane interactions might be more common than you think.
The brand-name Accutane is no longer available. But since many people know isotretinoin by this name, we’ll use it throughout this article.
1. Vitamin A supplements
Accutane is part of a group of vitamin A-related medications called retinoids. So it’s best to avoid taking other products that contain vitamin A while you’re taking Accutane. Getting too much vitamin A may lead to toxicity. Symptoms of vitamin A toxicity may include:
Nausea and vomiting
Headache
Dizziness
Blurred vision
Itchy and peeling skin
Dry skin, lips, and eyes
If you’re experiencing symptoms of vitamin A toxicity, contact your dermatologist immediately. You can also call Poison Control at 1-800-222-1222. If your symptoms feel severe, call 911 or seek emergency care.
Good to know: Multivitamins, and even some vitamin waters, also contain vitamin A. It’s best to avoid these when taking Accutane. If you aren’t sure whether a product you take contains vitamin A, check with your pharmacist.
2. Retinoids
The term retinoid is often used to describe any vitamin A-based product. This includes retinols, the natural form of vitamin A. It also includes retinoids, which are the chemical form.
There are several retinoids on the market. Some are available OTC, and some are prescription only. Many are applied to the skin (topical), while others are taken orally.
Examples of topical retinoids include Differin (adapalene), Retin-A (tretinoin), and Tazorac (tazarotene). Oral retinoids include acitretin and Targretin (bexarotene). Targretin is also available as a topical gel.
Combining retinoid medications with Accutane can contribute to vitamin A toxicity. Give your dermatologist and pharmacist a list of all the medications you take. Include oral and topical medications, including OTC products. This will help them check for Accutane interactions.
3. St. John’s wort
St. John’s wort is an OTC herbal supplement that may help treat depression. But it has several drug interactions. The herb isn’t known to interact with Accutane, but it may interact with birth control pills. Why would this matter to someone taking Accutane?
Accutane is known to cause birth defects. For this reason, it is prescribed under a Risk Evaluation and Mitigation Strategy (REMS) program. One requirement is that you use two forms of birth control while taking Accutane. This ensures you won’t become pregnant and risk harm to a fetus.
If you’re taking hormonal birth control, St. John’s wort can make it less effective and increase your risk of pregnancy. This is because St. John’s wort can cause hormonal birth control methods to break down in the body more quickly. But the risk is greater with oral birth control pills than other hormonal options, like some intrauterine devices.
If you’re taking St. John’s wort, tell your prescriber before starting Accutane. If you’re using hormonal birth control, you’ll need to stop taking St John’s wort. But make sure you talk to your prescriber. You may need extra support or another medication to manage your depression.
Good to know: Progestin-only birth control pills need to be taken at the same time every day to be effective. This can be hard to do. Ask your dermatologist if it’s safe for you to take a progestin-only birth control pill with Accutane.
4. Some seizure medications
Several seizure medications may be unsafe to take with Accutane. They could decrease the effectiveness of birth control. This can increase your chances of getting pregnant and having a child with birth defects.
Seizure medications that may affect birth control include Tegretol (carbamazepine), Dilantin (phenytoin), and Topamax (topiramate). Additionally, Accutane may decrease carbamazepine levels in the body. This can raise your risk of seizures.
If you take a seizure medication, tell your dermatologist before starting Accutane.
5. Rifamycin antibiotics
Rifadin (rifampin) and Mycobutin (rifabutin) are rifamycin antibiotics used for certain bacterial infections. These medications can also make hormonal birth control products less effective. Using hormonal birth control while taking Accutane could lead to an unintended pregnancy.
If you’re taking a rifamycin antibiotic and hormonal birth control, tell your dermatologist before starting Accutane. If a healthcare professional prescribes a rifamycin antibiotic, tell them you’re taking Accutane.
6. Tetracycline antibiotics
Tetracyclines are a group of antibiotics that treat bacterial infections, including acne. A few examples include Vibramycin (doxycycline), minocycline (Minocin), and tetracycline.
Rarely, Accutane can increase the fluid pressure inside your head. When combined with tetracyclines, the risk is higher. As a result, a rare but serious condition called pseudotumor cerebri may occur. Symptoms include a heartbeat-like sound in your head, headaches, and nausea.
It’s best to avoid taking tetracycline antibiotics and Accutane together. This combination is easy to avoid because several types of antibiotics are available. If you’re taking Accutane, tell all the healthcare professionals you work with. And anytime you’re prescribed a new medication, let your dermatologist know. This will help prevent this Accutane interaction.
7. Some antiretrovirals
Antiretrovirals are a group of medications that treat HIV. They can also cause hormonal birth control to be less effective. Examples include efavirenz and Viramune (nevirapine). So before starting Accutane, talk to your dermatologist if you’re taking one of these medications. An antiretroviral that doesn’t affect hormonal birth control levels may be a better option.
When should you contact your healthcare team about Accutane interactions?
The best way to manage Accutane interactions is to prevent them. This is important if you need to take hormonal birth control while taking Accutane.
Give your dermatologist and pharmacist a list of all the prescription medications and OTC products you take. Include skin care products. They can check for any Accutane interactions. Additionally, tell all your healthcare professionals if you’re taking Accutane.
If you experience side effects from Accutane, a drug interaction may be responsible. So if you start to experience dry or peeling skin, nausea, or headache, tell your dermatologist. If symptoms feel severe, including sudden vomiting or vision loss, seek emergency care.
The bottom line
Accutane (isotretinoin) is a medication that treats a severe type of acne. Like all medications, Accutane can interact with other medications and herbal supplements. Possible Accutane interactions include vitamin A supplements and retinoid products.
Additionally, several medications can affect Accutane treatment. Since Accutane may cause birth defects, you’re required to use two forms of birth control while taking it. But several medications can reduce the effectiveness of hormonal birth control. This includes certain antibiotics, seizure medications, and St. John’s wort.
Give your pharmacist and dermatologist a list of medications and OTC products you’re taking. This will help them check for interactions.
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References
American Academy of Dermatology Association. (2021). Retinoid or retinol?
Garg, A., et al. (2015). Abstract from the global literature: ‘Interaction between antiretroviral therapy and contraceptives.’ Indian Journal of Sexually Transmitted Diseases and AIDS.
JG Pharma Inc. (2023). Accutane- isotretinoin capsule, gelatin coated [package insert].
Layton, A. (2009). The use of isotretinoin in acne. Dermato-Endocrinology.
Marsden, J. R. (1988). Effect of isotretinoin on carbamazepine pharmacokinetics. British Journal of Dermatology.
National Institute of Neurological Disorders and Stroke. (2023). Pseudotumor cerebri.
Organization of Teratology Information Specialists (2023). Isotretinoin (Accutane). Mother to Baby.
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