The 15 Accutane (Isotretinoin) Side Effects Everyone Should Know Before Starting It

If you have acne, chances are you’ve tried lots of things to get rid of it. But if nothing has worked, your dermatologist may suggest Accutane (isotretinoin). Accutane is also available as a generic product and as a branded generic. Other brands, including Claravis and Amnesteem, are also available.

Accutane has a number of side effects, and they tend to be fairly noticeable. Chapped lips, dry skin, and temporary worsening of your acne are a few examples. You may have heard that Accutane can make your nose smaller, too. While that last one isn’t true, there are many real side effects and risks to consider before you start the medication.

For many people with severe acne, Accutane is worth it, even with the side effects. Here’s what you should know before starting it.

Accutane (isotretinoin) side effects at a glance

Accutane side effects may be pesky, but they typically are not permanent. They’ll typically resolve after you’ve finished your treatment course. But in rare cases, more serious side effects are also possible.

Common Accutane side effects include:

• Dry lips

• Peeling skin

• Dry eyes

• Nosebleeds

• Worsening acne

• Muscle and joint pain

• Thinning hair

• Increased sun sensitivity

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Less common but potentially serious Accutane risks include:

• Serious skin rash

• High cholesterol

• Stomach problems

• Liver problems

• Hearing changes

• Increased pressure around the brain

• Mood changes, including depression and suicidal thoughts and behaviors

• Severe allergic reactions

Accutane also has a boxed warning (the FDA’s strongest medication warning) against taking it during pregnancy as it may cause harm to a growing fetus.

Below, we break down what you should know about 15 Accutane side effects and how to manage them.

1. Dry lips

Accutane works a few different ways to treat acne. One of these is by targeting excess oil production that can contribute to clogged pores. But this effect can also dry out your skin, especially on your lips.

Dry, chapped lips are common with Accutane. This should improve after you stop taking it. A typical course of Accutane lasts about 4 to 5 months. During that time, using a good lip balm, Vaseline, or Aquaphor to keep your lips hydrated is a must.

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2. Peeling skin

Dry skin is another common Accutane side effect. It can cause your skin to flake and peel. Like dry lips, peeling and flaking skin should subside after you stop taking the medication.

A good moisturizer is key to making this side effect more manageable. Be sure to choose one that’s oil-free to prevent breakouts. Your dermatologist can recommend a moisturizer that’s good for your skin type.

3. Dry eyes

Accutane doesn’t just dry out your skin. It can dry out your eyes, too. If you wear contact lenses, your eyes may be more sensitive to them during and shortly after treatment with Accutane. Over-the-counter (OTC) eye drops, such as artificial tears, can help provide relief from dry, irritated eyes.

There are many brands of eye drops to choose from, including those with and without preservatives. Preservative-free drops can be more expensive. But they may be a better option if you’re having to use the drops several times a day or if you wear contact lenses. That’s because preservatives found in other drops can be harmful to your eye.

Accutane can cause other eye problems as well. One potential side effect is trouble seeing in the dark (night blindness), which can make it difficult to drive. In some cases, this issue may not resolve after you stop treatment. Let your dermatologist know if you notice any vision changes.

4. Nosebleeds

Your nasal passages can also become dry and irritated during Accutane treatment. This can result in nosebleeds. Hydration is essential in managing this side effect. Applying petroleum jelly inside of your nose can help keep it moist.

5. Worsening acne

As with many acne treatments, it can take time to start seeing results while using Accutane. And your skin may get worse before it gets better. It’s important to keep this in mind as you’re getting started.

But after a month or two of taking the medication, your skin should start clearing up. And it should continue to do so for a period of time after you’ve finished treatment.

6. Muscle and joint pain

Accutane can also affect other parts of your body, including your muscles and joints. You may experience mild to moderate muscle or joint pain during treatment. This is usually temporary and should get better after you stop taking Accutane.

If this side effect becomes bothersome, your dermatologist may suggest an OTC pain reliever to help. But if you develop muscle weakness, let them know right away. While rare, this can be a sign of serious muscle damage.

7. Thinning hair

You may notice your hair thinning during Accutane treatment. This side effect is usually temporary. Your hair should grow back after you stop the medication.

Not everyone will experience thinning hair from Accutane. But if you do, talk to your dermatologist. They can give you suggestions for shampoos and other products to help keep your scalp and hair healthy during treatment.

8. Sun sensitivity

Accutane can make your skin more sensitive to the sun. This can increase your risk of getting a serious sunburn. 

In addition to being diligent about wearing sunscreen, there are additional ways to protect your skin while you’re outside. For instance, it’s a good idea to wear sunglasses and protective clothing such as long sleeves and a wide-brimmed hat. You should also avoid tanning beds and do your best to avoid being in the sun for long periods of time.

9. Skin rash

Some people can develop serious skin rashes from taking Accutane. If you develop a rash, especially one that’s accompanied by a fever or by blistering or peeling skin, stop the medication and contact your dermatologist right away. 

10. Harm to a growing fetus

Accutane has a boxed warning about the risk of life-threatening harm to a growing fetus. Because of this, Accutane is only available if you sign onto a special risk management program called iPLEDGE. Everyone taking Accutane must be enrolled, even if they can’t get pregnant.

But if you can get pregnant, you’ll need to use two forms of birth control for at least 1 month before, during, and 1 month after treatment. Monthly pregnancy tests are also required. This is to prevent a growing fetus from being exposed to Accutane. Let your dermatologist know right away if you become pregnant during treatment.

11. Stomach problems

Accutane can also damage other organs in your body, including your intestines and esophagus. If this happens, you may experience stomach-related problems, such as stomach pain, diarrhea, or heartburn. Rectal bleeding and trouble swallowing are also possible. Let your dermatologist know right away if these symptoms develop.

12. Liver problems

Although uncommon, liver problems have been reported in some people taking Accutane. Your liver will be monitored before and during treatment to ensure it’s safe for you to take Accutane.

Let your dermatologist know right away if you develop symptoms like jaundice, abdominal pain, and dark urine during treatment. These may be signs or symptoms of liver damage.

13. High cholesterol

Accutane can affect cholesterol levels, including your level of triglycerides (fats in your blood). Because of this, your cholesterol is checked before and during treatment. If you’re at higher risk for cholesterol problems (for instance, if you have Type 2 diabetes), it may be checked more frequently.

High triglycerides can sometimes cause inflammation in your pancreas (called pancreatitis). If this happens, you may experience nausea, severe abdominal pain, and jaundice. Get immediate medical attention if these symptoms develop.

14. Increased pressure on the brain

While rare, increased pressure on the brain (intracranial hypertension) has been reported in people taking Accutane. This may be more likely to develop if you’re also taking a tetracycline antibiotic at the same time.

Early indicators of this side effect may include headache, nausea and vomiting, and vision changes. Let your dermatologist know right away if you notice these symptoms. If pressure on the brain is left untreated, you may experience vision problems or permanent vision loss.

Before starting Accutane, share your current medication list with your dermatologist. They can review it for any medications that might increase the risk of this side effect.

15. Mood changes

Some people have reported mood changes while taking Accutane. This can include depression and thoughts of suicide or self harm. But it’s not clear if Accutane is the cause of this side effect, especially since having acne is associated with developing depression.

Your dermatologist will ask you about your personal and family mental health history before you start Accutane and during each visit. Let them know right away if you notice any changes in mood or behavior.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.  

Are Accutane side effects different between men and women?

Most Accutane side effects are similar between men and women. But one study found that muscle pain was more commonly reported by women. The likelihood of other side effects, such as abnormally dry skin, may be influenced by factors such as your dose and age.

When should you contact your dermatologist about Accutane side effects?

Your dermatologist will be monitoring you closely while you’re taking Accutane. In fact, you’ll need to meet with them every month to refill your prescription. Let them know about any side effects you’re experiencing. They can determine if Accutane is still safe for you to take.

But if you’re experiencing any side effects that seem severe or life-threatening, go to your nearest ER. This includes symptoms of a severe allergic reaction, such as swelling of the face, lips, or throat, difficulty breathing, and a fast heartbeat.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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