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Side-effects of Accutane
The most feared complication of isotretinoin is its teratogenicity, i.e., the ability to cause birth defects. Isotretinoin has many side effects, listed in the table on the right. The more severe side effects are listed here in more detail.
It is also worth noting that the following side effects can persist, even after discontinuing therapy:
- Alopecia (hair loss)
- Arthralgias
- Decreased night vision
- Degenerative Disc Disease
- Cartilage Degeneration
- Bone disease
It should also be mentioned that isotretinoin users are not allowed to give blood for at least a month after having discontinued isotretinoin use.
Teratogenicity
Isotretinoin is a teratogen - it is highly likely that if taken during pregnancy that it will cause birth defects. In the USA, isotretinoin is in pregnancy category X. Isotretinoin must be prescribed under a policy that mandates that female patients be placed on two separate, effective forms of birth control [3]. Male patients should be informed of the risk associated with use during pregnancy, emphasising that they should not share the drug, especially with females.
In the U.S. more than 2,000 women have become pregnant while taking the drug between 1982 and 2003, with most pregnancies ending in abortion. About 160 babies with birth defects were born. Doctors normally require two separate methods of birth control for sexually active women taking isotretinoin and until one month after terminating the drug.
Depression
Several studies [4][5][6] have emerged suggesting a possible link between isotretinoin and depression. It must however be acknowledged that its primary use is for the treatment of the most severe acne. The possibility that this severe acne is causing the depression is therefore not to be ruled out. Moreover, improvement of a patient's acne by successful treatment with isotretinoin can actually reduce symptoms of anxiety and depression. [7] Statistical evidence shows that the suicide rate among Accutane users is actually lower than average. [8]
Emory University conducted a study of isotretinoin and depression. The study subjects were given psychological tests beforehand that showed no correlation between the severity of their acne and feelings of depression. A baseline PET scan of all the subjects was done. A second PET scan showed that individuals who had used the drug for four months showed decreased activity in the orbitofrontal cortex, a section of the brain thought to control mood and social interaction. Individuals in the control group who had not used the drug showed no change. (Bremner et al. 2005)
Alleged cases of isotretinoin linked suicide
After Charles Bishop, a 15-year old student pilot, flew a light aircraft into a Tampa, Florida building on January 5, 2002, his family claimed Accutane had caused severe psychosis in the boy and filed a $70 million lawsuit against Hoffman-La Roche. However, an autopsy found no traces of the drug in the boy's system.
Bart Stupak, a Michigan congressman, has alleged this connection ever since his son, B.J., an Accutane user, committed suicide hours after his junior prom in May 2000. (this article compliements of Wikipedia)
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