Isotretinoin: what to know before you start

Isotretinoin can clear severe acne when nothing else works, but it’s not a casual choice. It works by shrinking oil glands and cutting bacteria on the skin. Many people see major improvement after one 4–6 month course, but the drug has real risks you need to understand before starting.

Key safety points

Biggest risk: birth defects. Isotretinoin causes severe fetal defects. If you can get pregnant, you must use two reliable birth-control methods and have regular pregnancy tests before, during, and after treatment. Most programs require negative tests and documented contraception.

Common side effects are dry lips, dry skin, nosebleeds, and more sensitive eyes. Less common but serious issues include high triglycerides, raised liver enzymes, and mood changes. Your prescriber will usually check blood lipids and liver tests at baseline and again after a few weeks. Tell your doctor right away if you have severe stomach pain, unexplained bruising, sudden vision changes, or strong mood shifts.

Typical dosing is based on body weight. Many plans aim for a total cumulative dose (often 120–150 mg/kg) over several months. Some people need a second course, but many get lasting benefit after one proper course.

Practical tips for managing side effects

Use thick moisturizers and a gentle cleanser. Apply lip balm frequently. If your eyes feel gritty, try preservative-free artificial tears. Avoid waxing or strong cosmetic procedures while on treatment and for months after — your skin heals differently. Don’t take vitamin A supplements or tanning treatments while on isotretinoin; that ups the risk of side effects.

Alcohol can worsen liver strain and triglyceride levels, so cut back or avoid it during treatment.

Watch for red flags that mean call your doctor: severe abdominal pain (could be pancreatitis), blurred vision, severe depression or suicidal thoughts, or signs of allergic reaction. If labs show very high triglycerides or liver problems, your prescriber may pause or stop the drug.

Want to buy isotretinoin online? You must have a valid prescription. Use a licensed pharmacy with clear contact info, verifiable reviews, and a pharmacist you can reach. Avoid sites that sell without a prescription, have no business address, or offer prices that look too good to be true. If an online provider offers a telehealth consult, make sure it’s a real licensed service and that they follow proper testing and monitoring. Never share leftover pills with others.

If you’re weighing options, ask your dermatologist about alternatives: oral antibiotics, hormonal therapy for women, or topical retinoids and benzoyl peroxide. For severe, scarring acne, isotretinoin is often the best choice, but it should be managed carefully and respectfully — with monitoring, clear contraception plans if needed, and honest talk about mood and side effects.