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Isotretinoin: profile and news
Huddersfield Town 2, Doncaster Rovers 2 07 Mar 2006 Right people in right jobs key to Radiophone's success 07 Mar 2006 Josephine Marie Fieata 07 Mar 2006 ITALY-USA: URSO, ALLIANCE WITHOUT INFERIORITY COMPLEX Mar 1, 2006 ITALIAN PRODUCTS: URSO IN ALBANIA WITH 80 ITALIAN FIRMS Feb 21, 2006 FOREIGN TRADE: URSO - 2006 STARTS WELL FOR MADE IN ITALY Feb 23, 2006 MEDITERRANEAN FORUM: URSO, SPECIAL LAW FOR NEXT FIVE YEARS Feb 20, 2006 CHINA:URSO, EU DECISIONS OVER SHOES NECESSARY BUT INSUFFICIENT Feb 23, 2006 URSO: 30 MLN EURO FUND FOR NEW JOINT-VENTURES WITH ALBANIA Feb 22, 2006 TRADE: URSO, ANTIDUMPING DUTIES ON KOREAN FRIDGES SOON Feb 17, 2006 BIRD FLU: URSO, ITALIAN POULTRY IS SAFE, NO TO ALARMISM Feb 13, 2006 MADE IN ITALY: URSO, BIOTECHNOLOGY IN INTERNATIONAL MARKETS Feb 8, 2006 TEXTILES: ITALY-CHINA AGREEMENT HERALDED BY URSO Feb 2, 2006 Europeans Again Lift Rates and Hint at More Increases Mar 3, 2006 For now, Fauquier sticking with the stickers Feb 28, 2006 Watershed group to study helping fish over two dams Mar 1, 2006 2nd killer of teen gets life in prison Feb 24, 2006 EU Says France May Break Law in Suez-GDF Merger Case (Update2) Mar 3, 2006 CHARIHO'S CHOICES Mar 5, 2006 Man gets life in girl's murder Feb 24, 2006 Slain teen's mother tells of her anguish Feb 23, 2006 Argentina extradites Bosnian Serb Feb 20, 2006 Man gets life sentence for teen's rape, murder Feb 24, 2006 ECB Ups Key Interest Rate to 2.5 Percent Mar 2, 2006 Peabody people Mar 1, 2006 Prosecutors: Prison didn't slow Megale's mob career Feb 28, 2006 Axcan announces record revenue of $70.6 million for the first ... Feb 9, 2006 Argentina sends Bosnian Serb war criminal to Hague Feb 20, 2006 VERONA: LUXURY EXHIBITION BEGINS ON SATURDAY Feb 21, 2006 COUNCILOR ECHOS WOMEN'S CONCERN Feb 24, 2006 Still rolling Feb 14, 2006 HOPKINTON DRAWS 23 APPLICATIONS FOR MANAGER'S POST Feb 3, 2006 Todd Spehler Drives Soccer Team to Town's First Tournament Success Feb 10, 2006 BERLUSCONI SPEAKING BEFORE US CONGRESS Mar 1, 2006 How young is too young for the catwalk? Feb 4, 2006 ECB Ups Key Interest Rate to 2.5 Percent Mar 2, 2006 Seminoles Exact A Bit Of Revenge On Gators With 6-4 Win Feb 28, 2006 CENTRAL CATHOLIC OPENS PENGUINS CUP SERIES WITH 9-3 VICTORY Mar 2, 2006 Highland girls still nest as DAC's best Feb 28, 2006 St. John's fencers earn share of state title Feb 27, 2006 Food events Mar 1, 2006 ELECTIONS: AN, SURVEYS? WIND HAS CHANGED Feb 4, 2006 Italy suspends seal skin imports Feb 13, 2006 Gwinnett swim teams win 10 events over weekend Feb 14, 2006 Jilted Italy considers revenge over French snub Feb 26, 2006 Brussels puts the boot into China over unfair shoe support Feb 23, 2006 Murderer's family pleads for his life Feb 23, 2006 TRADE: AGREEMENT BETWEEN IATT FOR "GREEN" TECHNOLOGIES Feb 1, 2006 EU puts foot down on imports Feb 23, 2006 Other information Indication For the treatment of severe recalcitrant nodular acne Pharmacology Isotretinoin, a retinoid, is indicated in the treatment of severe recalcitrant nodular acne. Nodules are inflammatory lesions with a diameter of 5 mm or greater. The nodules may become suppurative or hemorrhagic. "Severe," by definition, means "many" as opposed to "few or several" nodules. Clinical improvement in nodular acne patients occurs in association with a reduction in sebum secretion. The decrease in sebum secretion is temporary and is related to the dose and duration of treatment with Accutane, and reflects a reduction in sebaceous gland size and an inhibition of sebaceous gland differentiation. Mechanism Of Action Isotretinoin noticeably reduces the production of sebum and shrinks the sebaceous glands. It stabilises keratinization and prevents comedones from forming. The exact mechanism of action is unknown, however it is known that it alters DNA transcription. Drug Category Anti-acne Agents; Skin and Mucous Membrane Agents (84:92.00); ATC:D10AD04; ATC:D10BA01 Brand Names/Synonyms Accutane; Accutane Roche; Amnesteem; Avita; Claravis; Isotretinoin; Lsotretinoin; Renova; Retin-A; Retin-a Micro; Retinoic Acid; Retinoic Acid, All Trans Isomer; Sotret; Tretinoin; Vesanoid; Vitamin a Acid Dosage Forms CAPSULE Absorption Not Available Interactions -->Interactions for Isotretinoin: · Vitamin A: Because of the relationship of Accutane to vitamin A, patients should be advised against taking vitamin supplements containing vitamin A to avoid additive toxic effects. · Tetracyclines: Concomitant treatment with Accutane and tetracyclines should be avoided because Accutane use has been associated with a number of cases of pseudotumor cerebri (benign intracranial hypertension), some of which involved concomitant use of tetracyclines. · Micro-dosed Progesterone Preparations: Micro-dosed progesterone preparations ("minipills" that do not contain an estrogen) may be an inadequate method of contraception during Accutane therapy. Although other hormonal contraceptives are highly effective, there have been reports of pregnancy from women who have used combined oral contraceptives, as well as topical/injectable/implantable/insertable hormonal birth control products. These reports are more frequent for women who use only a single method of contraception. It is not known if hormonal contraceptives differ in their effectiveness when used with Accutane. Therefore, it is critically important for women of childbearing potential to select and commit to use 2 forms of effective contraception simultaneously, at least 1 of which must be a primary form, unless absolute abstinence is the chosen method, or the patient has undergone a hysterectomy. · Phenytoin: Accutane has not been shown to alter the pharmacokinetics of phenytoin in a study in seven healthy volunteers. These results are consistent with the in vitro finding that neither isotretinoin nor its metabolites induce or inhibit the activity of the CYP 2C9 human hepatic P450 enzyme. Phenytoin is known to cause osteomalacia. No formal clinical studies have been conducted to assess if there is an interactive effect on bone loss between phenytoin and Accutane. Therefore, caution should be exercised when using these drugs together. · Systemic Corticosteroids: Systemic corticosteroids are known to cause osteoporosis. No formal clinical studies have been conducted to assess if there is an interactive effect on bone loss between systemic corticosteroids and Accutane. Therefore, caution should be exercised when using these drugs together. Prescribers are advised to consult the package insert of medication administered concomitantly with hormonal contraceptives, since some medications may decrease the effectiveness of these birth control products. Accutane use is associated with depression in some patients. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. Johnís Wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding on oral contraceptives shortly after starting St. John's Wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John's Wort. Laboratory Tests Pregnancy Test Female patients of childbearing potential must have negative results from 2 urine or serum pregnancy tests with a sensitivity of at least 25 mIU/mL before receiving the initial Accutane prescription. The first test is obtained by the prescriber when the decision is made to pursue qualification of the patient for Accutane (a screening test). The second pregnancy test (a confirmation test) should be done during the first 5 days of the menstrual period immediately preceding the beginning of Accutane therapy. For patients with amenorrhea, the second test should be done at least 11 days after the last act of unprotected sexual intercourse (without using 2 effective forms of contraception). Each month of therapy, the patient must have a negative result from a urine or serum pregnancy test. A pregnancy test must be repeated each month prior to the female patient receiving each prescription. · Lipids: Pretreatment and follow-up blood lipids should be obtained under fasting conditions. After consumption of alcohol, at least 36 hours should elapse before these determinations are made. It is recommended that these tests be performed at weekly or biweekly intervals until the lipid response to Accutane is established. The incidence of hypertriglyceridemia is 1 patient in 4 on Accutane therapy. · Liver Function Tests: Since elevations of liver enzymes have been observed during clinical trials, and hepatitis has been reported, pretreatment and follow-up liver function tests should be performed at weekly or biweekly intervals until the response to Accutane has been established. · Glucose: Some patients receiving Accutane have experienced problems in the control of their blood sugar. In addition, new cases of diabetes have been diagnosed during Accutane therapy, although no causal relationship has been established. · CPK: Some patients undergoing vigorous physical activity while on Accutane therapy have experienced elevated CPK levels; however, the clinical significance is unknown. There have been rare postmarketing reports of rhabdomyolysis, some associated with strenuous physical activity. In a clinical trial of 217 pediatric patients (12 to 17 years) with severe recalcitrant nodular acne, transient elevations in CPK were observed in 12% of patients, including those undergoing strenuous physical activity in association with reported musculoskeletal adverse events such as back pain, arthralgia, limb injury, or muscle sprain. In these patients, approximately half of the CPK elevations returned to normal within 2 weeks and half returned to normal within 4 weeks. No cases of rhabdomyolysis were reported in this trial. Chemical IUPAC Name 3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexenyl)-nona-2,4,6,8-tetraenoicacid Chemical Formula C20H28O2 Half Life 17-50 hours Drug Type Approved Drug # Accession No APRD00140 CAS Registry Number 4759-48-2 |
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