Q: I am a 32 years old female. My sister has been prescribed Isotroin 20 mg for one month followed by Isotroin 10 mg for 2 months by a reputed dermatologist. She does not have severe acne, but gets eruptions on face, which have reduced since she began taking Isotroin 20 mg. She has taken Isotroin 20 mg for 17 days now. Is it okay for her to take this medicine for such a long duration? I'm aware of the side effects of severe birth defects. My sister and her husband are not planning a second baby at least for the next six months. Will consuming this medicine have an affect on the liver? Does it affect the leg muscles? Can one get cancer by taking Isotroin?

A:Isotroin (isotretinoin) is indicated only when there are cystic and conglobate acne or severe acne, which do not respond to antibiotic therapy. List of precautions before using the drug:

• Exclude pregnancy before starting treatment
• Effective contraception measures must be taken by women of child-bearing potential for 1 month before, during and for at least 4 weeks after therapy
• Monitor liver functions before starting treatment, 1 month later and then at 3 months interval;
• Reduce dose or discontinue if liver enzyme (SGPT / SGOT) levels exceed normal
• Monitor fasting serum lipids before starting treatment, 1 month later and then at end of treatment
• Discontinue if there is rise in triglycerides or symptoms of inflammation of pancreas occur
• If there is history of depression
• Monitor for signs of depression and suicidal ideation.
• Avoid dermabrasion for 5-6 months, or wax epilation for minimum 6 months (such as arms, legs etc), after treatment
• Discontinue if severe diarrhoea
• Caution in diabetes
• Do not donate blood during and for one month after therapy
• Avoid sun, UV light
• Discontinue if eye or hearing disturbances occurs
• The drug can reduce tolerance to contact lenses
• Side effects include: Dryness, erosion of mucosa. Monitor for keratitis with dry eye. Loss of scalp hair. Drowsiness, dizziness, sweating, mood changes, flushing, neurological disorders, psychiatric reactions, seizures, menstrual irregularities, muscle or joint pains. Reversible blood or protein in urine. Occasionally, hearing loss, allergic vasculitis, decrease in blood platelets count, nose bleeds, visual disturbances, inflammatory bowel disorders. Breathlessness, voice changes, flushing. Osteoporosis risk (e.g. osteomalacia, anorexia nervosa) or risk of metabolic bone disorders. Back / chest pain. Palpitations. Abnormal wound healing. Monitor bone growth, glucose, complete blood count. Thrombotic disease. Pseudotumour cerebri. Liver toxicity. Glucose intolerance. Blood disorders. Rarely, facial hyperpigmentation, hirsutism (unwanted facial hair)or kidney inflammation.