Accutane Side Effects: The Complete Guide

Accutane (Isotretinoin) is one of the most effective treatments for severe nodular acne — but it comes with a longer list of potential side effects than most medications. The good news: most side effects are manageable and temporary. The key is knowing what's normal, what's not, and when to contact your doctor.

This guide breaks down the common and serious side effects based on FDA labeling, with practical tips for managing them during your treatment course.

What Is Accutane?

Accutane is the original brand name for Isotretinoin, a powerful retinoid (Vitamin A derivative) used to treat severe acne that hasn't responded to other treatments. While the Accutane brand was discontinued in 2009, Isotretinoin is still widely available as generics including Claravis, Amnesteem, Myorisan, Zenatane, and Absorica. For a deeper dive, see our guide on what Accutane is and how it works.

Isotretinoin works by dramatically reducing sebum (oil) production, shrinking oil glands, and reducing inflammation. A typical treatment course lasts 15 to 20 weeks at a dose of 0.5 to 1.0 mg/kg/day.

Common Side Effects

These side effects affect a large percentage of patients and are generally expected during treatment. Most resolve after you finish your course.

• Dry lips (cheilitis) — Nearly universal. Expect significant lip dryness and cracking. A heavy lip balm (like Aquaphor or CeraVe Healing Ointment) becomes essential.
• Dry skin (xerosis) — Your skin will produce much less oil. Use a gentle, fragrance-free moisturizer daily.
• Dry eyes — Artificial tears can help. Contact lens wearers may need to switch to glasses during treatment.
• Dry nasal passages and nosebleeds (epistaxis) — A saline nasal spray or petroleum jelly inside the nostrils can prevent this.
• Muscle and joint aches (myalgia/arthralgia) — Common, especially with physical activity. Usually mild to moderate.
• Increased sun sensitivity — Your skin burns more easily. Wear SPF 30+ sunscreen daily and avoid prolonged sun exposure.
• Elevated triglycerides and cholesterol — Monitored through monthly blood work. Usually returns to normal after treatment.
• Elevated liver enzymes — Also monitored via blood tests. Mild elevations are common.
• Skin fragility — Skin tears and bruises more easily. Avoid waxing, laser treatments, and aggressive exfoliation during treatment and for 6 months after.
• Temporary hair thinning — Some patients notice increased shedding. Hair typically recovers after stopping the medication.

Serious Side Effects

These are less common but require immediate medical attention. If you experience any of the following, contact your doctor right away or go to an emergency room.

• Pregnancy while on Isotretinoin — This is the most critical risk. Isotretinoin causes severe birth defects in virtually all exposed pregnancies. This is why the iPLEDGE program exists. If you suspect pregnancy, stop the medication immediately and contact your doctor.
• Signs of depression or mood changes — Including persistent sadness, withdrawal from activities, irritability, or thoughts of self-harm. The link between Isotretinoin and depression is debated in the medical literature, but these symptoms should always be taken seriously.
• Severe headache with nausea or vision changes — Could indicate pseudotumor cerebri (increased pressure in the skull). This risk increases significantly if you're also taking tetracycline antibiotics — a combination that is contraindicated.
• Severe abdominal pain — Could indicate pancreatitis, especially if your triglycerides are very elevated.
• Yellowing of skin or eyes (jaundice) — A sign of liver damage. Stop the medication and seek medical care.
• Severe skin rash, peeling, or blistering — Very rarely, Isotretinoin can cause Stevens-Johnson syndrome.
• Night vision problems — Difficulty seeing in low light. If this occurs, use caution driving at night and inform your doctor.
• Hearing changes — Rare, but report any ringing in the ears or hearing loss.
• Rectal bleeding or severe diarrhea — Rarely, Isotretinoin has been associated with inflammatory bowel disease, though this connection is debated.

Side Effects in Specific Populations

Women of Childbearing Age

The iPLEDGE REMS program requires two forms of contraception (or complete abstinence), monthly pregnancy tests, and a 30-day waiting period before starting treatment. You must not become pregnant during treatment or for one month after stopping. You also cannot donate blood during treatment or for one month afterward.

Adolescents

Isotretinoin is commonly prescribed to teenagers with severe acne. Parents should be aware of the mood-related side effects and maintain open communication. There is some concern about effects on bone development with prolonged or repeated courses, though standard treatment courses are considered safe.

Patients with Pre-existing Conditions

If you have diabetes, obesity, or metabolic syndrome, your doctor will monitor your lipids and liver function more closely. Patients with a history of depression or mental health conditions should discuss this thoroughly with their prescriber before starting.

How to Manage Common Side Effects

Most patients can complete their full course of Isotretinoin with the right supportive care. Here's a practical toolkit:

• Lips: Apply a thick occlusive balm (Aquaphor, Vaseline, or Dr. Dan's Cortibalm) multiple times daily. Keep one at your desk, bedside, and in your pocket.
• Skin: Switch to a gentle, fragrance-free cleanser (like CeraVe or Vanicream). Moisturize morning and night. Skip active ingredients like benzoyl peroxide, salicylic acid, and exfoliating acids during treatment.
• Eyes: Use preservative-free artificial tears as needed. Avoid contact lenses if dryness is severe.
• Nose: Apply a thin layer of petroleum jelly inside your nostrils before bed. Use a saline nasal spray during the day.
• Joint pain: Over-the-counter pain relievers like Acetaminophen (Tylenol) can help. Stay hydrated and stretch regularly.
• Sun protection: SPF 30+ every day, even when it's cloudy. Wear a hat and protective clothing for extended outdoor time.
• Hydration: Drink plenty of water. Isotretinoin dries you out from the inside.

Final Thoughts

Accutane's side effects are real, but they're also well-studied and largely predictable. The dryness is nearly universal — plan for it. The serious side effects are rare but important to recognize early. Monthly blood work and check-ins with your dermatologist exist specifically to catch problems before they become dangerous.

If you're weighing whether Accutane is right for you, talk to your dermatologist about your specific risk factors. And if you're already on treatment and having trouble finding your next refill, Medfinder can help you locate Accutane in stock near you.