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Hello I am a 21 yr old male with severe acne. I have recently started my course of oratane (isotretinoin) from a public hospital in Singapore. The problem is, the dermatologist i saw started me on a really low dose (10mg/day) for the first two weeks and then (20mg/day) subsequently for 2 months. I reasoned with her that I wouldn’t mind taking a higher dose as I want to experience the break out asap (before uni starts which starts 3 months later) and I wouldn’t want to take the drug over a longer period than other people would. What do you think of the low dose method? Should i go back to the dermatologist after a month to request for a much higher dosage?
Isotretinoin is a drug that needs care on the part of the doctor when prescribing.
Firstly, it is teratogenic ( causes malformed fetuses) thus a female patient CANNOT and MUST NOT get pregnant while on the pill ( and 3-6 months thereafter to be safe).
Secondly, it has possible side effects. Disturbances of your lipid levels, renal and liver function may be possible and blood monitoring must be observed for safety’s sake.
Thirdly, it can cause really dry skin and mucous membranes ( lips) etc.
All the above occur much more often in patients on a higher dose. Therefore, I can understand why your doctor is very cautious on the dosage. I would suggest for you to be patient and follow the doctor’s advice, if not, go for a second opinion.
Hi Anon – yes it’s true that in Sg doctors generally prefer giving lower dose – ie 10-20 mg, as opposed to in the UK where doctors tend to give 30-40 mg.
1. I reasoned with her that I wouldn’t mind taking a higher dose as I want to experience the break out asap
A breakout is actually not that common. I didn’t get one myself, neither did most of the patients I’ve started on Isotretinoin in the past. All doctors just tell you that it MAY happen as it’s a known side effect. Even if you do, don’t worry as your overall condition will rapidly improve over weeks.
2. What do you think of the low dose method?
Low dose works just as well for acne. It’s the cumulative dose that matters ie you have to take a total dosage of 1mg/kg at your bodyweight. Refer to this study:
Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris. The benefits accrued to the society from using isotretinoin outweigh the risks, and thus low-dose isotretinoin can be used in the treatment of moderate to severe acne vulgaris as an effective modality of treatment, with a low incidence of severe side effects and at a lesser cost.
I understand why you may be keen on taking a higher dose and finishing the course sooner – but same with all other meds – doctors err on the side of giving a lower dose so the medication has minimal side effects.
Having said that, see point 3.
3. Should i go back to the dermatologist after a month to request for a much higher dosage?
Yes, I don’t see why not. As a general rule, I’d always encourage you to speak directly to your doctor about your concerns/queries. Ie tell your doctor straight up why you are keen on a higher dose of isotretinoin. If he doesn’t think it’s a good idea, he will explain to you why.