From: ((Steven B. Harris))
Subject: Re: Accutane?
Date: 23 May 1995
Newsgroups: misc.health.alternative

In <22MAY199515360283@ubvms.cc.buffalo.edu>
v074l54q@ubvms.cc.buffalo.edu (Bryan T Hoch) writes:

>
>	I am considering taking Accutane for my acne (as prescribed by my
>dermatologist).  Before I agree to it, I was hoping to get any
>information I could from any one who's had experience with it, knows
>about it, or whatever. I'm looking for general information on it (like
>benifits, short term side affects, long term side affects, succesful or
>not with it, was it worth it for you, etc.). Please send all responses to
>V074L54Q@UBVMS.CC.BUFFALO.EDU
>
>				Thanks to all those who help.
>
>							Bryan H
>

Just about everybody is happy with it, although everyone gets VERY
chapped lips (you need topical steroids to take care of this, often),
and there are a few cases of very mild arthritis here and there, which
clear with stopping or lower dosing. Or even as your body gets used to
it.  That's about the extent of the problem, for men.  It's definately
worth going for.  If you doubt, get your dermatologist to let you talk
to some patients.  And try the lower dose (one 40 mg per day) first.
You may find it works quite well enough, although taking longer to
produce results.

                                          Steve Harris, M.D.
                                       (No, I don't sell Accutane)

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Accutane and results
Date: 14 Jun 1997
Newsgroups: sci.med.pharmacy

In <01bc76ea$80a73d80$19c153cc@pharmer.link.ca> "Evan Franko"
<pharmer@link.ca> writes:
>
>
>
>data9@hotmail.com <dont@want.spam.com> wrote in article
><01ba3622$645e4e80$5fcc85ce@jack>...
>> I have just started a treatment of Accutane, for above average,
>> but certainly not severe acne and I was wondering when I should
>> expect to see results if there are no immediate flare-ups?
>> thanx in advance
>> data9@hotmail.com
>
>
>Inprovements will not happen right away.  Usually the acne will worsen
>slightly within three to four weeks.  In the four to six week time period
>some improvement will be noticeable (along with the side effects; dry
>skin, cracked lips, red face). After about six weeks improvement should
>be steady and definitely noticeable.  Also be aware that improvements
>will continue to happen even after the treatment is complete (for about a
>two months) so don't be too concerned if your acne hasn't totally cleared
>at this time.  Finally, everyone is different so these aren't hard and
>fast time lines.
>
>Evan Franko  B.S.P.



   For sure.  Many people actually see an effect with Accutane in the
first week, due to the almost immediate effect on sebum production (the
drying action).  In that sense, it's a lot more satisfying to use than
the closely related (but not identical) topical isotretinoin/Retin A
(where you often get worse before getting better).  That's the rule
with topicals, but I would say it's more the exception with Accutane.

   Of course, the really deep conglobate acne doesn't respond this
fast.  Accutane is increasingly being used for milder and more
superficial disease, however.

                              Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: Acne Drug May Cause Depression
Date: 4 Mar 1998 00:08:22 GMT

In <19980303150301.KAA04091@ladder02.news.aol.com> marleenoet@aol.com
(Marleenoet) writes:
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>>THE WEEK IN HEALTH
>>
>>Acne Drug May Cause Depression
>>
>>The U.S. Food and Drug Administration (FDA) announced this week that
>>some people using the prescription anti-acne drug Accutane
>>(isotretinoin) have reported depression, psychosis and suicidal
>>thoughts and actions.
>
>sbharris wrote:
>    Probably just a natural result of having your lips peel away and
>fall off.
>
>I take it you do not believe this drug is the perfect? I just found
>out a dear friend of mine from LA  had a near death situation
>with Accutane. She got adult acne about a year ago and
>started on the drug.
>
>She became clinically depressed & she has
>never been known to be the depressive type. Luckly they found
>it was the Accutane that was causing her deep depression. She
>still said it took 30 days from the last dose to start to feel her
>normal self. She also said the LA papers did a story about it and
>said some people actually took their life due to the depression.
>Just wanted to warn anyone who may not have heard about
>the story.
>


    You did good.  Excuse the flippant remark.

    Acutane side effects have long been known to mirror the effects of
vitamin A poisoning.  In a Mayo study of chronic vitamin A poisoning
I've seen, these included tiredness, weakness, fatigue, headache,
insomnia, loss of appetite, and "psychiatric symptoms" including
depression.  I suppose I would have been surprised if Acutane hadn't
been found to do the same, at least in some people.  Nasty stuff.

   In internal medicine, and especially geriatrics, we have the "FTD
rule."   That is: First, Think Drugs.  In other words, if your patient
has some strange sign or symptom or complaint, and recently started on
some new drug or pill or potion, THAT's the culprit, until proven
otherwise.  Even if you can't find the symptom in the PDR.  Even if it
doesn't make sense to you.

    I wail about the FTD rule to the students and residents until they
are tired of me.  But they are all destined to get nailed by forgetting
it, and causing somebody much grief, even so.  Just as I have been.
And possibly will be again.

                                    Steve Harris, M.D.
                                    A Slow Learner, But Getting There

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: Acne Drug May Cause Depression
Date: 4 Mar 1998 00:31:19 GMT

In <19980303201601.PAA12311@ladder02.news.aol.com> marleenoet@aol.com
(Marleenoet) writes:

>Syd wrote:
>Accutane causing depression is more plausible when you consider that its
>close relative, vitamin A, has also been reported (in the medical
>literature) to cause depression in high doses.  It's also very
>interesting that her depression took so long to lift after she
>discontinued the accutane; but then if accutane is fat soluble and has a
>long half-life in the body, like vitamin A/retinol, this is just what one
>would expect.
>
>She said they told her it would take about a month for it to be totally
>out of her system, and that is when she said it was exactly 30 days to
>the day that she discontinued.
>
>To think that we could have lost this beautiful soul over something like
>this is appalling. What is even more appalling is that people have
>actually committed suicide because they didn't realize the drug was
>causing this deep depression.
>
>I don't remember reading or hearing about this story before now. Has
>it been public knowledge and I just missed it?
>Marleen


    Looks like Syd beat me to the remarks about the similarity between
Accutane and vitamin A poisoning.

     However, note that the package insert (see your PDR) for the drug
says:

    "Depression has been reported in some patients on Accutane therapy.
In some of these patients, this has subsided with discontinuation of
therapy, and recurred with reinstitution of therapy."

    How about that?  Of course, this is one side effect mentioned out
of about a hundred.

                                               Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: Can Accutane cause Hypervitaminosis A?
Date: 24 Mar 1998 06:49:26 GMT

In <6f64b7$lh0@freenet-news.carleton.ca> ce090@FreeNet.Carleton.CA (T.
Porawa) writes:

>I took Accutane 2 years ago, and am now experiencing all kinds
>of side effects which I'm wondering are related to the Accutane:
>hair- brittle, falling out, nails breaking off, skin excessively
>dry (esp. after having foods containing vitamin A), nausea from
>rich meals, etc.  Is it possible that I have hypervitaminosis A?
>If so, does it ever go away?  I took Accutane only in the
>recommended dose and time period; have others experienced this?


   Yes, all are typical symptoms of hypervitaminosis A.  Only in this
case they are due directly to the Accutane, a derivative of vitamin A.
Due to fat soluability of the drug they can take 6 weeks to resolve,
and even longer for the mild arthritis symptomatology.  If you start
again, do it at a much smaller dose.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.pharmacy
Subject: Re: Accutane-long term use?
Date: 20 Apr 1998 10:22:13 GMT

In <3539A896.B7BD1EB9@hotmail.com> Christopher Maris
<auchan@hotmail.com> writes:
>
>Does anyone know the effects of long term usage of Accutane? For
>example, for an acne patient who wants to keep the oil production down
>on his/her face, would it be dangerous for that person to take a low
>dose of Accutane (5-10mgs a day) for a long period of time (years)? Any
>input would be appreciated.
>
>Chris
>


   I don't think anyone knows.  Some people have surely done it, but
long term tracking of them in the literature doesn't show up.  I'd
contact the company and see if you can get some info.  Or contact the
largest derm group in your down and talk to some older dermatologists,
who will surely have some long time users in their practices.

   Remember retinoic acid is essentially a hormone, which your body
uses to support growth in tissues in many, many places.  When you take
13 cis retinoic acid, you mess with one of your body's main hormones,
for YEARS.  That has to carry risks.  At miniumum I would do DEXA scans
and watch for osteoporosis, just as you would if you were on steroids.

   And certainly, make sure that topical application of isotretinoin at
high doses (which has got to be safe over LONG periods of time) is a
total failure.

                                           Steve Harris, M.D.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,misc.health.alternative
Subject: Re: roaccutane: what is in it? a dangerous drug?
Date: Sun, 9 Dec 2001 15:08:58 -0700

"David Wright" <wright@clam.prodigy.net> wrote in message >
> Isotretinoin is indeed a variant of vitamin A, 13-cis-retinoic acid.
>
> Your doctor was wrong not to tell you that it's a powerful drug.
> However, as long as you're getting your blood tests on schedule, you
> really don't need to worry.  Although Roaccuatane (or Accutane in the
> US) can cause liver problems, the point of the blood tests is to
> discover any incipient problems before they become serious.
>
> I know quite a few people who've used it.  Nobody suffered serious
> problems; the only change we all had in common was our acne went
> away.  You do get dry skin and eyes and may get some minor stiffness
> of the joints first thing in the morning.  It's worth it.  All those
> symptoms go away once you stop taking the Roaccutane.
>
> There have been extremely rare reports of depression as a result of
> taking this drug -- should you start feeling particularly depressed,
> see your doctor immediately.  And don't accept a brush-off on that
> one, either.  If necessary, see a different doctor.


COMMENT:

I second the above. The stuff occasionally causes pseudotumor cerebri
(headache from spinal fluid buildup, generally not a serious condition), so
watch for headaches.  If you start getting them, you need to stop the drug.

The dry lips can be treated with a steroid cream.

The most common mistake with Accutane to use of too large a dose, too fast.
40 mg a day works fine for most people-- it merely takes the patience to
take it for a couple of months.  Even 40 mg every other day has far fewer
side effects, and still has considerable anti-acne effect. Again, however,
patience is the key.

See another doc until you get drug. Dermatologists are least likely to fear
it, since they use a lot of it. Then start at a low dose (40 mg 2 or 3 times
a week), go slow, don't be afraid to stop the stuff for side effects, then
start again in a week or two when they resolve. You body gets used to the
stuff.

SBH

From: wright@clam.prodigy.net (David Wright)
Newsgroups: sci.med,misc.health.alternative
Subject: Re: roaccutane: what is in it? a dangerous drug?
Date: Mon, 10 Dec 2001 02:05:03 GMT

In article <9v0ndr$hnf$1@slb1.atl.mindspring.net>,
Steve Harris <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>"David Wright" <wright@clam.prodigy.net> wrote in message >
>> Isotretinoin is indeed a variant of vitamin A, 13-cis-retinoic acid.
>>
>> I know quite a few people who've used it.  Nobody suffered serious
>> problems; the only change we all had in common was our acne went
>> away.  You do get dry skin and eyes and may get some minor stiffness
>> of the joints first thing in the morning.  It's worth it.  All those
>> symptoms go away once you stop taking the Roaccutane.
>>
>> There have been extremely rare reports of depression as a result of
>> taking this drug -- should you start feeling particularly depressed,
>> see your doctor immediately.  And don't accept a brush-off on that
>> one, either.  If necessary, see a different doctor.
>
>
>COMMENT:
>
>I second the above. The stuff occasionally causes pseudotumor cerebri
>(headache from spinal fluid buildup, generally not a serious condition), so
>watch for headaches.  If you start getting them, you need to stop the drug.
>
>The dry lips can be treated with a steroid cream.

But you don't usually need to go that far -- most everyone I know did
fine just using ChapStick or some similar OTC product.  And you do
need it; I would have casually murdered anyone who tried to take mine
away from me.

Interestingly, I found that even after I went off Accutane, I still
needed the ChapStick, though nowhere near as often, and mostly during
the winter.  I still do -- but it was a small price to pay.

  -- David Wright :: alphabeta at prodigy.net
     These are my opinions only, but they're almost always correct.
       "If I have not seen as far as others, it is because giants
                  were standing on my shoulders."