What is the dosing schedule for isotretinoin in the treatment of acne vulgaris?

Updated: Mar 26, 2019
  • Author: Jaggi Rao, MD, FRCPC; Chief Editor: William D James, MD  more...
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Answer

Isotretinoin therapy should be initiated at a dose of 0.5 mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved. [33] Coadministration with steroids at the onset of therapy may be useful in severe cases to prevent initial worsening. [33] Some patients may respond to doses lower than the standard recommendation dosages. A lower dose (0.25-0.4 mg/kg/d) may be as effective in clearing acne as the higher dose given for the same period and with greater patient satisfaction. However, the benefit of prolonged remission is not as great with such therapy as with standard doses. [56] Lower intermittent dosing schedules (1 wk/mo) are not as effective. [56]

Some patients only require one course of oral isotretinoin for complete acne remission, while others require additional courses of isotretinoin therapy. A study found 38% of the patients had no acne during 3-year follow up, and, among the remaining patients, 17% were controlled with further topical therapy, 25% with topical and oral antibiotics, and 20% with second course of isotretinoin. [57] Relapse is more likely in younger or female patients. [57]


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