Isotretinoin

Isotretinoin is a retinoid, which is a type of Vitamin A. It is commonly used for the treatment of severe acne. Retinoids are thought to influence the way in which cells grow and develop, and prevent the production of specific genes that may cause cancer.This page from Great Ormond Street Hospital (GOSH) explains what isotretinoin is, how it is given and some of the possible side effects.

Isotretinoin is a retinoid, which is a type of Vitamin A. It is commonly used for the treatment of severe acne. Retinoids are thought to influence the way in which cells grow and develop, and prevent the production of specific genes that may cause cancer.

It is known to be effective in the treatment of a number of different types of cancer. It has recently been shown to improve survival in patients with a stage four neuroblastoma.

Isotretinoin is also called 13-cis-retinoic acid, which is available as 10mg and 20mg capsules( and 20mg/ml oral liquid if you are on a clinical trial) . There is now also a liquid formulation available as part of a clinical trial for patients with neuroblastoma.

Soya allergy - Isotretinoin capsules contains soya. If your child is allergic to soya he or she should not take isotretinoin. Please tell your doctor who will be able to discuss possible alternative treatment with you.

It is given by mouth as a capsule or liquid. You should give one dose to your child twice a day for 14 days in a row, followed by a break of 14 days. Your doctor or pharmacist will tell you how many capsules to give.

This 28-day course is usually repeated five more times. Giving the treatment in this way has been shown to be the best way to achieve maximum effect with the minimum of side effects.

Moisturisers and lip salves containing vitamin E should be used during treatment with isotretinoin, ideally even before the skin and lips become cracked and dry.

Your child’s skin may also become more sensitive to sunlight. Your child should avoid being exposed to sunlight and other forms of ultraviolet light.

If they do go out in the sun, always use a good sunblock (SPF 50 or higher and wear a hat).

Isotretinoin may change how well your child’s liver works. These changes may happen rapidly. Blood tests (LFTs) will be taken to monitor your child’s liver function during treatment. Please contact your doctor immediately if your child complains of pain in their right side or the whites of their eyes or their skin develops a yellow tinge.

Isotretinoin can cause raised levels of some fats in the blood (triglycerides). This will not have any noticeable effect. Blood tests will be taken and doses adjusted if necessary.

Isotretinoin must not be given to girls who may be pregnant or are likely to become pregnant in the near future. If your daughter is ten years old or older, we will ask her about her periods and any possibility that she could be pregnant. We will also carry out a pregnancy test on a fresh urine sample. If your daughter is sexually active, she must use a reliable form of contraception.

There will be a temporary reduction in how well your child’s bone marrow works. This is unlikely to have any noticeable effects.

Some medicines can react with isotretinoin, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.

You can mix the medication with ice cream, yoghurt or similar food like chocolate mousse, as below. You should do this away from bright sunlight.

1.  Assemble all the equipment you will need:

• gloves (disposable or household)
• a small pair of sharp, clean scissors (to be used only for this purpose)
• a dessert spoon
• a teaspoon
• a small tray (this can be plastic or disposable cardboard)
• small portion of ice cream, yoghurt or chocolate mousse
• kitchen roll - kept just for this purpose
• a sharps bin
• a plastic medicine pot 

2. Put the on gloves.
3. Remove the capsule from the blister pack and put the required number of capsules for each dose into the plastic medicine pot.
4. Place the dessert spoon on a clean surface.
5. Take a capsule between finger and thumb and hold upright firmly
6. Working over the tray use the scissors to cut the tip off the capsule and then carefully squeeze the contents on to the dessert spoon. 

7. Discard the empty capsule in the sharps bin.
8. Use the kitchen roll to wipe any drug from the gloves and then dispose of the used kitchen roll immediately in the sharps bin.
9. Repeat for each capsule needed.
10. After all the required capsules have been snipped, use the teaspoon to place some soft ice cream, yoghurt or mousse onto the dessertspoon.
11. Using the teaspoon mix the ice cream, yoghurt or mousse with the medicine. 
12. Give the medicine to your child.
13. Clean all equipment, including scissors and gloves (if using house-hold gloves) in warm soapy water.
14. Put the disposable gloves in the sharps bin. Wash your hands thoroughly.
15. Return the sharps bin to hospital when full.

• If you accidentally spill the contents of the capsules or mixture on the work surface or floor, wearing gloves, cover the spillage with kitchen paper. Wipe the area with water then clean with household cleaner and water. 
• If the mixture gets onto your skin, you must wash the area immediately, using plenty of water. If the skin is sore you should contact your GP (family doctor) for advice.
• If the mixture accidentally gets into your eyes, wash with plenty of running water for at least 10 minutes. If your eyes are sore after this, you should go to your nearest Accident and Emergency (A&E) department.
• If the mixture is spilt on clothing, the spill should be blotted dry with kitchen paper. Clothing should be removed immediately and washed separately from other items. Used kitchen paper should be disposed of as above.
• Used paper towels, masks, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.

• Keep all medicines in a safe place where children cannot reach them. 
• Isotretinoin capsules should be kept in a cool, dry place away from direct sunlight or heat. Keep the capsules in their original packaging. 
• You may be able to obtain further supplies from your Shared Care Centre. Ask the pharmacist when you collect your child’s prescription. You cannot get this medicine from your GP or local community pharmacy.
• Do not give your child any other medicines that contain Vitamin A, while they are taking isotretinoin. If you are not sure about other medicines, please ask your pharmacist, doctor or nurse.
• You should handle these medicines with care, avoiding touching the capsules where possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our Special handling requirements information sheet for further details.
• If you forget to give your child a dose and it is within a few hours of when the dose was due, give it as soon as you remember. Otherwise, do not give this dose but wait until the next dose is due. Do not give a double dose. 
• If your child vomits straight after taking the dose, inform your doctor or nurse, as your child may need to take another one.
• If your doctor decides to stop treatment with isotretinoin or the medicine passes its expiry date, return any remaining medicine to the pharmacist. Do not flush it down the toilet or throw it away.