The side effects of isotretinoin can also include pain in the:bonesjointsmusclesligaments

bleeding gumsa lack of appetiteheartburnstomach painbowel paindark urinenauseavomitingdiarrhearectal bleeding

mental health problems, including depression, psychosis, and suicidal thoughts. Warning signs include emotional outbursts, withdrawal, and seeing or hearing things that aren’t real. Get medical help immediately if you have any of these symptoms.

ymptoms of increasing brain pressure include:severe headacheblurred visiondizzinessnauseavomitingseizuresstroke

hearing loss can become permanent.

trouble seeing in the dark.

r central nervous system.

iPLEDGE

It’s not clear if that can cause birth defects.

small or missing earshearing losssmall eyes, which is called microphthalmiamissing eyesa small or missing thymus gland, which is responsible for making white blood cellsa cleft palatecongenital heart defects

four weeks after you stop taking it

birth control, plus a backup method.

develop fragile skin, rash, or peeling skin on the palms and soles

which can make your nose bleed

chapped lips

your acne may get worse before it gets better

You shouldn’t take vitamin A supplements while taking isotretinoin.

including other skin problems and certain kinds of cancer

Vulgaris

Particular vigilance may be warranted in the case of patients with a personal or family history of bipolar disorder or other psychiatric illness.

Kontaxakis et al100 speculated that genetic factors may predispose certain individuals to psychiatric adverse effects when taking isotretinoin, based on 4 cases observed in 2008 where psychiatric symptoms were deemed likely attributable to isotretinoin use. Two cases involved patients with a family history of psychosis and affective disorder, and for these patients isotretinoin induced mixed clinical syndromes with both psychotic and depressive features. The other 2 cases involved patients with a family history of affective disorder or psychosis, and for these patients isotretinoin induced nonpsychotic major depression and schizophrenia, respectively. The authors speculated that isotretinoin-induced psychiatric symptoms may be the product of a gene–environment interaction, where isotretinoin treatment functions as an environmental stressor

The search for literature related to psychiatric effects of isotretinoin yielded a single description of Kleine-Levin syndrome, characterized by periodic hypersomnia and cognitive and behavioral symptoms, in close temporal relation to the start of isotretinoin treament

observing that individuals with Fragile X syndrome and Williams syndrome show neuropsychological profiles similar to those of children exposed to isotretinoin during early embryogenesis.97

homocystein

t is notable that retinoid dysregulation has previously been linked to schizophrenia.

or few effects on spatial learning and memory in rats (with a dose of 7.5 mg/kg).

The literature also includes reports of panic attacks in a 20-year-old man and another 17-year-old patient in relation to use of isotretinoin

disorder after 7 years of

Isotretinoin is contraindicated in psychosis because it worsens the course of the disease.77 Similarly, an excess of dietary vitamin A has been reported to induce psychosi

diosyncratically susceptible patients may exist, or that individuals with a family history or personal history of mental illness may be susceptible.

In the United States in 2015, isotretinoin ranked in the top 10 of the FDA's database of drugs associated with reports of depression and suicide attempt

Information regarding depression was added to isotretinoin labeling in 1998 in response to numerous reports submitted to the FDA MedWatch system

71 reports of severe psychiatric disorders involving isotretinoin

25.16% of adverse effects

with the isotretinoin user group showing relatively increased use of mental health resources compared with controls

Beck Depression Inventory, and Beck Depression Inventory scores were found to decline significantly (P < 0.001) among patients taking isotretinoin.54

has remained controversial

In the United States, questions regarding isotretinoin's psychiatric safety came to broader public attention after a 15-year-old male patient flew a stolen plane into a Florida office tower and his family filed a wrongful death lawsuit against isotretinoin's manufacturer, attributing the pilot's acute psychosis to use of the medication.

37 suicides were also reported to the FDA.

400 case reports received by the US Food and Drug Administration (FDA) from 1982 to 2000 alone,

Reported effects have included agenesis of the cerebellar vermis; malformation of posterior fossa; multiple leptomeningeal neuroglial heterotopias; hydrocephalus; abnormalities of the corticospinal tracts; mid-hindbrain malformations; craniofacial defects including anotia and microtia; abnormalities of the inner ear; ocular, retinal, or optic nerve abnormalities, including myopia and light sensitivity; psychomotor retardation; mental retardation; learning disabilities; and premature birth.25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35

induce depression-related behaviors by decreasing adult neurogenesis or altering expression of components of the serotonergic neurotransmitter system, resulting in impaired serotonin signaling.

sebocyte differentiation

basal sebocytes

Literature was obtained by English-language PubMed search for the term isotretinoin in combination with each of the terms psychosis, psychiatric, and teratogenic.

thalidomide

limited to inflammatory bowel disease,

efficacious drug

remains to be clarified

epression, and suicide is well documented but controversial. A link to psychosis and exacerbation of bipolar symptoms is less extensively addressed in the literature.

conceptualization

primarily teratogenic)

Resulting articles met inclusion criteria for review if they addressed psychiatric side effects of isotretinoin treatment or the neurobehavioral teratology of isotretinoin.

this association remains controversial.

ISO's list of contraindications and warnings has continuallyincreased over the years to now include the possibility of acute orchronic psychiatric disorders, including sadness, depression, irrit-ability, increased aggression, loss of concentration, loss of appetite,and suicide-related behavior