Most side effects of isotretinoin are dose dependent. As a rule, with the appointment of recommended doses, the benefit-risk ratio, taking into account the severity of the disease, is acceptable to the patient.Usually, side effects are reversible after dose adjustment or drug withdrawal, but some may persist after discontinuation of treatment. The most commonly reported symptoms of undesirable phenomena associated with isotretinoin: dry skin, dry mucous membranes, such as lips (cheilitis), nose (epistaxis) and eyes (conjunctivitis). The frequency of this or that side effect is determined as follows: very often (>1/10 cases), often (>1/100 and <1/10 cases), infrequently (>1/1000 and <1/100 cases), rarely (>1/10000 and <1/1000 cases), very rarely (<1/10000 cases), the frequency is unknown (it is impossible to estimate the frequency of occurrence according to available data).
From the side of metabolism:
Rarely: diabetes, hyperuricemia.
Allergic reactions:
Rarely: allergy, anaphylactic reaction, hypersensitivity, systemic hypersensitivity reactions.
From the central nervous system:
Rarely: depression, worsening of depression, aggressive behavior, excitability, frequent change of mood;
Rarely: inadequate behavior, psychotic disorder, suicidal thoughts, suicidal attempts, suicide.
From the nervous system:
Often: headache;
Rarely: benign intracranial hypertension ("pseudotumor brain": headache, nausea, vomiting, impaired vision, edema of the optic nerve), convulsions, drowsiness, dizziness.
Frequency unknown (including individual messages): excessive fatigue.
From the skin:
Often: dermatitis, dry skin and mucous membranes, oiiohystrophy, increased proliferation of granulation tissue, rash, itching, face erythema, cheilitis, slight trauma of the skin;
Rarely: alopecia;
Rarely: increased perspiration, pyogenous granuloma, paronychia, persistent thinning of hair, reversible hair loss, nail dystrophy, fulminant forms of acne, hirsutism, hyperpigmentation, photosensitivity, photodermatosis, vasculitis (Wegener's granulomatosis, allergic vasculitis). At the beginning of treatment, there may be an exacerbation of acne, which lasts for several weeks.
Frequency is unknown (including individual messages): Stevens-Johnson syndrome,
toxic epidermal necrolysis, peeling of the skin of the palms and soles.
From the urinary system:
Often: hematuria, proteinuria;
Rarely: glomerulonephritis.
From the musculoskeletal system:
Often: myalgia (with increased activity of creatinine phosphokinase (CK) in the serum or without it) *, arthralgia;
Rarely: hyperostosis, arthritis, calcification of ligaments and tendons, other bone changes, tendinitis;
Frequency is unknown (including individual messages): rhabdomyolysis, in some cases
with a lethal outcome.
From the digestive system:
Often: transient and reversible increase in the activity of "liver" transaminases **;
Rarely: nausea, diarrhea, inflammatory bowel disease (colitis, ileitis), gastrointestinal bleeding; Pancreatitis (especially with concomitant hypertriglyceridemia above 800 mg / dl), dry throat, hepatitis.
Frequency is unknown (including individual messages): dryness of the oral mucosa, bleeding from the gums, inflammation of the gums. Rare cases of pancreatitis with a lethal outcome are described.
From the hematopoiesis:
Often: anemia, increased erythrocyte sedimentation rate, thrombocytopenia,
thrombocytosis;
Often: neutropenia;
Rarely: lymphadenopathy.
Frequency unknown (including individual messages): a decrease in hematocrit, and leukopenia.
From the respiratory system:
Often: nasal cavity bleeding, dry nasal and laryngeal mucosa, nasopharyngitis;
Rarely: bronchospasm (more often in patients with bronchial asthma in anamnesis), hoarseness.
From the sense organs:
Often: blepharitis, conjunctivitis, dry eye syndrome, eye irritation;
Rarely: individual cases of visual impairment, decreased visual acuity, contact lens intolerance, corneal opacity, color blindness and other color perception abnormalities, cataract, keratitis, optic disc swelling (as a manifestation of benign intracranial hypertension), visual disturbances, hearing impairment. Laboratory indicators:
Often: hypertriglyceridemia, a decrease in high-density lipoproteins;
Often: hypercholesterolemia, hyperglycemia;
Rarely: increased activity of CK in serum.
Other:
Rarely: local or systemic infections caused by gram-positive pathogens (Staphylococcus aureus).
* In some patients, especially those engaged in intensive physical activity,
Some cases of increased activity of CK in serum are described.
** In many of these cases, the changes did not go beyond the limits of the norm and returned to baseline in the treatment process, but in some There is a need to reduce the dose or cancel the drug Sotret.