Adverse Reactions to Oral Retinoids An Update

Mills, Caroline M.; Marks, R.

doi:10.2165/00002018-199309040-00006

Cited by 56 publications

(40 citation statements)

References 63 publications

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“…Transient abnormalities of liver function have been reported. Increases of liver function tests are said to occur in patients on this drug [6][7][8][9]. These findings were in agreement with those of our patients.…”

Section: Discussionsupporting

confidence: 93%

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The Effect of Isotretinoin on Biotinidase Activity

Schulpis

Georgala

Papakonstantinou

et al. 1999

Skin Pharmacol Physiol

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Background: Among the reaction and effects of isotretinoin, mucocutaneous reactions, xerosis and erythema of the skin as well as elevation of liver enzymes and lipids except high density lipoprotein have been reported. Objective: Since biotinidase is mainly produced in the liver and partial biotinidase deficiency causes dermatological manifestations, seborrheic dermatitis, alopecia etc., isotretinoin side effects in relation to biotinidase activity were studied. Methods: Forty-two (n = 42) patients with severe cystic acne had liver function tests, lipid estimations, serum biotin as well as biotinidase activity evaluations before (value 1) and on the 30th day (value 2) of treatment with isotretinoin monotherapy (Roaccutane 0.5 mg/kg/24 h). The same laboratory tests were evaluated in 50 controls only once. Moreover, the effect of isotretinoin on a known plasma biotinidase activity was evaluated after incubation in vitro with various concentrations of the drug. Results: A statistically significant elevation of liver enzymes and lipids, except high density lipoprotein, was observed at the end of this study. On the contrary, biotinidase activity was found to be significantly decreased as compared to the initial values (value 1 = 4.70 ± 0.89 nmol/min/l, value 2 = 2.50 ± 0.8 nmol/min/l, p < 0.001) and to controls (5.2 ± 0.9 nmol/min/l vs. value 2 = 2.50 ± 0.8 nmol/min/l, p < 0.001). Additionally, biotin levels showed no significant alterations and the in vitro incubation of the enzyme with various concentrations of the drug exhibited no effect on its activity. Conclusion: It is suggested that isotretinoin isomers-metabolites act in the liver, resulting in low biotinidase activity.

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Section: Discussionsupporting

confidence: 93%

“…Thinning of the hair tends to be more frequent in patients receiving isotretinoin whereas the usual ocular complications are mild and benign in nature [3][4][5][6]. Dyslipidemia, muscular and skeletal complications, minor transient abnormalities of liver function have also been reported [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Isotretinoin on Biotinidase Activity

Schulpis

Georgala

Papakonstantinou

et al. 1999

Skin Pharmacol Physiol

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“…Besides its efficacy, it has many side effects too. Dyslipidemia, increased liver enzymes, as well as a reduction of the enzyme biotidinase have been reported in the literature (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 96%

Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: A prospective controlled study

Polat

Lenk²,

Bingol

et al. 2008

Journal of Dermatological Treatment

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Hcy levels are elevated in patients on Iso treatment for CA. It may be due to either the inhibition of cystathionine-beta-synthase, an enzyme required in the metabolism of Hcy, by the drug and/or the liver dysfunction. Daily supplementation with vitamin B12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy, so it is recommended to take these vitamins in case of deficiency along with Iso to prevent premature occlusive vascular disease.

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“…Adverse ocular reactions are rare and do not require dis continuation of treatment, since they are reversible. Apart from drying of the conjunctivae, mentioned above, the most notable ocular complication is impaired light-dark adapta tion and occasionally night blindness [15]. These possible adverse events should be mentioned to patients as it may pose a problem, particularly for car drivers.…”

Section: Systemic Side Effects Of Oral Isotretinoin Therapymentioning

confidence: 99%

“…Time has shown, however, that although live parameters can rise to the upper end of the normal range, they rarely exceed it [15,16]. Disturbances of lipid metabolism, manifesting as hyperlipidemia with or without hypercholesterolemia, i.e.…”

Section: Systemic Side Effects Of Oral Isotretinoin Therapymentioning

confidence: 99%

How Safe Is Oral Isotretinoin?

Meigel

1997

Dermatology

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Since oral isotretinoin (Roaccutane®/Accutane®) is the only therapy to address all major acne causes, it remains the most effective antiacne therapy available. Due to this unique efficacy and its potential side effects that are predictable and can be managed easily and effectively, it is widely used also in acne patients suffering from serious systemic diseases. As the primary mechanism of action of oral isotretinoin is suppression of sebaceous gland activity, mucocutaneous side effects such as dry lips, nasal passages and eyes are predictable. Pretreatment counseling and concomitant use of moisturizing agents usually manage these side effects effectively; in unusual cases of particularly poor tolerability, dose adjustments suffice. Severe side effects are rare, the most common being aches and pains requiring no therapy, aspirin or paracetamol. As with other retinoids, reliable contraception is mandatory for women of childbearing potential. Acne patients with serious concomitant systemic diseases, such as insulin-dependent diabetes, epilepsy or spina bifida, transplant patients, patients with renal failure, multiple sclerosis motor neuron disease and others can also safely be treated with a standard cumulative dose of 120 mg/kg per treatment course.

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Adverse Reactions to Oral Retinoids An Update

Cited by 56 publications

References 63 publications

The Effect of Isotretinoin on Biotinidase Activity

The Effect of Isotretinoin on Biotinidase Activity

Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: A prospective controlled study

How Safe Is Oral Isotretinoin?

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