Accutane dose is usually 0.5 to 2mg per kilo of your body weight, but there
have been some studies looking at the effectiveness of low dose regimes,
such as just taking 20mg once daily for 6 months. Has anyone had any
experience of low dose treatment?

Cheers

James

I was on an extended low dose course, but I wasn't looking for
post-therapy results. I used the drug continuously to keep my skin
clear. Both my derm and I determined there was no such thing as
post-therapy results in my case.

I don't know why a lower cumulative dosage would work better than a
higher cumulative dosage. I can image someone being on 20mg for 1.5
years maybe, but 6 months seems a little short.

James Varty wrote:

Its not a case of a lower dose being better, it just seems to be the case
that a lower dose is safer (i.e., less severity of side effects and less
toxicity) and less costly (much less of the drug to purchase). If a lower
dose is AS effective for someone with moderate acne as a higher dose, then a
lower dose would suffice. You say you think 6 months is a little short and
1.5 years would be a more reasonable time to take a low dose course. Is this
just your opinion or is it based on any valid published research or
scientific findings?

Based on the cumulative dosage guidelines, which, if you are looking
for post-therapy results, would be the same regardless of whether you
are reaching it via a low-dose or a high dose.

I think the idea is to get a cumulative dose of about 120mg/kg. That's
the cumulative dosage over the entire course. For someone who weighs,
say, 70kg, that would be a cumulative dosage of 8400mg. At 20mg per
day, that would take about 420 days (1.15 years). At 80mg per day, that
would take about 3.5 months. Someone should check my math.

The cumulative dosage is usually a little higher (it was for all my
courses), but might be lower or much higher depending on the
stubborness or location of your acne (e.g., chest acne is often treated
with a much higher cumulative dose, but maybe not a higher daily dose).

I am neither a doctor nor scientifically-oriented. I can't explain why
these guidelines are why they are. I just go by what I read (e.g.,
http://www.skintherapyletter.ca/stl/..._factsheet.pdf)
and by what my doctor tells me. Hopefully, someone else will chime in
with more information.

James Varty wrote:

<nabbed@hotmail.com> wrote in message

Thanks for that. I've got to be honest though, I think the cumulative dosage
idea is nonsense, and makes little pharmacological sense. I suspect Roche
had input into the guidelines and its simply a way for them to maximise
sales. More recent research seems to be based on more pragmatic
pharmacological principles, and the results for short term low dose
prescribing look promising.

James

Could be. People should do what works.

If you have any links, I'd be interested to see any of the studies.

James Varty wrote:

Here's one such study - found on PubMed site.


J Am Acad Dermatol. 2006 Apr;54(4):644-6.


Low-dose isotretinoin in the treatment of acne vulgaris.

Amichai B, Shemer A, Grunwald MH.

Huzot Clinic of Clalit Health Services, Ashkelon, Israel.

BACKGROUND: The efficacy of isotretinoin at 0.5 to 1.0 mg/kg per day in the
treatment of acne is well established and considered safe, although it is
sometimes not easily tolerated because of its cutaneous side effects.
OBJECTIVE: The purpose of this study was to determine the efficacy of
low-dose isotretinoin in the treatment of acne. METHODS: In this
prospective, noncomparative, open-label study, 638 patients, both male and
female, with moderate acne were enrolled and treated with isotretinoin at 20
mg/d (approximately 0.3-0.4 mg/kg per day) for 6 months. The patients were
divided into two age groups: 12 to 20 and 21 to 35 years old. Patients were
evaluated at 2-month intervals by means of clinical and laboratory
examinations. A 4-year follow-up was also carried out. RESULTS: At the end
of the treatment phase, good results were observed in 94.8% of the patients
aged 12 to 20 years, and in 92.6% of the patients aged 21 to 35 years.
Failure of the treatment occurred in 5.2% and 7.4% of the two groups,
respectively. Twenty-one patients dropped out of the study because of lack
of compliance, and another patient discontinued participation because of a
laboratory side effect. During the 4-year follow-up period, relapses of the
acne occurred in 3.9% of the patients aged 12 to 20 years and in 5.9% of the
patients aged 21 to 35 years. Elevated serum lipid levels (up to 20% higher
than the upper limit of normal value) were found in 4.2% of the patients and
abnormal (<twice the upper limit of normal values) liver tests were observed
in 4.8%. LIMITATIONS: This was a noncomparative, open-label study.
CONCLUSION: Six months of treatment with low-dose isotretinoin (20 mg/d) was
found to be effective in the treatment of moderate acne, with a low
incidence of severe side effects and at a lower cost than higher doses.

PMID: 16546586 [PubMed - in process]




<nabbed@hotmail.com> wrote in message
news:1146176930.843233.245160@j33g2000cwa.googlegr oups.com...

http://www.dermatologytimes.com/derm...l.jsp?id=65528

"James Varty" <jamesvarty@btinternet.com> wrote in message
news:GfWdnSmVCvMpXcnZnZ2dnUVZ8tydnZ2d@bt.com...

Interesting. It is likely you will be in the group that gets good
results (since it is listed here as 92-94%). Sounds like it is a good
avenue to take.

Caveat: What they mean by good results is not completely clear to me:
Certainly, my derm thinks I am maintaining good results from the
multi-year course that ended 5 years ago, even though I get so much
painful and deep acne that I often cannot make normal facial
expressions or open my mouth wide enough to eat a deli sandwich.
Luckily, he is willing to start me back on continuous low-dose Accutane
(a regime that is addressed by the article linked by the other poster).

James Varty wrote:

<nabbed@hotmail.com> wrote in message

It may be worth you considering breaks in your treatment. I'm not sure what
the benefit of continuous treatment would be, given that sebum production
should be disrupted sufficiently by low dose prescribing to maintain lasting
results after 6 months of treatment. If the problem then returned after a
year or two, you could then do another 6 months treatment, so you treatment
is episodic instead of continuous.

I would love to go down that path. It would be safer and much cheaper.
Alas, my acne, although low-grade to moderate, is extremely persistent.
Even after very high-dosage courses lasting close to 6 months, my skin
returns to normal -- that is, the acne returns as before -- in just 2-3
months.

For me, continuous treatment at 10mg/day provides continuous relief.
Episodic treatment provides episodic relief (but with much start-up
cost per episode, like short periods with both acne and Accutane
side-effects).

Of course, everyone should try short term treatments before ever
considering continuous treatments. I might even try it to see what
happens. But continuous treatments at fairly low doses (e.g.,
40mg/week) is a good fallback for some people.

James Varty wrote: