ISOTRETINOIN treats severe acne that has not responded to other therapy such as antibiotics.

They need to know if you have any of these conditions:

• heart disease
• high blood cholesterol or triglycerides
• inflammatory bowel disease
• liver disease
• mental problems, such as depression, psychosis, attempted suicide, or a family history of mental problems
• osteoporosis, osteomalacia, or other bone disorders
• pancreatitis
• an unusual or allergic reaction to isotretinoin, vitamin A or related drugs, parabens, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Take this medicine by mouth with a full glass of water. Do not chew or suck on the capsules. Take your medicine at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

If you miss a dose, skip that dose. Do not take double or extra doses. If you take more than your prescribed dose, call your doctor or poison control center right away.

Do not take this medicine with any of the following medications:

• vitamins and other supplements containing vitamin A

This medicine may also interact with the following medications:

• alcohol
• benzoyl peroxide, salicylic acid, or other drying medicines used for acne
• medicines for seizures
• orlistat
• other drugs that make you more sensitive to the sun such as sulfa drugs
• progestin-only birth control hormones
• st. john's wort
• steroid medicines like prednisone or cortisone
• tetracycline antibiotics like doxycycline and tetracycline
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

You may experience a flare in your acne during the initial treatment period. You will need to see your doctor or health care professional monthly to get a new prescription and to check on your progress and for side effects.

This medicine can cause birth defects. Do not get pregnant while taking this drug. Females will need to have 2 negative pregnancy tests before starting this medicine and then monthly pregnancy tests during treatment, even if you are not sexually active. Use 2 reliable forms of birth control together for 1 month prior to, during, and for 1 month after stopping this medicine. Avoid using birth control pills that do not contain estrogen. They may not work while you are taking this medicine. If you become pregnant, miss a menstrual cycle, or stop using birth control, you must immediately stop taking this medicine. Severe birth defects may occur even if just one dose is taken. Do not breast-feed while taking this medicine or for 1 month after stopping treatment.

Do not give blood while taking this medicine and for 30 days after completion of treatment to avoid exposing pregnant women to this medicine through the donated blood.

Some patients have become depressed or developed serious mental problems while taking this medicine or soon after stopping. Stop taking this medicine if you start feeling depressed or have thoughts of violence or suicide. Contact your doctor.

This medicine can increase cholesterol and triglyceride levels and decrease HDL (the good cholesterol) levels. Your health care provider will monitor these levels and recommend appropriate therapy, including changes in diet or prescription drugs, if necessary. Alcohol can increase the risk of developing high cholesterol or high blood lipids. Avoid alcoholic drinks while you are taking this medicine.

If you wear contact lenses, they may feel uncomfortable. If your eyes get dry, check with your eye doctor. This medicine may decrease your night vision or cause other changes in vision. If you experience any change in vision, stop taking this medicine and see an eye doctor.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Cosmetic procedures to smooth your skin including waxing, dermabrasion, or laser therapy should be avoided during therapy and for at least 6 months after you stop because of the possibility of scarring. Check with your health care provider for advice about when you can have cosmetic procedures.

This medicine may affect your blood sugar levels. If you have diabetes check with your doctor or health care professional if you notice any change in your blood sugar tests.

Side effects that you should report to your doctor or health care professional as soon as possible:

• changes in menstrual cycle
• changes in vision, like blurred or double vision or decreased night vision
• chest pain
• depression
• difficulty breathing or shortness of breath
• dizziness
• fainting
• hearing loss or ringing in the ears
• hives, skin rash
• increased irritability, anger, aggression or thoughts of violence
• increased urination and/or thirst or dark urine
• irregular heartbeat
• loss of interest in usual activities
• muscle or joint pain
• muscle weakness with or without pain
• nausea and vomiting
• severe headache
• severe stomach pain
• slurred speech or trouble swallowing
• start to have thoughts about hurting yourself
• swelling of face or mouth
• unusual bruising or bleeding
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• chapped lips
• dry mouth, nose or skin
• flushing
• hair loss, increased fragility of hair
• headache (mild)

This list may not describe all possible side effects.

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.