Isotretinoin gel (Isotrex)

NHS Choices

About isotretinoin gel

Isotretinoin gel is an effective treatment for mild to moderate acne (spots).

It can be used on its own or with other creams, gels or antibiotic tablets.

Key facts

Isotretinoin gel takes 6 to 8 weeks to work.
The most common side effects of isotretinoin gel are red, sore or dry skin and lips. These side effects go away when you stop the treatment.
If you're a woman, it's really important not to become pregnant while using isotretinoin gel and for at least 1 month after stopping. Isotretinoin can harm an unborn baby.
Isotretinoin gel can make your skin sensitive to sunlight. For safety, stay out of bright sun and use a high factor sun cream even on cloudy days.
The brand name for isotretinoin gel is Isotrex.

Who can and can't use isotretinoin gel

Isotretinoin gel is for teenagers and adults with mild to moderate acne.

Don't use isotretinoin gel in children under the age of 12 or before puberty.

Isotretinoin gel may not be suitable for some people. Tell your doctor before starting treatment if you:

have had an allergic reaction to isotretinoin or any other medicines in the past
get eczema
have had skin cancer
are pregnant or think you could be pregnant, or you're breastfeeding

Do not use isotretinoin gel if you're pregnant or think you might be pregnant, or you're breastfeeding.

Side effects

Like all medicines, isotretinoin gel can cause side effects, although not everyone gets them. Side effects will usually go away when you stop using the gel.

Common side effects

Common side effects of isotretinoin gel happen in more than 1 in 10 people. Talk to your doctor or pharmacist if these side effects bother you or don’t go away.

dry skin
red or peeling skin
skin irritation or itching
skin becoming more sensitive to sunlight

Serious side effects

Sometimes these skin reactions can be more severe. If you have severe burning, peeling, redness or itchiness of your skin, stop using the gel and see a doctor straight away.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to isotretinoin.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

These are not all the side effects of isotretinoin gel. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

How to cope with side effects

What to do about:

dry skin or lips - apply a moisturiser and lip balm regularly (the best type of moisturiser is an oil-free face moisturiser for sensitive skin) and try to keep your showers shorter than 2 minutes, using lukewarm water rather than hot
skin irritation or pain - try using the gel less often (maybe once a day instead of twice, or every other day), or you could stop using the gel for a few days until the irritation goes away and then try using it again. If the irritation doesn't go away, stop using the gel and speak to your doctor
your skin becoming sensitive to sunlight - stay out of bright sun and use a high factor oil-free sun cream (SPF 15 or above) even on cloudy days; don't use a sunlamp or sunbeds

How to use the gel

Apply isotretinoin gel once or twice a day as instructed by your doctor.

Always wash and dry your skin, and completely remove any make-up, before you apply the gel. This will help it work better.

Put a thin layer of the gel on the affected skin using your fingertips and smooth it in. Apply it to all areas of skin that have acne and not just each spot.

You only need to apply a thin layer of gel. Try not to use too much, especially where the gel could run into your eyes or build up in folds of skin. Using more gel will not make your spots clear up more quickly.

Don't apply isotretinoin gel to irritated areas of skin - for example, cuts, burns or sunburn - as it can make the irritation worse.

Only ever use isotretinoin gel on your skin, and keep it away from your mouth, lips and eyes.

What if I forget to take it?

If you forget to apply the gel, skip the missed dose and apply the next dose at the usual time.

Never apply a double dose. Never apply an extra dose to make up for a missed one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I use too much?

If you use too much isotretinoin gel or use it more often than you should, it may make your skin red or irritated. If this happens, use the gel less often or stop using it for a few days.

Will the amount I take go up or down?

The dose of isotretinoin gel will probably not change, although if your skin becomes irritated, your doctor may suggest you use it less often for a while.

Advice for women

This medicine is likely to harm a baby.
Use reliable contraception to prevent pregnancy while you're using isotretinoin gel - some brands of contraception pill can help with acne.
If you become pregnant during treatment with isotretinoin gel, stop using it and talk to your doctor straight away.
Don't breastfeed while you're using isotretinoin gel. This medicine can get into breast milk and harm your baby.

Do not use isotretinoin gel if you're pregnant, think you're pregnant or are breastfeeding. This medicine can harm a baby.

Cautions with other medicines

Some medicines and isotretinoin gel can interfere with each other and make it more likely that you'll have side effects.

Tell your doctor if you're taking these medicines before you start isotretinoin gel:

other acne medicines - using both together may make skin irritation worse
benzoyl peroxide cream or gel (another acne treatment) - it may make isotretinoin gel less effective

Mixing isotretinoin gel with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements while you use isotretinoin gel.

However, for safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

Common questions

How does isotretinoin gel work?

Isotretinoin gel is for mild to moderate acne. This is acne that's mostly on the face with spots that are mainly whiteheads and blackheads.

Isotretinoin gel relieves acne by:

reducing the amount of natural oil made by your skin so blocked pores are less likely
killing the bacteria that cause acne
relieving redness and soreness

How long does it take to work?

Your acne may get worse when you first start treatment with isotretinoin gel, but will then normally improve after 6 to 8 weeks.

How long will treatment last?

A treatment course of isotretinoin gel usually lasts for 16 to 24 weeks (around 4 to 6 months).

Acne will normally keep improving for up to 8 weeks after stopping treatment. After that time, most people have clear skin, but a few will need another round of treatment.

Are there other acne treatments?

For mild acne, there are a range of medicines that you can rub on to your skin. These include other retinoid creams and gels, or benzoyl peroxide cream or gel.

If these don't work, your doctor may prescribe a cream or gel that contains an antibiotic, plus a retinoid or benzoyl peroxide. They might also choose another type of gel called azelaic acid.

For some women, taking the contraceptive pill helps their acne.

For more severe acne, your doctor may prescribe antibiotic tablets, plus a gel or cream, before you're referred to a hospital specialist, or while you're waiting for an appointment with a hospital specialist.

It can take 2 to 3 months for many of these treatments to work.

Will it affect my fertility?

Isotretinoin gel doesn't reduce a man or woman's fertility.

For women, it's safe to try for a baby 1 month after their treatment with isotretinoin gel has finished.

Can I drive or ride a bike?

Yes, you can drive or ride a bike as usual when using isotretinoin gel.

Can I drink alcohol with it?

Yes, you can drink alcohol with isotretinoin gel.

Is there any food or drink I need to avoid?

You can eat and drink normally while using isotretinoin gel.

Can I donate blood while taking isotretinoin?

Don't donate blood while using isotretinoin gel and for at least 1 month after stopping using it. If your blood is given to a pregnant woman, it may harm her unborn baby.

Can lifestyle changes help my acne?

Try not to wash affected areas of skin more than twice a day. Too much washing can irritate your skin and make spots worse.
Wash spotty skin with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
Never 'clean out' blackheads or squeeze spots. This can make them worse and cause permanent scars.
Don't use too much make-up and cosmetics.
Use water-based make-up and toiletries that are described as non-comedogenic (this means the product is less likely to block the pores in your skin).
Remove make-up before going to bed.
Use a fragrance-free, water-based moisturiser if dry skin is a problem.
Shower as soon as possible after exercising, as sweat can irritate acne.
Wash your hair regularly, and try to stop letting your hair fall across your face.

Related conditions

Acne