My son is 23 years old and has just started taking Accutane. He weighs 140 lbs. The dermatologist has prescribed him 80 mg for 4 months. I'm concerned about the potential side effects of such a high dosage, such as hair loss and testosterone issues. The dermatologist claims to have not encountered these side effects in any of their patients. Is starting with such a high dosage too much? My son has moderate, stubborn acne that runs in the family.
When initiating an Accutane regimen for a patient, several factors need to be considered: the severity of acne, the patient's compliance, and the environment. While the goal of Accutane is to administer a specific dosage over a designated period of time, I have found that most of my patients prefer a lower dosage for a longer duration to mitigate side effects such as dry skin, bloody noses, and dry lips. In my practice, I typically start with a 20mg dosage and then increase to 40mg for the remainder of the regimen. However, it's important to consider individual factors and adjust the dosage accordingly. For instance, in a dry climate like Las Vegas, higher dosages may not be tolerable.
While each dermatologist has their own preferred dosage, I personally find this dosage to be slightly high. The general recommendation is a dosage of 1 mg/kg. Your son's dosage would exceed that by approximately 40%. While there is nothing inherently wrong with this dosage, it is less likely for your son to experience problems with a dosage that is half of what is currently prescribed, spread out over a period of 6 months. Since pregnancy is not a concern for males, there is no urgent need to limit the duration of exposure as there might be for females (to avoid potential pregnancy complications). Most of the side effects of Accutane are dose-dependent, so I believe it would be wise to start your son on a dosage of 20 mg per day for two weeks, and if no issues arise, increase it to 40 mg for the remaining 22 weeks. With the higher dosage, your son would have a greater likelihood of developing uncomfortable but non-life-threatening side effects such as dry skin, chapped lips, muscle cramps, decreased night vision, nosebleeds, and rashes. Hair loss is actually quite rare, and there should not be any testosterone-related issues. The side effects of primary concern are inflammatory bowel disease (which is still a subject of scientific controversy), increased intracranial pressure (usually when taken concurrently with Tetracycline), liver toxicity, depression, anger, and elevated triglyceride levels.
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