Informational only — Not medical advice. Always consult a licensed healthcare provider.

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Indications

Acne Vulgaris

Aknill capsule is indicated in severe forms of acne (such as nodular or conglobate acne, or acne at risk of permanent scarring) that has resisted adequate courses of standard therapy with systemic antibacterials and topical treatment.

⚠️ Always consult a registered physician before taking any medicine.

Pharmacology

Isotretinoin works by altering the cell cycle, cell differentiation, cell survival, and apoptosis. Through these actions it reduces sebum production, which helps prevent blocked pores and limits the growth of acne causing bacteria. Both isotretinoin and its metabolite, 4 oxo isotretinoin, significantly reduce sebum production. Isotretinoin itself has little to no affinity for retinol binding proteins (RBPs) or retinoic acid nuclear receptors (RARs). Tretinoin and 4 oxo tretinoin, however, do bind to the RAR gamma receptor, and this is thought to play a part in how isotretinoin helps treat acne.

Isotretinoin triggers apoptosis in sebocytes, the cells that produce sebum, further lowering sebum output. It also reduces the formation of comedones by lowering hyperkeratinization, though the exact mechanism behind this is not known. Isotretinoin does not kill acne causing bacteria directly, but by shrinking sebum ducts it makes the surrounding environment less favorable for their growth. It may also boost certain immune mechanisms and change how monocytes move toward sites of inflammation, helping to reduce inflammation overall.

Pregnancy & Breastfeeding

Isotretinoin must never be used during pregnancy. If a woman does become pregnant while taking Isotretinoin, or within a month of stopping it, her baby faces a high risk of severe, serious birth defects. These include problems with the brain and spinal cord (such as hydrocephalus, a small head, or abnormalities of the cerebellum), an abnormally shaped face, cleft palate, ear defects (including a missing outer ear or a small or absent ear canal), eye defects (such as an abnormally small eye), heart and blood vessel defects (including tetralogy of Fallot, transposition of the great vessels, and septal defects), and abnormalities of the thymus and parathyroid glands. The chance of miscarriage is also increased. If pregnancy occurs while a woman is being treated with Isotretinoin, the medicine must be stopped immediately, and she should be referred to a doctor who specialises in, or has experience with, birth defects for assessment and guidance. Because Isotretinoin dissolves readily in fat, it is very likely to pass into breast milk. As this could harm a nursing infant, Isotretinoin must not be used by breastfeeding mothers.

⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

Dosage Reference

⚠️ Reference ranges from official sources only. Consult your doctor for personalized dosing.

Adults: Isotretinoin capsules should be taken with food, once or twice a day. Treatment should only be prescribed by, or carried out under the supervision of, doctors experienced in using systemic retinoids for severe acne who fully understand the risks of Isotretinoin therapy and the monitoring it requires. Adults, including adolescents and elderly patients: therapy is usually started at 0.5 mg per kg of body weight daily. Both how well the medicine works and the side effects it causes are related to dose and vary from person to person, so the dose needs to be adjusted individually during treatment. For most patients the dose falls somewhere between 0.5 and 1.0 mg/kg per day. How long remission lasts, and how likely acne is to return, depends more on the total dose received over the whole course than on either the length of treatment or the daily dose. Studies show that little extra benefit is gained from a cumulative dose beyond 120 to 150 mg/kg. The length of the treatment course therefore depends on the daily dose chosen, and a course of 16 to 24 weeks is normally enough to bring the acne into remission. Most patients clear completely with a single course. If the acne clearly returns afterward, a further course using the same daily and cumulative dose can be considered. Because improvement can continue for up to 8 weeks after stopping treatment, a repeat course should not be started until at least that much time has passed. Patients with severe kidney impairment: treatment should begin at a lower dose, for example 10 mg a day, and can then be increased up to 1 mg/kg per day or to the highest dose the patient can tolerate. Children: Isotretinoin is not indicated for prepubertal acne and is not recommended for patients under 12 years of age, since there is not enough data on how well it works or how safe it is in this age group. Patients who cannot tolerate the standard dose: if a patient has severe difficulty tolerating the recommended dose, treatment can continue at a lower dose, though this usually means a longer course and a greater chance of the acne returning. To get the best possible result in these patients, the dose should generally be kept at the highest level they can tolerate.

Side Effects & Interactions

Side Effects

No side-effect data recorded yet.