Accutane dosing: space throughout the day?

nabbed DeleteThis @hotmail.com wrote:
> So I am up to 70mg/day of Accutane -- actually, Claravis -- after 3
> months on the drug. I am taking one 40mg capsule and one 30mg capsule
> per day. It's not helping all that much with breakouts, so I want to
> maximize the effectiveness as much as possible [1].
>
> Is it best to take those two capsules at different times of the day?
> Should I take both at once? Or does it even matter? Maybe there's no
> data on this.
>
> My derm is stingy on the Accutane dosage (I am a male that weighs 75kg,
> so 40mg, 60mg, and now 70mg per day seems rather low to me, considering
> I was taking 160mg/day at one point 8 years ago). Therefore, I might
> need to supplement my dosage with my emergency stock that I bought
> elsewhere. I keep the emergency stock only to carry me over during
> iPledge SNAFUs (of which there have been several), and I don't want to
> use it day-to-day. I want to do this on the up-and-up as much as
> possible.
>
> [1] I am not on the drug for long-term benefit: after 5 previous
> courses, I learned that I get no post-therapy benefit. I am attempting
> only to achieve clear skin while actually on the drug. That's why it's
> very important to stop the break-outs soon. I've never broken-out
> beyond the 8 week point before (but I was always on much higher doses
> in the past), so I find this disturbing.

I found an interesting powerpoint presentation on the web by an MD who
was making a presentation on new long acting formulation of
isotretinoin (accutane). The presentation also had graphs and
information on absorption and blood levels of "normal" isotretinoin. I
dont' have a link for you and can't remember the details, but here's
some facts I remember:

The med has a fairly long half life, meaning that spacing between doses
can be long. I've seen recommendations of "single or split doses".
HOWEVER, the guy's graphs showed a peak in blood level followed by a
slow taper. He showed the blood level over 24 hours of a single dose
vs. divided doses. Both maintained a therapeutic blood level, but the
divided dose had two lower peaks followed by tapers that were at a
significantly higher average level. That means that a divided dose will
keep a consistently higher level in your blood. My opinion is that
divided doses are best. As for exact timing - I don't think that's
nearly as critical. I'd do them at breakfast and dinner, maybe the
higher dose at dinner since there's a longer time between dinner and
breakfast than between breakfast and dinner, generally.

There are numberous sources you can find that STRONGLY recommend taking
the med with fatty food. The presence of fat in the stomach when the
med is taken increases absorption by as much as twice. In other words,
the medication can achieve nearly twice the blood level taken with food
vs. taken without. What effect this has on clinical results, I don't
know, but my opinion is that you should take it with meals which
contain a normal amount of fat (your butters, margarines, meat fat,
salad dressings, cheeses, desserts, etc which are part of normal
eating). Thus my advice to take them at breakfast and dinner rather
than try for equal spacing at other times of day.

As for your daily dose - I've seen many credible sources that show that
the total cumulative dosage of 125-150 mg per KG is more important than
the daily dose in prefenting relapse. For your weight, you'll want
around 10,000 total mgs. when your course is completed. So if I were
you, I wouldn't be too concerned about 70 mg per day It's pretty clear
that your doctor is dosing you at around 1 mg/kg/day, which is very
normal. I would however strongly recommend that you really push your
doctor to keep you on the med until you reach a cumulative dose of at
least 125 mg/kg. If he's not aware of this, do some web searching for
bonafide medical sources on this and discuss it with him. The same
sources show no benefit for exceeding 150 mg/kg cumulative.

I'd be interested in knowing what your previous total dosages was. I
think a low cumulatve dosage is behind some of my own issues.

I've had two previous courses at 40 mg/kg/day for 4 months - a "normal"
course for someone with my not so severe condition at that time, before
the cumulative dose thing was researched. Both courses held me totally
for around 5 years, then not so well for a few years, and I did the med
again 10 years after the previous course. Now 10 years later I'm in
the midst of a third course. I plan to take 10,000 mg total over
whatever length of time it will take me. I started at 40 and upped it
to 60, but my cholesterol is a little high so I'm going to go back down
to 40 if I can't lower it in a month with increased exercize, diet and
weight loss. i don't really care if it takes 4 or 7 months.
 >> Stay informed about: Accutane dosing: space throughout the day? 

Thanx for the interesting information.

As for cumulative dosage, that matters to me but doesn't solve my
problem. No matter the cumulative dosage, I get no post-therapy
benefits. I've had various cumulative doses in my various courses. It
was as high as 337mg per kg. That was with my last course in 1998 (I
weigh 75kg):

1 month at 80mg
2 months at 120mg
1 month at 160mg
2 weeks at 80mg
2 weeks at 40mg
3 months at 20mg
2 years at 10mg

The 10mg course was enough to maintain the clear skin provided by the
preceding high-dose course. However, when I ended it about 6 years ago
-- a mistake I hope to never repeat -- my skin returned to normal.

My plan is to blast my acne such that a later 10mg/day course will work
as well as it did in the 1999-2000 time frame.

However, I am not sure I will be able to convince my doctor that an
open-ended 10mg/day course is a good idea. Also, access to isotretinion
from foreign pharmacies is tenuous at best (a crackdown could occur at
any time if that hysteria ever whips up again). So I want to get as
much on-drug clear skin as I can, as there is no possibility of
off-drug clear skin.

In your case, it seems the drug does provide a period of relief (if
could get 5 years of clear skin at a time, I would consider that a
solution). It makes sense to try to nail it with a higher cumulative
dosage. I don't think it matters how long it takes: my current derm
tends to stretch the cumulative dosage across 6-7 months, which
explains why I am getting a lower dosage than I have in the past.


Zoilo wrote:
> nabbed.DeleteThis@hotmail.com wrote:
> > So I am up to 70mg/day of Accutane -- actually, Claravis -- after 3
> > months on the drug. I am taking one 40mg capsule and one 30mg capsule
> > per day. It's not helping all that much with breakouts, so I want to
> > maximize the effectiveness as much as possible [1].
> >
> > Is it best to take those two capsules at different times of the day?
> > Should I take both at once? Or does it even matter? Maybe there's no
> > data on this.
> >
> > My derm is stingy on the Accutane dosage (I am a male that weighs 75kg,
> > so 40mg, 60mg, and now 70mg per day seems rather low to me, considering
> > I was taking 160mg/day at one point 8 years ago). Therefore, I might
> > need to supplement my dosage with my emergency stock that I bought
> > elsewhere. I keep the emergency stock only to carry me over during
> > iPledge SNAFUs (of which there have been several), and I don't want to
> > use it day-to-day. I want to do this on the up-and-up as much as
> > possible.
> >
> > [1] I am not on the drug for long-term benefit: after 5 previous
> > courses, I learned that I get no post-therapy benefit. I am attempting
> > only to achieve clear skin while actually on the drug. That's why it's
> > very important to stop the break-outs soon. I've never broken-out
> > beyond the 8 week point before (but I was always on much higher doses
> > in the past), so I find this disturbing.
>
> I found an interesting powerpoint presentation on the web by an MD who
> was making a presentation on new long acting formulation of
> isotretinoin (accutane). The presentation also had graphs and
> information on absorption and blood levels of "normal" isotretinoin. I
> dont' have a link for you and can't remember the details, but here's
> some facts I remember:
>
> The med has a fairly long half life, meaning that spacing between doses
> can be long. I've seen recommendations of "single or split doses".
> HOWEVER, the guy's graphs showed a peak in blood level followed by a
> slow taper. He showed the blood level over 24 hours of a single dose
> vs. divided doses. Both maintained a therapeutic blood level, but the
> divided dose had two lower peaks followed by tapers that were at a
> significantly higher average level. That means that a divided dose will
> keep a consistently higher level in your blood. My opinion is that
> divided doses are best. As for exact timing - I don't think that's
> nearly as critical. I'd do them at breakfast and dinner, maybe the
> higher dose at dinner since there's a longer time between dinner and
> breakfast than between breakfast and dinner, generally.
>
> There are numberous sources you can find that STRONGLY recommend taking
> the med with fatty food. The presence of fat in the stomach when the
> med is taken increases absorption by as much as twice. In other words,
> the medication can achieve nearly twice the blood level taken with food
> vs. taken without. What effect this has on clinical results, I don't
> know, but my opinion is that you should take it with meals which
> contain a normal amount of fat (your butters, margarines, meat fat,
> salad dressings, cheeses, desserts, etc which are part of normal
> eating). Thus my advice to take them at breakfast and dinner rather
> than try for equal spacing at other times of day.
>
> As for your daily dose - I've seen many credible sources that show that
> the total cumulative dosage of 125-150 mg per KG is more important than
> the daily dose in prefenting relapse. For your weight, you'll want
> around 10,000 total mgs. when your course is completed. So if I were
> you, I wouldn't be too concerned about 70 mg per day It's pretty clear
> that your doctor is dosing you at around 1 mg/kg/day, which is very
> normal. I would however strongly recommend that you really push your
> doctor to keep you on the med until you reach a cumulative dose of at
> least 125 mg/kg. If he's not aware of this, do some web searching for
> bonafide medical sources on this and discuss it with him. The same
> sources show no benefit for exceeding 150 mg/kg cumulative.
>
> I'd be interested in knowing what your previous total dosages was. I
> think a low cumulatve dosage is behind some of my own issues.
>
> I've had two previous courses at 40 mg/kg/day for 4 months - a "normal"
> course for someone with my not so severe condition at that time, before
> the cumulative dose thing was researched. Both courses held me totally
> for around 5 years, then not so well for a few years, and I did the med
> again 10 years after the previous course. Now 10 years later I'm in
> the midst of a third course. I plan to take 10,000 mg total over
> whatever length of time it will take me. I started at 40 and upped it
> to 60, but my cholesterol is a little high so I'm going to go back down
> to 40 if I can't lower it in a month with increased exercize, diet and
> weight loss. i don't really care if it takes 4 or 7 months.
 >> Stay informed about: Accutane dosing: space throughout the day? 

nabbed DeleteThis @hotmail.com wrote:

....

>
> My plan is to blast my acne such that a later 10mg/day course will work
> as well as it did in the 1999-2000 time frame.
>
> However, I am not sure I will be able to convince my doctor that an
> open-ended 10mg/day course is a good idea. Also, access to isotretinion
> from foreign pharmacies is tenuous at best (a crackdown could occur at
> any time if that hysteria ever whips up again). So I want to get as
> much on-drug clear skin as I can, as there is no possibility of
> off-drug clear skin.

I've also read a lot of stuff about indefinite courses of low level and
how it has shown virtually no problems with the blood labs. I'd really
talk to the MD about that and really consider that it would just be an
indefinite thing.

I cant remember if you said you're male or female, obviously long term
low dose wouldn't be an option for a fertile female unless she's taken
and kept vows of celibacy.

The damn hurdles put up onthis drug just infuriate me. The morbidity
of this drug is well within acceptable for many of the very common
pharmaceuticals we use. There should be virtually no restricitoins,
othier than following blood work, for men.

I too have gone foreign source for my current course. It's completely
self prescribed. But I understand the blood labs involved (I'm a
health professional). I know what it did to my blood work last time
(have the labs in hand), and have figured out a way to get the labs
done every 4-6 weeks or so.

You might also consider that after you blast it, a traditional
antibiotic and/or topical might do the trick, again, indefinitely
without end.
 >> Stay informed about: Accutane dosing: space throughout the day?