accutane dose too aggressive?

[Lilliahall]

Pending the results of my initial blood test, I will be starting Accutane shortly.  My doctor mentioned she was going to start me on at 40 mg, which she'll then raise to 60-80 mg.  I am very small (about 90 lbs, under 5 ft tall) and this seems like a pretty high dose, based on the limited research I have done on my own.  

As Accutane-worthy acne goes, mine isn't very severe (cystic, but just in a few spots).  I did a 6-month course of Accutane several years ago with a different doctor -- in that case, the doctor started me on a low dose to minimize side effects and then eventually took me up to 40 mg.  Side effects were tolerable, and my skin remained clear for a few years afterward.  

Given my weight, I'm a little worried about side effects at this dose.  I expressed my concern to my doctor, but she said that she felt that 40 mg was actually a low/moderate dose for my size, and that 60-80 mg would be normal for my size.  This doesn't seem consistent with the information I've read.  She said she didn't want to go too low because she didn't want me to have to take Accutane longer than 6 months.  

I don't want to be second-guessing my doctor's judgment unnecessarily, but I would be grateful for any advice as to whether this dose falls into the normal range for my weight.  Also, I'm interested in whether (in your experience) starting at a higher dose affects how severe the side effects are.  

Thank you.

[Lilliahall]

Dr. Rockoff,

Thank you for your response.  I don't know if it's appropriate for me to ask a follow-up question, but just in case -- do you think that an increase to 60-80 mg (which my doctor has indicated she intends to do after the first month) would be excessive for my weight?  

Thank you again.

[Alan Rockoff, MD]

There is an acceptable range of dosing, but I generally use 1 milligram per kilogram of body weight, which in your case would be 40 milligrams a day.  Since your case is relatively mild and you're a small person, that seems like a reasonable dose to me.

Best.

Dr. Rockoff