Isotretinoin

[TJ48]

I'm a 48 yo man who had taken isotretinoin for 4 months for cystic acne. Dosage was 20mg/day for 4 months & then increased to 40mg for about a week. I experienced a sharp pain in my right side a week ago and thought it was indigestion as I have had a reaccurring problem with that especially during stressful times & when eating late heavy meals. Prilosec and other OTC heartburn products didn't help,& the pain was in a different location than the past. I went into the hospital when the pain in my side was still there after 3 days. Blood tests came up with AST=54 ALT=203 Alk Phosphatase 81 Triglycerides 149 Cholesterol=287 HDL 41 CLDL= 216  I had stopped the isotretinoin within a day after the pain started & the doctor said to stay off it. She is having me come in for a follow up blood test/appointment in two weeks. My dermatologist who prescribed the isotretinoin repeatedly asked me to have blood tests taken, but I travel a lot for work and didn't ever seem to have enough time to get to it. Since I am 225 lbs (6'1" height) and the doses I were taking of the isotretinoin were so low (recommended dose of up to 1mg/kilo body weight) and I was taking 0.2-0.4 mg/kg body weight I didn't worry about it. - - Does it seem likely that the isotretinoin caused this pain to occur ?  Will the pain go away in time? Has there been permanent damage to my liver ?  I know that these questions can't be answered by long distance, but I am worried and would appreciate any light you can shed on this for me. I am hoping that with my stopping of the isotretinoin that things will go back to normal and that I haven't damaged anything. (I am now Absolutely Dedicated to getting on a healthy diet & exercise program too.) Are my doctors & I doing all we can at this point? What's the next step?  I look forward to you reply. Thank you - - TJ

[Kalio1]

hey sorry about that, I told you there isnt a doc here and there is!

[Kalio1]

There are no doctors on this board, just so you know.
Your doc probably wanted to monitor your bloodwork to see if the drug was affecting your liver, there are quite a few drugs that require blood monitoring, aso drug dosages can be deceiving, what seems like a small amount can still cause adverse effects. When a drug is known to cause these issues the doc will order bloodtests so he can see if they are causing aresults like you had and adjust the dosage or change the drug. Usually med induced raised liver enzymes will return to normal when you stop the meds. I guess you learned a hard lesson that meds. can and do affect us adversely sometimes even when they can at the same time have a positive effect on the condition they are prescribed for. If your LFT's stay elevated, your doc can follow up with a closer look at your liver with a biopsy but I suspect they will revert to normal when the drugs are removed if you give it some time.
good luck to you.

[Kevin Pho, MD]

The ALT is quite elevated and may be due to the side effects of the medication.  It can also be elevated by other liver and gallbladder diseases - leading to right sided pain as well.  

An ultrasound as well as blood tests looking for hepatitis are both recommended for an initial evaluation.  Abstaining from alcohol as well as any possible offending medication and then repeating the blood tests should be considered.

If the enzymes continue to elevate, a biopsy should be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b