Can a Lower Dose of Accutane Help with Side Effects and Still Be Effective?

When someone has severe, painful acne that’s resistant to other treatments, dermatologists often prescribe isotretinoin, an oral medication more widely recognized by its brand name, Accutane. 

Accutane shrinks the skin’s oil glands and keeps skin cells from clumping, both of which can clog pores. It may also lower inflammation, in turn reducing redness, swelling, and pain.

Most people who take Accutane enjoy clear skin for the long term. But the drug can have distressing and sometimes severe side effects, including dry skin, lips, and eyes; headaches; muscle aches; nosebleeds; joint pain; irritability; depression; and high cholesterol. In some cases, acne may return.

For those who’ve experienced side effects (or are concerned about them), or if their acne has returned after treatment, dermatologists may prescribe lower doses of Accutane, or what’s become known as “microdosing.”

What is a microdose?

There’s no standard definition of an Accutane “microdose.” How much a dermatologist prescribes is based on the patient’s weight, how severe their acne is, and how well they tolerate the medication when they take it. For example, if you’re 130 pounds, a standard dose may range from about 30 milligrams to 60 milligrams per day; a lower-dose regimen may be around 10 milligrams to 30 milligrams per day. 

Or, a dermatologist may recommend taking a low-dose pill just three times a week.

Whether you’re prescribed a full dose or a “microdose,” the goal is to receive the same total amount of Accutane by the end of treatment. So it will likely take longer with a lower dose. A standard treatment typically takes four to six months, whereas a “microdose” might require eight months to a year, or maybe more.

Reaching the cumulative dose reduces the risk that your acne will return after treatment.

Is microdosing right for you?

Dermatologists mainly recommend low doses of Accutane to help reduce side effects. But microdosing can also help manage acne that returns after a standard Accutane course. It could also be a good fit for those with mild to moderate acne that hasn’t cleared with other treatments.

No dose of Accutane is safe for those who are pregnant or might soon become pregnant. The drug can cause severe birth defects, miscarriage, and stillbirth. Everyone who wants to take Accutane must register with the Food and Drug Administration’s iPLEDGE Program. 

This system monitors isotretinoin prescriptions and ensures that patients who can become pregnant use contraception and submit negative pregnancy tests before starting the medication. It also requires women to submit regular pregnancy tests while taking the medication. 

Isotretinoin may raise blood cholesterol and triglyceride levels and may potentially elevate liver enzymes, so dermatologists regularly perform blood tests to monitor those levels.

This testing could feel like a lot if you’re on a lower dose. Because you’ll be taking the drug for longer than a standard course, you may need regular monitoring for a year or more.

But both standard and low-dose regimens can deliver excellent results. The standard course, however, may come with a few more risks than the alternative.