RESEARCH STARTER

Isotretinoin (drug interactions)

Isotretinoin is a powerful medication derived from vitamin A, primarily used to treat severe acne. However, it is important for users to be aware of potential drug interactions that can affect their health. For instance, taking additional vitamin A while on isotretinoin can lead to toxic symptoms due to the cumulative effects of both substances. Individuals are generally advised to avoid vitamin A supplements, as a typical diet usually provides sufficient amounts. Furthermore, the herbal supplement St. John's wort may reduce the effectiveness of oral contraceptives, posing a risk for unintended pregnancies, which is a significant concern for women taking isotretinoin due to its association with congenital disabilities.

There are also concerns regarding the concurrent use of isotretinoin and tetracycline antibiotics, as this combination can increase the risk of intracranial hypertension. Additionally, patients should abstain from alcohol consumption, as isotretinoin can place stress on the liver. While some studies suggest that vitamin E might help reduce side effects from isotretinoin, users should always consult healthcare providers about all substances they are taking, including herbal supplements, to ensure safe and effective treatment.

Full Article

DEFINITION: A drug related to vitamin A that is used to treat severe acne.

  • INTERACTIONS: St. John’s wort, vitamin A, vitamin E, Tetracycline, alcohol
  • TRADE NAME: Accutane

Vitamin A

Effect: Probable Harmful Interaction

Both vitamin A and isotretinoin can cause toxic symptoms if taken in excess. It is presumed that the simultaneous use of vitamin A and isotretinoin would amplify the risk. For this reason, persons using isotretinoin should not take vitamin A at doses higher than the recommended daily allowance. Because most people get enough vitamin A from their diet, it might be preferable to take no vitamin A supplements at all. (Supplements that use beta-carotene to supply vitamin A are probably safe.)

St. John’s Wort

Effect: Indirect Harmful Interaction

Because isotretinoin can cause congenital disabilities, women who use it are often advised to take oral contraceptives (birth control pills). The herb St. John’s wort is thought to interact with birth control pills and reduce their effectiveness, raising the risk of pregnancy. For this reason, people taking Accutane and oral contraceptives should avoid using St. John’s wort.

Vitamin E

Effect: Possible Helpful Interaction

One preliminary study hints that vitamin E might reduce the side effects of isotretinoin.

Other Interactions

There are other notable interactions that patients should be aware of when taking isotretinoin. Tetracycline antibiotics, when taken with isotretinoin, may increase the risk of developing intracranial hypertension, or increased pressure in the skull. Patients should also avoid other acne medications, as this can lead to overdrying and skin irritation. Because isotretinoin already puts a lot of strain on the liver, drinking alcohol is not advised. Due to the relatively limited information on herbal supplements and isotretinoin, patients are advised to discuss all substances they take with their healthcare provider.


Bibliography

McIntyre, Chelsea. "Isotretinoin: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing." WebMD, 15 Apr. 2024, www.webmd.com/drugs/2/drug-6661/accutane-oral/details. Accessed 12 Dec. 2025.

Murphy, P. A., et al. "Interaction of St. John’s Wort with Oral Contraceptives: Effects on the Pharmacokinetics of Norethindrone and Ethinyl Estradiol, Ovarian Activity, and Breakthrough Bleeding." Contraception, vol. 71, 2005, pp. 402-8.

Pfrunder, A., et al. "Interaction of St. John’s Wort with Low-Dose Oral Contraceptive Therapy." British Journal of Clinical Pharmacology, vol. 56, 2003, pp. 683-90.

Pile, Hannah D., et al. “Isotretinoin - StatPearls .” NCBI, 4 Mar. 2025, www.ncbi.nlm.nih.gov/books/NBK525949/. Accessed 12 Dec. 2025.

Skroza, Nevena, et al. "Advantages of Tailored Isotretinoin Treatment in Moderate to Severe Acne: Real-Life Data." Frontiers in Pharmacology, vol. 12, 2021, p. 733526, doi.org/10.3389/fphar.2021.733526. Accessed 12 Dec. 2025.


Full Article

DEFINITION: A drug related to vitamin A that is used to treat severe acne.

  • INTERACTIONS: St. John’s wort, vitamin A, vitamin E, Tetracycline, alcohol
  • TRADE NAME: Accutane

Vitamin A

Effect: Probable Harmful Interaction

Both vitamin A and isotretinoin can cause toxic symptoms if taken in excess. It is presumed that the simultaneous use of vitamin A and isotretinoin would amplify the risk. For this reason, persons using isotretinoin should not take vitamin A at doses higher than the recommended daily allowance. Because most people get enough vitamin A from their diet, it might be preferable to take no vitamin A supplements at all. (Supplements that use beta-carotene to supply vitamin A are probably safe.)

St. John’s Wort

Effect: Indirect Harmful Interaction

Because isotretinoin can cause congenital disabilities, women who use it are often advised to take oral contraceptives (birth control pills). The herb St. John’s wort is thought to interact with birth control pills and reduce their effectiveness, raising the risk of pregnancy. For this reason, people taking Accutane and oral contraceptives should avoid using St. John’s wort.

Vitamin E

Effect: Possible Helpful Interaction

One preliminary study hints that vitamin E might reduce the side effects of isotretinoin.

Other Interactions

There are other notable interactions that patients should be aware of when taking isotretinoin. Tetracycline antibiotics, when taken with isotretinoin, may increase the risk of developing intracranial hypertension, or increased pressure in the skull. Patients should also avoid other acne medications, as this can lead to overdrying and skin irritation. Because isotretinoin already puts a lot of strain on the liver, drinking alcohol is not advised. Due to the relatively limited information on herbal supplements and isotretinoin, patients are advised to discuss all substances they take with their healthcare provider.


Bibliography

McIntyre, Chelsea. "Isotretinoin: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing." WebMD, 15 Apr. 2024, www.webmd.com/drugs/2/drug-6661/accutane-oral/details. Accessed 12 Dec. 2025.

Murphy, P. A., et al. "Interaction of St. John’s Wort with Oral Contraceptives: Effects on the Pharmacokinetics of Norethindrone and Ethinyl Estradiol, Ovarian Activity, and Breakthrough Bleeding." Contraception, vol. 71, 2005, pp. 402-8.

Pfrunder, A., et al. "Interaction of St. John’s Wort with Low-Dose Oral Contraceptive Therapy." British Journal of Clinical Pharmacology, vol. 56, 2003, pp. 683-90.

Pile, Hannah D., et al. “Isotretinoin - StatPearls .” NCBI, 4 Mar. 2025, www.ncbi.nlm.nih.gov/books/NBK525949/. Accessed 12 Dec. 2025.

Skroza, Nevena, et al. "Advantages of Tailored Isotretinoin Treatment in Moderate to Severe Acne: Real-Life Data." Frontiers in Pharmacology, vol. 12, 2021, p. 733526, doi.org/10.3389/fphar.2021.733526. Accessed 12 Dec. 2025.


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