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Isotretinoin (Accutane/Claravis)

Metabolicprescriptionoral · inferred

Oral 13-cis-retinoic acid used for severe recalcitrant nodulocystic acne and select other dermatoses. Typical dosing 0.5-1 mg/kg/day divided BID with food (high-fat meal roughly doubles F), targeting cumulative dose 120-150 mg/kg per course. Parent t1/2 ~20h; major active metabolite 4-oxo-isotretinoin t1/2 ~29h. Oral bioavailability ~25% fasted but up to ~60% with food (Lidose formulation reduces food effect). SEVERE TERATOGEN, U.S. iPLEDGE program mandatory: two negative pregnancy tests, two contraceptive methods, monthly monitoring. Class AEs: mucocutaneous dryness, transaminitis, hypertriglyceridemia, photosensitivity; controversial depression/suicidality signal warrants mood monitoring. Avoid vitamin A supplements, tetracyclines (pseudotumor cerebri risk).

Projected serum levels — 40 mg, twice daily

Isotretinoin (Accutane/Claravis)
Isotretinoin (Accutane/Claravis) modeled serum levels, 40 mg twice daily over 15 days Population-based pharmacokinetic estimate. Steady state reached after approximately 3 days. 0 12.5 25 37.5 50 Day 0 Day 4 Day 7 Day 11 Day 15 Time on a regular schedule ≈ steady state · day 3
Isotretinoin (Accutane/Claravis) modeled serum levels with a loading dose of 118 mg, then 40 mg twice daily The first dose is larger so levels approach steady state faster. 0 12.5 25 37.5 50 Day 0 Day 4 Day 7 Day 11 Day 15 Time on a regular schedule

Maintenance schedule: 40 mg twice daily (oral).

Loading schedule: 118 mg on day 1, then 40 mg twice daily — reaching therapeutic levels sooner.

Modeled steady state after ~3 days: peak ≈ 26.5 mg, trough ≈ 19.2 mg body load. Population-based estimate over 15 days for a 40 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.

Key facts

Category
Metabolic
Route modeled
Oral
Model confidence
inferred
Half-life
20 h
Common dose
40 mg
Suggested maximum
80 mg/day
Reference dose range
10–80 mg (single dose)
Suggested cadence
twice daily
Validated against
40 mg oral — Cmax 0.40 mg/L at 3.2 h

Documented interactions

  • danger
    Carbamazepine (Tegretol) + Isotretinoin (Accutane/Claravis) CYP induction

    Carbamazepine (Tegretol) inducer of CYP3A4 predicted to change Isotretinoin (Accutane/Claravis) AUC by ~0.47x

  • danger
    Efavirenz (Sustiva) + Isotretinoin (Accutane/Claravis) CYP induction

    Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Isotretinoin (Accutane/Claravis) AUC by ~0.34x

  • danger
    Levothyroxine (Synthroid) + Isotretinoin (Accutane/Claravis) Protein binding

    Isotretinoin (Accutane/Claravis) may displace Levothyroxine (Synthroid) from plasma protein binding sites, transiently raising free drug concentration. This drug has a narrow therapeutic index; free…

  • danger
    Rifampin + Isotretinoin (Accutane/Claravis) CYP induction

    Rifampin inducer of CYP3A4 predicted to change Isotretinoin (Accutane/Claravis) AUC by ~0.34x

  • warning
    Apigenin + Isotretinoin (Accutane/Claravis) Protein binding

    Apigenin may displace Isotretinoin (Accutane/Claravis) from plasma protein binding sites, transiently raising free drug concentration.

  • warning
    Aripiprazole (Abilify) + Isotretinoin (Accutane/Claravis) Protein binding

    Aripiprazole (Abilify) may displace Isotretinoin (Accutane/Claravis) from plasma protein binding sites, transiently raising free drug concentration.

Serum checks 213 modeled interaction pairings for isotretinoin (accutane/claravis) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.

Research behind this entry

  1. Pharmacokinetics of isotretinoin (Accutane) in healthy male subjects Colburn WA et al. · Journal of Clinical Pharmacology, 1983 DOI

    Foundational PK study: isotretinoin t1/2 ~20h, 4-oxo-isotretinoin active metabolite t1/2 ~29h, oral F highly dependent on co-ingestion with fatty meal.

  2. Oral isotretinoin: mechanism of action for the treatment of acne vulgaris Layton A · Dermato-Endocrinology, 2009 DOI

    Clinical mechanism review: isotretinoin reduces sebocyte size/activity and P. acnes burden; cumulative 120-150 mg/kg dose correlates with durable remission in severe acne.

2 published studies referenced in the app, each with a plain-language summary.