What Are the Side Effects of Isotretinoin?

The most common side effects of isotretinoin are dry skin, dry lips, a dry nose with nosebleeds, and dry or irritated eyes. Muscle or joint aches, headaches and changes in liver tests or blood fats can also happen. Rare but serious effects include mood changes, severe skin reactions and pancreatitis. It can seriously harm an unborn baby.

Isotretinoin can be very effective for severe acne, and many of its side effects are predictable and manageable. A small number are serious. Knowing which is which helps you get help quickly when you need it.

Common side effects

Dry skin, itching and skin that is more fragile or easily irritated
Dry, cracked lips (cheilitis)
Dryness inside the nose and nosebleeds
Dry, irritated or inflamed eyes; contact lenses may become uncomfortable
Muscle, joint and back pain
Headache
Raised blood fats and changes in liver tests, found on blood tests
A short flare of acne in the first 7 to 10 days

Using a moisturiser and lip balm from the start of treatment helps with dryness. Many of these effects depend on the dose and settle after treatment, although some, such as dry eyes, can persist after stopping.

Mental health

Depression, anxiety, aggressive behaviour, mood changes and psychotic symptoms have been reported. Very rarely, suicidal thoughts, suicide attempts and suicide have been reported. Regulators have not been able to show that isotretinoin causes these problems, but every patient should be asked about their mood before, during and after treatment. Stopping isotretinoin may not be enough on its own, so further support may be needed.

Mental health warning: if you notice low mood, depression, anxiety, aggression, unusual changes in mood or behaviour, or any thoughts of self-harm or suicide while taking isotretinoin, contact your prescribing doctor straight away so this can be reviewed. If you feel unsafe or at immediate risk, call 999 or 112 or go to your nearest emergency department. It can help to tell a family member or friend that you are taking isotretinoin so they can tell you if they notice a change.

Serious side effects that need urgent help

Stop taking isotretinoin and get urgent medical advice if you have:

A persistent headache with nausea, vomiting or changes in your vision, which can be a sign of raised pressure around the brain
A widespread rash with blistering, peeling, or sores in the mouth, eyes or genitals
Swelling of the face, lips or throat, or difficulty breathing (call 999 or 112)
Severe stomach pain, which can be a sign of pancreatitis
Severe or bloody diarrhoea
Yellowing of the skin or eyes
Muscle weakness or pain with dark urine, particularly after hard exercise
Blurred vision or other sudden changes in your eyesight

Eyes, hearing and driving

Isotretinoin can reduce night vision, sometimes suddenly, so take care driving or operating machinery at night. In rare cases this has persisted after treatment. Hearing problems have also been reported. Tell your prescriber about any change in your eyesight or hearing.

Other side effects

Hair thinning, changes in blood counts and raised blood sugar can occur. Sexual side effects, including erectile dysfunction and reduced libido, have also been reported. If you notice any of these, tell your prescriber.

Pregnancy

Isotretinoin can cause severe birth defects and miscarriage. Anyone who could become pregnant must follow the Pregnancy Prevention Programme, including effective contraception from at least one month before until at least one month after treatment, and supervised pregnancy tests. It must not be taken during pregnancy or while breastfeeding.

Frequently asked questions

Does everyone get serious side effects?

No. Dryness is very common, but serious side effects are rare. Everyone taking isotretinoin still needs monitoring and clear information on which symptoms to report.

Can I exercise while taking isotretinoin?

Yes, but tell your prescriber if you do intensive exercise. Muscle pain and raised muscle enzymes are more likely after vigorous exercise, and severe muscle damage has been reported rarely.

Can I take vitamin A supplements?

No. Vitamin A supplements should be avoided because they add to the effects of isotretinoin. Check any supplement with your prescriber.

Can I get waxing or laser treatment?

Avoid waxing during treatment and for at least 6 months after. Avoid laser treatment and aggressive chemical resurfacing during treatment and for 5 to 6 months after.

Do side effects go away after treatment?

Many settle once treatment stops, but some can persist. Tell your prescriber about anything that does not settle.

Can I donate blood?

No. Do not donate blood during treatment or for 1 month after stopping.

When should I see a doctor?

Contact your prescribing doctor promptly about any new or worsening side effect, and urgently about any of the serious symptoms or mood changes listed above. If you have not started treatment, you can read about when to talk to a doctor about your acne.

Sources

Reviewed by Dr Tara Treacy, GP with a special interest in dermatology (IMC 411337). Last reviewed: 2 November 2026. General information only; it does not replace an individual medical assessment.