Accutane Side Effects: Common Ones and When to Call

Quick answer: The Accutane Medication Guide calls dry skin, chapped lips, dry eyes and a dry nose that may lead to nosebleeds the common, less serious side effects. The American Academy of Dermatology (AAD) says that once you stop isotretinoin, the dryness will clear. The same Medication Guide lists serious problems that mean you should stop the medicine and call your doctor. They include signs of depression or psychosis, signs of high pressure in the brain, vision or hearing problems, stomach and liver symptoms, severe skin reactions and muscle weakness. Birth defects are a separate risk, so the iPLEDGE rules depend on whether you can get pregnant.

The medical statements here come from the sources listed at the end, checked October 12, 2026.

What are the common side effects of Accutane?

The Medication Guide names dry skin, chapped lips, dry eyes and a dry nose that may lead to nosebleeds. It says to call your doctor about any side effect that bothers you or does not go away.

The AAD describes a four-step plan of a gentle cleanser, moisturizer, sun protection, and lip balm or petroleum jelly. The paragraphs below and the sun section sum up its advice.

Skin: The AAD says to use a gentle cleanser with your fingertips, limit cleansing to twice daily and after sweating, and avoid abrasive scrubs. It also says to apply a non-comedogenic moisturizer while your skin is still damp after cleansing.

Lips: The AAD says to use lip balm with SPF 30 or higher outdoors. Indoors, it says to apply petroleum jelly throughout the day and before bed.

Nose: The AAD says that treating dryness inside your nose as soon as you notice it can prevent or reduce nosebleeds. It suggests a moisturizing nasal spray or a very small dab of petroleum jelly just inside the nostril, without snorting or inhaling it.

Eyes: The AAD says to use saline eye drops or artificial tears for relief from dry, irritated eyes. It cautions that medicated eye drops should be used only if your dermatologist recommends them.

For product choices, our article on the moisturizers for dry skin on Accutane® walks through how to read a label.

How does Accutane affect sun sensitivity?

The AAD says your skin may become more sensitive to the sun, causing you to sunburn more quickly and unexpectedly. It says this effect goes away once you stop taking isotretinoin. Its advice is to seek shade, wear sun-protective clothing, and use a non-comedogenic sunscreen with SPF 30 or higher, broad-spectrum protection and water resistance. The Medication Guide says to avoid sunlight and ultraviolet lights as much as possible, including tanning machines.

What about muscle and joint aches?

The Medication Guide says Accutane may affect bones, muscles, and ligaments and cause pain in your joints or muscles. It tells you to tell your doctor if you plan hard physical activity during treatment. It also tells you to report back pain, joint pain or a broken bone. MedlinePlus also says to talk to your doctor before you participate in hard physical activity such as sports. Muscle weakness appears in the stop-and-call list below.

What happens with contact lenses during treatment?

The Medication Guide says you may have trouble wearing contact lenses while taking Accutane and after treatment.

Which Accutane side effects mean you should call your doctor?

The Medication Guide separates the common effects above from a list of serious ones. Most items say to stop the medicine and call, and a few say to tell your doctor.

• Mental health: The Medication Guide says Accutane may cause depression, psychosis and suicide. It says to stop Accutane and call your doctor right away if you or a family member notices warning signs. Examples include feeling sad, losing interest in activities, sleep changes, new aggression and thoughts of self-harm.
• High pressure in the brain: The Medication Guide says Accutane can increase the pressure in your brain, which can lead to permanent loss of eyesight and rarely death. Signs include a bad headache, blurred vision, dizziness, nausea or vomiting, seizures and stroke. It says to stop and call right away.
• Skin reactions: The Medication Guide says a rash can be serious. It says to stop and call right away for red or inflamed eyes, a rash with a fever, or blisters on the legs, arms or face. The same applies to sores in the mouth, throat, nose or eyes, or skin that begins to peel.
• Stomach, liver and bowel symptoms: The Medication Guide lists severe stomach, chest or bowel pain, trouble swallowing or painful swallowing, new or worsening heartburn, diarrhea, or rectal bleeding. It also lists yellowing of the skin or eyes, or dark urine, and says to stop and call.
• Hearing and vision: The Medication Guide says to stop and call if your hearing gets worse or you have ringing in your ears. It also says to stop and call for any vision problem or for dry eyes that are painful or constant.
• Muscle weakness: The Medication Guide says muscle weakness, with or without pain, can be a sign of serious muscle damage. It says to stop and call right away.
• Allergic reactions: The Medication Guide says to stop and get emergency care for hives, a swollen face or mouth, or trouble breathing.

The Medication Guide also lists lipid problems, blood sugar problems and decreased red and white blood cells. It says to return for lipid blood tests and to tell your doctor if you are very thirsty or urinate a lot. It says to call if you have trouble breathing, faint or feel weak.

The prescribing information says patients should be assessed at each visit during therapy for symptoms of depression, mood disturbance, psychosis, or aggression. Our article on Accutane® and mental health covers this topic. The AAD also says your check-ins give you the chance to mention any change in how you feel, even if it seems unrelated to isotretinoin.

Does acne get worse at first, and what about alcohol?

The AAD says that while it does not happen to most patients, some see their acne worsen when they start isotretinoin. It says to tell your dermatologist if that happens. Our article on the Accutane® purge covers that early flare. Alcohol has its own page, Accutane® and alcohol risks, so we do not repeat it here.

Which lab tests does the label require?

The AAD says your dermatologist will check your cholesterol and liver with a blood test before you start and again while you’re taking isotretinoin. The label says pretreatment and follow-up blood lipids should be obtained under fasting conditions. It also says lipids should be checked before Accutane is given and then at intervals until the lipid response is established, which usually occurs within 4 weeks.

For the liver, the label says pretreatment and follow-up liver function tests should be performed at weekly or biweekly intervals until the response to Accutane has been established. The label reports mild to moderate liver enzyme elevations in approximately 15% of individuals treated in clinical trials. It reports marked triglyceride elevations in approximately 25% of patients receiving Accutane in clinical trials. It says acute pancreatitis has been reported, and that the drug should be stopped if triglycerides cannot be controlled or if pancreatitis symptoms occur.

A 2023 Cutis article states that frequent laboratory monitoring for spironolactone and isotretinoin continues to be prevalent despite little evidence to support its clinical utility. Your prescriber sets the schedule that applies to you.

What do birth defects and iPLEDGE mean for each patient group?

The Medication Guide says Accutane can cause birth defects, miscarriage, death of the baby, and early births. It says patients who are pregnant or plan to become pregnant must not take it. If you get pregnant while taking Accutane, it says to stop right away and call your doctor. The prescribing information describes an extremely high risk of life-threatening birth defects if pregnancy occurs while taking Accutane in any amount, even for short periods of time.

MedlinePlus says all patients, including women who cannot become pregnant and men, can get isotretinoin only if they are registered with iPLEDGE. It also says not to buy isotretinoin over the internet. The rules differ by group, and the sections below state the group each time. The current FDA page is the source for the dates that follow, as of October 12, 2026.

What applies if you can get pregnant?

The label says patients who can become pregnant need two negative pregnancy tests before the first prescription. It says the second test must be done in a CLIA-certified laboratory and that the interval between the two tests should be at least 19 days. It also says these patients must use two forms of effective contraception simultaneously. The label lists exceptions, including continuous abstinence. The Medication Guide says not to get pregnant for 1 month before starting, while taking, and for 1 month after stopping.

The label says these patients must use the iPLEDGE system before starting, monthly during therapy and one month after the last dose. Each time, they answer questions on the program requirements and enter their two chosen forms of contraception. For these patients, the label says the prescription must be obtained within 7 days of the date the pregnancy test specimen was collected. MedlinePlus says your pharmacist cannot dispense your medication if you pick it up after the allowed time has passed. Our iPledge FAQ says both pre-treatment tests are lab tests for telehealth patients.

Home tests are covered by the FDA’s October 2023 update. The FDA says it does not intend to object if prescribers rely on the patient to perform home pregnancy tests. The patient reports the dates and results during and after isotretinoin treatment. All pre-treatment tests must still be performed in a medical setting. The label still says a pregnancy test must be repeated every month in a CLIA-certified laboratory, so ask your prescriber which applies to you.

What applies if you cannot get pregnant, including men?

Patients who cannot become pregnant must sign a Patient Enrollment Form for Patients who cannot get Pregnant. The label says they must obtain the prescription within 30 days of the office visit. The label’s table of monthly iPLEDGE interactions lists the counseling confirmation and the pharmacist’s authorization for this group, and no monthly patient step. MedlinePlus adds that a very small amount of isotretinoin will probably be present in semen, and that it is not known whether this could harm a fetus. It says to tell your doctor if your partner is pregnant, plans to become pregnant or becomes pregnant during treatment.

Two rules apply to patients in both groups. Do not donate blood while on isotretinoin or for one month after treatment, and do not share the medicine. Both rules appear in the Medication Guide. Our prescription window article covers each group.

What changes are planned for November 15, 2026?

The FDA approved changes to the iPLEDGE REMS on February 9, 2026, and the planned implementation date is now November 15, 2026. As of October 12, 2026, those changes are not in effect, and the rules above still apply. The FDA says that after the changes, there is no longer a 30-day prescription window for patients who cannot get pregnant. After those changes, it also says monthly documentation of counseling in the REMS for that group is no longer required.

Once the planned changes take effect, the FDA says a patient who can get pregnant and misses the 7-day window may repeat the pregnancy test immediately. Pre-treatment pregnancy tests stay in a medical setting both now and after that date.

What can last after you stop Accutane?

The AAD says the dryness will clear and that sun sensitivity will go away once you stop. The Medication Guide says lipid problems usually go away when Accutane treatment is finished.

The label says some effects may continue. The Medication Guide says hearing loss may be permanent, and that the ability to see in the dark usually clears up after you stop but may be permanent. It says organ damage may not get better even after you stop taking Accutane. The prescribing information says symptoms of inflammatory bowel disease have been reported to persist in some instances, and alopecia, which is hair loss, in some cases persists. The Medication Guide also says contact lens trouble can continue after treatment, and that Accutane may stop long bone growth in teenagers who are still growing.

The Medication Guide says not to have waxing, dermabrasion or laser procedures while you are using Accutane and for at least 6 months after you stop. It says to check with your doctor about timing. A 2017 JAMA Dermatology review found insufficient evidence to support delaying some specific procedures, including laser hair removal. That review does not change the Medication Guide’s instruction.

Where does The Goal Is Clear fit in your care?

At The Goal Is Clear, a U.S. board-certified dermatologist licensed in your state reviews every case, and a prescription is never guaranteed. Its how it works page says you can message your dermatologist through the dashboard with side-effect reports, refill questions and photo updates. It adds that a real person reads every message. For Accutane® patients, the Accutane FAQ says an iPledge concierge tracks monthly windows, pregnancy tests and refills.

Medication is billed separately by the pharmacy, as low as $0 for the prescription with insurance. Details are on the pricing page and in the Accutane cost FAQ. BNG Health Services, LLC operates the brand and is not the prescribing physician. If you want your case reviewed, the quiz takes about two minutes, and our complete guide to Accutane® covers the full course.

Common questions about Accutane side effects

What are the common Accutane side effects? The Medication Guide names dry skin, chapped lips, dry eyes, and a dry nose that may lead to nosebleeds as the common, less serious effects. The AAD says the dryness clears once you stop isotretinoin.

How do you manage dry lips, dry skin and nosebleeds? The AAD recommends a gentle cleanser, a non-comedogenic moisturizer, and lip balm with SPF 30 or higher outdoors. It also recommends petroleum jelly indoors. For the nose, it suggests a moisturizing nasal spray or a very small amount of petroleum jelly just inside the nostril, without snorting or inhaling it.

Which side effects mean you should call your doctor? The Medication Guide says to stop and call for signs of depression or psychosis, a bad headache, blurred vision or severe rashes. The same applies to severe stomach pain, yellowing of the skin or eyes, worsening hearing, vision problems and muscle weakness.

Are there blood tests during treatment? The AAD says your dermatologist checks your cholesterol and liver before you start and again while you’re taking isotretinoin. Patients who can get pregnant also need a pregnancy test before each monthly prescription, and the label says it is done in a CLIA-certified laboratory.

Can you use a home pregnancy test on Accutane? For patients who can get pregnant, the FDA’s October 2023 update says it does not intend to object to prescribers relying on home tests during and after treatment. Both pre-treatment tests must stay in a medical setting. The label still says monthly tests are done in a CLIA-certified laboratory, so your prescriber decides what applies to you.

This article is general information, not medical advice. A prescription is never guaranteed, and treatment decisions stay with the board-certified dermatologist who reviews your case. Accutane® is a registered trademark of its respective owner, and isotretinoin is the generic name. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician; board-certified dermatologists prescribe.

Sources

• Accutane (isotretinoin) prescribing information and Medication Guide, DailyMed
• American Academy of Dermatology, Isotretinoin: side effects and skin care
• FDA, iPLEDGE Risk Evaluation and Mitigation Strategy (REMS)
• MedlinePlus, Isotretinoin
• Shields and Barbieri, From Breakouts to Bargains: Strategies for Patient-Centered, Cost-effective Acne Care, Cutis 2023
• Spring et al., Isotretinoin and Timing of Procedural Interventions, JAMA Dermatology 2017