Isotretinoin (for Neuroblastoma)

• Fever and headache may be common during the first few doses but fever should be transient. Paracetamol can be useful for this.
   
• Other common side effects include dry or peeling skin, cracked lips and dry eyes. Moisturisers and lip balm can be helpful when the skin and lips are cracked and dry. Lubricant eye drops are also helpful if the eyes become dry and irritated.
   
• The medicine may also cause back, muscle and joint pain, particularly in children.
   
• This medicine may also cause the skin to become more sensitive to sunlight; avoid exposure to sunlight, wear protective clothing (long sleeves and pants), wide-brimmed hats and apply sunscreen liberally.

• Other less common side effects may include increase in triglycerides levels, calcium levels and reduction in blood counts, thinning of the bone (osteoporosis).

Please inform your doctor if you (or your child) experience any other side effects or if the side effects become severe and bothersome.

Although uncommon, there have been reports of psychiatric reactions (e.g. depression, mood swings, anxiety) in adolescents and adults who use isotretinoin for acne conditions. Please inform your doctor immediately if you(or your child) experience any of these reactions.

Very rarely, it may cause thinning of the bone (osteoporosis) which could lead to weakness of the bone, bone fractures or delay in healing of the fractures.

Isotretinoin is recommended to be taken with food and is usually taken twice daily.

Swallow capsules whole with a full glass of water.

Other ways if you are unable to swallow whole capsule:

• Pierce the capsule with a large-gauge needle OR use a scissors to snip the tip off the capsule (if the capsule is too hard, you can put the capsule in a small amount of lukewarm water to soften the outer shell). Squeeze the contents ​onto food for immediate consumption. It is best to use food with high fat content (e.g. peanut butter, cheese, chicken noodle soup broth, pudding, or ice cream) to help absorb the medicine.
• Chew the capsule to empty the contents. Shell of capsule can then be swallowed or spit out.

If you forget a dose, take it as soon as you remember. If it is nearer to the time of the next dose, skip the missed dose. Do not take two doses at the same time.

Do not repeat dose if vomiting occurs after dose has been administered, wait until the next scheduled dose. Contact the pharmacist or doctor if you (or your child) repeatedly miss doses due to vomiting, even with the administration of anti-vomiting medicine.

• This drug can cause fetal abnormalities, caregivers who are pregnant or female of child-bearing age, please handle with care.
• Do not take any other medications or herbal products without first consulting your doctor. Please inform your doctor or pharmacist if you (or your child) are taking any other medicines, especially antifungals or antibiotics. Some medication may reduce its efficacy, or increase its toxicity.​
• ​Do not take multivitamins that contain vitamin A or beta-carotene. These vitamins may make the side effects of isotretinoin worse