Accutane - Does it Damage Muscles?

E Hodak, N Gadoth, M David, and M Sandbank

Muscle damage induced by isotretinoin.

Br Med J (Clin Res Ed). 1986 August 16; 293(6544): 425–426.

The purpose of this case study was to examine the link between isotretinoin treatment and neuromuscular adverse effects. Approximately fifteen percent of patients treated with isotretionin develop musculoskeletal symptoms and occasionally increased creatine kinase activity (a muscle enzyme which is a marker of severe muscle breakdown and muscular dystrophy). There is inadequate data to establish a causal relationship between the drug and creatine kinase activity.

This small study included only two patients, aged 16 and 20, who presented with severe acne that had been resistant to treatment. Apart from the acne lesions, physical and neurological examinations revealed no abnormalities and laboratory tests were normal. Both patients commenced on a course of isotretinoin therapy at a dose of 0.5 mg/kg/day.

At a follow up examination after the first month of treatment, both patients complained of muscle pain and weakness which had started after the first few days. Both were experiencing muscle tenderness on palpation. Most laboratory tests were normal, but in the first case, the patient showed significantly increased levels of muscle enzyme activity. A biopsy sample of deltoid muscle tissue was obtained in the second case which showed evidence of damage to the muscle and myoneural junction (the junction between a nerve fiber and a skeletal muscle).

Isotretinoin was discontinued and the muscle pain abated over the next few days. When examined one month later both had normal strength, muscle enzyme levels and needle electromyograms.

The authors of the case study concluded that isotretinoin may induce reversible damage to skeletal muscle.

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