Breakthrough -- Accutane 0.5 mg capsules

[drnase]

Hi Group,

Companies are now working on low dose accutane capsules (0.5mgs) for cancer treatment. The lowest doseage currently is 10 mgs.

This 0.5 mg could really change the face of rosacea. This is all many need for major clearance of papules/pustules, redness, dermal inflammation, swelling and rhinophyma.

Most importantly, it is set just under the Vitamin A hypervitamintosis level so the patient side effects are almost non existent in cancer patients at least.

Dr. Geoffrey Nase
-------------------------------------
Ph.D. Microvascular Physiologist
http://www.drnase.com
-------------------------------------

[Kel]

Great news! Please let us know when this comes available. I was on Accutane 3 years ago to clear sebum. :oops:

Let me be one of the first to say it is great to chat with you again Dr. Nase. I think this forum will be much more condusive to focusing on the cure (or cures) for Rosace and not personal attacks.

[drnase]

Thanks Kel,

The 0.5 mg capsules are on fast track FDA approval due to the lack of side effects and its effect blocking ability of VEGF production (something new they just found) which explains partly why it helps so many rosacea sufferers in small doses and why it stops progression of cancer. Learned all this new stuff while getting my skull cut open and cancer scooped out of it. You have got to admit that I am a little bit strange. All my physicians where focusing on my brain tumor and I was asking them all about the new accutane (still researchin rosacea while wearing a gown and going through chemo).

[Kel]

Dr. Nase,

Thats why I aupport you 100% -- you are passionate about finding a cure for Rosacea! All the best on your continued recovery. Your research and postings have helped me manage my condition.

PS Lets get Dr Darm on here as well -- he needs to be supported for his groundbreaking efforts on IPL treatment in collaboration with you.

[Bob Bear]

Good, good, gooooood! This is what we like to hear :D

[Sally]

This is very good news indeed. But is it true that Accutane destroys sebaceous glands permanently? i.e. there will be no return of normal oil/sebum production when you stop taking it?

I don't want my skin and hair to remain as dry as they are now after 9 months on Accutane. It's helped enormously with inflammation and getting rid of p&p's but the excess oil I used to have kept wrinkles at bay. And that's not a bad thing when you're getting older, believe me!

Sally

[recluse]

does very low dose accutane (10mg or less) thin the skin or is this phanomina only characteristic of the higher dosages?

[Chris23]

Sound great! Just wondering if it will be the same for Roaccutane, which I believe is the same as Accutane, just a different name.

If my IPL's doesn't work out, then I will surely try accutane at some point.

Btw, could it be possible to make an own thread/place for Accutane discussion?

Regards,
Chris

:arrow:

:arrow:

[Max]

0,5 mg - should this really prevent you from getting rhinophyma - seems a bit too little to do any good??

i guess 0,5mg daily would too low, but this way you're able to get daily doses below 10mg. e.g. 2mg or 5mg.

i'd really like to see 5mg, i know this dose has been sold some years ago, they just stopped it for whatever reason...

[recluse]

funny that dr. nase mentioned that accutane is now recognized as having antiogenesis effects. when i went on accutane for my acne a year ago, i noticed that when i started off at the lower dosage, some of my telengectasia actually disappeared! they never have returned. yet at the higher dosage, i noticed new veins forming. Wierd! but maybe i am a freakshow case because i have not heard of anyone else who has seen similar results with their facial veins as i have. but accutane got rid of 2 bright red veins just above my eyebrows and one on the side of my nose. my derm even remarked that he had not seen this reaction from accutane before!

[Chris23]

Hi Chris,

You should ask for generic isotretinoin - it's much cheaper, in Denmark I bought 50 10mg isotretinoin tabs for only 3 dollars

Is there a differense? I don't really care what it cost, the only thing that matters for me is getting the best possible treatment..

Regards,
Chris

[drnase]

marc,

Good question. 0.5mgs will do everything 10 mgs will do except it will take a little longer. 10 mgs does not usually thin the skin or increase redness in 85% of rosacea sufferers. There will always be a few that react poorly to any med.

If the rhinophyma is in end stage then I certainly would start on 10 mgs. But if it is just mild to moderate the 0.5 mg dose will do.

Actually Roche is not making this product.

[yossarian]

Hi Chris,

You should ask for generic isotretinoin - it's much cheaper, in Denmark I bought 50 10mg isotretinoin tabs for only 3 dollars

Is this without a prescription?

:arrow:

[cactus]

I know Dr. Nase says that 10 mg. of Accutane doesn't usually thin the skin of most people. What about 20 mg.? I took that dosage years ago for acne, before I had rosacea, and now wonder if I permanently thinned my skin from that. I had no adverse effects at the time in terms of redness.

[Tamara]

Yeah, I have the same concern. I took 20 MG of Accutane for three months, prescribed by my derm for rosacea. Is that likely to have done damage to my skin?

[cactus]

I took 20 mg. for 8 months - back in 1999. I was told full dosage for my body weight would have been 50 mg.

[recluse]

dr. nase,

do you think that the 0.5 mg dosage would inhibit angiogenesis more or less than the 10mg dosage? also, what has more effecacy in inhibiting angiogenesis, antibiotics or accutane?

I don't expect that any clinical studies have been done on this so i realise that i am asking you to speculate. that's fine. with you i am sure that it is very educated speculation. . .

[Buster]

http://www.blackwell-synergy.com/links/doi/10.1046/j.1439-0353.2003.03738.x/abs/?cookieSet=1

Seems at least down to 2.5 mg *3 weekly is effective. 0.5 sounds VERY promising, since it is virtually non toxic. Good recearch Nase, I will ask my derm about this. I did not like 10 g *3 pr week since I do a lot of sport and the side effect were not too pleasant.

But I read that Zileuton is as effective. Know anything about this Dr Nase or anyone?

If I ever get my scull opened I will prepare intelligent questions, too.

Mads, Norway

[bettina]

Anyone else have trouble with that link? Can't get to Buster's article! :(

[Buster]

Very low dose isotretinoin is effective in controlling seborrhea
Niedrig dosierte Isotretinoin-Therapie ist wirksam bei Seborrhö
Sabine E. Geißler, Silke Michelsen, Gerd Plewig
Summary

Background: Excessive seborrhea, coarse-pored skin, minimal acne and oily scalp hair comprise a well-known clinical entity. It causes considerable concern, has social impact, and affects the quality of life in some individuals. Some patients seek treatment for seborrhea. No effective topical sebosuppressive medication is available. Oral isotretinoin is the only remedy for men. In women, oral isotretinoin is the most effective remedy, followed by antiandrogens.

Patients and methods: Eleven patients in three groups were treated for 6 months with very low dose isotretinoin. The influence on seborrhea was measured during oral treatment with 5 mg/d, 2.5 mg/d, or 2.5 mg 3 weekly.

Results: Sebum production, measured with Sebutape®, was reduced by up to 64 %. Acne lesions regressed by as much as 84 %. Follicular filaments were reduced by 66 %. Microcomedones were reduced on average up to 86 %. Quantitative bacteriology showed a reduction of Propionibacterium acnes but no increase of Staphylococcus epidermidis. Biopsies revealed a 51 % reduction in sebaceous gland size. With Bentonite, a reduction of lipids was demonstrated with 2.5 and 5 mg isotretinoin/d but not with 2.5 mg 3 weekly. There was a shift within the lipid fractions: triglycerides dominated, followed by squalenes and free fatty acids.

Conclusions: Good results were achieved in all patients. The small number of patients did not permit a statistical analysis of the three isotretinoin doses studied, but there was a tendency toward better results with the two higher doses.

[Buster]

I was wondering. Is it possible to take a 10 mg accutane capsule and make it into 0.5 capsules?
Anyone with thoughts?

[RedHotCanuck]

Buster.

10 mg into 0.5 mg? that is like dividing it into 20 parts is it not??

From what I remember, it is not supposed to be even split in 1/2.

[fut]

Buster,

Dr. Nase said this is not possible. Not even splitting in half, i'm afraid =\

[Buster]

I was wondering if the pharmacists could do it. I was not suggesting doing it myself.
I see vaguely to remember this being possible.

[Buster]

I went to the pharmacy today and asked if they could compound 0.5 mg pills of isotretinoin. They said it could be done, but it would probably be expensive. But there was no law against it, and it would be possible.
But it was ore realistic to wait for the new medication to be released since the cost would be high.
But I will see what my derm says about this.

[yossarian]

What form does isotretinoin come in? Is it power in a capsule? If so, I don't see why it can't be split at home, I've done it before with other (herbal) medicines. If it is a solid pill then that could be cut in half. Did Dr Nase give any reason why it cannot be split?

[RedHotCanuck]

From what I remember it had something to do with it being exposed to the air .. maybe i'm wrong.

[Buster]

http://health.groups.yahoo.com/group/rosacea-support/message/67974

Seems it can be done. If nothing else, what you can do is take a 10 mg capsule and empty it and just swallow the capsule. The substance that is left on the inside walls of the capsule should be around 0.5 mg or maybe a bit more.

[Buster]

I would say the best solution is to NOT freeze or heat the capsule, but rather just split it open, drain the content into a 10 or 20 ml plastic syringe (not with a needle, just a plastic type syringe used for liquid) and fill it with olive oil, udos choice or flax seed or whatever oil you think best.
Then shake well.
The best would be if the syringe was dark so there would not be too much light corrupting the isotretinoin.
Then with the syringe you can with ease take out dosages as small as 0.5 ml. If you mix a 10 mg pill with 10 ml of oil then 1 ml of that, if mixed well, should be 1 mg of accutane.

[diger_diga]

im wondering wheather isotretinoin or accutane or whatever its called reduced redness or it make redness more.
there seem to be many ppl having accutance induced rosacea - if i have redness does it help making it better / less or will it increase redness ???

[Buster]

Hello. Wie geht es dir mein Freund? Ist Sommer schøn in NordRheinWestfahlen?
As I understand it, the accutane induced rosacea is caused by regimens intended to clear up acne vulgaris, that means taking 40 mg or more daily for up to 6 months. This causes thinning of the skin and a host of unpleasant side effects.
The low dose regimens that Dr Nase recommends is from the range of 10 mg pr day, but even that is a lot. 10 mg every other day, or even as the study I linked to in another post, 2.5 mg every other day can give good results.
Nase has mentioned how these dosages have an anti inflammatory effect. I also read that it actually decreases the facial temperature, so there are several ways that isotretinoin can help reduce redness.

[diger_diga]

mir geht's ok, hier ist es ziemlich heiß zwischenzeitlich :-( cant tollerate that at the moment - anyway thanks for that info - just wondering wheather the redness is actually removed or just stopped from progressing ?!?!?! and if flushs disappear or are they just cut down like sorta from clonidine. id be very interested in it.so do you take 2.5 a day or is 0.5 enough?

[YankeesRtheBest]

My questions about the .5 mg accutane

1.) Will it not dry out my eyes like the 10 mg did, I only took it twice a week and it made my already terrible ocular rosacea and dry eye worse, it was weird though cause for a couple days they were whiter than they ever were since I was 14 years old (now I'm 20) , but with continued use they got drier. Even though I'm on restasis and doxy now and not taken accutane any longer my eyes have been super dry and I'm sensitive to every over the counter eyedrop. I'm also on elestat for pollen and lotemax temporarily because my eyes are on such bad condition.

2.) Will the .5 mg finally stop my bad cystic acne? I'm sure it will take longer, but will this do it? I continue to scar, have large pores, and tiny holes from past pimples, will this help?

3.) Can this be used through laser treatment since it's not supposed to thin the skin? Or do you have to be off of it 6 months prior like the regular accutane?

4.) Can it be used long term through out your whole life to hault/reverse rosacea permanently and not have any rebound effects?

5.) About when will this be available?

Thanks -Chris

[Buster]

I can not answer the questions about dry eyes or laser. Maybe Dr Nase can? But as I understood it, the 0.5 mg dosage is below the treshhold for toxicity, this may not prevent a little dryness, but I think it does rule out any liver complications and no aching joints and depression tendencies etc.

Can you take it the rest of your life? I would think it can be taken for years with no problems, and then maybe there will come some thing else that is even more effctive?

Can it get rid of acne vulgaris? I am not an expert, but I think it will at least take longer.

I only started taking accutane yesterday. I was on 10 mg every other day july-end of year 2004 and it was good for my sebum, acne, seb derm inflamation (I dont have rosacea, I think, apart from a spider vein on my nose). What I did yesterday was just open a 10 mg capsule (I have a couple of boxes left) and take out ost of the content and swallow the rest. I figured that would be something like 0.5-1 mg. But I will go to the pharmacy today and get a 10 ml and a 20 ml syringe and do what was suggested in the other thread.

[cantfakereality]

I would say the best solution is to NOT freeze or heat the capsule, but rather just split it open, drain the content into a 10 or 20 ml plastic syringe (not with a needle, just a plastic type syringe used for liquid) and fill it with olive oil, udos choice or flax seed or whatever oil you think best.
Then shake well.
The best would be if the syringe was dark so there would not be too much light corrupting the isotretinoin.
Then with the syringe you can with ease take out dosages as small as 0.5 ml. If you mix a 10 mg pill with 10 ml of oil then 1 ml of that, if mixed well, should be 1 mg of accutane.

Interesting.
Have you done this for a while? And do you still experience symptoms (dry eyes, etc), indicating that the isostretinoin is still working?

[Buster]

I just started doing it. I dont know how it will work. But not freezing it or heating it up would be best way to go, in my opinion, since Roche warn against this. Also the substance is light sensitive.

I dont know how much dryness to expect when taking so small dosages. But the best way to tell if it is working I guess is if it reduces sebum and possibly makes the lips and the eyes a bit dry. I wear contact lenses, so maybe I will notice the effect there first.

best wishes,

[cantfakereality]

I just started doing it. I dont know how it will work. But not freezing it or heating it up would be best way to go, in my opinion, since Roche warn against this. Also the substance is light sensitive.

I dont know how much dryness to expect when taking so small dosages. But the best way to tell if it is working I guess is if it reduces sebum and possibly makes the lips and the eyes a bit dry. I wear contact lenses, so maybe I will notice the effect there first.

best wishes,

You could take a higher dose just for a couple of days, to gauge any side effects.

[irishgenes]

What form does isotretinoin come in? The kind I have is a thick oily liquid inside a soft gel. Very difficult to break down that drug form into smaller amounts, but I would not pay any attention to what Roche says about it being so ultra-fragile. They are not going to tell you how to save money, and their legal department would advise them to tell people it is impossible to split doses. I used to just insert a very fine needle from an insulin syringe into a soft gel and draw out what I needed each day. I did not worry about micro-cauterizing the hole. It seemed to seal itself, or at least nothing leaked out. I am sure the drug was working from the results I got. First, of course, you have to withdraw all the contents of one capsule to figure out how much you have in terms of drops and then do the math.

[Buster]

Interesting. Does this syringe measure ml and/or mgs?
Do you mean that if a 10 mg capsule gave you 10 drops, then every drop would be 1 mg?

How did you injest the accutane fro the syringe? Did you just spray it into your mouth?

Thanks

[irishgenes]

Insulin syringes measure units. A 3/10 cc short-needled syringe can hold 30 units. The larger the gauge number, the thinner the needle, but the needle has to be thick enough to suck up the thick oil. I can't remember now what size I was using. My cat had diabetes, so I had some on hand. In most states you can buy insulin syringes without a prescription. I never could figure out cc and ml and mg, so I didn't try to measure the amount by using the gauge on the syringe, just went by drops like you said. I also figured the capsule itself contained at least a drop coating the inside that couldn't be removed. I sprayed it in my mouth. I suppose it wasn't all that accurate as far as dose goes, but if you can pulse dose Accutane once or twice a week, I didn't think it mattered. I wasn't trying at the time to get these ultra-tiny .5 mg. doses, though, so that would be harder.

[Buster]

Dr Nase said that 0.5 mgs is below the level for toxicity.
I was wondering where this level is. Is 1 mg also below the level?
And further, when one goes above the level, at what point does the different side effects kick in? I am noticing not much more than dry lips at slightly less than 2 mgs pr day, but with 10 mgs I noticed back aching and muscle soreness.

Also, when doing low-low dose, like 2 mgs pr day or less, how long does it take to get good results. Nase mentioned 0.5 mgs being as effective as 10, but only taking longer time. WHat is the time frame?

[fut]

Weird, my side effects are minimal on 10 MG a day. My lips are a little dry and my eyes were a little dry aty first but now I am fine.

[adyus]

Also, when doing low-low dose, like 2 mgs pr day or less, how long does it take to get good results. Nase mentioned 0.5 mgs being as effective as 10, but only taking longer time. WHat is the time frame?

Hello Buster. Mathematically speaking, I guess you will still be aiming for around the same total quantity of isotretinoin(either if you take 10mg/day or .5 mg/day). So, that will mean 20(!!!) times longer for some permanent results. This is just a guess.

Best wishes,

Adrian.

[RedHotCanuck]

Hi Dr. Nase,

I searched the net high and low and can't find anything about 0.5 mg or a smaller dosage. Do you have any updated information?

Thanks,
Mike

[drnase]

Hi Dr. Nase,

I searched the net high and low and can't find anything about 0.5 mg or a smaller dosage. Do you have any updated information?

Thanks,
Mike


Hi RedHot,

This is being used in cancer treatment and being compounded by cancer-related pharmaceutical companies (not dermatologic companies). It is my understanding that the cancer pharmaceutical companies need to (1) Evaluate just accutane's effect on cancer, compared to the combination treatments they are currently testing with multiple drugs and accutane, and (2) See what the new FDA regulations do to this drug. The fast track was possilbe because male and female cancer patients are not usually trying for babies (depending on the cancer) during treatment which was the biggest hurdle. They still need to do isolated studies on accutane and then would be the time they make a determination whether to produce these pills and put them to market.

[fanta]

what kind of cancer is treated by accutane, wasnt bloodcancer they originally invented accutane for and then ditched it cause it wasnt strong enough?

[drnase]

what kind of cancer is treated by accutane, wasnt bloodcancer they originally invented accutane for and then ditched it cause it wasnt strong enough?


Hi Fanta,

Great question. I have seen at least 12 to 14 different types of cancer all throughout the body being treated by low dose accutane. What they have found since the information that you posted is that it is a tremendous adjunctive therapy -- meaning they give one or two cancer specific treatments plus 0.5 mgs of accutane and it significantly increases the reduction of the cancer and the survival rates.

[fanta]

If accutane is chemotherapeutic , would it then reduce the chance of getting skin cancer?

[drnase]

If accutane is chemotherapeutic , would it then reduce the chance of getting skin cancer?


Oddly enough, that is the one cancer that I have never seen looked at with accutane, but I certainly could have missed it. The mechanism of action seems to be a retinoic acid interruption in cell division and/or an anti-VEGF property that substantially decreases blood flow to certain types of cancer. Another great question.

[FUredness]

Dr. Nase, what do you think about splitting the 10mg dose into smaller doses like these people have been talking about? Would that make sense? Would it work just as well? And how do you think the best way to do it would be? Ok enough questions for one post.

[fanta]

There are studies on low dose isotretinoin and skin cancer - they show that it does not prevent occurrence of skin cancer if you already have had it. However there seems to be no studies on individuals not having had any occurrence of skin cancer. Im surprised to see that 10mg daily for 3 years should be associated with much toxity.
http://www.meb.uni-bonn.de/cgi-bin/mycite?ExtRef=MEDL/92148865

[drnase]

If accutane is chemotherapeutic , would it then reduce the chance of getting skin cancer?


Oddly enough, just found one abstract on the subject:


Am J Clin Dermatol. 2005;6(3):175-84. Related Articles, Links


Non-acne dermatologic indications for systemic isotretinoin.

Akyol M, Ozcelik S.


Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata accuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

[drnase]

Dr. Nase, what do you think about splitting the 10mg dose into smaller doses like these people have been talking about? Would that make sense? Would it work just as well? And how do you think the best way to do it would be? Ok enough questions for one post.


Hi Fu,

You can get this done at compounding pharmacies for a small fee (which actually ends up saving you money because if you get a script for 20 mg tablets, you can make it into four months of 5 mg tabs or eight months of 2.5 mg tabs). Make sure the compounding pharmacy has experience with accutane though and places it into an airtight capsule like accutane. Accutane is very sensitive to light and air and will be useless within a week or two if not properly prepared.

[FUredness]

Dr. Nase,
If I took .5mg of accutane a day, would it take a really long time to reduce chronic redness and blushing, like a couple years, or would it only take a few months. Taking so little a day seems like it could take a couple years to really work. Thanks for the info.

[fanta]

wondering if isotretinoin is good for the eyes? They always say eat fruits rich in A-vitamins cause thats good for the eyes, so might be that isotretinoin was good for the eyes too.

[FUredness]

Also, can accutane be taken with paxil. I've been on paxil for years and have been trying to get off it but get sick everytime. I take 5mg of Paxil and day. Would it be ok to take a low dose of accutane with it? Thanks

[FUredness]

Oh, and go Eagles! that game yesterday was much better, we'll see how they do against Oakland. 8)

[FUredness]

Hey, just wondering if anyone knows if you can use a beta blocker such as propranolol while using Accutane. I am thinking about taking 2.5mg a day of accutane(if I can find a compouning pharm to do this) and maybe using propranolol during real stressful times such as a presentation or interview. I would only use it sparingly. Is that ok?
Paul