The Dangers of Mixing Alcohol and Accutane

Most people throughout their life will be required to take medication for a condition that is not necessarily life-threatening but can still be very inconvenient and erode their self-esteem.

An example of this is the skin condition acne which at its most severe can cause a great deal of distress for the person concerned.

Because the condition can be severe the medication would need to be quite strong to reduce and remove the obvious physical symptoms. All medicinal drugs unfortunately come with side effects due to the powerful chemicals they contain.

The drugs are also likely to lead to unwanted and harmful effects if the patient drinks alcohol while taking the medication.

Alcohol is seen as a social lubricant by many people who also use alcohol to relax and unwind during the evening and at weekends.

Because of these benefits, it is not always easy for people to give up alcohol for a significant period, which can be the case when they have been prescribed certain medications. (11)

What is Accutane?

Also known as Isotretinoin, Accutane is a prescription medication used to treat severe acne, it works by limiting the functioning of the oil glands by shrinking the glands and therefore reducing the production of oils that can find their way onto the skin and cause acne.

Accutane is a retinoid medicine, which means it contains chemicals that are related to vitamin A, which helps prevent acne sufferers from developing clogged pores and also inhibits the growth of bacteria that can cause acne.

Accutane also reduces the redness and inflammation associated with skin conditions. (1,2)

However, there are several side effects that patients may experience whilst take the medication.

Side effects of Accutane

• Stomach / digestive problems.
• Hair loss/hair thinning.
• Muscle and joint pain.
• Difficulty seeing at night.

How long do people take Accutane for?

Because the level of vitamin A in the drug is so high it can have an extremely toxic effect on the human body and therefore should not be taken for too long.

People who are placed on a course of Accutane will usually take the drug for 4-6 months and improvements begin to appear after two months. (3,4)

The toxic effects of alcohol

The poisonous effects of alcohol are well documented, and The National Health Service in the UK and the World Health Organisation are frequently warning people about the physical damage they can do to themselves by regularly drinking large quantities of alcohol.

Alcohol is primarily processed in the liver but can also be processed right throughout the body as all our internal tissues can metabolise alcohol quickly so its toxic effects can spread throughout the body affecting key systems and organs such as the liver, the digestive system and cardiovascular and respiratory mechanisms.

Because of this, harmful chemicals in alcohol are likely to negatively affect many areas of the body that are already causing us pain and worry including our skin. (11)

The danger of interaction effects

Alcohol is a psychoactive substance which means that it will affect our brain chemistry and therefore impact our mood, awareness and perception, our subjective experience, feelings and our behaviour.

As a central nervous system depressant alcohol will tend to act on the GABA neurotransmitter and suppress brain activity, this process results in a series of messages being sent around the whole body to relax and calm down.

All medicines contain different chemical properties, many of which have a degree of toxicity and also have the potential to interact with alcohol, which can change both the way alcohol and Accutane is processed and lead to the Accutane becoming less effective which means it will not treat acne as effectively as it could have done.

The more alcohol a person drinks the greater the interaction effect that it will have as very often alcohol and Accutane amplify each other’s negative effects which can lead to highly intense and uncomfortable physical effects.

Matters are further complicated if the patient is taking other medication, particularly if that medication is known to significantly interact with alcohol as well.

What happens when people drink alcohol while taking Accutane

There are many types of physical effects that will occur after mixing alcohol and Accutane which may surface within a couple of hours, or will slowly appear within days, weeks or even months of combining them.

Effects Of Mixing Alcohol & Accutane

Both alcohol and Accutane trigger increased activation of a neurotransmitter called GABA which has an inhibitory effect on several areas of the brain and slows down several biological processes, including respiration and consciousness.

As a result, we may become drowsy and lethargic very quickly when the two are combined within a close time period. (3)

Anyone drinking alcohol will feel the effects after only having one or two drinks whereas normally they could consume a lot more before feeling any effects.

The side effects people experience when taking the two substances within a short time frame include:

Mild symptoms

• Feeling lethargic or sluggish.
• Extreme dryness of the skin.
• Itching/hives.
• Nausea and vomiting.
• Increased heart rate.
• Abdominal discomfort.

More serious symptoms

• Heart palpitations.
• Respiratory depression.
• Vulnerable to cardiac arrest.
• Vulnerable to slipping into a coma.
• Brain seizures.
• Feeling sedated. (2,4)

Harmful effects of drinking alcohol whilst taking Accutane

Below, we list some of the harmful effects caused when you mix alcohol whilst taking Accutane:

Liver damage

The liver is responsible for metabolising Accutane, so it is vitally important that anyone on a course of Accutane does nothing to negatively affect the liver whilst taking the medication.

Alcohol is also metabolised in the liver as well so drinking alcohol at the same time will mean the liver will be overloaded with all the processing it is being asked to do.

The fact that alcohol is a toxic substance will mean that the liver will not be able to fully process the Accutane as well as it could have done which can limit its capacity to effectively treat the skin condition a person is taking the medication for.

Accutane on its own can potentially damage the liver, and it is not a medication that patients will only take for a few weeks as 4-6 months is the standard duration for one course of treatment and the liver will be in a vulnerable position during this period.

High levels of toxicity

So drinking high volumes of alcohol during the treatment course will potentially make the patient even more vulnerable to developing a high level of toxicity in the liver which can be life-threatening or cause life-changing damage.

As Accutane is such a powerful (and potentially harmful drug) doctors do tend to complete a risk assessment of each patient who expresses an interest in taking the drug for their skin condition due to the threat of liver damage.

As part of the assessment, they will enquire whether the patient is taking another medication as well and ask questions about aspects of their lifestyle, including smoking and alcohol. (3,6)

It is very important, to be honest about your alcohol use when asked by your GP as this can have serious consequences further down the line if you do not fully admit the true extent of your alcohol use.

This could impact you in two ways if you drink alcohol during your treatment phase:

• The treatment may not be so effective
• Your liver may become permanently damaged

Liver damage is dependent on several factors

The degree to which a person is likely to experience liver damage as a result of drinking alcohol does depend on several factors, including:

• The dose strength of the Accutane.
• The amount of alcohol they drink.
• How long they are required to take Accutane for
• Are they taking any other medication?

Extreme caution and mild drinking is advised, the more alcohol you drink the higher the probability of having liver damage.

If a person consistently drinks over the recommended 14 units per week during the 4-6 months, they are taking Accutane, then there is a high probability that they will develop liver damage.

However, having one or two drinks in an evening once a month is unlikely to increase the risk of liver damage by too much, although the only advice which can guarantee you will not develop any liver damage is not to drink any alcohol at all.

Increases in cholesterol levels in the body

The interactive effect of the two substances means that alcohol will significantly enhance any effects generated by Accutane, one of which is an increase in certain lipids in our bloodstream called triglycerides.

Having high levels of triglycerides can cause high cholesterol levels in your body which can make you more vulnerable to developing heart disease, pancreatitis and a stroke.

If your current state of health and fitness is a concern and you are prone to cholesterol then you should carefully monitor your cholesterol levels during the time you take Accutane to ensure they do not rise too much.

Research has indicated that drinking alcohol regularly whilst taking Accutane can lead to your cholesterol levels rising even higher. (3,6,7)

A decline in Mental health

Research has found that drinking alcohol while on a course of Accutane does interfere with the natural dopamine levels in the brain which can lead to a change in our mental functioning and leave people more susceptible to experiencing a low mood and an increased vulnerability to developing depressive disorders. (5)

There have been several research studies conducted over the years that have examined the link between Accutane and several possible psychiatric side effects including depression, increased aggression, psychosis and an increased risk of suicide.

Alcohol on its own as a central nervous system depressant has been found on many occasions to lower mood and cause poor mental health so taking the two substances close together would increase the risk even further of a patient developing a mental health problem if they drink alcohol whilst on the medication.

This is especially important for Accutane users as it is a medication that is taken for several months. (5,9,10)

However, it must be added that some patients are more vulnerable than others to experience a decline in their mental health after combining the two substances, so people who have been diagnosed with a mental health condition such as depression should be monitored carefully whilst taking the drug and be advised not to drink any alcohol at all during their treatment.

Can I just have one or two drinks?

This is very difficult to say with any certainty due to the wide range of individual differences between us all, and each individual should speak with their healthcare provider to check if it is OK to drink alcohol whilst taking Accutane.

The medical advice they give you is likely to depend on factors related to your medical history and personal circumstances such as:

• Sex
• The amount of alcohol they consume.
• Their tolerance to alcohol.
• Liver health.
• Other medications they may be taking.
• If they have any underlying medical conditions.

It is extremely difficult to say with any certainty how much alcohol it is safe to consume whilst taking a course on Accutane. Research indicates mild to moderate drinkers may be OK, but there is no definitive guidance on how many alcoholic drinks represents either mild or moderate use.

Do NOT base your decision to drink alcohol on consulting with other people who have drunk alcohol while taking Accutane and have not suffered any adverse effects, or refer to online articles to inform your decision.

Your GP is the only person you should consult with as they have all the relevant information relating to your medical history and is in the best position to advise you.

But if in any doubt the best course of action would be NOT TO DRINK any alcohol at all when taking the medication.

What if I cannot stop or reduce my drinking?

If you are considering organising a consultation with a doctor or dermatologist about starting a course of Accutane and you have concerns about whether you can stop drinking during the course of treatment you should express your concerns to your GP when you meet with them and they can talk you through your options.

If you are unable to control your drinking then it may be unwise to begin a course of Accutane and instead focus on seeking the help of treatment services to enable you to stop drinking.

Your GP will be able to signpost you to the relevant services if you are honest enough to reveal the extent of your alcohol consumption.

Alcohol use disorder and Accutane

If you are advised to give up alcohol to begin a course of Accutane but don’t think you can stop then it is likely that you have alcohol dependence or addiction and should obtain a clinical diagnosis.

The fact that a person cannot stop drinking indicates that they have lost control over their alcohol intake and this will have serious health consequences for them if they proceed to begin a course of Accutane.

If a patient does receive a diagnosis of alcohol use disorder then it would be wise for them to delay beginning a course of Accutane until they can control their alcohol use. (8,10)

References

(1) Advanced Acne Institute (2022) Five Frequently Asked Questions About Accutane Treatment for Acne. available@ Five Frequently Asked Questions About Accutane Treatment for Acne – Advanced Acne Institute

(2) American Osteopathic Clinic of Dermatology (2022) Accutane. available@Accutane – American Osteopathic College of Dermatology (AOCD)

(3) ARK Behavioural Health (2022) Mixing Alcohol and Accutane. available@Mixing Alcohol & Accutane | Effects & Dangers – ARK Behavioral Health (arkbh.com)

(4) British Association of Dermatologists (2019) Isotretinoin. available@ British Association of Dermatologists (bad.org.uk)

(5) Bremer et al (2011) Retinoic Acid and Affective Disorders: The Evidence for an Association. Journal of Clinical Psychiatry. 73(1) pp37-50. available@ Retinoic Acid and Affective Disorders: The Evidence for an Association – PMC (nih.gov)

(6) Cascorbi, I. (2012) Drug Interactions: Principles, examples and clinical consequences.available@ Drug Interactions—Principles, Examples and Clinical Consequences – PMC (nih.gov)

(7) Kizilyel, O. et al (2014) Effects of oral isotretinoin on lipids and liver enzymes in acne patients. available@ Effects of oral isotretinoin on lipids and liver enzymes in acne patients – PubMed (nih.gov)

(8) NHS (2022) Common questions about Isotretinoin capsules. available@Common questions about isotretinoin capsules – NHS (www.nhs.uk)

(9) Rajagopal, S. (2014) Acute Psychosis induced by Isotretinoin. available@Acute psychosis induced by isotretinoin – PMC (nih.gov)

(10) Weatherman, R, Crabb, D. (1999) Alcohol and Medical Interactions. available@ Alcohol and Medication Interactions – PMC (nih.gov)

(11) World Health Organisation (2022) Psychoactive drugs. available@ Drugs (who.int)

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