Accutane- side effect - joint ache

[susanK]

Dr. Rockoff,

   My 17 year old son has been taking Accutane for about 2 months now. First month 40mg/day, this month 80mg.  He is an athelete, and plays competitive soccer.  Since the increased dosage, he has noticed severe joint pain, and weakness in his legs during his soccer games.(in the last 2 weeks).  This has slowed him down and has affected his ability to perform to the level he is used to.  It is having an adverse effect on his mental attitude as well. Will his body adjust, is this symptom temporary?  Have you heard of this in other accutane patients?   Please advise the best management of this symptom so that he can increase his performance.  To give you an idea of how it has impacted him, last weekend he went for a run to try to increase his stamina, hoping it would give him better results for his next soccer game. He can usually run 3-5 miles.  He could only run 1 mile and had to stop 3 times!  Needless to say he was very frustrated.  Please advise-- Thank you.   Sue

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[Alan Rockoff, MD]

Your note is puzzling, because joint aches are a recognized side effect.  I alsways ask about them, though it's been a long time since I saw soemone with as much disability from them as you had.  Most patients who get it just get a mild ache hard to distinguish from what you get from working out a lot, which many of them do.  

You're certainly right to say that if these aches are debilitating, the drug should be stopped.

Dr. Rockoff

[Ditra]

I took Acutane twice in my twenties.  Once at age 25 for the complete course (4o mg dose) which helped clear my acne.  Then again at age 27 when the acne came back.  The first time, there were no side effects.  The second time, I began to have joint aches and pain in my knees and elbow (especially knees) midway throught the treatment.  I saw my dermatologit and he said it's probably not related to Acutane becauase that's not one of the known side effects.  I continued for another week or two but the joint pains became worst and I was begining to feel like a 90 year old woman and had a hard time getting out of bed in the morning.
I finally stopped the treatment and within a week, the pain was gone. At that time (12 years ago) they included a questionaire in the package which asked about side effects experienced by users in which I mentioned my joint problems.  Frankly, I'm surprised it's still not mentioned or accepted as one of the side effects.  I know two other people that had the same problem and had to stop.
Clearly, Acutane is a very effective drug for cystic acne for many people.  But if one does not respond well to it and experiences side effects such as the one I did, I think it may not be the best treatment. In my humble opinion, better to exhaust all other possibilities (i.e. Differin, Benzaclin, even change of diet, etc) than to continue such a powerful medication that can potentially create serious problems.
Just thought I share my experience with you.

[Alan Rockoff, MD]

Accutane can cause muscle aches, but I've never seen it cause weakness.  I've treated many athletes, some competitive on a high school or college level, with this drug over the years, with no problem.

I think one has to wonder whether the aches and tiredness could be from working out too much, not sleeping enough, etc.

I advise discussing with your son's dermatologist such maneuvers as: lowering the dose, taking a break for 1-2 weeks (won't cancel the effect), sleeping more, or some combination of these.

Best.

Dr. Rockoff