Accutane Shows Strong Link to Higher Cholesterol

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The drug package insert currently notes that about one-quarter of patients may experience elevated triglycerides and 15 percent elevated liver enzymes. Other studies have found elevated triglycerides in 5 percent to 18 percent of people taking isotretinoin and elevated total cholesterol in 6 percent to 32 percent of patients.

Previous studies had involved much smaller sample sizes than the new trial, however.

For this study, the UCSF team looked at the frequency of abnormal lab tests among nearly 14,000 patients, aged 13 to 50, who took Accutane for acne between 1995 and 2002.

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Among individuals whose pre-treatment lab results were normal, 44 percent developed high triglycerides, 31 percent high cholesterol and 11 percent high liver enzymes while taking the drug. These changes were "generally transient and reversible," the authors noted, meaning that blood test results usually returned to pre-treatment levels once patients stopped taking Accutane.

Ninety-two percent of participants with liver enzyme abnormalities returned to normal after stopping the drug, 80 percent of those with high triglyceride levels and 79 percent of those with high cholesterol levels.

However, the elevations could put people at risk for what doctors call the "metabolic syndrome," the researchers warned.

Metabolic syndrome refers to a collection of unhealthy factors, including hypertension, cholesterol abnormalities, a waist circumference greater than 40 inches in men and 35 inches in women, and hyperglycemia. Studies have shown that people with metabolic syndrome have a 1.5 times increased risk for coronary heart disease.

All of this points to an "added message to do the blood tests," Stone said.

When a patient does have abnormal lab tests, doctors often keep them on the drug but try to manage the cholesterol and triglyceride levels with diet and exercise and, possibly, also with cholesterol-lowering statin drugs.

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