Isotretinoin, formerly known as Accutane, reduces acne
Q: When I was 18 years old, I had severe acne. The dermatologist prescribed a type of vitamin A prescription. It got rid of my acne within a few months. I then stopped taking the pills due to possible toxicity. My cousin had a similar experience. It felt like a miracle, as the acne never returned.
Now my grandson is 18. He has very bad acne, and the treatment is not yielding good results. How can we find a dermatologist who prescribes the pills we took, so he doesn’t throw his money away on unsuccessful treatments?
A: We suspect that the drug you are describing is isotretinoin. It was originally prescribed by the brand name Accutane.
Although that brand is no longer available, dermatologists can still prescribe isotretinoin. Because isotretinoin can cause birth defects if taken during pregnancy, it must be dispensed by a certified specialty pharmacy with precautions in place to prevent pregnant people from taking it. Another risk is severe depression. Any dermatologist who treats severe acne should be familiar with isotretinoin.
Q: Like other readers of your newspaper column, I have problems swallowing big pills.
I take the diabetes drug metformin twice a day, and it does not come in small sizes. Initially I cut the large tablets in half to swallow them. I have also crushed pills and taken them with applesauce. Then my son told me to turn my head to the left while swallowing to get
the pill to go down. This works wonderfully. He was a Green Beret medic for 24 years, so maybe this is something he learned in his training.
A:
Your son is onto a well-established strategy for swallowing pills. A study of children who had trouble getting pills down found that changing head position by turning to the left or the right could be helpful (Paediatrics & Child Health, May-June 2010). The authors report that “Success was achieved in all 33 children who practiced for 14 days.”
Researchers also recommend the “pop-bottle” technique by “placing a tablet on the tongue and closing the lips tightly around a flexible container such as a plastic bottle.
The consumer then swallows the tablet through a suction motion of water as they tilt the head back” (Patient Preference and Adherence, July 26, 2018).
Q: My husband was put on a very high fiber diet a while ago, including a daily fiber supplement. This seems to be causing a lot of intestinal gas, which is very uncomfortable — for him AND me! Beans are
problematic, of course, but other foods seem to cause this as well. Do you have any suggestions? He’s tried using Beano with beans, but it had minimal effect.
A:
It can take time for the digestive tract to adjust to a high-fiber diet. In the meantime, though, he shouldn’t have to suffer. Each person may vary in their sensitivities. Some individuals react badly to apples, while others find broccoli and cabbage are culprits. A diary of foods and flatus events can help identify which meals require the most attention.
While Beano helps some people, others do better with activated charcoal. Unfortunately, there is little scientific support for this approach.
Pepto Bismol (bismuth subsalicylate) can help control odor but won’t reduce the quantity of gas produced.
Other options include probiotics or herbs such as asafoetida, fennel or turmeric.