Isotretinoin therapy should be initiated at a dose of 0.5 mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved.
contradict the following evidence for multiple courses? Even if a patient has achieved acne clearance (meaning absence of primary acne lesions especially inflammatory ones (multiple and/or deep comedones may require adjunctive therapy)), why not continue for another 6 months? To wit, aren't multiple courses of therapy the same as exceeding the maximum dosage?
Aug 21 2019 PRODUCT MONOGRAPH on Accutane, Hoffmann-La Roche Limited, p. 13 of 36.
Effects of multiple courses of Accutane on the developing musculoskeletal system are unknown. There is some evidence that long-term, high-dose, or multiple courses of therapy with isotretinoin have more of an effect than a single course of therapy on the musculoskeletal system.
The therapeutic response to isotretinoin is dose-related and varies between patients. This necessitates individual adjustment of dosage according to the response of the condition and the patient’s tolerance of the drug. In most cases, complete or near-complete suppression of acne is achieved with a single 12 to 16 week course of therapy. If a second course of therapy is needed, it can be initiated eight or more weeks after completion of the first course, since experience has shown that patients may continue to improve while off the drug.