Isotretinoin-associated intracranial hypertension.
OBJECTIVE
To evaluate the association between intracranial hypertension (IH) and isotretinoin use.


METHODS
Observational case series.


METHODS
In this retrospective study, approximately 1950 case reports of adverse ocular side effects related to isotretinoin were received from spontaneous reporting systems. Reports were evaluated as to the occurrence of IH with isotretinoin use. A survey was mailed to all members of the North American Neuro-ophthalmology Society soliciting their opinions on whether isotretinoin caused IH.


RESULTS
One hundred seventy-nine reports of IH were associated with isotretinoin use. The mean time from drug exposure to IH diagnosis was 2.3 months. There were 6 cases of positive rechallenge; 5 new cases are reported here, along with 1 previously published report. Of neuro-ophthalmologists surveyed (62% response rate), 6% believed an association between IH and isotretinoin use was certain; 32%, probable; 52%, possible; and 10%, unlikely. Twelve respondents (4%) had personally seen one or more cases of positive rechallenge with isotretinoin causing IH.


CONCLUSIONS
Based on the number and pattern of rapid IH onsets after isotretinoin exposure and the 6 cases of positive rechallenge, along with the probable similarity in metabolic pathways of this agent and vitamin A (a known cause of IH), it seems certain that there is a direct correlation between IH and isotretinoin use.
Fraunfelder
Frederick W
FW
University of Mississippi School of Medicine Neurology Department, Jackson, Mississippi, USA. eyedrug@ohsu.edu
Fraunfelder
Frederick T
FT
Corbett
James J
JJ
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000139:chemically induced*; D015474:Isotretinoin / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D015474:Isotretinoin