According to Dr.
Wysowski of the FDA in her publication in 2005 the most frequently
reported adverse event for Accutane/Roaccutane was depression.
|"Compared wtih all drugs in the AERS
database to June 2000, isotretinoin (Accutane) ranked number 4 and
5 in number of reports of depression and serious depression, respectively,
and 10th in number of reports of suicide attempt. (Most drugs with
top ranks have known psychoactive properties and psychiatric indications;
in fact, isotretinoin was the only drug with a nonpsychiatric indication
in the top 10 ranked drugs for suicide attempt)."
||Wysowski (FDA), 2001 - J
Am Acad Dermatol.
number 1) and headache (ranking number 4) were amoung the most frequently
reported adverse events for the suspect drug isotretinoin (Accutane/Roaccutane).
(FDA), 2005 (Arch
are more than 500,000 different prescription medications sold via
pharmacists in the U.S. and other countries. The FDA indicate that
Accutane/Roaccutane is number 4 on the FDA top ten list of medications
attracting serious adverse reaction reports and is number 5 on the
FDA top ten list of medications attracting severe psychiatric adverse
articles, April 2002):
|An analysis of adverse
reactions on the FDA database was conducted for the year ending 2001.
Accutane was ranked second for all drugs for depression and ninth
for all drugs for suicide. The other drugs were mainly drugs used
in the treatment of psychiatric disorders, anxiety and alcohol.
||FDA database analysis
| Isotretinoin ranks
among the top 10 drugs in the FDA's data base in terms of the number
of reports of depression and suicide attempts among its users.
(FDA), 2001 (NEJM)
|. Dr. Marilyn Pitts,
FDA: The top 10 adverse events for Accutane include depression, ranked
number 6. By contrast, we looked at tetracycline, which is another
agent used for less severe acne. We have 8 cases of depression and
2 deaths, and we looked at Claritin in the AERS database where we
have 10 cases of depression and 2 deaths.
|We did look at the
rank order for depression of all drugs in the spontaneous reporting
system and the Adverse Event Reporting database. For depression, Accutane
ranks number 4. For serious depression, it ranks number 5, and for
suicide attempt, it ranked number 10 of all drugs.
||Dr Wysowski (FDA
| Dr. Middelkoop reviewed and compared adverse drug reaction (ADR) events
obtained directly from Roche, World Health Organisation and National
Health Authorties (France, UK, Ireland, FDA) for Accutane/Roaccutane
to five of the most commonly prescribed antiacne treatments. The study,
published in 1999, found that there were 1830 reports of psychiatric
events attributable to the six medications, of which Accutane/Roaccutane
was implicated in 60%. Second was minocycline which was implicated
in 14%. Suicide and suicide ideation were reported in association
with the use of Accutane/Roaccutane in 47 and 56 cases, respectively,
with none being reported for other medications. The study found that
Accutane/Roaccutane was 900 times more likely to cause depression
than the 5 other acne medicines reviewed. Click
here for study
Dr O' Donnell published paper 'Overview
of Existing Research and Information Linking Isotretinoin (Accutane),
Depression, Psychosis, and Suicide' which discussed adverse drug
reaction reports (page 152).
Dr Pitts, FDA (FDA Heaing, 2000). There were 8 cases of depression
and 2 cases of suicide on the database for all of the tetracyclines
(acne antibiotics), tetracycline, oxytetracycline, minocycline, and
The reports are evaluated by clinical reviewers in Health Authorties
to detect safety signals and to monitor drug safety. They form the
basis for further epidemiological studies when appropriate.
As a result, Health Authorties may take regulatory actions to improve
product safety and protect the public health, such as updating a product’s
labeling information or re-evaluating an approval decision.
Click here for more information on how to file an adverse report and the World Health Organisation (WHO) for definitions of
adverse reactions (WHO
Website). Dr. O' Connell, Medical Reviewer at the FDA stated in
her report, which reviewed submissions from Roche in 1998 regarding
psychiatric adverse events, that the investigation was "based
on the seriousness of accumulating reports and on the pattern of robust positive de-challenge
and re-challenge cases."
A problem with spontaneous reporting is that less than 10% of serious,
and only 2-4% of non-serious adverse reactions are reported. [Source
-See Report on Adverse Drug Reactions by the Irish National Medicines
Information Center, 2000 (http://www.ukmi.nhs.uk/NewMaterial/html/docs/08070201.pdf)].
The report also states that ADR's are hte leading cause of death in
Positive dechallenge occurs when the adverse reaction
disappears once the drug is stopped. Positive rechallenge occurs when
the adverse reaction re-emerges once the drug is restrarted.
|Wysowksi, 2001 (J Am Acad Dermatol). Dr Wysowski selects positive
rechallenge reports - see page 3 of the publication - Click
FDA Hearings, 2000.
Dr. Marilyn Pitts, FDA: In conclusion, dechallenge-rechallenge cases
provide strong evidence to support a link between a drug and an observed
adverse event. We have presented 41 cases of positive dechallenge-rechallenge which provide further evidence to support a relationship between Accutane
and depressive symptoms.
FDA Hearings, 2000. Dr.Wysowski, FDA: In evaluating spontaneous
adverse events, positive dechallenge/rechallenge cases provide the
best evidence to support a relationship between a drug and an observed
**In 1998, OPDRA analyzed spontaneous adverse drug event reports of
positive dechallenge/rechallenge cases of depression, mania, psychosis,
and suicide attempt. The 1998 case series supported the Accutane labeling
change, which included a warning concerning psychiatric disorders.
The warning stated that Accutane may cause depression, psychosis,
and rarely, suicidal ideation, suicide attempts, and suicide. There
were 20 cases in this report. 19 were U.S. cases. There were 14 cases
of depression, 5 cases of psychosis, and 1 case of a mood disorder.
**In support of this meeting, OPDRA analyzed dechallenge/rechallenge
cases of Accutane-associated depression, mood changes, and suicide
attempts. Spontaneous adverse event reports were reviewed for positive
dechallenge/rechallenge cases. We found 41 cases. 20 cases were from
the previously reviewed 1998 case series and 21 new dechallenge/rechallenge
cases focusing on depression and suicide attempt were found. There
were again 21 cases in this case series. 17 of the 21 cases were from
the U.S. There were 14 cases of depression, 3 cases of depression
with suicidal ideation, and 4 cases of mood changes. There were 16
females and 5 males. The median age was 23 years. 5 patients reported
a psychiatric history, and 1 patient required hospitalization.
**According to FDA alert in May
2005, the following data is
isotretinoin’s initial marketing in 1982 through August 2004, 4,992
spontaneous reports of psychiatric disturbances associated with
using isotretinoin in patients in the United States have been submitted
to the FDA.
number of reported
suicides among isotretinoin users in the United States was 190 through
January 2005. Between 1982 and 2002, there were 165 reported suicides,
which were fewer than the 220 predicted based on U.S. vital statistics
data. However, because the degree of under-reporting of suicides
is unknown, the fact that the reported number is lower than the
predicted number cannot be interpreted as evidence against a causal
is licensed for the treatment of severe forms of acne (such as cystic
and conglobate acne or acne at risk of permanent scarring) resistant to
adequate causes of standard therapy with systemic antibacterials and topical
Wysowski reported that in the last 8 years there was a 2.5 fold
(250%) increase in the number of dispensed prescriptions for isotretinoin
in the United States. Data also revealed an increasing proportion
of isotetinoin use for mild and moderate acne [link to Wysowski
Roche provided to the MHRA (UK licensing authority) a review of all suspected
adverse reports for Roaccutane in children (<18 years) for the period 1st Nov 2001 to 31st May 2004 (Period of
2 years and 7 months).
The document entitled "Review
of Adverse Events reported for Roaccutane for children and adolescents
aged under 18 years of age" provides all serious and non serious
events from both clinical trials and spontaneous suspected adverse
reaction reporting where the patient age was stated to be <18
years. Reports between 01/11/2001 and 31/05/2004 were retrieved.
For the age group 13-17, psychiatric events were the most frequently
reported serious adverse event. The following serious events were
recorded: 27 cases of completed suicide (4.2%) 36 cases of suicidal
attempt (6%) 28 cases of suicidal ideation (4.4%) 119 cases of depression
(19%) 5 cases of psychotic disorder 6 cases of obsessive compulsive
disorder For <13 year olds, there were 25 serious reports which
included one report of suicidal ideation and one report of suicide
According to recent report - "In 2004,
The Alliance for Human Research Protection asked Keith Altman, Adverse
Drug Reaction Statistics Analyst, to analyze FDA's Medwatch database for
drug-linked suicides by children under 18 years of age.
found that between 1989 and June 2003, there were 216 reported drug-linked suicides in
under 18 year olds. Of these, 72
suicides were linked to Accutane.
The next highest number of suicides - 55--involved Prozac." Source, http://www.ahrp.org/infomail/04/12/07.php
Roche revealed a total of 170 cases of suicide, suicide attempt
or suicide ideation were reported as associated with the drug as
of December 1997. Roche also stated that they had 40,000 adverse
drug reactions on their database.
drug reaction reports are available from the following websites