Stop isotretinoin and contact the prescriber now

Current U.S. prescribing information says to discontinue isotretinoin immediately if rectal bleeding, abdominal pain, or severe diarrhea occurs. Stop the medicine and contact the prescribing clinician right away, even if the amount of blood seems small.

Do not wait for the next routine appointment, take another dose to test whether the symptom returns, or restart isotretinoin until the prescriber gives case-specific instructions.

When to get urgent or emergency help

Seek medical help right away for black or tarry stool; dark or bright red blood mixed through the stool; fainting, lightheadedness, or dizziness; shortness of breath; or severe abdominal pain. These findings need prompt evaluation, but they do not all mean shock.

Shock is an emergency. Get emergency medical help for confusion or loss of consciousness, a fast heartbeat, pale skin, cold hands and feet, sweating, or other signs of shock.

Do not assume it is only dryness, constipation, a fissure, or hemorrhoids

Bright red blood can come from hemorrhoids or an anal fissure, but it can also have other causes. Black or tarry stool can suggest bleeding higher in the digestive tract. Color and amount help clinicians triage the problem, but they do not establish the diagnosis by themselves.

An examination is still recommended even when hemorrhoids seem likely. While taking Accutane, the medication's stop instruction applies before the cause has been determined.

The cause still needs evaluation

Rectal bleeding can have several causes and does not diagnose inflammatory bowel disease. A large systematic review did not find increased odds of inflammatory bowel disease among isotretinoin users.

Regardless of the cause, the prescribing instruction is to stop isotretinoin immediately and obtain prompt medical guidance.

What to tell the clinician

Report when the bleeding began, whether it is on toilet paper, coating the stool, mixed into the stool, or black and tarry; the approximate amount and whether it is increasing; abdominal or anal pain; diarrhea or constipation; fever; dizziness or fainting; and all medicines and supplements you take.

If possible, note the time of your last isotretinoin dose. Do not delay urgent care to collect details or take a photograph.

Frequently asked questions

Should I stop Accutane for rectal bleeding?

Yes. Current U.S. prescribing information says to discontinue isotretinoin immediately for rectal bleeding, abdominal pain, or severe diarrhea and to contact the prescriber right away.

What if there is only a small streak of bright red blood?

Stop isotretinoin and contact the prescriber even if the amount seems small. Do not assume hemorrhoids or a fissure without evaluation.

When is blood in stool an emergency?

Get emergency help for confusion or loss of consciousness, a fast heartbeat, pale or cold clammy skin, or other signs of shock. Black or tarry stool, blood mixed through stool, dizziness or fainting, shortness of breath, or severe abdominal pain need medical help right away.

Does rectal bleeding mean Accutane caused IBD?

No. Rectal bleeding does not identify its cause or diagnose inflammatory bowel disease. The immediate label instruction applies while a clinician evaluates the symptom.

Sources

  1. Rectal bleedingMedlinePlus, U.S. National Library of Medicine
  2. Symptoms & Causes of GI BleedingNational Institute of Diabetes and Digestive and Kidney Diseases
  3. Isotretinoin Exposure and Risk of Inflammatory Bowel DiseaseAmerican Journal of Clinical Dermatology (PubMed record)