New In My Practice: Rx

In each issue, Practical Dermatology® magazine spotlights a new device or over-the-counter or prescription treatment that dermatologists are recommending to their patients. This month, Hilary E. Baldwin, MD, medical director of the Acne Treatment and Research Center and clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ, gives us the rundown on Sun Pharma’s newly launched Absorica LD isotretinoin capsule for severe recalcitrant nodular acne in patients 12 years of age and older.

What is Absorica LD and how does it compare to Absorica and/or other isotretinoin formulations?

Hilary E. Baldwin, MD: It’s new in that the particles have been micronized, which allows for optimized absorption at a 20 percent lower dose than we use for Absorica. LD brings to the table improved absorption without having to consume a fatty meal. Studies suggest the LD form of the drug results in 50 percent higher blood levels on an empty stomach than Absorica, despite the fact that it is a 20 percent lower dose.

Other isotretinoin formulations must be taken with a fatty meal for optimal absorption. Since it’s intended for twice-daily use, this often exceeds the daily-recommended average for fat and calories. Many people don’t eat breakfast, especially teenaged girls. If they are taking conventional isotretinoin in the morning, it may be falling on a deaf stomach. Not having to eat breakfast may increase compliance, which may increase efficacy, especially in teen acne patients. This is a big deal.

How does micronization effect dosing and duration?

Dr. Baldwin: There haven’t been any head-to-head trials of LD versus the older version of Absorica. We don’t want to reduce duration or dose without proof that it is OK to do so. The last thing we want is a relapse. The overall dose that I give will be decreased because of the lower dose of the pills themselves, 0.4-0.8mg/kg/day with Absorica LD versus 1mg/kg/day with Absorica. I aim for a total dose of 120mg/kg and for the patient to go two months without a new pimple. I didn’t have it go beyond the 120 mark and found that patients reached the one to two months without a pimple much earlier with Absorica than food-dependent isotretonin. I am not aiming to stop earlier with LD, but I probably will be able to stop on the mark of 120mg/kg and not go beyond that. Of course, we want to get isotretinoin courses finished as quickly and as safely as possible so we don’t expose women of child-bearing age to this teratogenic drug for longer than needed.

How do you monitor patients taking Absorica LD?

Dr. Baldwin: The monitoring of patients will be the same as with other formulations of isotretinoin. With Absorica LD, we are increasing bioavailability even though we are giving less medication, so we certainly want to follow the same parameters. Every physician has their own monitoring protocol. I take lipid and hepatic panels and check creatine kinase (CK) levels in the begining and then monthly for a couple of months. If the labs are stable, I’m not increasing the dose, and there are no prior concerns, I usually stop there. With athletic boys, however, I still watch CK, as those levels can get high.