Most teens or adolescents get acne at some point, but some have worse cases than others. When usual medications or topical treatments don’t work, some doctors prescribe Accutane (Isotretinoin). Accutane is a prescription medication for adults and children older than 12 to treat severe forms of acne.  It has been known for some severe side effects, so we asked Le Bonheur pharmacist Rebecca Chhim, PharmD, to weigh in. Though are the certain significant risks to be aware of, she assured us that is safe to take.

When should I look into Accutane for my child? Does it work?
Accutane is used for severe acne -- large, painful nodules under the skin, covering a significant portion of the face, back, or other parts of the skin often affected by acne.  It does effectively improve severe forms of acne when other medications have not worked. Other acne treatments, such as creams or antibiotics, should be tried before using Accutane.  Your child will require close monitoring and enrollment in the iPLEDGE program (discussed below) while on Accutane.

How should you take Accutane?
Accutane is for adults and children 12 years of age and older. It is prescribed for 15 to 20 weeks and should be taken twice a day with meals and a full glass of water.  If you miss a dose, skip that dose and take your next dose at the normal time.  Let your doctor and your pharmacist know every prescription, over the counter and herbal medication you or your child takes while on Accutane.  Some medications and herbals may interact with Accutane.  It is important to avoid alcohol and vitamin A supplements while on Accutane.

What are the side effects?
Accutane can cause muscle, joint or bone pain more often in children than in adults.  It may also cause eye dryness or vision changes.  It is important to avoid driving at night until the full effects on your vision are understood.  Accutane has many effects on the skin including skin dryness, rash or extra sensitivity to the sun.  For this reason, patients on Accutane should limit sun exposure and wear sunscreen.  Accutane could cause hair loss, liver and blood disorders.  Accutane is associated with behavior changes, depression and suicidal thoughts.  Tell your doctor any behavior changes you may notice in your child while he or she is taking Accutane.

Accutane and Pregnancy Risk
Accutane can be harmful if taken while pregnant.  Accutane could cause a loss of pregnancy, premature birth, infant death or infant birth defects if taken while pregnant.  The risk of fetal harm is unknown when the partner of a male on Accutane becomes pregnant.  For this reason, in order to receive Accutane, every patient, male and female, must register with the national iPLEDGE program.  In addition, every doctor who prescribes Accutane and every pharmacy that dispenses Accutane, must also register with iPLEDGE.

iPLEDGE requires very strict rules for women who are able to become pregnant on Accutane, including the use of two forms of contraception while on Accutane, as well as one month before and after taking Accutane.  iPLEDGE also requires all patients to see their doctor every 30 days in order to get a new prescription.  Women must also take a pregnancy test every month while on Accutane.  iPLEDGE has many other regulations in place for patients, doctors and pharmacies in order to avoid pregnancy while on Accutane.  The risk of pregnancy while on Accutane must be taken very seriously.

Infants’ TYLENOL Oral Suspension Liquid was voluntarily recalled by its manufacturer on Feb. 17 amid complaints about the product’s SimpleMeasure™ dosing system.

A small number of consumers complained that the dosing device – which is supposed to make it easier to measure the appropriate dose and prevent accidental ingestion by young children --  is hard to use.  The product’s flow restrictor (the cap at the bottle’s mouth) falls into the bottle when the syringe is inserted, some consumers said.

The medicine is still safe to use though, clarified Le Bonheur’s Director of Pharmacy Brandon Edgerson, PharmD. “The product is still safe if the flow restrictor at the top of the bottle remains in place. You just may need to use a different dosing device to administer it to your child,” he said.

Parents can also use a generic version, if preferred, Edgerson said. The recall only affects TYLENOL’s Infants’ Oral Suspension Liquid, and consumers can request a refund.

TYLENOL offers a video that shows how to properly use its SimpleMeasure™ dosing system.

For more information about this recall, visit TYLENOL’s website.

We asked Le Bonheur Pharmacist Kelley Lee, PharmD, to talk about a popular subject this time of year: antibiotics. See what she says about this type of drug below.

All parents hate to see their children suffer during a sore throat, cold or flu.  We’d all like a drug we could use to quickly make our child feel better.  Antibiotics are too often used to provide this relief.  Most minor infections such as colds, flu, coughs, runny nose, most sore throats (excluding strep throat) and some ear infections are caused by viruses.  Although bacteria and viruses are both types of germs that cause diseases in children, antibiotics only work when used for infections caused by bacteria.

Shouldn’t I use an antibiotic “just in case?” There’s no harm in using an antibiotic, is there?

While antibiotics are truly “wonder drugs,” they should only be used when an infection is likely caused by bacteria.  Antibiotics can cause serious side effects.  While most common side effects are mild such as nausea, vomiting, diarrhea and headache, these effects can cause discomfort in all children and may lead to more serious problems in certain children. Not all side effects from antibiotics are mild.  Antibiotics can cause severe diarrhea, blistering rashes, liver and kidney problems and other serious illnesses. 

Most people have heard from the media about “super bugs.”  “Super bugs” are bacteria that have become resistant to commonly used antibiotics.  No antibiotic will get rid of all bacteria.  Every time an antibiotic is taken the bacteria that are sensitive to that antibiotic will be killed, but bacteria that are resistant will remain. This can be a problem for several reasons.  In some people these resistant bacteria may grow and cause other problems like severe diarrhea.  Even if these resistant bacteria don’t cause a problem immediately, they can become more common in the person who has taken the antibiotic, causing the antibiotics not to work next time.  The more antibiotics a person takes, the more likely they will get an infection from resistant bacteria. Resistant bacteria can also be spread to classmates, family and friends. 

If I shouldn’t give antibiotics for these mild childhood infections, what can I do to make my child feel better?

Getting plenty of rest and drinking plenty of fluids are two of the most helpful ways to make your child feel better.  Viral infections will usually go away within seven to 10 days.  Antibiotics will not speed up the process.  Saline nasal sprays or using a humidifier in the child’s bedroom can help stuffy, congested noses.  Breathing steam from a warm shower can also help.  Cough drops (for older children only) or throat sprays can help a sore throat feel better.  Over-the-counter products such as acetaminophen can be used for mild fever or pain, but always read the package or consult with your doctor or pharmacist to be sure the correct dose is used.   The best treatment is prevention:  children older than 6 months of age should get a flu shot each year, and remind children to wash their hands.

How can I help prevent antibiotic resistance?

The best thing parents can do to prevent antibiotic-resistant infections in their children is to only use antibiotics for infections caused by bacteria.  Parents should not ask for a prescription for antibiotics for colds and flu.   When antibiotics are prescribed for an infection caused by bacteria, give your child the entire amount prescribed.  Giving doses that are too small for short lengths of time can cause bacteria to become resistant.

Parents will soon see big changes to their usual over-the-counter (OTC) pediatric pain relievers. The makers of many store-brand acetaminophen drugs say they will standardize dosing for children and infants in an effort to improve the safety of the products.

The decision to implement these changes is based on research and recent reports of accidental overdoses in children, according to the Food and Drug Administration. In several cases of overdose, liquid infant acetaminophen drops were mistaken for the children’s version of the pain killer.

The children and infant versions of OTC pain killers differ in their acetaminophen dosages, says Le Bonheur Children’s Hospital Pharmacist Kelley Lee. One teaspoonful of the infant drops contains 500 mg of acetaminophen, where one teaspoonful of the children's product contains only 160 mg.

“Confusing the two products will result in a very large difference in the dose,” says Lee. “When acetaminophen is given in larger doses than intended it can cause great harm to the child.”

By creating one formula, drugmakers hope to eliminate the dosage confusion.

Also in an effort to reduce dosing errors, the products will feature a new dosing device – a syringe, instead of a dropper. The new formula will also be free of high fructose corn syrup and dye, based on the preference of most mothers as reflected in the drug companies’ research.

These products are scheduled to hit the market in September. Until then, parents and caregivers should be particularly careful when a physician or pharmacist has recommended a dose for their child, says Lee.

“Parents should be sure they understand which version – infant or child – the clinician has based the recommended dose on,” she said. “If no dose is recommended, the parent should always read the product label and never give more than is stated for their child’s age or weight.”

Always double check the label, even if you’ve given your child acetaminophen in the past.