Weed and Accutane: Can You Use Cannabis During Isotretinoin Treatment?

Oral isotretinoin, commonly referred to as “Accutane,” has become many people’s go-to medication for stubborn acne. Meanwhile, cannabis, better known to many as weed or marijuana, has long been used recreationally and is now gaining traction for its potential health benefits, including possible acne-busting effects.

With increasing cannabis legalization and a rising number of young adults taking isotretinoin, it’s important to consider how these substances might interact. While clinical studies about the combined effects of weed and Accutane are limited, available research and expert guidelines offer some clues about potential risks.

If you’re wondering whether smoking weed while on isotretinoin is safe, read on. This guide unpacks the science, expert opinions, and safety tips for mixing these substances.

What Is Accutane?

The active ingredient of Accutane is isotretinoin, an FDA-approved drug that works like a fortified version of vitamin A. Accutane is taken in pill form to combat severe, persistent acne. This powerful medication counters the four contributors to pimple formation, which are:

• Overgrowth of skin cells in hair follicles, which causes clogged pores. This process is influenced by androgens (male hormones).
• Increased production of sebum (skin oil), which mixes with dead skin and leads to blackheads and whiteheads. Sebum in a person with acne-prone skin often has an abnormal composition.
• Bacteria, specifically Cutibacterium acnes, a fat-loving species that feeds on sebum and irritates the skin.
• Inflammation, which causes swollen, red or pus-filled pimples.

Accutane clears the skin by reducing clogged pores and soothing inflammation. Its ability to decrease oil production and induce long-lasting changes to the skin’s natural bacteria promotes acne relief that can last for many years. However, Accutane requires a doctor’s prescription because it can give rise to various side effects, from tolerable to serious ones, if used inappropriately.

What Are the Potential Side Effects of Accutane?

While Accutane therapy can be life-changing for people with severe acne, its strength comes with trade-offs. The drug’s actions can extend beyond the skin, causing unwanted symptoms in other parts of the body. Understanding these downsides—what’s expected, what’s unusual, and what’s preventable—can help you manage your treatment safely.

Common side effects are usually linked to reduced oil production and changes in the skin and moist surfaces in various parts of the body. Symptoms include the following:

• Dryness of the skin, lips, and eyes
• Skin thinning and sensitivity to sun exposure
• Cracked, peeling, or fragile skin
• Hair thinning and nail brittleness
• Increased risk of boils or skin infections due to less sebum, which normally fights bacteria

Most patients experience these changes during treatment, but they typically resolve a few months after finishing the regimen.

Isotretinoin works on many types of cells. So, it may also induce unwanted responses in other body systems, some of which are potentially serious. These possible complications include the following:

• Birth defects, miscarriage, or premature birth if taken during pregnancy
• Joint or bone pain, abnormal bone growth, and osteoporosis (bone thinning or weakening)
• Visual issues, including reduced night vision
• Hearing impairment
• Rare buildup of pressure inside the head (pseudotumor cerebri), with symptoms like blurred vision and nausea
• Mental health challenges like mood swings, depression, anxiety, or suicidal thoughts. However, these effects are rare and still debated in studies.
• High triglycerides (a type of body fat), blood sugar spikes, and increased risk of pancreatic disease
• Liver problems, shown by elevated liver enzymes in blood tests or, rarely, jaundice
• Digestive issues, including nausea or diarrhea, especially in those with inflammatory bowel disease
• Blood disorders, including low platelet or red blood cell counts
• Allergic reactions, often due to capsule preservatives
• Respiratory or vocal symptoms, especially in people with asthma
• Menstrual irregularities, including missed periods

Accutane can remain in sperm for weeks after stopping intake. Studies show that the drug may impact sperm development, though its effect on male fertility needs further research. In rare cases, sexual dysfunction may develop as an adverse effect and persist in some male patients months after isotretinoin therapy.

The risks associated with Accutane are uncommon and preventable but highlight the importance of using it only under close medical supervision. For a more thorough explanation, you may refer to our related articles explaining isotretinoin’s side effects and what to expect before and after the treatment.

What Does Cannabis Do for the Skin?

Cannabis extracts contain a variety of compounds called “cannabinoids,” which include cannabidiol (CBD). This substance has been studied in its purified form for its potential role in treating acne.

Early research suggests that skin-applied CBD helps reduce acne in several ways. First, it helps stop the skin from producing too much oil, minimizing pore clogging. Second, it curbs inflammation, which can lead to skin redness, pain, and swelling. Third, CBD has shown an antibacterial effect. Fourth, it slows down the growth of skin cells to prevent them from blocking pores and triggering more breakouts.

However, in these acne studies, CBD’s effects have only been tested on the skin. In everyday life, a cannabis product can be vaped, smoked, or eaten in the form of edibles like gummies or cookies. Additionally, CBD and another marijuana-derived substance, tetrahydrocannabinol (THC), are sold in herbal supplement or medicine forms. When taken in these preparations, cannabinoids can spread throughout the body.

In the brain, these chemicals can improve your mood, sleep quality, and appetite and reduce pain perception. Cannabinoids have anti-inflammatory effects in many body areas, including the heart, testicles, muscles, liver, pancreas, and fat tissue. But when taken excessively or combined with other substances, including alcohol and some prescription meds, cannabinoids can cause potential drug interactions that may produce serious health issues.

What Are the Negative Effects of Cannabis?

Research shows that skin-applied cannabis, which largely stays on the skin surface, is relatively safe. However, most people who consume cannabis use it in forms that affect the whole body, which are responsible for many of its reported risks.

Mild reactions seen in oral CBD studies include the following:

• Digestive problems like diarrhea, nausea, vomiting, constipation, stomach pain, and bloating
• Fatigue
• Changes in appetite
• Headaches
• Weight changes (gain or loss)
• Skin irritation
• Sleep problems like insomnia
• Dizziness or lightheadedness
• Fever

Less common but serious complications of oral CBD include liver stress, producing abnormal liver function test results. Seizures have also been documented.

The mental health effects of excessive marijuana use include hallucinations, paranoia, and memory and attention deficits. However, its connection to anxiety or mood disorders is still unclear.

Smoking marijuana, whether through joints or with devices like vapes or bongs, can irritate and damage the respiratory system. Persistent inflammation increases the risk of developing chronic lung diseases and lung cancer, mirroring the dangers of long-term cigarette use.

Marijuana smoking has been linked to reproductive health risks in both men and women. In men, cannabis can make them feel more interested in sex but cause problems with performance (erectile dysfunction). It can also lower testosterone levels and sperm count. In women, it may reduce fertility and raise the odds of pregnancy loss after treatments like in vitro fertilization.

Is Cannabis Use Safe While Taking Accutane?

Drug interactions occur when the effects of combined drugs either enhance or oppose each other. Although research on the interaction between Accutane and marijuana is limited, it’s likely that they amplify each other’s actions.

The liver is reasonably the site most significantly involved in this interaction. Both isotretinoin and cannabinoids are metabolized in this organ. This overlap can potentially slow the breakdown of either substance. Taken together, these drugs may build up in the body and put added strain on the liver.

Other areas where isotretinoin and cannabinoids can have stronger combined effects include the brain, skin, digestive system, and reproductive organs. In the brain, both substances can influence mood. When used together, they may heighten risks of anxiety, depression, or mood swings, especially in vulnerable individuals. Cannabis use may impair memory and motivation, making it harder to stick to isotretinoin’s strict dosing and monitoring requirements.

In the skin, lips, and eyes, isotretinoin is well known for causing dryness. Cannabis, especially when smoked, can worsen the symptoms, leading to increased irritation and discomfort.

Accutane can cause nausea and abdominal pain, while cannabis is linked to diarrhea and appetite changes. Combined, both drugs may increase digestive upset or obscure symptoms that need medical attention.

Both Accutane and cannabinoids have been linked to reproductive issues in men and women. Accutane may reduce fertility and increase miscarriage risk in women. Cannabinoids have similar effects and can worsen those problems. In men, mixing both substances may affect hormones, sperm quality, and sexual performance.

Isotretinoin and cannabinoids both modulate immune responses but in different ways. Their combined use may lead to unpredictable effects on inflammation or immunity.

How Can You Use Weed Safely While on Accutane Treatment?

If you prefer to use cannabis while on Accutane, be sure to inform your doctor. Consider low-THC or CBD-dominant preparations, as CBD poses fewer mental health risks than THC. Stay hydrated and apply moisturizers to help manage combined dryness from both substances.

Limit your cannabis use in terms of frequency and dose to avoid overwhelming your body. Regular checking of liver function can help detect any early signs of strain from the combination of both treatments.

When Does Mixing Isotretinoin and Cannabis Become a Medical Concern?

Combining isotretinoin and cannabis may not cause problems for some people. However, the following red flags should prompt you to seek medical care right away:

• Severe abdominal pain, nausea, vomiting, or diarrhea
• Dark urine and yellowing of the eyes, signifying liver damage
• Difficulty concentrating, poor memory, or confusion
• Sudden mood swings, anxiety, or depression
• Intolerably dry mouth, eyes, or skin
• Reproductive health troubles, such as menstrual changes, fertility issues, and performance problems

Consult your healthcare provider immediately and stop taking both substances unless advised otherwise.

What Can You Use Instead of Marijuana While Taking Accutane?

If you’re using cannabis to manage anxiety, pain, or sleep issues while on isotretinoin treatment, some alternatives may be worth exploring. Options include over-the-counter melatonin (with your doctor’s approval), mindfulness practices, relaxing herbal teas like chamomile, and exercise or yoga. Always consult a licensed medical provider before trying any of these alternatives to ensure they’re safe for you.

Drug Interactions with Accutane: Erring on the Side of Caution

Accutane works well for severe acne, but it’s also a strong drug that has many potential risks when used improperly. Mixing it with other body-influencing chemicals like cannabinoids can worsen these issues. Not everyone reacts the same way, so the manifestations can be different for each person.

For some, taking cannabis with Accutane can lead to serious problems, such as impaired liver function, mood, or memory. Other people may feel no symptoms. In any case, the best way to stay safe while taking Accutane is to cut back on substances like cannabis, manage any side effects, or try safer alternatives.

Finally, though common, acne can be trickier to get rid of than some may think. To get the best results from any acne therapy, trust only a board-certified dermatologist—a true pimple expert!

Have Lingering Questions About Accutane Therapy? Ask LA’s Acne Specialists

Accutane may help if you’re struggling with breakouts, but it’s just one treatment option. With so many choices, it’s hard to know what’s right for your skin.

At BHSkin Dermatology, our board-certified dermatologists are leaders in providing expert care for even the toughest acne cases. Come visit us at our Glendale or Encino clinic, or use our telederm portal for your initial consultation.

Don’t wait long to get healthy, clear skin. Book your appointment today!

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.