Oral Acne Medication Options

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Oral acne medications are typically prescribed when topical medications fail to clear or control acne. These drugs may be used on their own but are more commonly used in combination with topical treatments.

Prescription oral acne medications include certain antibiotics, hormonal contraceptives, Accutane (isotretinoin), and Aldactone (spironolactone). They're typically used for moderate to severe acne vulgaris (the most common form of acne)

This article describes the various oral acne treatment options, including the possible side effects and risks.

Pharmacist taking medicines from shelf - stock photo

Kamonchai Mattakulphon / Getty Images

When Oral Acne Drugs Are Needed

Not all acne responds to topical medications like benzoyl peroxide or salicylic acid. When acne resists topical treatment, oral drugs may be prescribed to treat the underlying causes of outbreaks. Some of these drugs are taken daily, while others require several doses a day.

Oral acne medications are typically recommended for moderate to severe refractory acne (treatment-resistant acne). This includes severe types of acne such as cystic acne or nodular acne.

Oral drugs may also be used if your acne is widespread (such as on the back where it can be hard to apply topical creams or lotions). At the same time, applying topical medications to large areas of the skin can cause widespread side effects like redness, irritation, dryness, or peeling.

Even if your acne isn't particularly severe, it can be stubborn and benefit from oral treatment. Speak with your dermatologist about the benefits and risks to make an informed choice. In most cases, the lowest effective dose is prescribed to reduce the risk of side effects.

All oral acne medications are by prescription only. There are no over-the-counter alternatives. 

Oral Antibiotics

Oral antibiotics work by reducing the bacteria responsible for most acne outbreaks, called Propionibacteria acnes. Unlike some oral drugs, dermatologists usually start people on a higher dose and then gradually reduce the dose as the acne symptoms improve.

The most common oral antibiotics prescribed for acne include:

Common side effects include dizziness, nausea, diarrhea, and yeast infections. A severe and potentially dangerous allergic reaction, called anaphylaxis, can also sometimes occur.

Antibiotic Resistance

Due to the rise in antibiotic-resistant bacteria, oral antibiotics for acne should only be used in combination with topical antibiotics. The dual approach greatly reduces the risk of drug resistance. Moreover, antibiotics for acne should be used for no longer than three to six months.

It is not uncommon for dermatologists to prescribe topical retinoids, benzoyl peroxide, or other topical treatments to support oral antibiotic therapy.

Oral Contraceptives

Oral contraceptives, also known as birth control pills, are frequently used to treat acne that comes and goes with the menstrual cycle. The drugs are able to reduce oil gland secretions by suppressing male hormones, known as androgens. They also serve a dual purpose for those seeking an effective birth control method.

There are several birth control pills approved by the Food and Drug Administration (FDA) specifically for the treatment of acne. These include Ortho Tri-Cyclen and Beyaz.

Possible side effects of oral contraceptives include nausea, vomiting, headache, stomach cramps, bloating, breast tenderness, swelling of the ankles and feet, and weight changes.

Most dermatologists will prescribe topical acne medication to use alongside oral contraceptives.

Isotretinoin

Accutane (isotretinoin) is often the first-line option when topical acne treatments fail. It is by far considered the best treatment for severe acne.

Accutane works by shrinking small glands in the skin, called sebaceous glands, that produce oil. This reduces the blockage of pores that can lead to comedones (blackheads and whiteheads). When pores aren't blocked, fewer pimples will result.

Common side effects of Accutane include headache, back pain, muscle or joint pain, sore throat, dry mouth, dry eyes, rash, and mild itching. Anaphylaxis is rare but can occur.

Pregnancy Risks

Accutane is not used during pregnancy due to the high risk of birth defects. If you become pregnant while taking Accutane, stop taking the drug immediately. Use condoms and other methods of birth control while taking Accutane to avoid pregnancy. Do not breastfeed while taking Accutane.

If prescribed Accutane, you will be enrolled in the iPledge program, an FDA initiative designed to manage the risks of isotretinoin.

Anti-Androgens

Aldactone (spironolactone) is another oral drug that treats acne by suppressing androgens. It is not specifically an acne treatment but can be used in certain instances when acne is caused by fluctuations in hormones during your menstrual cycle.

Aldactone isn't commonly used and is not a first-line acne treatment choice. However, it may be appropriate for some who cannot tolerate or take oral contraceptives. It can also do double duty as a prescribed treatment for high blood pressure and heart failure.

Aldactone should not be used if you are pregnant or trying to get pregnant. Since this medication blocks androgens, it can cause defects in the genitals and reproductive system of male babies.

Summary

If you have moderate to severe acne that does not respond to topical treatment, oral acne medications may be prescribed. These are commonly used with topical acne creams and ointments to treat acne directly and from within.

These include oral antibiotics, oral contraceptives, Accutane (isotretinoin), and Aldactone (spironolactone). Oral contraceptives and Aldactone are used for acne related to the menstrual cycle.

Speak with your dermatologist to understand the benefits, risks, and proper use of any oral acne medication. Some like Accutane and Aldactone can be hazardous if you become pregnant.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.