Effect of isotretinoin on CYP2D6 and CYP3A activity in patients with severe acne

Yuqian Zhao, Jay C. Vary, Aprajita S. Yadav, Lindsay C. Czuba, Sara Shum, Jeffrey LaFrance, Weize Huang, Nina Isoherranen, Mary F. Hebert

Research output: Contribution to journalArticlepeer-review


Aims: Previously, retinoids have decreased CYP2D6 mRNA expression in vitro and induced CYP3A4 in vitro and in vivo. This study aimed to determine whether isotretinoin administration changes CYP2D6 and CYP3A activities in patients with severe acne. Methods: Thirty-three patients (22 females and 11 males, 23.5 ± 6.0 years old) expected to receive isotretinoin treatment completed the study. All participants were genotyped for CYP2D6 and CYP3A5. Participants received dextromethorphan (DM) 30 mg orally as a dual-probe substrate of CYP2D6 and CYP3A activity at two study timepoints: pre-isotretinoin treatment and with isotretinoin for at least 1 week. The concentrations of isotretinoin, DM and their metabolites were measured in 2-h postdose plasma samples and in cumulative 0-4-h urine collections using liquid chromatography-mass spectrometry. Results: In CYP2D6 extensive metabolizers, the urinary dextrorphan (DX)/DM metabolic ratio (MR) (CYP2D6 activity marker) was numerically, but not significantly, lower with isotretinoin administration compared to pre-isotretinoin (geometric mean ratio [GMR] [90% confidence interval (CI)] 0.78 [0.55, 1.11]). The urinary 3-hydroxymorphinan (3HM)/DX MR (CYP3A activity marker) was increased (GMR 1.18 [1.03, 1.35]) and the urinary DX-O-glucuronide/DX MR (proposed UGT2B marker) was increased (GMR 1.22 [1.06, 1.39]) with isotretinoin administration compared to pre-isotretinoin. Conclusions: Administration of isotretinoin did not significantly reduce CYP2D6 activity in extensive metabolizers, suggesting that the predicted downregulation of CYP2D6 based on in vitro data does not translate into humans. We observed a modest increase in CYP3A activity (predominantly CYP3A4) with isotretinoin treatment. The data also suggest that DX glucuronidation is increased following isotretinoin administration.

Original languageEnglish
Pages (from-to)759-768
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Issue number3
StatePublished - Mar 2024

Bibliographical note

Publisher Copyright:
© 2023 British Pharmacological Society.


  • CYP2D6
  • CYP3A
  • UGT2B
  • dextromethorphan
  • isotretinoin
  • retinoids

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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