Accutane and Lifestyle: Alcohol, Smoking, Weed

Why Drinking Alcohol While Taking Accutane Is Problematic

Accutane is metabolized almost entirely by the liver, which is the same organ responsible for breaking down alcohol. When both substances are present, they compete for the same metabolic pathways. This does not mean a single drink will necessarily harm you, but it does mean the liver has to work significantly harder, and this is one of the reasons dermatologists caution patients strongly about drinking during treatment.

One of the most important considerations is liver enzymes, specifically AST and ALT. These are the markers your doctor checks in monthly blood tests. Accutane can raise these values slightly in a small portion of patients. Alcohol can do the same, and when combined, the elevations may become clinically relevant. If your enzymes rise too high, your doctor may lower the dose or pause treatment.

A second issue is triglycerides, which Accutane commonly increases. Alcohol, especially beer and sugary drinks, can raise triglycerides sharply, even after a single night of heavier drinking. Elevated triglycerides are not only a reason to adjust your Accutane dose but, at very high levels, can increase the risk of pancreatitis. This is why dermatologists take the interaction seriously.

Alcohol also worsens several subjective side effects. Because it dehydrates the body, drinking can intensify dryness of the lips, nose, eyes, and skin. Many patients report that after drinking, they wake up with stronger flaking or redness than usual. Alcohol is also known to cause headaches, which can become more pronounced when combined with Accutane-related dehydration or fatigue.

Another important factor is mood. While Accutane has not been proven to cause depression, dermatologists monitor emotional wellbeing as a precaution. Alcohol can interfere with this monitoring; it may cause irritability, affect sleep, or trigger low mood the following day, making it harder to determine whether symptoms are due to the medication or the alcohol.

For all these reasons, drinking alcohol on Accutane is not strictly “forbidden,” but medically speaking, it is strongly discouraged and should only be considered after discussing your lab results with your dermatologist.

What Official Recommendations Say

Dermatology guidelines around the world do not impose an absolute ban on alcohol during Accutane treatment, but they consistently urge significant caution. In practice, most dermatologists recommend avoiding alcohol altogether, especially during the first months of therapy when your baseline liver function and triglyceride response are still being assessed.

What do the recommendations boil down to?

Moderation only: If your monthly bloodwork is normal and your dermatologist agrees, an occasional single drink may be acceptable.
No heavy drinking: Binge drinking or frequent alcohol consumption is unsafe on Accutane and significantly raises the risk of liver and lipid complications.
Stop immediately if labs rise: If your AST/ALT or triglycerides increase, the standard medical response is to avoid alcohol completely until values return to normal.
Individual variation matters: Some people tolerate occasional alcohol; others see measurable lab changes after even one drink. Your doctor will guide you based on your testing results.

In short, alcohol on Accutane is not “illegal,” but it is medically restricted, and always conditional on normal lab monitoring.

Weed / Cannabis and Accutane

Patients often assume cannabis is safer than alcohol during Accutane treatment because it does not directly affect the stomach or liver in the same obvious way. However, the interaction between cannabis and isotretinoin is more complex. There is no formal contraindication, but there are several important reasons dermatologists advise caution.

The first consideration is liver metabolism. Cannabinoids are processed through the CYP450 enzyme system, the same system involved in isotretinoin metabolism. This does not mean cannabis blocks or enhances Accutane, but it does mean the liver may experience additional workload. If your monthly blood tests show rising liver enzymes, cannabis could make those elevations more persistent or harder to interpret.

The second issue is mood and psychological effects. Accutane itself is not proven to cause depression, but emotional monitoring is still part of safe treatment. Cannabis affects mood, motivation, anxiety levels, emotional processing, and short-term memory. In some people, it is calming; in others, it worsens rumination or anxiety. Because Accutane users must report mood changes promptly, cannabis can blur the lines between a medication side effect and a substance-induced emotional shift. This complicates clinical decision-making and may delay necessary adjustments.

Third, cannabis, especially inhaled forms, can aggravate dryness and mucous-membrane irritation. Smoke irritates the lips, nostrils, and throat, all of which are already more sensitive on Accutane. Many patients experience more nosebleeds, cracked lips, or coughing after smoking. Vaporizing may reduce some irritation, but dryness still tends to worsen overall.

Cannabis also causes sedation and slower reaction time. Accutane can contribute to fatigue in some users. Combined, these effects may impair driving, decision-making, or focus more than either substance alone. Edibles avoid respiratory irritation but still affect cognition and mood.

There are specific situations in which dermatologists strongly advise avoiding cannabis entirely:

if liver enzymes are elevated
if you are experiencing even mild mood changes
if you struggle with sleep regulation or concentration
if you cannot distinguish a symptom from a side effect

For most patients, cannabis is not strictly forbidden, but the safest approach is: use rarely, at low doses, only when feeling mentally stable, and always inform your dermatologist. Accutane is temporary, keeping your system as “clean” as possible helps keep treatment predictable and safe.

FAQ

Can you drink while on Accutane?: It is possible, but not recommended. Accutane already places metabolic stress on the liver and can raise triglycerides. Alcohol adds to both burdens. If your monthly bloodwork is normal and your dermatologist approves, a single occasional drink may be acceptable, but frequent or heavy drinking is unsafe and may lead to dose reduction or treatment interruption.
Can you drink alcohol while on Accutane?: Yes, the medication label does not prohibit alcohol outright, but dermatologists consistently advise patients to limit or avoid it. Alcohol increases dryness, headaches, fatigue, and makes it harder to distinguish normal side effects from signs of liver stress. Most experts recommend abstaining, especially early in treatment when your lab values are still stabilizing.
Can you smoke weed while on Accutane?: Cannabis is not formally contraindicated, but it requires caution. Some cannabinoids are metabolized by the same liver enzyme systems as isotretinoin, and in sensitive individuals, this may contribute to enzyme elevations. Cannabis can also affect mood, motivation, and anxiety, making it more difficult to monitor emotional wellbeing during treatment. Inhaled smoke irritates already dry mucous membranes, while edibles may still intensify sedation or fogginess. If you notice mood changes, sleep disruption, or worsening dryness, avoid cannabis entirely and inform your dermatologist.
Does smoking (cigarettes or cannabis) affect skin during Accutane?: Yes. Smoke exposure worsens dryness, irritates the lips and nose, slows healing, and may make acne marks look more inflamed. Skin is unusually fragile on Accutane, and smoking amplifies that effect.
How long after Accutane can I drink normally again?: Most people return to normal alcohol use within 1–2 months after finishing treatment, once liver enzymes and triglycerides have stabilized. Your dermatologist may request a final set of labs before giving full clearance.

References

American Academy of Dermatology Association. (2023). Isotretinoin: Overview. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin
American Academy of Dermatology Association. (n.d.). Isotretinoin: Patient safety. https://www.aad.org/diseases/acne/isotretinoin-patient-safety
Food and Drug Administration. (2021). Isotretinoin medication guide. https://www.fda.gov/media/74460/download
Layton, A. M. (2009). The use of isotretinoin in acne. Dermatology and Therapy, 22(5), 393–404. https://pmc.ncbi.nlm.nih.gov/articles/PMC2835909/
National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol’s effects on the body. https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body
National Institute on Drug Abuse. (2020). Cannabis (marijuana) drug facts. https://nida.nih.gov/publications/drugfacts/cannabis-marijuana
Huestis, M. A. (2007). Human cannabinoid pharmacokinetics. Chemistry & Biodiversity, 4(8), 1770–1804. https://pubmed.ncbi.nlm.nih.gov/17712819/