Glycolic Acid/Isotretinoin 1599
Ichthammol (BAN) Preparations light, especially in solution. Store in airtight containers at a tem-
Proprietary Preparations (details are given in Part 3) perature not exceeding 25°. Protect from light. It is recommend-
Ammonii Bituminosulfonas; Ammonii Sulfogyrodalas; Ammonio ed that the contents of an opened container be used as soon as
Austria: Crino Cordes; Ichthraletten; Lavichthol; Ger.: Aknichthol Creme;
Sulfoittiolato; Ammonium Bithiolicum; Ammonium Bitumenosul- Crino Cordes N†; Dermichthol†; Ichthoderm; Ichtholan T; Ichthosin; Ich- possible and that any unused part be protected by an atmosphere
fonicum; Ammonium Bituminosulphonate; Ammonium Ichtho- thraletten; Leukichtan; Solutio Cordes. of an inert gas.
sulphonate; Ammonium Sulfobituminosum; Ammonium Sulpho- Multi-ingredient: Arg.: Selegel; Austria: Aknichthol; Ichthalgan forte; USP 31 (Isotretinoin). Yellow crystals. Practically insoluble in
Ichthyolate; Amonowy sulfobituminian; Bithiolate Ammonique; Ichtho-Bellol; Ichtho-Cortin; Leukichtan; Chile: Ichtyosoft†; Fr.: I-Soft†; Ich- water; sparingly soluble in alcohol, in isopropyl alcohol, and in
tyosoft†; Sebosquam; Ger.: Aknederm Neu; Aknichthol N; Ichthalgan†; Ich-
Bithyol; Bitiol; Bitiolato amónico; Bitomol; Bituminol; Ichtammol; tho-Bellol compositum S†; Ichtho-Bellol†; Ichthocortin; Ichthoseptal; Pelvi- macrogol 400; soluble in chloroform. Store in airtight containers
Ichtamolis; Ichthammolum; Ichthamol; Ichthosulphol; Ichthyol; chthol N; Switz.: Aknichthol N. under an atmosphere of an inert gas. Protect from light.
Ichthyolammonium; Ictamol; Ictiolsulfonato amónico; Ihtamol; Ik-
tammol; Iktammoli; Sulfobituminato amónico; Sulfoictiolato Adverse Effects
amónico. Iscotrizinol (USAN) The adverse effects of isotretinoin and other oral retin-
Ихтаммол; Ихтиол Diethylhexyl Butamido Triazone; Diethylhexylbutamido Tria- oids are similar to those of vitamin A (see p.1971) and
C AS — 8029-68-3. zone; Dioctylbutamidotriazone. Bis(2-ethylhexyl) 4,4′-[(6-{[4- are generally reversible and dose-related. The most
(tert-butylcarbamoyl)phenyl]amino}-1,3,5-triazine-2,4-diyl)diimi- common are dryness of the mucous membranes and
Pharmacopoeias. In Chin., Eur. (see p.vii), Jpn, and US.
Ph. Eur. 6.2 (Ichthammol). A dense blackish-brown liquid. It is no]dibenzoate. skin, which can often progress to cheilitis, epistaxis,
obtained by distillation of certain bituminous schists, sulfonation C 44 H 59 N 7 O 5 = 766.0. conjunctivitis, localised exfoliation including palmo-
of the distillate, and neutralisation of the product with ammonia. C AS — 154702-15-5.
plantar exfoliation, pruritus, erythematous rash, and
It contains not less than 4.5% and not more than 7.0% of total
ammonia, not less than 10.5% of organically combined sulfur,
skin fragility. Less common effects have included hair
calculated with reference to the dried substance, and not more OH C CH thinning (occasionally irreversible), hirsutism, photo-
than 20% of the total sulfur in the form of sulfates. CH N CH CH
sensitivity, changes in skin pigmentation, paronychia,
Miscible with water and with glycerol; slightly soluble in alco- H nail dystrophy, pyogenic granuloma, and increased
hol, in fatty oils, and in liquid paraffin; forms homogeneous mix- O HN O sweating. Acne can be exacerbated at the beginning of
tures with wool fat and soft paraffin.
USP 31 (Ichthammol). A reddish-brown to brownish-black vis- O N N O
isotretinoin treatment, and there are very rare reports of
cous fluid with a strong characteristic empyreumatic odour. It is acne fulminans occurring. Less common adverse ef-
CH N N N H C fects on the eyes include corneal opacities, visual dis-
obtained by the destructive distillation of a bituminous schist, H H
sulfonation of the distillate, and neutralisation of the product with turbances such as blurred vision and colour vision dis-
ammonia. It yields not less than 10.0% of total sulfur and not less NOTE. Uvasorb HEB is a trade name that has been used for isco- orders, impaired night vision that may persist,
than 2.5% of ammonia. Miscible with water, with glycerol, and trizinol.
with fixed oils and fats. Partially soluble in alcohol and in ether.
photophobia, and keratitis. Papilloedema, visual dis-
Profile turbances, headache, and nausea and vomiting can be
Incompatibility. Ichthammol is incompatible with wool alco- Iscotrizinol is used as a sunscreen (p.1576). It is effective against signs and symptoms of benign intracranial hyperten-
hols. UVB light (for definitions, see p.1580).
sion. Arthralgia, myalgia, and back pain are commonly
Profile Preparations reported, and there have been rare reports of arthritis,
Ichthammol has slight bacteriostatic properties and is used in a Proprietary Preparations some preparations are listed in Part 3. osteoporosis, and tendinitis. Hyperostosis and calcino-
wide range of topical preparations, for a variety of skin disorders;
it has also been used in suppositories for anorectal disorders. Ich-
sis have also occurred, particularly in patients treated
thammol is often used with zinc oxide in medicated bandages for with high doses of isotretinoin over long periods for
Isopropyldibenzoylmethane
chronic lichenified eczema (p.1579). Ichthammol may be slight- keratinisation disorders. Premature closure of the epi-
ly irritant to the skin and there have been rare reports of hyper- Isopropildibenzoilmetano. 1-[4-(1-Methylethyl)phenyl]-3-phenyl-
physes has occurred in children treated with isotretin-
sensitivity. 1,3-propanedione.
oin. Elevation of serum triglycerides is common, and
Light Ammonium Bituminosulfonate (Ammoniumbituminosul- Изопропилдибензоилметан
C 18 H 18 O 2 = 266.3.
pancreatitis has occurred in patients with high concen-
fonat Hell) is produced from the light distillate fraction of shale trations; cholesterol concentrations may also be in-
oil. C AS — 63250-25-9.
creased. Increases in hepatic enzymes, erythrocyte sed-
Ammoniumsulfobitol, an ammonium bituminosulfonate similar
to ichthammol but with a low sulfur content, was commercially
imentation rate, and blood glucose can also occur.
CH3 Alterations in haematological measures are common;
available as Tumenol Ammonium.
there have also been reports of anaemia, thrombocyto-
Preparations H3C penia, and neutropenia, and very rare reports of agran-
BP 2008: Zinc and Ichthammol Cream;
USP 31: Ichthammol Ointment. ulocytosis. Other effects that have been reported rarely
Proprietary Preparations (details are given in Part 3)
include gastrointestinal symptoms, hepatitis, hearing
Austral.: Egoderm; Austria: Ichtho-Bad; Ichtholan; Ichtopur; Belg.: Bithiol; O O
impairment, drowsiness, seizures, vasculitis, and hy-
Poudre Velours; Cz.: Ichtoxyl; Fr.: Gelictar†; Ger.: Ichtho-Bad; Ichtholan; persensitivity reactions including anaphylaxis. Mood
Ichtholan spezial; Ichthyol; Thiobitum; Neth.: Daroderm Trekzalf; Trekzalf;
Switz.: Ichtho-Bad; Ichtholan; Turk.: Ihtiyol; Pomat Ichthyole; Pommade Profile changes, psychotic symptoms, depression, and suicidal
Ichthyole. Isopropyldibenzoylmethane, a substituted dibenzoylmethane, is behaviour have occurred in patients treated with oral
Multi-ingredient: Arg.: Cicatrina; Austral.: Egoderm; Icthaband†; Aus- a sunscreen (p.1576) with actions similar to those of avobenzone isotretinoin. There may also be an association with skin
tria: Aknemycin compositum; Delta-Hadensa; Hadensa; Ichth-Oestren; In- (p.1589). It is effective against UVA light (for definitions, see infections and an inflammatory bowel syndrome.
otyol; Belg.: Antipiol; Inotyol; Canad.: Boil Ease†; Cz.: Pityol; Saloxyl; p.1580).
Denm.: Inotyol; Fin.: Hadensa; Fr.: Anaxeryl; Gelictar Fort; Inotyol†; Node Isotretinoin and other retinoids are teratogenic.
DS; Novophane S; Oxythyol; Phytheol; Phytolithe†; Provictol†; Selegel; Sq- Preparations
uaphane Masque-Creme; Ger.: Aknemycin; Hong Kong: Acnederm; Ego- Proprietary Preparations some preparations are listed in Part 3.
When isotretinoin is applied topically the adverse ef-
derm; Israel: Aknemycin; Inotyol; Ital.: Antiemorroidali; Dermatar; Ichtho- fects are similar to those of tretinoin (see p.1618).
paste; Inotyol†; Tricoderm F; Malaysia: Acnederm†; Egoderm; Norw.:
Inotyol; NZ: Acnederm†; Egoderm; Pol.: Neo-Tormentil; Tormentile ◊ General references.
Forte; Tormentiol; Port.: Efluvium Anti-caspa; Efluvium Anti-seborreico;
1. Mills CM, Marks R. Adverse reactions to oral retinoids: an up-
Oleoban Composto†; Pansebase Composto; Secpel Composto; Rus.:
Bethiol (Бетиол); S.Afr.: Antipeol; Singapore: Egoderm; Spain: Hadensa;
Isotretinoin (BAN, USAN, rINN) date. Drug Safety 1993; 9: 280–90.
Ictiomen; Lamnotyl†; Swed.: Inotyol; Switz.: Aknemycin; Bain extra-doux 2. Keefe M. Adverse reactions profile: retinoids. Prescribers’ J
Isotretinoiini; Isotretinoína; Isotrétinoïne; Isotretinoinum; Izo- 1995; 35: 71–6.
dermatologique; Epithelial†; Furodermal; Leucen; Radix; Riccovitan†; Turk.:
Hedensa; UK: Antipeol; Ichthopaste; Icthaband; St James Balm; USA: Boil tretinoin; Izotretinoinas; Izotretynoina; 13-cis-Retinoic Acid; Ro- 3. McLane J. Analysis of common side effects of isotretinoin. J Am
Ease; Boyol Salve; Medicone Derma†; Venez.: Node DS. 4-3780. (13Z)-15-Apo-β-caroten-15-oic acid; (2Z,4E,6E,8E)- Acad Dermatol 2001; 45: S188–S194.
3,7-Dimethyl-9-(2,6,6-trimethylcyclohex-1-enyl)nona-2,4,6,8- 4. British Association of Dermatologists. Advice on the safe intro-
duction and continued use of isotretinoin in acne (2003). Avail-
tetraenoic acid. able at: http://www.bad.org.uk/healthcare/guidelines/acne.asp
Изотретиноин (accessed 27/09/07)
Ictasol (USAN) 5. Charakida A, et al. Safety and side effects of the acne drug, oral
C 20 H 28 O 2 = 300.4. isotretinoin. Expert Opin Drug Saf 2004; 3: 119–29.
Ichtasol; Ichthyol-Natrium Hell; Light Sodium Bituminosulpho- C AS — 4759-48-2. 6. Goldsmith LA, et al. American Academy of Dermatology con-
nate; Natrium Sulfobituminosum Decoloratum; Sulfobituminato ATC — D10AD04; D10BA01. sensus conference on the safe and optimal use of isotretinoin:
sódico; Sulfobituminato sódico decolorado. ATC Vet — QD10AD04; QD10BA01. summary and recommendations. J Am Acad Dermatol 2004; 50:
900–906. Correction. ibid.; 51: 348. [dose]
C 28 H 36Na 2 O 6 S 3 = 610.8.
C AS — 12542-33-5; 1340-06-3. Effects on the blood. Serious adverse effects on the blood
ATC — D10BX01. H 3C CH3 CH3 CH3 have been reported rarely with oral retinoids, and are thought to
be idiosyncratic in nature. There have been reports of thrombo-
ATC Vet — QD10BX01. cytopenia in patients taking isotretinoin1 and etretinate.2,3 A few
Profile cases of agranulocytosis have involved isotretinoin4 and acitre-
Ictasol is a sodium bituminosulfonate produced from the light tin.5 In contrast, there are also reports of transient and asympto-
COOH
distillate fraction of shale oil. Sodium bituminosulfonate is ob- CH3 matic thrombocytosis associated with isotretinoin6 and tretin-
tained by the destructive distillation of certain bituminous oin.7,8 Leucocytosis is often associated with the retinoic acid
schists, sulfonation of the distillate, and neutralisation of the syndrome caused by tretinoin (p.1618).
Pharmacopoeias. In Chin., Eur. (see p.vii), and US.
product with sodium hydroxide. 1. Moeller KE, Touma SC. Prolonged thrombocytopenia associated
Ph. Eur. 6.2 (Isotretinoin). A yellow or light orange, crystalline with isotretinoin. Ann Pharmacother 2003; 37: 1622–4.
Ictasol has similar properties to ichthammol (above) and is used powder. Practically insoluble in water; slightly soluble in alco- 2. Naldi L, et al. Etretinate therapy and thrombocytopenia. Br J
in a wide range of preparations for a variety of skin disorders. hol; soluble in dichloromethane. It is sensitive to air, heat, and Dermatol 1991; 124: 395.
The symbol † denotes a preparation no longer actively marketed The symbol ⊗ denotes a substance whose use may be restricted in certain sports (see p.vii)
