Dietary Supplements, Isotretinoin, and Liver Toxicity in Adolescents: A Retrospective Case Series

Pediatrics. 2017 Oct;140(4):e20152940. doi: 10.1542/peds.2015-2940. Epub 2017 Sep 1.


Isotretinoin is the most effective acne therapy available, but has the potential for a number of adverse side effects, including transaminitis. The iPLEDGE isotretinoin program recommends avoiding some herbals and supplements due to potential side effects. However, little is known about the effects of protein supplements on the liver, particularly in patients taking isotretinoin. We designed a retrospective chart review to evaluate the symptoms, diagnosis, treatment, and outcome of patients on or preparing to take isotretinoin therapy who were concurrently ingesting protein or herbal supplementation and who developed transaminitis. In 100% (8/8) of cases, dietary supplementation was determined to be at least a possible cause of elevated liver transaminases. In 75% (6/8) of cases, dietary supplement appears to be the most likely cause at some point in their evaluation. Most of our patients' elevations in aspartate aminotransferase and/or alanine aminotransferase were likely caused by supplementation with protein, creatine, or herbal extracts, rather than prescribed isotretinoin or tetracycline antibiotics for acne. Hence, dietary supplementation may cause liver function abnormalities. As supplement usage appears common in teenagers, clinicians should consider counseling their patients to avoid these products, particularly when prescribing known hepatotoxic drugs.

Publication types

  • Case Reports

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Adolescent
  • Biomarkers / metabolism
  • Camellia sinensis / adverse effects
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / enzymology
  • Chemical and Drug Induced Liver Injury / etiology*
  • Creatine / adverse effects
  • Dermatologic Agents / adverse effects*
  • Dermatologic Agents / therapeutic use
  • Dietary Proteins / adverse effects
  • Dietary Supplements / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Isotretinoin / adverse effects*
  • Isotretinoin / therapeutic use
  • Male
  • Plant Preparations / adverse effects
  • Retrospective Studies
  • Transaminases / metabolism
  • Treatment Outcome


  • Biomarkers
  • Dermatologic Agents
  • Dietary Proteins
  • Plant Preparations
  • Transaminases
  • Isotretinoin
  • Creatine