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At a glance Drug / isotretinoin (Accutane), oral retinoid for severe nodular acne Supplement / green tea extract (GTE), standardized to EGCG (epigallocatechin gallate) Primary concern / additive hepatotoxicity at GTE doses 400 mg EGCG/day Secondary concern / CYP1A2 and CYP3A4 modulation may shift isotretinoin metabolism Dietary green tea risk / low, typical brewed cup contains 50 to 100 mg EGCG Monitoring required / LFTs (ALT, AST) at baseline and weeks 4, 8 per iPLEDGE protocol FDA DILI signal / GTE linked to drug-induced liver injury in 29 case reports reviewed by NIH LiverTox Recommendation / avoid concentrated GTE supplements during isotretinoin