I was told the same Justjuan, it's only through doing some digging online that I found people talking about taking it with high fat meals. Turns out that Vitamin A is a fat soluble vitamin, therefore for your body to absorb it best you need to take it with enough fat (isotretinoin is a Vitamin A derivative). Here's what I found.
'For optimal absorption, isotretinoin must be taken with high-fat, high-calorie meals.3 The FDA defines “high fat” as 50 percent of total caloric intake of the meal, while “high calorie” refers to 800 to 1,000 calories (150 from proteins, 250 from carbohydrates, 500-600 from fat).4 Clinical trials evaluating the efficacy and safety of isotretinoin are all performed under those conditions. In the real world, where many patients do not even eat three meals a day, let alone high-fat, high-calorie meals, absorption of isotretinoin may be much lower. Moreover, many dermatologists are not educating patients on the true dietary needs of patients on this medication.'
A bit more digging turned up a couple of studies, one suggesting that more than double the amount of isotretinoin was absorbed when taken with a meal containing 20g of fat compared to fasting, another suggested 50g of fat more than doubled the amount absorbed.
It's also believed that one of the potential reasons for relapse is underdosing. I really don't want to have to do another course of roaccutane if I can help it so I'm trying to stick to the high fat recommendation to give it the best chance of working. That said, I also want to keep it to good fats where possible as I don't want them to lower my dose due to skyrocketing cholesterol levels! So for now I'm aiming for 20g of fat per dose and have switched my doses around so I'm taking the low dose with breakfast (when I struggle to eat enough fat) and the high dose with dinner.