isotretinoin treatment

• Isotretinoin dosing is weight-based and should be taken exactly as prescribed.

• If you miss a dose, skip that dose. Do not take two doses at the same time.

• Take with food to help with absorption.

• All instructions in the iPLEDGE program packet (ipledgeprogram.com) that was provided must be followed (see below, "initiating isotretinoin and the iPledge program").

• You will get a 30-day supply of isotretinoin at a time. It cannot be automatically refilled. When you pick up your prescription, make certain that you have been given enough medication to last 30 days as pharmacists are unable to refill or make changes within a month.

• You must return to your dermatologist every month to make sure you are not having any serious side effects from isotretinoin. For female patients, this visit will always include a monthly pregnancy test. Other laboratory studies, including liver function tests, cholesterol and triglycerides, must also be conducted before and during treatment.

• Do not become pregnant from one month prior to and one month following taking any isotretinoin.

• Do not donate blood while taking isotretinoin or until one month after coming off the medication.

• Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures while taking this medication and for at least six months after you stop.

• Do not share isotretinoin with any other people. It can cause birth defects and other serious health problems.

• Do not use any other acne medications, including medicated washes, cleansers, creams or antibiotic pills (especially doxycycline) during your treatment with isotretinoin unless expressly directed by your dermatologist provider.

• Avoid alcohol and tylenol/acetaminophen. For mild pain and headaches, ibuprofen is preferred.

• Isotretinoin can cause increased sun sensitivity. Please utilize sun-protection measures such as sun protective clothing, hats, sunscreen and sun avoidance during peak hours.

Like any oral medication, isotretinoin can come with side effects. The below list is by no means comprehensive of all the possible adverse effects, but are some of the most common ones and serious ones to look out for:

• Most side effects from isotretinoin are mild and can be easily improved with simple remedies. Others are more concerning. 

• Dry skin: Apply sensitive skin moisturizers to dry skin at least 2 times a day. You may need non-comedogenic sunscreen (SPF 30) in the morning and to reapply every 2 hours when outside. 

• Dry eyes: This is especially common in contact lens wearers. We recommend to discontinue contact lenses for the duration of treatment, and to utilize moisturizing eye drops.

• Chapped lips: Apply petrolatum-based lip balms routinely. Avoid anything “medicated.” Contact your dermatologist for excessive dryness, cracks, tenderness or pain. Please see below for product suggestions.

• Dry nose/nosebleeds: Use saline nasal spray and/or a small amount of petrolatum jelly into the nose, during the day and at bedtime. To stop nosebleeds, hold pressure. If this does not work, call your dermatologist. 

• Increased blood fats and cholesterol (usually in patients with a personal or family history of cholesterol or triglyceride problems). Your dermatology provider will be checking monthly lab work to assess your lipid levels. For this reason, it is best to refrain from eating or drinking anything other than water for 8 hours before your blood draw.

• Vision problems a!ecting your ability to see in the dark and drive at night. Please tell your doctor if this is a concern. 

• Bone, muscle and tendon aches can occur. Additional stretching before and after activities may help relieve aches. If you are otherwise healthy, consider the use of ibuprofen or naproxen. If you are unsure if you can use these pain medications, ask your doctor first. Also, call your doctor if you experience severe back pain, joint pain, or a broken bone. 

• Changes in mood, including anxiety, depressive symptoms or suicidal thoughts which may or may not be temporary. Initial isotretinoin studies showed a correlation with a decline in mental health, however experts agree that more studies need to be performed to confirm this association. Notify your doctor if you or a family member have suffered from these conditions or if you have any concerns during treatment. 

• Serious birth defects or miscarriage can occur while taking this medication and for 1 month after taking your last dose of isotretinoin. You must not get pregnant while taking isotretinoin. The medication takes approximately 30 days to make its way out of your system. Once you have been off the medication for at least 30 days, there is no effect on the baby. 

• Increased pressure in the brain. Call your doctor right away if you experience bad headache, blurred vision, dizziness, nausea or vomiting, or seizures. 

• Skin rash. Call your doctor right away if you develop any rashes or blisters on the skin. 

• Liver damage. Call your doctor right away if you experience severe stomach, chest or bowel pain, painful swallowing, diarrhea, blood in your stool, yellowing of your skin or eyes, or dark urine. 

• Gastrointestinal bleeding. If you experience unusual abdominal pain or red or black/tarry stools, call your doctor immediately. Some studies have shown a relationship does exist between taking isotretinoin and GI disease. You should also notify your doctor if you or a family member has a history of ulcerative colitis or Crohn's disease. 

• Worsening acne. Mild worsening of acne can occur in the first few weeks of using isotretinoin. If your acne is getting significantly worse, call your doctor. This may require temporarily stopping the isotretinoin and possibly adding other medications.

The iPLEDGE Program is a strict, government-required program to prevent patients from becoming pregnant while on isotretinoin. All patients, regardless of gender, must participate. Note: Your provider must follow this program and cannot change any of the requirements. 

Before starting isotretinoin, your provider will talk to you about the safe use of this medication and you will need to sign consent forms in order to receive treatment. If you fail to keep appointments, you will be unable to get your prescription filled. 

FOR PATIENTS WHO CANNOT GET PREGNANT: 

• There is no waiting period. Once laboratory tests are done, treatment can start. Prescriptions must be !lled within 30 days of being sent by the physician. 

FOR PATIENTS WHO CAN GET PREGNANT:

• You must be on 2 specific forms of birth control before starting isotretinoin. Your provider must get 2 negative pregnancy tests, 30 days apart, before you can proceed with the medication. The second pregnancy test must be obtained within 5 days of the menstrual cycle. If you choose not to be sexually active during treatment, you still must have the two negative pregnancy tests. 

• You must answer a series of questions either online or by phone every month. 

• Monthly prescriptions must be filled within 7 days of the visit to the dermatologist. It is important that you notify your physician well before the 7th day if there are any unforeseen delays, such as prior authorizations.