Starting Isotretinoin for Acne: What You Need to Know

What is isotretinoin?

Isotretinoin is an oral medication (medication taken by mouth) used to treat severe acne or acne that does not get better after trying several other treatments. Isotretinoin is also called Accutane®.

What should I do before taking isotretinoin?

Everyone who takes isotretinoin has to enroll in the iPLEDGE® Program. This is a strict, government-required program that ensures people safely start and take isotretinoin. For more information about iPLEDGE®, visit the iPLEDGE® website or call 866-495-0654.

As part of the program, you will need:

• Monthly lab tests
• Monthly pregnancy tests at your doctor’s office or a lab (for people who can give birth, such as people assigned female at birth)
• Sign written consent forms (If you are under 18 years of age, a family member or legal guardian will need to sign for you.)
• Answer questions from iPLEDGE® once a month about your chosen form(s) of birth control and how to prevent pregnancy while taking isotretinoin. It is important to prevent pregnancy while taking isotretinoin. It can cause serious birth defects.

What should I do while taking isotretinoin?

• Set up an online account with iPLEDGE® to answer your monthly questions. A password will be mailed to you. If you do not have internet or computer access, you may also call iPLEDGE® monthly at 866-495-0654 to answer the questions.
• Schedule follow-up visits with your dermatologist (skin doctor) every 4-5 weeks. It is okay if you run out of medication and have a short gap between taking your next dose. Isotretinoin stays in your system for a while.
• Stop using all your creams, lotions and washes that you use to treat your acne before starting isotretinoin.
• It is normal for your skin and other parts of your body (such as your eyes or nose) to feel dry. If your skin is very dry, you may use an oil-free moisturizer.
• Wash your face 1-2 times a day with a gentle, fragrance-free facial cleanser.
• Do not donate blood.
• Do not share isotretinoin with anyone. It can cause birth defects and other serious health problems.

What should I do after finishing my isotretinoin treatment?

• For at least one month: Do not donate blood.
• For at least 6 months: Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion or laser procedures.

My skin, eyes, lips or nose feel dry while taking isotretinoin. What can I do to help?

It is common for different parts of your body to feel dry or chapped while taking isotretinoin. Below are tips that can help:

• Dry skin: Apply sensitive skin moisturizer to dry skin at least 2 times a day. You may need non-comedogenic (does not clog pores) sunscreen (SPF 30) in the morning. Reapply the sunscreen every 2 hours when outside.
• Dry eyes: Use saline eye drops or artificial tears.
• Chapped lips: Apply petroleum-based lip balms routinely. Avoid anything medicated.
• Dry nose/nosebleeds: Use saline nasal spray and/or a small amount of petrolatum jelly (Vaseline® or Aquaphor®) into your nose during the day and at bedtime. To stop nosebleeds, tilt your head back and press a tissue or clean towel against your nose. If the nosebleed does not stop after 20 minutes, call your dermatologist.
• Contact your dermatologist if you experience excessive dryness, cracked lips or skin, tenderness or pain.

Important things to know for people who can become pregnant

• Isotretinoin can cause severe birth defects in babies. It is important to prevent pregnancy while you take isotretinoin and for at least one month after you stop taking isotretinoin.
• Everyone who is sexually active and takes isotretinoin must use 2 forms of birth control before starting isotretinoin. Abstinence (not taking part in sexual activity that can lead to pregnancy) does not require a second birth control method. If you are abstinent, you do not need to use a second form of birth control.
• Before starting isotretinoin, you must have 2 negative pregnancy tests 30 days apart. Pregnancy tests must be done at your doctor’s office or at a lab. You cannot use store-bought pregnancy tests. In order to pick up your prescription, you also need to have a negative pregnancy test every month.
• Fill monthly prescriptions within 7 days of your pregnancy test or the test will need to be repeated.
• Each month your doctor will have to update iPLEDGE® and your pharmacy before the prescription is ready.
• When you finish your isotretinoin treatment plan, you will need a negative pregnancy test after your last dose and again one month later. You must continue with the 2 forms of birth control for one month after the last dose.

Rev. 3/2022. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.