Everything Accutane and I-Pledge

Accutane for Nodulocystic Acne

Isotretinoin (Accutane)

What is it?

It is a Vitamin A derivative which is extremely effective in treating recalcitrant or moderate to severe cystic, scarring acne.

What does it do?

The drug decreases both the sebaceous gland (or oil gland) size and sebum (oil) production. 

Will it cure my acne?

We do not think of isotretinoin as a cure for acne. Usually, a patient’s skin stays very clear for at least 2-5 years after a complete course. It is not uncommon for those very prone to acne to need another course of isotretinoin at some time in their lives.

What are the side effects?

• Severe birth defects can happen if a person becomes pregnant while taking isotretinoin.

• Dry lips happen in 90% of patients. We recommend patients manage this with the use of Aquaphor and Hurraw Chapstick. Most patients find it manageable. 

• Dry skin (especially on the forearms) is common. Moisturizing within five minutes of showering with a fragrance-free moisturizer, such as Aveeno Daily Moisturizing Lotion or Vaseline helps with this side effect. 

• Nosebleeds happen frequently . These can be prevented by applying Vaseline/ Aquaphor around the inside walls of the nostrils with a cotton tip applicator.

• Joint pain. This can arise as “feeling more sore than usual” after a workout. Ibuprofen or Acetaminophen usually helps with this side effect. 

• Headaches- Usually relieved by increasing fluid intake, or NSAID’s. 

• Sensitivity to the sun- Wearing sunscreen and sun protective clothing is best. You are much more susceptible to sunburn when taking isotretinoin, so sun protection is very important. 

• Mood changes- Some people feel more irritable while taking this medicine. If this happens, please contact us. Frequently we can adjust the dose to improve this.

• Vision changes- While taking isotretinoin, some people have vision changes such as a decrease in night vision.

• Suicidal Ideation: While this is a very uncommon side effect, it is important to be aware of this feeling. If you feel depressed, or are considering suicide, please seek care immediately. Suicide Lifeline

• Refer to the package insert for a complete list of side effects.

What is IPLEDGE?

IPLEDGE is  a risk-management program run by the U.S. Food and Drug Administration (FDA) that helps to monitor safe administration of isotretinoin and ensure patients are not pregnant before they start isotretinoin or while they are taking it.

What do I have to do every month?

• Come to the office for a visit. IPLEDGE mandates us to see patients once a month to monitor patients and adjust their dose as necessary.

• Have blood tests done before and midway through your course. This helps us to monitor how your body is processing the medicine.

• Women of childbearing potential must provide a  pregnancy test thirty days prior to starting the medicine, right before starting the medicine and then once a month. 

• People of child bearing potential must adhere to two methods of birth control or declare abstinence. The list of potential birth control options are listed in IPLEDGE. 

What do I do after my monthly visit? (For women of child bearing potential only)

• Once we have received and entered your pregnancy test, log into IPLEDGE and answer the quiz questions.

• You have only seven days to pick up your prescription! After seven days,  pharmacies are not able to release the medication until a thirty-day window has passed. We don’t want to start over, so please don’t miss the seven day window. 

Steps for Isotretinoin IPLEDGE therapy

For patients who can get pregnant:

1. At your office visit when isotretinoin therapy is started, the the following will be needed:

   1. Signature of all IPLEDGE consent forms.Your guardian or you (if over 18 years old) will review and sign paperwork. 

   2. Pregnancy Test: Either have one done at your desired lab or provide us with results from a home pregnancy test. 

   3. Blood work: We will provide you with a lab order for blood work. It is important that this be done fasting (nothing to eat 8 hours before blood draw) and within two weeks of appointment. 

   4. Schedule a follow up visit 30-35 days from the day you provide the pregnancy test. Thirty days from the pregnancy test  is the soonest day IPLEDGE will allow you to start isotretinoin

   5. Determine method of contraception: IPLEDGE requires patients who are able to get pregnant adhere to two forms of birth control or abstinence.

2. At the 30 day followup visit:

   1. Please bring your own home pregnancy test to take at the office

   2. We will likely start isotretinoin if labs are normal and the pregnancy test is negative. 

   3. After we have entered the pregnancy test results, you will login to IPLEDGE and answer their comprehension questions

   4. Once isotretinoin has been ordered, it is only available at the pharmacy for seven days; so please pick it up right away!*

3. Every thirty days

   1. Plan a visit to come into the office with a home pregnancy test 

   2. IPLEDGE required a 30 day follow up visit to monitor side effects and pregnancy status. If you do not follow up with an office visit within 30-40 days of the prior date of pregnancy test, IPLEDGE may make your account inactive and require a thirty day waiting period from a current pregnancy test. 

   3. Once isotretinoin has been ordered, it is only available at the pharmacy for  seven days; so pick it up right away!*

4. After three months on the medicine

   1. Plan to have blood work redrawn a week or so before the visit so that we can monitor any changes compared to baseline. 

Steps for Isotretinoin IPLEDGE therapy

For patients who cannot get pregnant:

1. At your office visit when isotretinoin therapy is started, the following will be needed:

   1. Signature of all IPLEDGE consent forms. Your guardian or you (if over 18 years old) will review and sign paperwork. 

   2. Blood work: We will provide you with a lab order for blood work. It is important that this be done fasting (nothing to eat 8 hours before blood draw) and within two weeks of appointment. 

   3. Schedule a follow up visit 30-35 days from the day you sign your IPLEDGE consents. 

2. Every thirty days

   1. Plan a visit to come into the office.

   2. IPLEDGE required a 30 day follow up visit to monitor side effects. If you do not follow up with an office visit within 30-52 days of the prior visit. IPLEDGE may make your account inactive. 

   3. Once isotretinoin has been ordered, it is only available at the pharmacy for  seven days; so pick it up right away!*

1. After three months on the medicine

   1. Plan to have blood work redrawn a week or so before the visit so that we can monitor any changes compared to baseline. 

-On the 53rd day you will become “inactive in IPLEDGE” if you do not follow up. 

-IPLEDGE requires a visit for prescriptions to be refilled.

Lesley Bowler, PA-C

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