Isotretinoin (Roaccutane): Pregnancy, Contraception and Breastfeeding

Written by Dr. K on 24 March 2021

What is Isotretinoin or Roaccutane?

Isotretinoin (ai·sow·truh·tee·now·uhn) is a prescription medication for the treatment of moderate to severe acne. It is a Vitamin A derivative, a retinoid. Isotretinoin is also known by its brand names including Absorica®, Accutane®, Amnesteem®, Claravis®, Myorisan®, Roaccutane®, Sotret®, and Zenatane™.

Method of Action

In the treatment of acne, Isotretinoin targets 5 main functions within the pathways leading to the development of acne:

  • decreases the production of sebum in the skin
  • reduces the size of sebaceous glands in the skin
  • inhibits the growth of acne-producing bacteria
  • anti-inflammatory properties
  • decreases follicular occlusion

Contraindications

Isotretinoin cannot be taken by pregnant women or women intending to become pregnant.

Whilst on Isotretinoin, patients are not allowed to donate blood, in the event the blood is given to pregnant women.

Isotretinoin also cannot be given to patients with hyperlipidaemia (high fats, triglycerides and cholesterol).

Pregnancy, Contraception and Breastfeeding

Isotretinoin is a teratogen, it can cause serious congenital birth defects in a baby. There is also a potential risk of Isotretinoin entering the breast milk and adversely affecting the baby in that way.

For this reason, Isotretinoin is contraindicated in pregnant women, women intending to get pregnant and breastfeeding women. There are very strict measures in the process of prescribing Isotretinoin.

All women of child-bearing age or those who have their menstrual cycle, regardless of age, must be on two different kinds of contraception for the entire duration of their treatment course and for four weeks after the treatment has been stopped. 

There are many widely available methods of contraception in the market. Speak to your doctor about the right one for you. A few include:

  • Abstinence
  • Condoms
  • Oral contraception tablets
  • Injectable contraceptive
  • Implantable contraceptive
  • Contraceptive Intrauterine Device – Hormonal
  • Contraceptive Intrauterine Device – Copper Coil
  • Diaphragm contraceptive

In the event you have had unprotected sexual intercourse whilst taking Isotretinoin, you can speak to your doctor or pharmacist for an emergency contraceptive pill. This is available as a prescription tablet and prevents pregnancy when taken within 72 hours of having intercourse.

If contraception fails, and a woman falls pregnant, termination of pregnancy (an abortion) will be advised by the doctor due to the dangers of significant birth defects in the baby.

Sources

References:

  1. Advice on the safe introduction and continued use of isotretinoin in acne in the UK 2010 – MJD Goodfield, NH Cox, A Bowser, JC McMillan, LG Millard, NB Simpson, AD Ormerod, BJD, Vol. 162, No. 5, June 2010 (p1172-1179)
  2. Mollan SP, Woodcock M, Siddiqi R, Huntbach J, Good P, Scott RA. Does use of isotretinoin rule out a career in flying? Br J Ophthalmol. 2006 Aug;90(8):957-9. PubMed.
  3. Accessed on 24.3.2021 https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/safety
  4. NICE BNF UK – Isotretinoin

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