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What is Accutane?

Accutane is a form of vitamin A. It reduces the amount of oil released by oil glands in your skin, and helps your skin renew itself more quickly.

Accutane is used to treat severe nodular acne. It is usually given after other acne medicines or antibiotics have been tried without successful treatment of symptoms.

Accutane may also be used for other purposes not listed in this medication guide.

Important information

Accutane can cause severe, life-threatening birth defects. Never use Accutane if you are pregnant.

Women of child-bearing potential must agree in writing to use two specific forms of birth control and have regular pregnancy tests before, during, and after taking isotretinoin.

Slideshow: Flashback: FDA Drug Approvals 2013

Accutane is available only under a special program called iPLEDGE. It is dangerous to try and purchase Accutane on the Internet or from vendors outside of the United States.

Do not take vitamin supplements containing vitamin A while you are taking isotretinoin. Do not donate blood while taking Accutane and for at least 30 days after you stop taking it.

What should I discuss with my healthcare provider before taking Accutane?

Accutane is available only under a special program called iPLEDGE. You must be registered in the program and sign documents stating that you understand the dangers of this medication and that you agree to use birth control as required by the program. Ask your doctor or call the drug maker if you have questions about the program or the written requirements.

It is dangerous to try and purchase Accutane on the Internet or from vendors outside of the United States. The sale and distribution of Accutane outside of the iPLEDGE program violates the regulations of the U.S. Food and Drug Administration for the safe use of this medication.

Do not use this medication if you are allergic to isotretinoin or to parabens, or if you are pregnant or may become pregnant.

To make sure you can safely take Accutane, tell your doctor if you have any of these other conditions:

a personal or family history of depression or mental illness;

heart disease, high cholesterol or triglycerides;

osteoporosis or other bone disorders;

an intestinal disorder such as inflammatory bowel disease, ulcerative colitis, or Crohn’s disease;



an eating disorder (anorexia nervosa); or

  • liver disease.
  • Accutane can cause severe, life-threatening birth defects if the mother takes the medication during pregnancy. Even one dose of Accutane can cause major birth defects of the baby’s ears, eyes, face, skull, heart, and brain. Never use Accutane if you are pregnant.

    For Women: Unless you have had your uterus and ovaries removed (total hysterectomy with oophorectomy) or have been in menopause for at least 12 months in a row, you are considered to be of child-bearing potential.

    Even women who have had their tubes tied are required to use birth control while taking Accutane.

    You must have a negative pregnancy test 30 days before you start taking Accutane. A pregnancy test is also required before each prescription is refilled, right after you take your last dose of Accutane, and again 30 days later. All pregnancy testing is required by the iPLEDGE program.

    You must agree in writing to use two specific forms of birth control beginning 30 days before you start taking Accutane and ending 30 days after you stop taking it. Both a primary and a secondary form of birth control must be used together.

    Primary forms of birth control include:

    tubal ligation (tubes tied);

    vasectomy of the male sexual partner;

    an IUD (intrauterine device);

    a male latex condom plus spermicidal foam or gel;

    a diaphragm plus spermicidal foam or gel;

    a cervical cap plus spermicidal foam or gel; and

    a vaginal sponge containing spermicide.

    Stop using Accutane and call your doctor at once if you have unprotected sex, if you quit using birth control, if your period is late, or if you think you might be pregnant. If you get pregnant while taking Accutane, call the iPLEDGE pregnancy registry at 1-866-495-0654.

    It is not known whether isotretinoin passes into breast milk. Do not take Accutane without first talking to your doctor if you are breast-feeding a baby.

    How should I take Accutane?

    Take Accutane exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

    Each prescription of Accutane must be filled within 7 days of the date it was prescribed by your doctor. You will receive no more than a 30-day supply of Accutane at one time.

    Always take Accutane with a full glass of water to prevent the capsule from melting in your esophagus (food pipe), causing irritation. Do not chew or suck on the capsule. Swallow it as quickly as possible. Take Accutane with food or milk. Take this medication for the entire length of time prescribed by your doctor. Your acne may seem to get worse at first, but should then begin to improve.

    To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your liver function may also need to be tested. Visit your doctor regularly.

    Do not take vitamin supplements containing vitamin A while you are taking Accutane.

    Do not donate blood while taking Accutane and for at least 30 days after you stop taking it. Donated blood that is later given to pregnant woman could lead to birth defects in her baby if the blood contains any level of Accutane.

    Do not use wax hair removers or have dermabrasion or laser skin treatments while you are taking Accutane and for at least 6 months after you stop taking it. Scarring may result.

    Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Accutane can make your skin more sensitive to sunlight and sunburn may result. Accutane may impair your vision, especially at night. Be careful if you drive or do anything that requires you to see clearly.

    Accutane side effects

    Get emergency medical help if you have any of these signs of an allergic reaction to Accutane: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Accutane and call your doctor at once if you have any of these serious side effects:

    depressed mood, trouble concentrating, sleep problems, crying spells, aggression or agitation, changes in behavior, hallucinations, thoughts of suicide or hurting yourself;

    feeling dizzy, drowsy, or nervous;

    dryness of the lips, mouth, nose, or skin; or

    cracking or peeling skin, itching, rash, changes in your fingernails or toenails.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    What other drugs will affect Accutane?

    Before taking Accutane, tell your doctor if you are also taking:

    steroids (prednisone and others);

    seizure medication such as phenytoin (Dilantin); or

    Accutane Recall

    Accutane is linked to serious side effects like birth defects, thoughts of suicide, depression and bowel disorders. Roche stopped manufacturing it in 2009, but there was no official recall.

    Accutane (isotretinoin) is an acne medicine that reached the U.S. market during the early 1980s and quickly become a best-settling prescription drug. Since then, a number of studies have connected Accutane to numerous side effects ranging from birth defects to Crohn’s disease to suicide.

    Although the drug was hailed by dermatologists as a breakthrough treatment for patients with severe acne, Accutane’s dangerous side effects affected thousands of patients during the past 30 years.

    In the summer of 2009, Accutane manufacturer Roche Pharmaceuticals stopped manufacturing the drug. Representatives for Roche said the acne treatment had hit the end of its life cycle because of the end of its patent and the addition of several generic Accutane drugs to the market.

    Roche’s brand-name Accutane had a market share of less than 5 percent of the market at the time of the decision. A number of generic equivalents of isotretinoin remain available today.

    What is Accutane?

    Accutane’s chemical composition resembles that of retinoic acid, a compound derived from Vitamin A. The primary application for Accutane is for nodular acne in patients that do not respond to topical applications (such as benzoyl peroxide) and standard antibiotic treatments.

    People with severe cases of nodular acne can display red, tender and swollen bumps under the skin. These bumps can have a diameter of a quarter-inch or larger. Left untreated, these bumps can lead to permanent facial scarring and disfigurement. Accutane treats these bumps by slowing the rate of chemical production that leads to skin breakouts.

    Accutane: A History of Adverse Reactions

    In discontinuing Accutane, Roche expressed no concern about the drug’s safety or effectiveness. However, numerous users of the drug reported harmful responses to it, dating to the time it was first marketed in 1982.

    Accutane is linked to serious birth defects when taken by pregnant women. Accutane also is connected with side effects of depression, suicidal thoughts and bowel diseases including Crohn’s .

    A 2007 study in the British Journal of Clinical Pharmacology examined women who became pregnant while taking isotretinoin. The study found among 90 pregnant women taking Accutane, only nine had a live birth. Three experienced spontaneous abortion, two had trauma during delivery resulting in the newborn’s death and 76 had elective abortions.

    A 2001 article in the New England Journal of Medicine linked Accutane to depression. A U.S. Food and Drug Administration (FDA) study examined 110 people who took Accutane and were hospitalized for depression or attempted suicide. Their ages ranged from 12 to 47.

    At a 2009 meeting of the American College of Gastroenterology in San Diego, a research team from the University of North Carolina at Chapel Hill presented the results of a study that showed a higher rate of digestive disorders, including ulcerative colitis, in Accutane users. The UNC study found that Accutane users were 1.7 times more likely to develop Inflammatory Bowel Disease than the general population, while those who had filled at least four Accutane prescriptions were 2.67 times more likely to come down with the disease. Patients with IBD experience diarrhea, abdominal pain, cramping and bleeding.

    The UNC presentation also showed that patients who took Accutane had more than four times the risk of developing ulcerative colitis than the general population. Ulcerative colitis is a condition in which the lining of the colon and rectum develops open sores, causing severe pain and irritation during bowel movements.

    Despite the studies outlining the negative effects from taking Accutane, Roche declined to denounce its drug. Instead, the company said, “Roche stands behind the safety of Accutane.”

    Lawsuits Play Role

    One factor beyond the expiration of patents that may have led to Roche’s decision to discontinue Accutane was litigation. Roche found itself defending thousands of Accutane lawsuits .

    By the time Roche stopped making the drug, people who experienced Accutane’s side effects – as well as their families – had filed nearly 1,000 lawsuits against the company. With more patients citing the ill effects of Accutane as reasons for their illnesses, the total number of cases is expected to exceed 5,000.

    Thousands of individuals who feel that they developed illnesses because of taking Accutane pursued legal recourse with the help of an experienced Accutane attorney. Many received verdicts to recover medical expenses as well as a measure of punitive and compensatory damages against the manufacturer for lost wages, and pain and suffering.

    Last modified: March 6, 2014

    What Is Accutane? Its Uses and Interactions

    Accutane (isotretinoin) is a popular drug for severe acne created by Hoffmann-LaRoche Inc. The drug is linked to severe bowel disease and other side effects.

    Accutane, approved by the U.S. Food and Drug Administration (FDA) in 1982, proved to be a miracle for some, offering blemish-free skin to those who had given up after trying many other treatments.

    The drug works for severe (cystic) acne, providing long-lasting and sometimes complete reduction of acne for 80 percent of patients. However, clear skin may be accompanied by serious side effects like Crohn’s disease.

    Following numerous reports of adverse events – and after doctors noted potential dangers with the drug and the FDA issued a black-box warning, Roche stopped manufacturing Accutane in 2009. Generic brands of the medication — Amnesteen, Claravis and Sotret — are still available.

    Uses of Accutane

    Accutane is part of a class of medications called retinoids and originally was marketed as a chemotherapy drug. It is known for its ability to treat acne that has not responded to antibiotics. The medication is a derivative of vitamin A and works by controlling the oil in the sebaceous glands. The acne it treats consists of nodules with a diameter or 5 mm or greater. Having this type of acne can be socially debilitating, so the potential of a cure can be life-changing.

    Undergoing Accutane treatment is a commitment of time and energy. It can take months to be effective, and patients often must deal with side effects like dry eyes and headaches. In addition, acne may worsen during the beginning stages of treatment before it starts to clear up.

    Doses of Accutane range from 0.5 to 1.0 mg/kg body weight per day, with a cumulative dose of greater than 100 to 120 mg/kg. Accutane comes in capsules of 10, 20 and 40 mg, and should be taken with food. Most patients take the medication for 15 to 20 weeks, and may repeat the treatment course if acne returns. Due to the risk of serious birth defects, women of child-bearing age must commit to programs aimed at preventing pregnancies during treatment.

    Doctor Warnings

    The first prescriptions of Accutane were written in 1982, and a year later came the first report of a baby born with malformations after Accutane was taken during pregnancy. In 1983, there were two “Dear Doctor letters” — special communications the FDA requires drug manufacturers to send out if the drug label is not complete in covering the extent and severity of side effects — sent out, alerting physicians of the possibility of birth defects. From 1984 to 1988, seven more of the letters went out.

    The FDA was not alone in noting the dangers of Accutane. Dr. Frank Yoder, one of the scientists involved in the discovery of Accutane, wrote a letter to the Journal of American Medicine in 1983, informing the public of the possibility that Roche was not clear in alerting users of the toxicity associated with Accutane.

    That same year, a nonprofit health advocacy group, Public Citizen, petitioned the FDA to add warnings of birth defects to Accutane labels. The FDA took action in 1985, when a black-box warning, indicating that Accutane can cause fetal deformities and possibly fetal death, was added to the medication.

    By 1988, a pregnancy prevention program had been put into place, with the goal of decreasing the number of woman getting pregnant while taking the drug. The program was eventually effective in decreasing the percentage of woman getting pregnant while taking the drug, from 4 women per every 1,000 a year to less than 2 for every 1,000. However the number of prescriptions given out also increased, keeping the number of affected pregnant women taking Accutane high.

    Other countries had even stricter rules about Accutane use by women of childbearing age. For example, in Britain, prior to receiving the medication, women were required to agree to have an abortion if they became pregnant during treatment.

    The Centers for Disease Control (CDC) played a role in affirming the danger of Accutane by publishing information on the fetal toxicity of the drug, conducting a study of Accutane-exposed pregnancies to raise awareness, and sending a letter to the FDA in 1998 recommending that the drug not be sold due to these dangers. Also, the CDC division of Birth Defects and Developmental Disabilities  received reports of infant death following maternal exposure to Accutane.

    In June 2009, as the number of adverse events reported to the FDA and lawsuits from patients continued to grow, Roche stopped manufacturing Accutane. The company said it was an economic decision based on generic brands of the medication taking over the market. Accutane was recalled in 11 other countries.

    Milder Side Effects of Accutane

    Most people experience some measure of common side effects with Accutane use and should not be concerned unless these conditions worsen or become extremely painful. With more serious side effects, however, a doctor should be consulted immediately.

    Accutane Side Effects Center

    Prescribing Information

    For Patients

    Accutane (isotretinoin) is an oral drug used for the treatment and prevention of severe acne. Generic formulations of Accutane are available and the brand name is discontinued in the United States. The most common side effects of Accutane are dry skin, itching, dry nose, nosebleeds (epistaxis), cracks in the corners of the mouth (chilitis), dry mouth, and inflammation of the whites of the eyes.

    The recommended dose of Accutane is 0.5 to 2 mg per kg of body weight daily. Combining vitamin A with Accutane may increase side effects. Accutane is harmful to the fetus and therefore should not be used during pregnancy. Accutane is harmful to the fetus and therefore should not be used during pregnancy.

    Our Accutane Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    Accutane in Detail – Patient Information: Side Effects

    Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

    Stop using isotretinoin and call your doctor at once if you have any of these serious side effects:

    • depressed mood, trouble concentrating, sleep problems, crying spells, aggression or agitation, changes in behavior, hallucinations, thoughts of suicide or hurting yourself;
    • sudden numbness or weakness, especially on one side of the body;
    • blurred vision, sudden and severe headache or pain behind your eyes, sometimes with vomiting;
    • hearing problems, hearing loss, or ringing in your ears;
    • seizure (convulsions);
    • severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;
    • loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
    • severe diarrhea, rectal bleeding, black, bloody, or tarry stools;
    • fever, chills, body aches, flu symptoms, purple spots under your skin, easy bruising or bleeding;
    • severe blistering, peeling, and red skin rash; or
    • joint stiffness, bone pain or fracture.

    Less serious side effects may include:

    • joint pain, back pain;
    • feeling dizzy, drowsy, or nervous;
    • dryness of the lips, mouth, nose, or skin; or
    • cracking or peeling skin, itching, rash, changes in your fingernails or toenails.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    Read the entire detailed patient monograph for Accutane (Isotretinoin) »

    What is Accutane?

    Introduction to Accutane

    How does Accutane work?

    Exactly how Accutane works on a cellular level is unknown but we do know that it affects all four ways that acne develops.

    • 1. It dramatically reduces the size of the skin’s oil glands (35%-58%) and even more dramatically reduces the amount of oil these glands produce (around 80%). 8-9
    • 2. Acne bacteria (P. acnes ) live in skin oil. Since oil is dramatically reduced, so is the amount of acne bacteria in the skin. 9
    • 3. It slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged in the first place. 10
    • 4. It has anti-inflammatory properties. 10

    Although acne may get worse within the first month of Accutane use for about 30% of patients, the ultimate results are usually dramatic. 11 Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne. 12 The majority of people who take it see their acne effectively cured, experiencing long-term remission of acne symptoms. Studies show an average relapse rate of around 33%, and in these cases sometimes a second course is given. 7,9,12-17 This relapse rate is dose-dependent. 13 Patients who receive a cumulative dose of 100-120 mg/kg see the best results and lowest relapse rates. Patients who receive a lower dose relapse more frequently. Daily dosage depends on how much the patient weighs; 0.5 mg – 2 mg/kg is typical. 15

    Low and intermittent dosing. Researchers have published several studies attempting to gauge whether people with mild to moderate acne can achieve long term remission of acne with lower dosages of Accutane. Initial data is showing that people with mild to moderate acne may be able to achieve long term remission with significantly lower dosages, and thus suffer less side effects, 18-20 including lower incidence of scarring. Relapse rates with lower dosages do not seem to increase, leading some researchers to posit that it is not cumulative dose that brings about permanent clearing as much as it is the length of time that the oil glands are suppressed. 20 Intermittent dosing (taking Accutane only 1 week of every month) appears to work less well, producing significantly poorer outcomes for more than half of the patients studied. 19,21




      Patient Information:


    Accutane (isotretinoin) must not be used by female patients who are or may become pregnant. There is an extremely high risk that severe birth defects will result if pregnancy occurs while taking Accutane (isotretinoin) in any amount, even for short periods of time. Potentially any fetus exposed during pregnancy can be affected. There are no accurate means of determining whether an exposed fetus has been affected.

    Birth defects which have been documented following Accutane (isotretinoin) exposure include abnormalities of the face, eyes, ears, skull, central nervous system, cardiovascular system, and thymus and parathyroid glands. Cases of IQ scores less than 85 with or without other abnormalities have been reported. There is an increased risk of spontaneous abortion, and premature births have been reported.

    Documented external abnormalities include: skull abnormality; ear abnormalities (including anotia, micropinna, small or absent external auditory canals); eye abnormalities (including microphthalmia); facial dysmorphia; cleft palate. Documented internal abnormalities include: CNS abnormalities (including cerebral abnormalities, cerebellar malformation, hydrocephalus, microcephaly, cranial nerve deficit); cardiovascular abnormalities; thymus gland abnormality; parathyroid hormone deficiency. In some cases death has occurred with certain of the abnormalities previously noted.

    If pregnancy does occur during treatment of a female patient who is taking Accutane (isotretinoin). Accutane (isotretinoin) must be discontinued immediately and she should be referred to an Obstetrician-Gynecologist experienced in reproductive toxicity for further evaluation and counseling.

    Special Prescribing Requirements

    Because of Accutane (isotretinoin) ‘s teratogenicity and to minimize fetal exposure, Accutane (isotretinoin) is approved for marketing only under a special restricted distribution program approved by the Food and Drug Administration. This program is called iPLEDGE™. Accutane (isotretinoin) must only be prescribed by prescribers who are registered and activated with the iPLEDGE program. Accutane (isotretinoin) must only be dispensed by a pharmacy registered and activated with iPLEDGE, and must only be dispensed to patients who are registered and meet all the requirements of iPLEDGE (see PRECAUTIONS ).

    Table 1. Monthly Required iPLEDGE Interactions

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    Recent reports from Health Canada, the U.S. Food & Drug Administration, and well-documented medical research from highly respected medical journals have all drawn attention to the potentially dangerous side effects associated with using Accutane. In 2009, Accutane’s manufacturer, Hoffmann-La Roche, indicated on its website that it had decided to discontinue the manufacture and distribution of Accutane in the United States due to rapidly declining product sales and an increasing number of personal injury claims being made.

    To help Canadians who have been injured as a result of taking Accutane receive compensation, two Canadian law firms, Legate & Associates and Harrison Pensa LLP. have joined forces. The two firms are now accepting Canadian clients who have been diagnosed with inflammatory bowel disease as a result of their experience with Accutane or its generic equivalents.

    The list of illnesses and symptoms related to Accutane includes:

      Overview Legal Perspective Jennifer’s Story

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    Roche’s 2003 Accutane Warning Label:

    Accutane (Isotretinoin) is a Vitamin A derivative known as a Retinoid which is sold under other pharmaceutical brand-names such as Amnesteen, Sotret, Roaccutane, Clarus, Oratane, Isotane, and Claravis. Accutane has been praised for being extremely useful as a treatment for severe, nodular forms of acne, but has been criticized for its inadequate labeling warning users and medical professionals about the drug’s effects on the gastrointestinal tract. As a result, medical and legal controversy has emerged involving these potentially dangerous and debilitating side effects. The severity of these side effects has become the subject of litigation in the Canadian and United States’ judicial systems where thousands of lawsuits have been filed against Hoffmann-La Roche (Roche).

    The law firms, Legate & Associates and Harrison Pensa. believe that Roche and the generic drug companies did not adequately warn the public about the severity of Accutane’s side effects and the severe harm it could do to a patient’s health.

    If you took Accutane and have since been diagnosed with inflammatory bowel disease, Crohn’s disease, or ulcerative colitis, we want to help. Our team of experienced and highly skilled lawyers at both Legate & Associates and Harrison Pensa are dedicated to litigating claims for people who have been injured due to taking Accutane.

    Please use the Contact Form to submit your experience to Legate & Associates, or send an email to We are offering FREE consultations. Thank you.



    Isotretinoin must not be taken by patients who are pregnant or who may become pregnant. There is a high risk that isotretinoin will cause loss of the pregnancy, or will cause the baby to be born too early, to die shortly after birth, or to be born with birth defects (physical problems that are present at birth).

    A program called iPLEDGE has been set up to make sure that pregnant women do not take isotretinoin and that women do not become pregnant while taking isotretinoin. All patients, including women who cannot become pregnant and men, can get isotretinoin only if they are registered with iPLEDGE, have a prescription from a doctor who is registered with iPLEDGE and fill the prescription at a pharmacy that is registered with iPLEDGE. Do not buy isotretinoin over the internet.

    You will receive information about the risks of taking isotretinoin and must sign an informed consent sheet stating that you understand this information before you can receive the medication. You will need to see your doctor every month during your treatment to talk about your condition and the side effects you are experiencing. At each visit, your doctor may give you a prescription for up to a 30-day supply of medication with no refills. If you are a woman who can become pregnant, you will also need to have a pregnancy test in an approved lab each month and have your prescription filled and picked up within 7 days of your pregnancy test. If you are a man or if you are a woman who cannot become pregnant, you must have this prescription filled and picked up within 30 days of your doctor visit. Your pharmacist cannot dispense your medication if you come to pick it up after the allowed time period has passed.

    Tell your doctor if you do not understand everything you were told about isotretinoin and the iPLEDGE program or if you do not think you will be able to keep appointments or fill your prescription on schedule every month.

    Your doctor will give you an identification number and card when you start your treatment. You will need this number to fill your prescriptions and to get information from the iPLEDGE website and phone line. Keep the card in a safe place where it will not get lost. If you do lose your card, you can ask for a replacement through the website or phone line.

    Do not donate blood while you are taking isotretinoin and for 1 month after your treatment.

    Do not share isotretinoin with anyone else, even someone who has the same symptoms that you have.

    Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with isotretinoin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( ), the manufacturer’s website, or the iPLEDGE program website ( ) to obtain the Medication Guide.

    Talk to your doctor about the risks of taking isotretinoin.

    For female patients:

    If you can become pregnant, you will need to meet certain requirements during your treatment with isotretinoin. You need to meet these requirements even if you have not started menstruating (having monthly periods) or have had a tubal ligation ('tubes tied’; surgery to prevent pregnancy). You may be excused from meeting these requirements only if you have not menstruated for 12 months in a row and your doctor says you have passed menopause (change of life) or you have had surgery to remove your uterus and/or both ovaries. If none of these are true for you, then you must meet the requirements below.

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