A 19-year-old woman is starting oral isotretinoin 20 mg daily for severe acne. She currently uses a progestogen-only contraceptive pill. What is the most appropriate advice before supplying isotretinoin?

• A. She must use at least one highly effective method or two complementary user-dependent forms of contraception for 1 month before, during, and 1 month after treatment
• B. Contraception is not required if she is on a progestogen-only pill
• C. She should discontinue contraception while on isotretinoin
• D. Only pregnancy testing is required before starting treatment

Answer: (A)

Isotretinoin is highly teratogenic, so preventing pregnancy is essential before starting and for a period after stopping treatment. The only acceptable contraception plan is either using a single highly effective method (such as an IUD or implant) or using two complementary user-dependent methods (methods that require ongoing and correct use, like a combination of pills, patches, or diaphragms plus a barrier). This protection with either approach must begin at least 1 month before starting isotretinoin, continue during treatment, and extend for 1 month after the course ends.

For a patient already on a progestogen-only pill, relying on it alone isn’t considered sufficient protection because it’s user-dependent and can fail if doses are missed or irregular. Therefore, an additional form of contraception or a switch to a highly effective method is advised to meet the required pregnancy-prevention standard.

Other options aren’t appropriate because isotretinoin requires contraception even when a progestin-only pill is used, pregnancy testing alone isn’t enough, and stopping contraception during treatment would remove essential protection.