How is oral isotretinoin administered for the treatment of acne vulgaris?

Patients should initially have comprehensive counseling about the potential side effects of this drug. Under the iPledge program, they must register online and answer a series of questions regarding their menstrual periods, method of birth control, and other mandatory information before they can enter the program. At a minimum, all patients should have pretreatment blood lipid and liver function studies. Some dermatologists also obtain complete blood counts. An initial pregnancy test is required to enter the iPledge program, followed by a second pregnancy test at an approved laboratory before actually receiving the drug.

Oral isotretinoin is taken with food in a dose range of 0.5 to 2.0 mg/kg given in two divided doses for 15 to 20 weeks. It is better absorbed if taken with a fatty meal. Women of childbearing age should start therapy on the second or third day of their next normal menstrual period after having had a negative serum pregnancy test. After 20 to 24 weeks, therapy should be stopped. If significant acne is still present after a 2-month period, a second course of isotretinoin therapy may be considered.