Patients on accutane may not sufficiently educated regarding contraceptive choices
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1. Patients taking isotretinoin (Accutane) had a high understanding of the harmful teratogenic effects of the medication, but did not feel they received sufficient information regarding the effectiveness of various contraceptive choices.
Evidence Rating Level: 2 (Good)Â
Study Rundown: Isotretinoin is a medication reserved for patients with severe treatment-refractory acne. Aside from its therapeutic benefit, isotretinoin is a known teratogen. The iPLEDGE program was instituted to better educate patients on contraception, but it has not significantly reduced pregnancy rates of those on the drug. Authors of this study sought to better understand the gaps in pre-treatment education and counseling with the goal of improvement and reduction in pregnancy rate. Patients understood the teratogenic effects of isotretinoin, but most disclosed that their contraceptive counseling was centered solely around oral contraceptives. Other higher efficacy contraceptive devices including subdermal- and intrauterine- contraception (IUC) were rarely discussed. The study’s strengths include the design to attain first-hand qualitative interviews, with limitations being the small study size and the selection of patients from one select urban setting.
Click to read the study in JAMA Dermatology
Relevant Reading: The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system
In-Depth [qualitative study]: In this study, authors performed qualitative interviews of 16 patients, ages 17-34, on isotretinoin regarding their experiences with the medication, pre-treatment education, and their contraceptive choices. 2 independent coders read transcripts and selected text related to pregnancy prevention and counseling for further analysis. 13/16 patients were using oral contraceptives for contraception while the remaining 3 were abstinent while on the medication. Most patients felt the counseling on contraception was incomplete with 15/16 patients being unaware of the superior effectiveness of IUC as compared to birth control pills. Patients felt their counseling could have been improved with more visual aids during the education process, stronger information comparing various contraceptive methods, and more information on adverse effects of the drug (other than teratogenic effects).
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