FBC, lipid panel, and LFTs are monitored regularly in all patients taking isotretinoin. Women also require monthly pregnancy tests to continue treatment with isotretinoin.
Before starting therapy, it is important to discuss realistic expectations with patients. With any acne therapy, it can take at least 4 to 8 weeks before a response is seen; the full effects of treatment may take several months, and acne may actually flare slightly after initiating treatment. Patients need to remain compliant even if they are not seeing an early response. Even with the best treatment, patients may get occasional acne lesions.
Before treatment with isotretinoin, patients require counselling about the possibility of adverse effects and the need for regular blood tests. Dry skin and chapped lips are very common, and lip and skin moisturisers may be considered. Severe headaches, decreased night vision, or signs of adverse psychiatric events should prompt the patient to seek medical attention. Patients should be instructed not to donate blood during treatment or 30 days thereafter. Women must be advised that isotretinoin causes birth defects; they should undergo pregnancy tests before starting, and monthly while taking the drug.