Compliance with pregnancy prevention measures during isotretinoin therapy

J Am Acad Dermatol. 2014 Jan;70(1):55-9. doi: 10.1016/j.jaad.2013.08.034. Epub 2013 Oct 21.


Background: Approximately 150 women annually become pregnant while taking isotretinoin despite participation in the iPLEDGE program. Noncompliance with the requirement to be abstinent or use 2 contraceptive methods may be a contributing factor.

Objective: We sought to determine the degree of adherence to contraception or abstinence among women taking isotretinoin.

Methods: We conducted an anonymous survey of women of childbearing potential taking isotretinoin for at least 2 months.

Results: Among 75 participants, 21 (28%) chose abstinence as their primary means of pregnancy prevention, of whom 4 (19%) were sexually active during treatment. The most commonly chosen contraceptive methods among the 39 women who were sexually active were condoms (35, 90%) and oral contraceptive pills (18, 46%). Twelve women (31%) admitted to having intercourse at least once using 1 or fewer forms of contraception; 10 failed to use condoms, and 1 reported completely unprotected intercourse. Among sexually active oral contraceptive pill users, 7 (39%) reported missing 1 or more pills in the previous month.

Limitations: Data were self-reported, thus participants may have inaccurately reported contraception use.

Conclusions: Encouraging the use of highly effective, patient-independent contraception and limiting abstinence to women who have never been sexually active may further reduce the rate of isotretinoin-exposed pregnancies.

Keywords: acne; condoms; contraception; iPLEDGE; intrauterine device; isotretinoin; oral contraceptive pills.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Drug-Induced / prevention & control
  • Acne Vulgaris / drug therapy
  • Adult
  • Condoms
  • Contraception Behavior*
  • Contraception*
  • Contraceptives, Oral / therapeutic use
  • Female
  • Humans
  • Isotretinoin / adverse effects*
  • Isotretinoin / therapeutic use
  • Medication Adherence*
  • Pregnancy*
  • Sexual Abstinence
  • United States
  • Young Adult


  • Contraceptives, Oral
  • Isotretinoin