Patterns of prescribing isotretinoin: focus on women of childbearing potential

OBJECTIVE: The primary objectives of this study were to determine how dermatologists currently prescribe isotretinoin and to determine if the potential for adverse effects, especially those affecting the fetus, has influenced dermatologists' prescribing patterns. DESIGN: A survey was mailed to 1618 dermatologists practicing in the US. The survey comprised 22 multiple-choice and fill-in-the-blank questions about the use of isotretinoin. Eight weeks were allowed for completion and return of the survey. SETTING: The setting of the study included dermatologists in private practice, those with academic appointments, those in administration, and a few dermatologists in other pursuits. PARTICIPANTS: The membership roster of the American Academy of Dermatology served as the sampling frame from which survey recipients were drawn. After arranging the list by zip code, a sample of dermatologists was taken by systematically choosing every fifth name on the list, giving the researchers the total sample of 1618 physicians. MAIN OUTCOME MEASURES: Questions were organized into the following sections: (1) practice status of respondent, (2) prescriber demographics, (3) influence of adverse effects on prescribing, (4) prescribing practices, (5) discontinuation of therapy, and (6) restriction of isotretinoin to dermatologists. The survey concluded by providing participants the opportunity to make further observations or comments. RESULTS: Of the 1618 surveys mailed, 670 usable responses were received (41.4 percent). Most respondents were in private practice. Data show that dermatologists were prescribing isotretinoin for indications other than those contained in the official labeling. Most physicians reported that they do perform a pregnancy test before prescribing the drug, and many require written informed consent before prescribing. Physicians report that, in general, their patients tolerate isotretinoin well. When therapy is discontinued, it is most often secondary to hypertriglyceridemia. Dermatologists believe that they should have sole authority for prescribing isotretinoin. CONCLUSIONS: Our results show that there is still a need for emphasizing the limited indications for isotretinoin and a need for effective patient education for women of childbearing potential who may be prescribed this drug.