Retinoid Medicines – Safe Prescribing and Supply Guideline – NHS Borders

Before issuing a prescription for isotretinoin/retinoid medication the prescriber must:

1. Complete the risk acknowledgement form and ensure it is signed by the patient.
   
   
2. Confirm understanding of risks, monitoring, contraception requirements and treatment indication.
   
   
3. Determine the appropriate pregnancy prevention group and prescribe an appropriate length of isotretinoin (as per Table 1).
   
   
4. For all individuals of childbearing potential, a copy of the risk acknowledgement form should be attached to the prescription.
   
   
5. On the prescription indicate the length of treatment and the pregnancy prevention group of the patient (as per Table 1).
   
   
6. The nurse undertaking the pregnancy test must indicate the result and date of the test on the prescription.

Table 1: Pregnancy prevention groups: required for all patients with childbearing potential (defined as anyone with a uterus and at least one ovary unless post-menopausal or surgically sterilised).

Sample Prescription

1. At each clinical review assess the patient for adverse effects using PROMs such as HADS, PHQ-9 and GAD-7.
   
   
2. Patients should be asked about side effects, or requested to complete the side effect questionnaire Isotretinoin-side-effects-patient-questionnaire-OCT-2025.pdf. 
   
   
3. Patients should be requested to watch the BAD patient video on the benefits, risks and requirements of isotretinoin treatment Isotretinoin Acne Treatment Information Video on Vimeo.

At the professional check stage of the pharmacy process the pharmacist must:

1. Check the PPP group is recorded on the prescription for individuals of childbearing potential.
   
   
2. Check the result of a valid pregnancy test on the prescription if appropriate (for individuals of childbearing potential as per the PPP group – see Table 1).
   
   
3. For group C: prescription is valid for 7 days after pregnancy test.
   
   
4. For the first dispensing: check that the acknowledgment of risk form has been completed (a copy of Page 2 - Pregnancy Prevention Programme should be attached to the prescription for individuals of childbearing potential for the first dispensing). If this is not attached to the prescription request it from the clinical team.
   
   
5. If it is the first dispensing of isotretinoin, access the patients TRAK record and insert a pharmacy note indicating that an acknowledgement of risk form has been completed and reviewed by a pharmacist. For subsequent dispensing, check the patient’s TRAK record for this pharmacy note – this is sufficient to allow dispensing.
   
   
6. Check the quantity to dispense does not exceed the recommendations in Table 1 above (as per PPP group).

The patient should be counselled on:

1. Never share isotretinoin.
   
   
2. Return unused capsules to the pharmacy for destruction.
   
   
3. For individuals of childbearing potential to avoid pregnancy for at least 1 month after stopping.
   
   
4. Report mood or sexual function changes immediately

Check that the patient has been provided with the British Association of Dermatologists’ Isotretinoin PIL (patient information leaflet) or the Patient Reminder Card (Patient_Reminder_Card.pdf)

MHRA Pharmacist Checklist

MHRA Acknowledgement of Risk Form