Isotretinoin (Accutane) Flowsheet

Congratulations on choosing to use isotretinoin. Isotretinoin is regulated and controlled by the iPledge Program. This program was designed to control the prescription writing of isotretinoin in an effort to minimize pregnancy and fetal risk. Both men and women have to participate within the iPledge program in order to receive isotretinoin. This program is not flexible, and participation in this program can be frustrating. Here is a flowsheet to help get you organized and keep you on track. Failure to follow the iPledge Program exactly as presented will result in lockout periods where you won’t be able to get your medication.

When You Decide To Start Isotretinoin

  • Read and sign all consent forms in the iPledge book; keep the white copy
  • Give a sticker with your iPledge number to your nurse
  • Get your first lab slip
  • Get a urine pregnancy lab slip for 1 month (women only)
  • Get a lab slip for your return visit (men in 1 month, women in 2 months)


  • Choose TWO forms of birth control – these MUST match the TWO birth control methods that you have told your nurse, in order. Changing these during your treatment MAY result in a lockout period where you will not get your medicine.
  • Get your first set of labs done. Make sure that the lab knows to fax them to us as soon as possible.
  • Your labs are entered by us into the iPledge system. A 30 day countdown period begins for you to get your urine pregnancy test. Make sure you get this date from our staff.
  • Start birth control (if applicable).
  • 30 days later, get your urine pregnancy test. Make sure that the lab knows to fax them to us as soon as possible.
  • Your urine pregnancy test is entered by us into iPledge. Your prescription is sent to the pharmacy.
  • You must login to iPledge and answer your comprehension questions. Your birth control methods MUST MATCH EXACTLY to what we enter on our side in iPledge.
  • You have 6 days from the date your urine pregnancy test was performed to pick up your prescription. If you do not pick up your prescription in this time, you will be locked out.


  • Get your first set of labs done. Make sure that the lab knows to fax them to us as soon as possible.
  • Your labs are entered by us into the iPledge system.
  • Your prescription is sent to the pharmacy. You have 29 days from the date of your office visit to pick up the medication. If you do not pick up the medication in this time, then you must restart the ENTIRE iPledge program and complete all the necessary requirements, including lab work, from the beginning.

Frequently Asked Questions

I’ve decided to start accutane, what should I do?

1. Get your in office consultation and the iPledge book
2. Sign the consents and turn them in to us
3. Get your lab slips
– Lab Slip 1 – Full Blood Work
– Lab Slip 2 – Urine Preg
– Lab Slip 3 – Full Blood Work
4. Stop all other oral acne medications for at least 7-14 days prior to your accutane start date
5. Follow the checklist provided in the iPledge book
6. Females must answer the comprehension questions on the iPledge website. Your contraception choices should match up IN THE SAME EXACT ORDER as what we enter for you.

What happens if I miss an appointment or test date?

You will not get accutane, and you could be locked out for 7-30 days where it will be impossible to even prescribe you accutane.

What if the lab doesn’t fax my labs to your office in time?

For women, if we do not enter your pregnancy test (urine or blood) within 6 days of you having it drawn/taken, then you will have no time to pick up your medication and will be locked out. From the time you get your blood drawn, or give urine, both you and we have 6 days to get everything entered and prescription sent to your pharmacy

Can I use labs that I just had done from my previous doctor?

Yes, but pregnancy tests must be done within the previous week and there must still be time for you to pick up the medication at the pharmacy.

If I get locked out, can you call iPledge and get them to reverse it?

No. If you are locked out, you must wait out the ENTIRE waiting period. There are no exceptions.

What medications can I use while on accutane?

You should stop your topical acne medications and oral antibiotics that have been given by your dermatologist. Do not stop any other medications given by any other physicians unless you have reviewed them with your dermatologist and have been told which specific ones you should stop and when.

What happens if I need to take a medication for a cold or other problem?

Please review the over-the-counter or prescribed medication with us first. One of our providers will either clear you to start your medication or give you an alternative.

Where can I get my blood drawn?

You can choose any lab draw station as determined by your insurance coverage close to your house, or find one online. Quest Diagnostics and LabCorp are two national companies covered by most insurances. You MUST VERIFY that your insurance will cover your lab and labwork prior to arriving at your labdraw. Please be aware of your insurance deductibles for your labs.

What are the key things I need to do every month?

You will ALWAYS need to:

1. Have an office visit every month
2. Get labs every month
3. Answer your comprehension questions and enter your birth control methods on the iPledge online system (females only). Your birth control methods must match our entries for you, exactly.

You can not get another prescription without BOTH of these done every month.

When can I get pregnant after accutane?

You should continue your contraception methods for ONE MONTH AFTER FINISHING accutane. You can stop your contraception and get pregnant one month after finishing accutane.

When is my last pregnancy test?

Your last pregnancy test will be one month after finishing accutane. You do NOT need to come in for this test.

What are acceptable pregnancy tests?

1. Blood pregnancy tests done at a lab
2. Urine pregnancy tests done at a lab
3. Urine pregnancy tests done at our office – a provider MUST see your test result; a staff observation is NOT acceptable.

What is a lock out period?

A lock out period is where the iPledge system restricts you from getting medication. You absolutely can NOT get any medication during a lock out period. We can not reverse it. Calling iPledge does NOT help and they will not remove any lockout periods.

What is the iPledge phone number?

The iPledge phone number is 1-866-495-0654. They are open from 9AM-12AM EST.

Can I drink on accutane?

Only social drinking is allowed on accutane, and up to a max of only 1-2 drinks per week. And of course, only if you are over 21 years old.