UK Clinical Pharmacy Association

Isotretinoin

Issues for surgery

Risk of perioperative flare of acne if omitted. 

Advice in the perioperative period

Elective and emergency surgery 

Continue.  

Consider checking liver function tests (LFTs) if not checked in previous 3 months – discuss clinically significant increases in transaminases with patient’s dermatologist.

Patients with diabetes

Retinoids can alter glucose tolerance; monitor blood glucose closely, especially at the beginning of the retinoid treatment period. Elevated fasting blood sugars have been reported, and new cases of diabetes have been diagnosed during isotretinoin therapy. 

Patients taking oestrogen-containing contraceptive

If pre-operative cessation of oestrogen-containing contraceptive is being considered see Further Information.

Post-operative advice

Restart when enteral intake resumed.

Interactions with common anaesthetic agents

None. 

Interactions with other common medicines used in the perioperative period

Tetracyclines

Acitretin can cause an increase in intracranial pressure which may be additive with the increase in intracranial pressure seen with tetracyclines; cases of benign intracranial hypertension (pseudotumor cerebri) have been reported with concurrent use. Tetracyclines (e.g. doxycycline, tigecycline) must be avoided.

Hepatotoxicity

Concomitant use of acitretin with the following medications may increase the risk of hepatotoxicity:

  • Doxycycline – AVOID (also see Tetracyclines)
  • Low molecular weight heparin (LMWH), if high dose
  • Paracetamol
  • Tigecycline – AVOID (also see Tetracyclines)
  • Unfractionated heparin (UFH)

Whilst single doses of LWMH and paracetamol should not pose a problem, continued post-operative treatment may require close monitoring of LFTs. 

Further information

Pregnancy Prevention Programme

Retinoids are highly teratogenic; therefore, it is essential that females of childbearing potential use effective contraception for a least 1 month before starting treatment, during treatment, and for 1 month after stopping isotretinoin. Females must use at least one highly effective method of contraception (i.e. a user-independent form), or two complementary user-dependent forms of contraception. Do not discontinue oestrogen-containing contraceptive pre-operatively without discussing with patient’s dermatologist.

References

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19th June 2024]

Summary of Product Characteristics – Isotretinoin 10mg Soft Capsules. Ennogen Healthcare Ltd. Accessed via www.medicines.org.uk 19/06/2024 [date of revision of the text October 2023]

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19th June 2024]