Before starting isotretinoin, Peak Skin Center reviews acne history (including scarring risk), prior treatments, medical history, medications, and any risk factors that influence monitoring. Because dryness and irritation are expected, the clinical team also reviews skin-care strategies and supportive measures used throughout treatment.

Most courses last several months, and dosing is adjusted over time based on response and tolerability.

Baseline bloodwork

Many isotretinoin regimens include baseline laboratory testing to check for side effects that can affect metabolism and organ function. Common baseline tests include:

• Liver function tests (such as AST/ALT)
• Fasting lipid panel (including triglycerides and cholesterol)

Professional guidance continues to recommend liver function testing and lipid monitoring during therapy, with frequency individualized based on baseline values and clinical context.

Pregnancy testing requirements

For patients who can get pregnant, iPLEDGE requires documented negative pregnancy testing before isotretinoin can be dispensed and ongoing pregnancy testing during treatment, including testing at the end of therapy and again after the last dose.

Peak Skin Center follows iPLEDGE requirements and provides specific instructions on acceptable testing logistics and documentation.

The iPLEDGE REMS is a required national distribution program for isotretinoin. Prescribers and pharmacies must be enrolled, and patients must be enrolled and meet requirements before each dispense.

For patients who can get pregnant, iPLEDGE materials describe:

• A required pre-treatment period (often structured as a 30-day window) with contraception planning
• Two negative pregnancy tests before the first prescription, separated by a minimum interval (commonly at least 19 days) (ipledgeprogram.com)

After a documented negative monthly pregnancy test, dispensing is time-limited; many iPLEDGE workflows use a 7-day window for patients who can get pregnant. (NCBI)

Isotretinoin care is structured around monthly check-ins. At Peak Skin Center, monthly visits with the dermatology providers commonly include:

• Symptom review (dry lips/skin, nosebleeds, headaches, muscle aches, mood symptoms, vision changes)
• Acne progress assessment and dose adjustment
• Review of skin-care and supportive strategies
• Review of lab results (lipids/liver testing when indicated)
• iPLEDGE documentation steps required for that month’s prescription
• For patients who can get pregnant, confirmation of the required pregnancy test result and ongoing pregnancy-prevention requirements including contraception

These visits help prevent delays that can occur when iPLEDGE deadlines or pharmacy dispensing windows are missed.

iPLEDGE uses pregnancy-risk categories rather than gender, but in practical terms the monitoring differs most between (1) patients who can become pregnant and (2) patients who cannot become pregnant (which commonly includes most males).

Patients who can get pregnant

Monitoring is more intensive because fetal exposure is the central risk addressed by iPLEDGE:

• Two negative pregnancy tests before starting (per iPLEDGE patient materials)
• Monthly pregnancy testing during treatment, plus testing after the last dose and again one month later
• Ongoing documentation of pregnancy-prevention requirements as defined by iPLEDGE

Patients who cannot get pregnant (commonly males)

Patients who cannot get pregnant still enroll and attend monthly visits, but pregnancy testing and contraception requirements do not apply in the same way. iPLEDGE still requires monthly authorization steps before dispensing.