Isotretinoin and pregnancy prevention in the UK: tests, contraception and what to do if plans change
If you could become pregnant, UK safety rules require pregnancy prevention before, during and for one month after oral isotretinoin treatment. This usually means joining the Pregnancy Prevention Programme (PPP), agreeing a suitable contraception plan or confirming that there is no pregnancy risk, and having pregnancy tests at the times set by your dermatology team.
The rules are strict because isotretinoin can seriously harm an unborn baby and increases the risk of miscarriage. They make treatment safer; they are not a judgement about anyone’s relationships or choices.
Who needs to follow the Pregnancy Prevention Programme?
The PPP applies to people of child-bearing potential—those who have a uterus and at least one ovary and could become pregnant. This includes some transgender men and non-binary people.
A healthcare professional may decide that contraception and testing are not needed when pregnancy is not possible, for example after confirmed menopause or certain surgery. Long-term abstinence or only having sex with someone who cannot cause pregnancy may also mean contraception is unnecessary. This must be documented and reviewed if circumstances change.
Never stop contraception or assume that you are outside the programme without speaking to the prescriber.
What happens before isotretinoin can start?
The clinician first decides whether isotretinoin is clinically appropriate. In the UK it is reserved for severe acne, acne at risk of permanent scarring, or acne that has not responded adequately to suitable standard treatment. An assessment does not guarantee a prescription.
If the PPP applies, the pre-treatment steps normally include:
explaining the pregnancy risk and providing written safety information;
agreeing contraception or documenting why pregnancy is not possible;
using the agreed contraception, or maintaining abstinence, for four weeks before starting;
confirming a negative pregnancy test at the correct time; and
completing the Acknowledgement of Risk Form and receiving a Patient Reminder Card.
The first isotretinoin assessment should be in person under current MHRA guidance. Later reviews and medically supervised pregnancy testing may sometimes be remote when the clinical team considers this appropriate and can verify that testing is performed correctly.
What contraception is considered suitable?
The British Association of Dermatologists describes two usual approaches. One is a highly effective method with a failure rate below 1%, such as an intrauterine device (IUD), intrauterine system (IUS) or contraceptive implant. It should normally have been in place for at least four weeks before treatment.
The alternative is two complementary methods, such as a hormonal pill or injection plus a barrier method. The choice depends on medical history, preference, reliability and possible interactions, and should be agreed with a suitably qualified clinician.
Vomiting, diarrhoea, missed pills and some medicines can reduce protection. St John’s wort may interfere with hormonal contraception. Tell the prescriber or pharmacist about every medicine and supplement, and ask promptly if protection may have been affected.
How often are pregnancy tests needed?
A negative test is required before treatment when there is pregnancy potential. Tests are commonly performed monthly during treatment and after the course, but the schedule can reflect the contraception used and individual risk. Testing may be less frequent with a highly effective method if the prescriber considers that safe.
Do not rely on a home test without instructions from the clinical team. The October 2025 MHRA clarification allows remote testing with appropriate medical supervision, but the prescriber must be able to verify that the right test was done correctly and at the right time.
Where monthly testing is required, prescriptions are usually limited to 30 days and must be dispensed within seven days. Follow the dates given by your own service.
What should I do during treatment?
Continue the agreed contraception and attend each review. Report any change in sexual activity, contraception, periods or pregnancy plans. Never share capsules, and return unused capsules to a pharmacy.
Current UK measures also require monitoring of mental health, sexual function and other adverse effects. Liver and lipid blood tests are separate from pregnancy testing. Read our guide to isotretinoin blood tests and the first appointment for more detail.
What if contraception fails or I have unprotected sex?
Act immediately—do not wait for the next appointment.
Stop taking isotretinoin.
Seek emergency contraception urgently from a pharmacy, GP or sexual-health service.
Contact the dermatology team as soon as possible.
Follow their instructions about pregnancy testing and restarting or changing treatment.
Emergency contraception may be an emergency pill or an emergency IUD. The effective window is time-sensitive, so obtain professional advice promptly.
If you miss a period, have a positive test, think you may be pregnant or become pregnant during treatment or within one month of stopping, stop isotretinoin immediately and seek urgent medical advice. Tell the dermatology team. Do not take further capsules while waiting for an appointment.
What happens after the final dose?
Continue pregnancy-prevention measures for one month after the last dose and complete any final pregnancy test requested by the prescriber. Isotretinoin does not appear to reduce future fertility. BAD guidance states that, after this one-month interval, a future pregnancy does not carry an additional isotretinoin-related risk.
Do not donate blood during treatment or for one month afterwards, because donated blood could be given to someone who is pregnant. Isotretinoin should not be taken during breastfeeding; discuss acne treatment and future pregnancy plans with a healthcare professional.
Preparing for an acne assessment
Bring a list of previous acne treatments, current medicines and supplements, relevant health conditions, and any contraception you use. You do not need to decide in advance that you want isotretinoin. A good consultation should review the severity of your acne, alternatives, scarring risk, physical and mental health, pregnancy potential and your preferences.
mySkinDoc provides acne and isotretinoin information and video acne consultations. The appropriate next step can only be decided after clinical assessment, and further in-person review or another treatment may be recommended.
Frequently asked questions
Do I always need two forms of contraception?
Not necessarily. A single highly effective method may meet the PPP requirements. Otherwise, two complementary methods are usually advised. The prescriber must confirm the plan.
Can pregnancy testing be done at home?
Sometimes, if the dermatology service provides appropriate instructions and medical supervision and can verify the result. Do not substitute an unsupervised home test for a required clinic test.
What if I decide I want to become pregnant?
Tell the prescriber and do not try to conceive during treatment. After stopping, continue the agreed precautions for one month before trying for pregnancy.
Does the PPP mean isotretinoin is my only option?
No. It is a safety framework for people for whom isotretinoin is being considered. Other acne treatments may be more suitable, and treatment choice should follow an individual assessment.
