The MHRA has reminded prescribers of the possible risk of psychiatric disorders in patients treated with oral isotretinoin, following a review of the available evidence and individual case reports.
Conflicting study results and limitations in the data made it impossible to identify an increase in risk. Despite the inconclusive review, current warnings were considered to still be appropriate.
In the December 2014 edition of the MHRA's Drug Safety Update, the following recommendations are highlighted:
- Isotretinoin should only be prescribed by or under the supervision of a consultant dermatologist with expertise in the use of systemic retinoids for the treatment of severe acne.
- Prescribers should warn patients and their family to be aware of the potential for psychiatric disorders such as depression, anxiety, and in rare cases suicidal thoughts, and to be vigilant for symptoms.
- In patients with a history of depression, the benefits of treatment should be carefully weighed against the possible risk of psychiatric disorders.
- Patients should be monitored for signs of depression and referred for appropriate treatment if necessary. Stopping isotretinoin may not be enough to alleviate symptoms and further psychiatric or psychological evaluation may be necessary.