This article is for informational purposes only and does not have the aim to endorse Isotretinoin (commonly known as Roaccutane or Accutane). Its aim is to inform people that are thinking of doing the treatment and want to know what the process would mean and what would happen.
Note: This article refers to the steps you make through the NHS (National Healthcare System) which is a public service. If you are a British citizen or an EU national, you will receive all appointments free of charge. In Scotland, Northern Ireland and Wales, all prescriptions are also free of charge. However, in England, there is a fee.
The first step you need to do is to go to your GP and ask for help with your acne. Based on the severity they will prescribe creams or antibiotics. Isotretinoin is a serious drug with severe potential side effects and thus it is only prescribed if you literally tried everything else and nothing worked.
I think there is a procedure in place and you need to take oral antibiotics first for at least six months. If that does not make your acne go away, then they will consider prescribing Isotretinoin. The problem with oral antibiotics is that almost no one gets rid of acne permanently, and they weaken your entire body. Antibiotics can damage your liver and have other unpleasant side effects which is why you will need blood tests done during this treatment as well. Unfortunately, Romanian doctors seem to always prescribe antibiotics first as well. Be careful as in the UK I have noticed that GPs encourage you to take antibiotics for a very long time, even close to a year. This is not healthy for you, especially since as I said, acne usually comes back as soon as you stop taking antibiotics.
It is the GP that has to refer you to the dermatologist for a possible Isotretinoin treatment. If no creams help, if you’ve tried hormonal contraceptives and they didn’t help (if you are a woman), if you’ve taken antibiotics and acne came back etc. then they will refer you to the dermatology clinic. The wait between your GP’s letter to a dermatologist and your first appointment can last quite a while (it was around six months for me).
Once you go to the dermatologist you will find out what they recommend. If they agree on the fact that you need Isotretinoin, they will give you information about the drug and the official leaflet for you to read at home. You can take time to think about it, or go again just to ask questions, but keep in mind that the appointments are generally very spaced out, with months of waiting in between.
Once you get prescribed Isotretinoin in the UK you follow a very strict set of rules which have never been bent for me.
Steps for getting the first prescription:
- (Women only) You must start two forms of contraception at least one month before starting your treatment. For women that are already on the pill, the process is simple. However, if you have not taken the pill or any hormonal contraceptive method, you will need to discuss this at length with your doctor and decide upon it months in advance. I suspect you would need a GP appointment in order to get the pill, which could take a few weeks as well.
- (Women only) Once you have been on the two methods of contraception for at least one month prior to the treatment, they do a pregnancy test which has to be negative.
- (Women Only) You sign a form taking full responsibility that you understand the risks if you get pregnant and that you will use appropriate methods of contraception during treatment.
- They do a blood test to make sure your liver and kidneys are functioning normally, as well as to check your glycaemia and other functions of your body.
- They do a mental health test which is very lame in my opinion, with obvious questions targeting signs of depression.
- They weigh you, as the cumulative dosage you need to reach with the treatment depends on your body weight.
- The UK prescribes different daily dosages than the USA and Romania for example. Recent studies have shown that a high daily dosage is not necessary as long as the patient reaches the optimum cumulative dosage at the end of the treatment. This means that in the UK they will start with the lowest dosage possible for your body weight and then gradually increase it depending on how your body reacts to the treatment. In Romania and the USA, they use previous studies that state that the higher the initial daily dosage is, the more effective the treatment is. You can find plenty medical studies about this topic online or you can ask the doctor about it.
- They will call you a few days later to tell you the blood test results, and if they are okay, you need to go to the hospital’s pharmacy in order to pick up your prescription.
- If you are a woman, you will have seven day to do this. If you fail to collect the prescription within seven days, you need to have another appointment and do another pregnancy test.
- Once you get your last prescription, you will need an appointment three months after finishing the treatment, to check how you are doing post-treatment.
How the treatment will continue
Isotretinoin will be prescribed to you in periods of 30 days. Before receiving the prescription and therefore receiving the 30 additional pills you need to do a pregnancy test, have an appointment with your nurse/doctor and have occasional blood tests. This means that you present yourself to the Dermatology Clinic at the hospital and urinate in a cup which then the nurse on duty tests for pregnancy. If the result is negative, you then proceed to your appointment, which will almost never be with the same person as before, which I believe is really bad, as no one can see the continuous progress you are making or if you present any side effects that you did not have before. This, in my opinion, would be very important when checking the mental health of the patient. The nurse (as it is usually not a doctor) first asks you how you feel, if you had any mental changes, and how the skin looks. The appointments are based on your stories and perspectives – almost like an informal chat with the practitioner. They compare notes from previous appointments, and if everything is well, they prescribe you another 30 days with the dose they feel it is suitable. You can also choose the dose yourself. For example, if you have an important job or project you can request a lower dose for the month.
After that, you make another appointment at the reception, if possible, within the next 30 days so you can receive the new prescription in time before interrupting your treatment. The dates are quite difficult to choose as they never have too many available appointments, but sometimes you do have a chance to choose a later time of the day in case you have a full-time job. However, this means that you will either get an earlier appointment than four weeks or a later one (five to six weeks later). In my case at least, it was common that they would arrange my next appointment after more than six weeks. If you are a woman, things are complicated, as I said. They refuse to give you more than 30 pills even if it means you will lose weeks of treatment.
After arranging the appointment, you will do a blood test every three months (or whenever necessary depending on what your doctor or nurse decides). You will find the results at your next appointment if you ask. However, if the results are worrying I presume they would call you and suggest stopping the treatment.
You then go to the hospital’s pharmacy, which is the only place where you can pick up your Isotretinoin. You have seven days to collect your prescription as after this date you need to repeat your pregnancy test. Waiting times at the hospital’s pharmacy is usually 15min to one hour. I advise to try pick up the prescription after your appointment as you would save another trip to the hospital in the same week.
The nurses do not really tell you what skincare to use or not, other than reinforcing the importance of sunscreen at all times. They never give any advice in protecting your hepato-functions of your body (liver) or to take Isotretinoin with an intake of fat. Nor do the pharmacists give any advice other than avoid sun exposure and take the pill after a meal. In short terms, you are on your own about optimising the treatment for yourself.
To be continued…
Next Post will be about how I optimise the treatment of Isotretinoin (Roaccutane) to suit me the best. I will talk about dietary options and what products help in minimising the side effects.
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