A woman has been treated with isotretinoin (Roaccutan) for about half a year (5 tablets/day) for ac

Fråga: A woman has been treated with isotretinoin (Roaccutan) for about half a year (5 tablets/day) for acne. The woman has refused to use contraceptive pills. She is now in pregnancy week four (verified by ultrasound) and has been taken isotretinoin (5 tablets/day) during that period. Indication for abortion?

Sammanfattning: Isotretinoin is a potent human teratogen. Treatment should be stopped 1-2 months before conception. If the women has been treated, as in this case, during the first month of pregnancy the indication for abortion is clear because of the large teratogenic potential of the drug.

Svar: We have had similar questions concerning isotretinoin and its teratogenicity earlier at the Drug Information Centre (1,2,3), which are being sent to the questioner. In summary, treatment with isotretinoin in women during early pregnancy increases the risk of malformation (1,2,3,4) to 25 per cent (5). The medical product agency in Sweden recommends that isotretinoin treatment be stopped two months prior conception. In the US the Food and Drug Administration recommends that isotretinoin therapy should be stopped at least one month prior to conception. In this case with a woman who has been treated during the first four weeks of pregnancy there is a clear indication for abortion, which is confirmed by professor Källen (5). 1 Drugline nr 10172 2 Drugline nr 09454 3 Drugline nr 07242 4 Briggs, Drugs in pregnancy and lactation. 1990; 3rd ed: 5 Professor Bengt Källen, personal communication, Embryologiska Institutionen, Universitetet, Lund