Ought to dermatologists prescribe emergency contraception at isotretinoin visits and is there a necessity for extra schooling about emergency contraception for dermatologists prescribing isotretinoin? The reply is sure to each. Entry to emergency contraception is crucial for sufferers taking isotretinoin, a identified teratogen, in accordance with the authors of a Viewpoint article in JAMA Dermatology.
For the reason that implementation of iPLEDGE REMs program in 2006, the variety of pregnancies occurring amongst girls taking isotretinoin has decreased, nevertheless, there’s nonetheless a median of 200 to 300 pregnancies yearly amongst sufferers taking isotretinoin, in accordance with iPLEDGE information. Abstinence (47%) and mixed oral contraceptives (31%) have been the most typical contraceptive strategies reported by girls on isotretinoin. Failure of those strategies resulted in 84% of the pregnancies reported. “When contraceptive strategies fail, emergency contraception is the final probability to keep away from being pregnant,” the authors stated.
Roughly one-third of pregnant girls on isotretinoin had a therapeutic abortion. As a result of entry to abortion has turn out to be restricted in lots of states, “educating sufferers who’re taking teratogens, corresponding to isotretinoin, about correct use of emergency contraception is vital,” the authors stated.
Undesirable pregnancies amongst girls taking isotretinoin happen due to a lack of awareness concerning the numerous choices for emergency contraception or methods to use emergency contraception accurately, in accordance with the examine authors. Solely 7% of pediatric dermatologists counsel sufferers at their first isotretinoin go to. In a survey of pediatric dermatologists, solely 37% have been assured of their understanding of emergency contraception and solely 33.5% reported confidence in counseling sufferers earlier than utilizing isotretinoin.
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Emergency contraception is often bought over-the-counter when wanted, however dermatologists ought to contemplate prescribing oral emergency contraception on the preliminary go to, particularly the place entry is proscribed.
The iPLEDGE information indicated that there’s a hole concerning details about emergency contraception and dermatologists prescribing isotretinoin. Research authors reported that dermatologists have referred to as for elevated details about emergency contraception in iPLEDGE supplies.
“iPLEDGE doesn’t present essential details about emergency contraception for clinicians or sufferers to information the mandated counseling it requires within the consent,” stated examine authors. “There is no such thing as a details about numerous emergency contraception choices or methods to receive and accurately use emergency contraception.”
Though emergency contraception is profitable when mixed oral contraceptives fail, numerous components, like weight, medical comorbidities, and different drugs can hamper their effectiveness. “Ulipristal acetate is simpler than oral levonorgestrel in all sufferers, notably these with chubby [>70kg]),” the authors reported. “Sufferers with malabsorptive diseases or those that expertise emesis inside 3 hours of capsule consumption might require repeated emergency contraception dosing. For sufferers taking cytochrome p450 inducers, emergency contraception capsules could also be much less efficient, and IUD choices are preferable.”
Though emergency contraception is often bought over-the-counter, the authors report that dermatologists ought to contemplate prescribing oral emergency contraception on the preliminary go to, particularly in areas the place entry is perhaps restricted. This can encourage sufferers to make use of emergency contraception within the occasion of unprotected intercourse or contraceptive failure (Desk).
Desk. Emergency Contraception Choices
| Type of emergency contraception | Dosage | Being pregnant threat, % |
| Levonorgestrel (Plan B) | Take 1 pill by mouth. Use inside 4 d of unprotected intercourse | 0.6-3.1 |
| Ulipristal acetate (ella) | Take 1 pill by mouth. Use inside 5 d of unprotected intercourse | 0.9-2.1 |
| Mixed oral contraceptives (Yuzpe routine) | Oral pill, dosing is dependent upon formulation. Could also be simpler to entry if already utilizing contraception capsules. Least efficient methodology | 2.0-3.5 |
| Copper intrauterine machine (Paragard) | Positioned within the uterus by a clinician; efficient for 10 y. Have to be inserted inside 5 d of unprotected intercourse | 0.1 |
| Levonorgestrel intrauterine machine, 52 mg (Mirena, Liletta) | Positioned within the uterus by a clinician; efficient for 3-8 y relying on system. Have to be inserted inside 5 d of unprotected intercourse | 0.3 |
Many insurance coverage corporations cowl the price of emergency contraception, which might value as much as $50. Nonetheless, some state plans might exclude emergency contraception from Medicaid protection or require parental consent for minors, the authors stated. Due to this fact, dermatologists ought to pay attention to legal guidelines concerning emergency contraception of their state and prescribe accordingly.
“Isotretinoin prescribers want to raised educate sufferers with being pregnant potential taking isotretinoin about how and when to make use of emergency contraception,” the authors concluded. “As a result of emergency contraception schooling needs to be strengthened month-to-month, this can’t be delegated to different specialties.”
Disclosure: Two authors disclosed affiliations with emergency contraception gadgets and iPLEDGE.
This text initially appeared on Medical Advisor