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Chemical Name: Isotretinoin
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Accutane
Information
FEMALE PATIENTS WILL BE RESTRICTED TO A ONE MONTH SUPPLY OF ACCUTANE PER MONTH ONLY. NO EXCEPTIONS WILL BE CONSIDERED.
To obtain Accutane (Isotretinoin), you must do the following:
1. Have a consultation with a dermatologist or other doctor who is licensed to prescribe this medication.
2. Receive a prescription for the medicine from your doctor.
3. Upon receiving your order, we will require you to complete the following questionnaire, sign it, and fax or email it back to us. (NO ORDER WILL BE PROCESSED WITHOUT COMPLETION OF THIS QUESTIOINNAIRE):
Is this medicine for you?
1. I have been informed by my medical provider of the risks involved with Accutane.
2. I am presently registered with the iPLEDGE Program.
3. I understand that if I get pregnant while on Accutane sever birth defects can occur.
4. I am presently pregnant.
5. I plan on becoming pregnant within one month after completing Accutane.
6. I am using at least two forms of contraception to prevent pregnancy.
7. I understand that must use at least tow forms of birth control one month prior to starting Accutane, during the full time I am on Accutane and for one month after stopping Accutane.
8. The form of contraception being used is.
9. My doctor has administered a pregnancy test on me in the last 30 days with a NEGATIVE result.
10. I agree to refrain from donating blood for at least one month after I have finished Accutane therapy.
11. I am currently emotionally or mentally depressed.
12. I have a history of depression.
13. I have a history of mental/psychological conditions.
14. I currently have thoughts of suicide or harming myself.
15. I have had thoughts of suicide or harming myself in the past.
16. I will share my Accutane (Isotretinoin) with someone else.
Accutane
Side Effects
Please note If you are pregnant or become pregnant while on Isotane there is a high risk that your baby will be severely deformed. Adequate birth control must be used one month prior to starting Isotane treatment, during and up to at least one month after treatment completion.
Do not take Accutane if you think you are allergic to Vitamin A, other retinoids or any of the ingredients listed here: soybean oil, yellow beeswax, hydrogenated vegetable oil, gelatin, glycerol, red iron oxid paste (E172), yellow iron oxide paste (E172) (in 20mg capsules only), titanium dioxide (E171), and black printing ink. Accutane does not contain sucrose or gluten.
The generic alternative is not manufactured by the company that makes the brand product.
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