Pregnancy prevention among women taking isotretinoin: failure to comply with the recommendations.

OBJECTIVE To assess whether prescribing physicians advised female patients taking isotretinoin according to pregnancy prevention recommendations, whether women understood those recommendations, and whether women complied with recommendations to prevent pregnancy.

DESIGN Cross-sectional study designed to collect patients' self-reported information. Women were interviewed by telephone with a standardized questionnaire.

SETTING Quebec.

PARTICIPANTS Participants were recruited through pharmacies, medical clinics, and newspapers in Quebec. All subjects (45 women 14 years and older) were treated with isotretinoin at the time of the interview or in the preceding 6 months.

MAIN OUTCOME MEASURES Women's self-report of their physician's behaviour regarding prevention of pregnancy, women's comprehension of the information, and their level of compliance with recommendations.

RESULTS Prescribing physicians discussed the risks of teratogenesis with 93% of the women but gave written information to only 36% of them. Seventy-eight percent of the women admitted not using 2 contraceptive methods all the time during the treatment, and 3 women reported having had sexual intercourse without any contraception. Physicians prescribed a pregnancy test before treatment for 44% of the women. Only 18% of the women waited for their next menstrual period to begin isotretinoin treatment, and this advice was given by 20% of physicians. A statistically significant relationship between counseling and recommendations given by physicians and women's use of double contraception was highlighted.

CONCLUSION Female patients reported physicians did not always advise them according to recommendations concerning pregnancy prevention. Women understood the information received but did not fully comply. The extent of pregnancy prevention measures taken by physicians was linked to women's compliance. Further study exploring underlying reasons for women's noncompliance could provide information on changing such behaviour.