| | Reported adverse effects | Suggestions for monitoring |
| Eyes | - Dry eyes
- Night blindness
- Retinal dysfunction
- Exacerbation of eye symptoms due to underlying ichthyosis
| - Formal ophthalmologic evaluation 4 to 6 months after initiation of systemic retinoid therapy. Continue follow-up every 6 to 12 months.
|
| Bones | - Potential decrease in bone density and growth
- Premature epiphyseal closure
- Calcific tendonitis
- Ligamentous calcification
- Osteophyte formation (bone spurs)
- DISH
| - Annual growth assessment (height, weight, BMI, and growth curve).
- Bone-specific imaging of musculoskeletal symptoms.
- Baseline skeletal survey; consider DEXA scan.
- For patients >18 years old, repeat skeletal survey every 3 to 5 years or sooner if symptomatic.
|
| Laboratory parameters | - Hepatotoxicity
- Hyperlipidemia
| - Baseline serum lipid panel and liver function testing.
- Repeat at least once on final retinoid dose.
- Follow-up testing every 6 months (sooner if abnormal).
- Follow American Academy of Pediatrics and American Heart Association guidelines as applicable for hyperlipidemia management and cardiovascular risk reduction, respectively.
|
| Pregnancy | - Extremely high risk for development of severe birth defects to any fetus
| - All patients and prescribers of isotretinoin in the United States must comply with current iPLEDGE guidelines.
|
