PAD Refills

Emergency contraception (EC) for patients taking isotretinoin for acne

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Conclusion: When prescribing isotretinoin to people of child-bearing potential, consider providing a prescription for EC that can be filled at the same time as the initial isotretinoin prescription. This might improve timely access for patients who have limited access to EC.

The BC Provincial Academic Detailing (PAD) service’s topic Medications for Acne looks at the evidence for topical therapies, oral antibiotics, combined oral contraceptives (COC), spironolactone and isotretinoin.¹ Visit www.bcpad.ca to book a session with an academic detailing pharmacist in your area. During PAD sessions, we’ve been discussing a 2024 article published in JAMA Dermatology titled “Emergency Contraceptives for Patients Taking Isotretinoin” which emphasizes that “providing patients with knowledge and access to EC may decrease the number of pregnancies among patients taking isotretinoin”.²

Isotretinoin is a known teratogen^1,2

There is no known safe level of isotretinoin exposure during pregnancy.¹ In the U.S., most unintended pregnancies were among those who relied on combined oral contraceptives (COCs) or abstinence as their method of contraception during isotretinoin use.²

Timely access to EC is important to reduce the risk of unintended pregnancy²

Emergency contraceptives vary in their effectiveness windows. The Canadian Guide to Emergency Contraception (PDF, 123KB) from UBC Continuing Professional Development (UBC CPD) provides an overview of EC differences in terms of their efficacy and optimal timing of administration or insertion. UBC CPD also provides an accredited online course: Emergency Contraception Update

Most contraceptives are free in B.C., (including IUDs and oral EC)

Levonorgestrel (Plan B, generics) is accessible without a prescription and is free in B.C. In July 2026, BC PharmaCare published a useful one-page infographic on accessing levonorgestrel for EC as a free medication in B.C.: Myth busters! Providing emergency contraceptives in B.C. (PDF, 114KB). Ulipristal (Ella) is not covered by BC PharmaCare; it requires a prescription and costs approximately $30 plus markup and fee. IUDs require a prescription and are free in B.C. Refer to Covered contraceptives for a complete list of contraceptives that are available at no charge for B.C. residents.

Consider providing a prescription for EC at the same time as initial isotretinoin dispensing²

This may be an important strategy for improving timely access in the context of potential contraceptive failure (e.g., missed or delayed COC; missed or delayed patch, ring or injection; broken condom; IUD displacement), unprotected intercourse or sexual assault.

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¹BC PAD Service Medications for Acne (May 2025); ²Gold JAMA Dermatol 2024 (PMID:38568679)