netFormulary

Lancashire and South Cumbria
Formulary

13 Skin

Dermatology prescribing may require use of expensive unlicensed
creams and ointments (known as ‘Specials’). Please consult the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) for advice on appropriate product choice.

Several medicines in the skin chapter are available for purchase over the counter and may be appropriate for self care. Please consult the local OTC policy for more details.

LSCMMG: Over The Counter (OTC) Items That Should Not Be Routinely Prescribed In Primary Care Policy

13-06-02 Oral retinoid for acne

Isotretinoin

Formulary

Capsules 5mg, 10mg, 20mg

Consultant dermatologist or specialist only.

Healthcare professionals are reminded that the use of oral retinoids is contra-indicated in pregnancy due to a high risk of serious congenital malformations, and any use in females must be within the conditions of the Pregnancy Prevention Programme.

MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

Each prescription for oral isotretinoin for women should be limited to a supply of up to 28 days' treatment. Pregnancy must be excluded before initiation and before each repeat prescription.

As a RED drug, isotretinoin should be supplied by secondary care. Local exceptions to this are for patients under the care of the consultant-led integrated community dermatology service, OMNES.

 Community pharmacies can dispense FP10s for isotretinoin from OMNES where it is clear that the prescription has been issued within the context of a Pregnancy Prevention Programme. Do not dispense 7 days beyond issue date of FP10. Please refer the pharmacy checklist and  Isotretinoin (Roaccutane▼): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age

Contra-indicated in patients with hypersensitivity to peanuts or soya (capsule filling contains soya-bean oil).

Neuropsychiatric reactions have been reported in patients taking oral retinoids. The MHRA advises patients and carers to seek medical attention if changes in mood or behaviour occur.

Patients should avoid excessive exposure to UV light (including sunlight, solariums)—sunscreen with a high protection factor should be applied.