Isotretinoin

Retinoid which is a synthetic derivative of vitamin A. It is a cis-configuration of Tretinoin, an acid form of vitamin A.
Indicated in the treatment of severe forms of acne.

At latest update no published data on excretion into breast milk were found.

Despite of a high plasma protein-binding capacity, it is a highly lipophilic substance, hence, it is presumed to accumulate in breastmilk. The natural form of vitamin A is readily excreted into breastmilk.

In addition to being a potent teratogen (Shirazi 2015), which affects pregnancy, it has been shown to decrease all pituitary hormones levels (Karadag 2011 and 2015) along with other potential serious side effects associated to the use of Isotretinoin. It may cause galactorrhea (Larsen 1985).

A safer alternative should be preferred until more published data on this drug related to breastfeeding is available, especially during the neonatal period and in case of prematurity.

Alternatives

• Adapalene (Very Low Risk)
• Azelaic Acid (Very Low Risk)
• Benzoyl Peroxide (Very Low Risk)
• Ethinylestradiol + Norethindrone (Low Risk probable)
• Tretinoin (topical use) (Very Low Risk)