Desogestrel and Isotretinoin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Isotretinoin
Desogestrel
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Isotretinoin (Accutane) and your birth control: Isotretinoin is a very powerful acne medicine, but it can cause serious birth defects if a pregnancy happens while you are taking it. Desogestrel is a progestin used for birth control. The concern here is that isotretinoin may make your hormonal birth control a little less reliable, and this is even more of a worry with progestin-only "mini-pills" like desogestrel.
The good news is this is very manageable. During isotretinoin treatment, women who can become pregnant are asked to use two forms of birth control at the same time. Please talk with your prescriber and pharmacist so they can set up a plan that keeps you protected.
Effect: Potential decreased effectiveness of hormonal contraception (including desogestrel) during isotretinoin therapy.
- Mechanism: Unknown. Reported PK/PD changes to estrogens/progestins are small but highly variable and unpredictable. Neither agent is a relevant prodrug for this interaction.
- Direction: Reduced contraceptive reliability; risk is highest with micro-dosed progestin-only pills used as sole contraception.
- Evidence/onset: Theoretical, supported by pregnancy case reports; onset unspecified.
- Management: Per iPLEDGE-type requirements, use 2 concurrent contraceptive methods (one a primary method) unless abstinent or post-hysterectomy. Do not rely on a progestin-only minipill alone. Counsel on pregnancy risk given teratogenicity.
What happens
Decreased effectiveness of hormonal contraceptives
Interaction Deep Dive
The pharmacokinetic and pharmacodynamic effects on estrogens and progestins seen with concurrent isotretinoin use are minor, yet they vary widely and cannot be predicted reliably. Pregnancies have been documented among women relying on combined oral contraceptives, and likewise among those using topical, injectable, implantable, or insertable hormonal contraceptive products. These occurrences have been reported more often among individuals depending on a single contraceptive method. When micro-dosed progestin-only pills are taken alongside isotretinoin, the likelihood of contraceptive failure rises. Throughout isotretinoin treatment, women of childbearing potential are required to employ 2 contraceptive methods at the same time, with one of them being: tubal ligation, a partner's vasectomy, intrauterine devices, birth control pills, or topical/injectable/implantable/insertable hormonal birth control products123.
Why it happens (mechanism)
Unknown
How to manage this interaction
How to manage this safely:
- Keep taking your medications as prescribed unless your care team tells you otherwise.
- During isotretinoin therapy, use two forms of birth control at the same time (unless you have agreed to complete abstinence or have had a hysterectomy).
- A progestin-only minipill like desogestrel used by itself may not be enough. One method should be a primary option such as an IUD, tubal ligation, a partner's vasectomy, combined birth control pills, or an implantable/injectable/insertable hormonal product, plus a backup like condoms.
- Ask your prescriber or pharmacist to confirm your contraception plan and to review behaviors that raise pregnancy risk.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In one study, isotretinoin showed no interaction with oral contraceptives. Nine women receiving isotretinoin 0.5 mg/kg for severe pustular acne had been taking oral contraceptives (brand unknown) for at least three months before beginning isotretinoin therapy. As measured by radioimmunoassay, plasma levels of ethinyl estradiol and levonorgestrel were comparable in the control cycle and in two cycles following the start of isotretinoin 4.
b) When isotretinoin was administered with a combination ethinyl estradiol/norethindrone product, the pharmacokinetic and pharmacodynamic changes were inconsistent and relatively small. In a single-center, open-label drug interaction study, 26 healthy women completed a protocol in which they took ethinyl estradiol/norethindrone oral contraceptive (OC) triphasic tablets (35 micrograms and 0.5/0.75/1 milligrams, respectively) each day. Beginning at the start of the third month, and after pregnancy had been excluded, participants additionally received isotretinoin 1 milligrams/kilogram/day in two divided doses to complete 16 to 20 weeks of isotretinoin treatment for severe, recalcitrant nodular acne. Plasma concentrations of ethinyl estradiol and norethindrone were slightly lower (9% and 11%, respectively) during the OC plus isotretinoin phase than during the OC alone phase; however, patient variability was high. Follicle stimulating hormone concentration fell 44% (p=0.03) with the addition of isotretinoin to the regimen, again with a high degree of variability; serum progesterone and luteinizing hormone levels remained unchanged. No pregnancies were reported 5.
Common questions
Can I take Desogestrel and Isotretinoin together?
Isotretinoin can make hormonal birth control, especially a progestin-only pill like desogestrel used alone, less reliable, and pregnancy during isotretinoin risks serious birth defects; use two forms of contraception at once and confirm your plan with your prescriber and pharmacist. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Desogestrel and Isotretinoin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Desogestrel and Isotretinoin interaction managed?
How to manage this safely: Keep taking your medications as prescribed unless your care team tells you otherwise. During isotretinoin therapy, use two forms of birth control at the same time (unless you have agreed to complete abstinence or have had a hysterectomy). A progestin-only minipill like desogestrel used by itself may not be enough. One method should be a primary option such as an IUD, tub… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Desogestrel or Isotretinoin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: Amnesteem(R) oral capsules, isotretinoin oral capsules. Mylan Pharmaceuticals Inc, Morgantown, WV, 2010. DailyMed
- Product Information: Claravis(TM) oral capsules, isotretinoin oral capsules. Barr Laboratories, Inc, Pomona, NY, 2010. DailyMed
- Product Information: Sotret(R) oral capsules, isotretinoin oral capsules. Ranbaxy Laboratories Inc. Jacksonville, FL, 2010. DailyMed
- Orme M, Back DJ, & Shaw MA: Isotretinoin and contraception. Lancet 1984; 2:752-753. PubMed
- Hendrix CW, Jackson KA, Whitmore E, et al: The effect of isotretinoin on the pharmacokinetics and pharmacodynamics of ethinyl estradiol and norethindrone. Clin Pharmacol Ther 2004; 75:464-75. PubMed
Keep reading about Isotretinoin
Keep reading about Desogestrel
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