Before starting Accutane: questions to ask

Before isotretinoin (Accutane, or Roaccutane), ask your dermatologist which side effects can last after the course, and who to call if mood or sex changes. The UK leaflet warns some effects “may continue after treatment has stopped”; patients call this post-Accutane syndrome, or PAS.

Patients use PAS more widely than sex alone: the leaflet also warns that stopping may not be enough to end mood effects. The UK regulator tells prescribers to give you time to “consider, reflect and ask questions” first.

Elliot was 17 when a hospital skin clinic offered him Roaccutane. He had heard the horror stories. He says he just wanted to get better. Watch this minute for the question he wishes he had asked.

Play video: Elliot on the questions he didn't ask

“You’re not asking yourself real questions at that point,” he says. The obvious one: how could a drug even do that? Thirteen years after his last capsule, he told Moral Medicine, he still had symptoms. His story is on our site.

Which Accutane side effects can last after stopping?

Some can, and the leaflet says so plainly. Side effects are “generally reversible after changing the dose or stopping treatment, however some may continue after treatment has stopped”.

On sex it is specific. It lists erection problems, lower libido, vaginal dryness, orgasm difficulties and “reduced sensation in the genitals”. Then it adds: “There have been reports of long-lasting sexual problems where the symptoms have continued despite stopping treatment with isotretinoin”.

On mood, it says: “Your doctor may tell you to stop taking Roaccutane. That may not be enough to stop the effects: you may need more help, and your doctor can arrange this.”

The NHS page on isotretinoin lists problems with sex but doesn’t say they can continue. So ask: “Which side effects can continue after the course, and what happens if one does?” Our page on Accutane’s long-term side effects lists the ones the labels name.

How often do they last? Nobody has worked it out. The UK regulator’s 2026 review says: “We do not know how often this happens, or how long those side effects can last”. More in Accutane’s sexual side effects.

What should I ask about sex and mood?

Ask what the clinic will write down about how things are now. Since 2023 the regulator has asked prescribers to “ask patients about any sexual function concerns before prescribing”, and to check mood and sexual function at each follow-up.

That first note matters later. If a problem lasts after the course, doctors will ask how things were before. In 2022, doctors and researchers proposed criteria for lasting sexual problems after isotretinoin. One is “no evidence of pre-drug sexual dysfunction that matches the current profile”. The clinic’s note of your “before” can show that.

Then ask who to call if something changes. On mood the leaflet warns: “You may not notice some changes in your mood and behaviour”. The leaflet asks you to tell friends and family you’re taking it.

The leaflet lists depression and suicidal thoughts among the possible mental problems. If you’re struggling now, the Samaritans are on 116 123, free, at any hour.

Not sure how to start? Try: “Before I decide, can we go through the side effects that can last?”

1

Which side effects can continue after the course?

The leaflet: “some may continue after treatment has stopped”.

2

Will you note how sex and mood are for me now?

The clinic should ask before prescribing.

3

Who do I contact if my mood changes?

Get a name and a number for the dermatology team.

4

What if a side effect hasn't gone after the course?

Ask who you go back to: the clinic or your GP.

5

Can I have a second opinion?

The 2026 form says you've been offered one.

What does the Accutane risk form say?

You’ll sign one in the UK, so read it first. The Acknowledgement of Risk Form is public. You confirm line by line what you’ve been told. Three lines are worth a question.

“Some side effects have been reported to continue after treatment.” Ask which.

Mental health and sexual side effects are of “unknown frequency”. Ask what that means for you.

“I have been offered a second opinion with another Lead Prescriber.” The Lead Prescriber is the one “who initiates isotretinoin treatment”, the regulator said in October 2023. In January 2026 it added, of a second opinion: “your doctor will offer this to you during your first consultation”. If nobody offered, you can ask.

The form also recommends a patient video from the British Association of Dermatologists. In the clip below, Professor Sir Munir Pirmohamed explains that the video adds to the talk with your prescriber and doesn’t replace it.

Play video: Isotretinoin Impact Review information session, 22 January 2026

What can I do?

Isotretinoin helps many people with severe acne, which can scar. Whether to take it, and what to do about a side effect, is a decision for you and your prescriber.

The regulator’s own advice to patients is to “take time to think about the information provided by your doctor”. In 2023, a UK expert report on isotretinoin noted that, in many of the testimonies it received, patients and families “were not made aware of the warnings prior to treatment”. Bring the questions above and keep your signed form.

Write your dates down from the first day: “Isotretinoin 30 mg a day from 3 November 2026”. If anything changes, add it: “Low mood since mid-December”.

If something hasn’t gone back to normal after your course, tell your GP and bring the leaflet line: “some may continue after treatment has stopped”.

Report it: it helps everyone

A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.

• No proof needed. A suspicion is enough, even years after stopping.
• Where: the Yellow Card scheme in the UK, MedWatch in the US.
• Use the right words. PAS has no medical term yet, so name each symptom and say it continued after stopping.

Our reporting guide walks you through it

What else do people ask?

What if I’m under 18? The same leaflet and form apply, and a parent or guardian is usually asked to sign too. Our pages on the 2026 under-18 rules and for parents of teenagers cover the rest.

Does the US label say the same? Since June 2026, the US regulator has asked every maker to list sexual problems that may continue after stopping. Our page on the FDA label change has the wording.

I’ve already started. Can I still ask these questions? Yes, at any follow-up. The regulator asks people already taking isotretinoin to seek advice about any side effects or concerns.

Elliot’s question was how a drug could do that. Yours can be simpler: which side effects can last, and who do I tell?

Sources

1. Roaccutane 10 mg and 20 mg soft capsules, patient leaflet, Electronic Medicines Compendium (EMC 100633), last revised April 2026. Section 2, “Warnings and precautions”: talk to your doctor before taking it about any past mental health problems. Also in section 2: “You may not notice some changes in your mood and behaviour”, so tell friends and family. The sexual problems paragraph is in section 2 too; we quote it in full. Section 4: side effects “generally reversible… however some may continue after treatment has stopped”; under “Mental problems”, depression (frequency not known) and suicidal thoughts, and “That may not be enough to stop the effects”. Read on 21 October 2026.
2. Isotretinoin Acknowledgement of Risk Form, version 3.0, MHRA approval date February 2026. The lines on side effects that “have been reported to continue after treatment”, “unknown frequency”, the second opinion and the patient video. The patient is given a copy of the completed form, an information sheet with the dermatology team’s contact details and a Patient Reminder Card. A parent or guardian “should also be asked to sign” if the patient is under 18, unless the prescriber thinks this is not in the patient’s best interests.
3. MHRA, Isotretinoin: introduction of new safety measures, Drug Safety Update, 31 October 2023. Advice to healthcare professionals: “the Lead Prescriber, who initiates isotretinoin treatment, must have expertise in the use of systemic retinoids for the treatment of severe acne”. Also: “ask patients about any sexual function concerns before prescribing isotretinoin”; “give the patient sufficient time to consider, reflect and ask questions before starting isotretinoin treatment”. Advice to patients: “take time to think about the information provided by your doctor about the benefits and risks of isotretinoin and decide whether it is the right treatment for you”.
4. MHRA, Isotretinoin: changes to prescribing guidance and additional risk minimisation measures, Drug Safety Update, 22 January 2026. Advice to patients: “all patients have the option to continue to seek a second opinion from another healthcare professional if they are unsure about starting treatment, your doctor will offer this to you during your first consultation”. Mood and sexual function are checked before prescribing and at each follow-up. People already on treatment should follow their agreed plan and seek advice about side effects or concerns.
5. MHRA, Review of the impact of recommendations for the prescribing of isotretinoin, Public Assessment Report, 22 January 2026. Plain language summary: “Some side effects may continue even after stopping isotretinoin. We do not know how often this happens, or how long those side effects can last.”
6. Commission on Human Medicines, Report of the Isotretinoin Expert Working Group, 26 April 2023, published by the MHRA. Section 8.2, page 98: “it was noted from many of the testimonies, that patients and their families were not made aware of the warnings prior to treatment with isotretinoin”. Page 101: patients should have “adequate time between initial counselling and subsequent prescription to reflect on the information about isotretinoin and ask questions”.
7. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Section 6, post-retinoid sexual dysfunction: problems present for 3 months or more after stopping, and “no evidence of pre-drug sexual dysfunction that matches the current profile”; the name PAS is often used more widely.
8. NHS, Isotretinoin (Roaccutane), page last reviewed 26 June 2026. Lists “problems with sex”; when we checked on 21 October 2026 it did not say they can continue after stopping.
9. Moral Medicine, He Took Accutane at 17. His Life Never Returned to Normal., interview with Elliot, 28 January 2025 (the title is the channel’s). Our page plays an extract, 17:45 to 18:45, checked against the captions. His story on our site: Elliot’s story: Accutane at 17.
10. MHRA, Isotretinoin Impact Review information session, held 22 January 2026. Our page plays an extract, 11:36 to 12:35, checked against the MHRA’s own captions. Professor Sir Munir Pirmohamed chairs the Commission on Human Medicines, which advises the MHRA.
11. British Association of Dermatologists, isotretinoin patient video. We could not open the page on 21 October 2026; we describe the video only as the risk form and the MHRA do.