HealthRX.com · Printable medication review sheet
Isotretinoin (Accutane) review for older adults
Use this sheet before, during and after a course of isotretinoin (Accutane, Absorica) to record your medicine details, gather iPLEDGE and lab information, track mood, eye and joint changes, and write questions for your prescriber or pharmacist.
Medicine and prescriber details
Copy these from your prescription label and pharmacy record.
Medicine name and form on labelFor example Accutane or Absorica, capsule
Dose and schedule written by prescriberCopy exactly as written
Planned course lengthWrite the length the prescriber gave you
Prescriber name and phone
Pharmacy name and phone
iPLEDGE enrolment reference or contactWrite who manages your enrolment
Before the visit
Bring this sheet and the items below to each appointment.
- Confirm your iPLEDGE enrolment status with your prescriber
- Bring a full list of vitamins and supplements, including any vitamin A products
- List any tetracycline-class antibiotics you have taken or been prescribed
- Note whether your fasting lipid profile and liver function tests are done
- Bring recent lab results, including lipid and liver test dates
- Write down every other prescription, over-the-counter medicine and herbal product
- Check with your pharmacist that all your medicines are on one list
- Note any past mood, eye or joint problems and when they started
- Confirm with your prescriber who to call if your mood changes
- Bring a caregiver or family member if you would like a second person present
Symptom and check-in diary
Record changes at home between visits. Share the diary at each appointment.
| Date | Mood, sleep or confusion | Eye or skin changes | Joint or back pain | Reported to team |
|---|---|---|---|---|
Questions for your prescriber or pharmacist
- Is there a separate dose plan for adults my age, or only weight-based dosing?
- How is my course length chosen for my acne and my body weight?
- What lab tests will you repeat during treatment, and when?
- How will you check my mood, depression and sleep at each visit?
- Which symptoms mean I should stop the medicine and call you straight away?
- Which vitamins, supplements and antibiotics should I avoid while taking this?
- Does iPLEDGE still apply to me, and what do I need to do to stay enrolled?
- Can my pharmacist check for interactions with my other medicines?
- What is my plan if I miss a dose or my supply runs out?
- Will my insurer cover this medicine and the required lab tests?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.