Some dermatologists are demanding abortion for those who conceive while using the medication
Pro-life supporters are concerned about the information given to patients using a popular acne treatment prescription.
Accutane, prescribed since the early 1980s in the treatment of severe acne, can result in serious birth defects in developing fetuses. Information given out by some dermatologists implies that female patients must undergo an abortion if they become pregnant while using Accutane.
According the 31st edition of the Compendium of Pharmaceuticals and Specialties (1996), Accutane can cause severe defects, included head deformities and cardiac problems, in a developing fetus.
The compendium, produced by the Canadian Pharmaceutical Association, says female patients should be fully counselled on the serious risks to the fetus should they become pregnant while undergoing Accutane treatment. Doctors must ensure sexually active female patients either abstains from sexual activity or practise contraception prior to, during and up to one month after treatment
The drug should not be administered until a female patient has undergone her menstrual cycle. In addition, pregnancy tests are be to undertaken for the duration of the Accutane treatment. The average treatment period with Accutane is four to five months.
“If a pregnancy does occur during this time, the physician and patient should discuss the desirability of continuing the pregnancy,” the pharmaceutical association says.
While the pharmaceutical association discusses the “desirability” of continuing such a pregnancy, instructions distributed by some dermatologists are much more explicit. They practically order a patient to undergo an abortion should she become pregnant while using Accutane.
“Any pregnancy occurring on this medication must be terminated,” one instruction says. “Your acceptance of a prescription for Accutane means you accept these facts—you will report any pregnancy to your dermatologist and you will comply with termination (abortion).”
Dermatologist Andrew Simone of Etobicoke said despite warnings, some female patients still become pregnant while undergoing Accutane treatment. Dr. Simone, who does not personally prescribe the drug, believes it is over-used by dermatologists and general practitioners. He cited the case of one dermatologist who prescribes the drug to more than 200 patients. Dr. Simone said there are a number of alternative medicines, including surgery, available in the treatment of severe acne.
“I would never tell a patient who became pregnant while using Accutane that she should have and abortion,” Dr. Simone told The Interim. “I’m sure the majority of doctors would urge the abortion, if for no other reason than to avoid a possible lawsuit in the event the child is born with abnormalities.
However dermatologist Harvey Shapiro of Sunnybrook in Toronto, doubted doctors routinely urge abortions for many patients who become pregnant while on Accutane. “Some doctors might feel that an abortion is indicated under such circumstances due to the high risk to the fetus,” Dr. Shapiro said, but you can’t order anyone to do anything. Patients would be counselled individually on how best to deal with the situation.”
Although he’s not had any of his patients become pregnant while on Accutane, Dr. Shapiro has heard of “several dozen” cases in the US. “It’s not common, given what we know about the risks involved, but that’s not to say it doesn’t happen,” he said.
Dr. Shapiro said the risk Accutane poses to the fetus has led some paediatricians to urge he drug be taken off the market. “It has been a godsend in the treatment of severe acne, but some paediatricians believe the danger it poses to the fetus outweighs other considerations.”
Helen Stone a spokesperson for Accutane manufacturer Hoffman La-Roche Limited, said dermatologists are regularly advised of the side effects of the drug. She said dermatologists must ensure their patients are told of the potential risks of using Accutane.
“They wouldn’t prescribe the medication to anyone who might be at risk,” Stone said. “Sexually active patients would be reminded of the harm to the fetus and they would be told to use contraceptives.” She also said doctors would have to be satisfied that the patient can be trusted to follow basic instructions.
However an official with the Hospital for Sick Children’s Mother at Risk program estimates that a significant number of women using Accutane do not heed their doctor’s warnings. The Mother at Risk program provides information to health workers and members of the public about potential risks to expectant mothers.
Anne Pastruszak, assistant director of the Mother at Risk program, said a patient compliance study indicated up to 40 % of women taking Accutane do not follow their doctor’s instructions about abstained from sexual activity or using contraceptives. She attributed this behaviour—which puts a preborn child at considerable risk—to a combination of miscommunication and carelessness.
“Dermatologists tends to see a high number of patients and its possible some don’t spend enough time explaining the risks to patients,” she said. “As well, some patients might simply forget what they’ve been told and fail to check back with their doctor.”
Pastruszak said the risk to a preborn childe exposed to Accutane depends on the dosage and the stage of fetal development. She added that most women faced with an Accutane-exposed fetus are not prepared to take a chance. “Our experience indicates that the majority of women who become pregnant while using Accutane choose termination over pregnancy,” Pastruszak said.