Online Purchasing of Isotretinoin: E-Pharmacies Provision of Safety Information

Background: The purpose of Isotretinoin Pregnancy Prevention Programs (PPP) is to utilise a variety of approaches and strategies to control the prescription of, and diminish the risks of women of child bearing age receiving this medication during pregnancy. With thegrowing phenomenon of online pharmacies, consumers are now able to purchase Isotretinoin online without the requisite safety procedures.Objectives: A structured survey of e-pharmacies selling Isotretinoin to evaluate what safety measures and regulations are in place for women of child bearing age.Methods: The terms ‘‘buy’’ and ‘‘Isotretinoin’’ was entered into five commonly used search engines. Ten different online pharmacies URL’s (Uniform Resource Locator) from each search engine, all selling isotretinoin, were stored for evaluation. The safety information content of each of the 50 sites was evaluated independently for accuracy and completeness by two raters using criteria derived from the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare Regulatory Agency (MHRA) for dispensing Isotretinoin to women at risk of pregnancy.Results: Eight (16%) of the websites made no reference to the use of Isotretinoin in pregnancy. Information provided by 35 (70%) of the websites was of poor or very poorquality in relation to the need for and recommended methods for pregnancy prevention. Misleading statements were recorded on several of the websites. Isotretinoincould be readily purchased from 42 (84%) of the sites without a valid prescription.Conclusions: Women of child bearing age have the option to self-purchase Isotretinoin directly from web sites that do not provide any form of risk assessment, pregnancyprevention education, or warnings of the dangers associated with taking this medication. These findings have implications for the design of Pregnancy Prevention Programmes,for clinicians, and for legal regulation of internet pharmacies.