SHIFT Newsroom · UK
Isotretinoin: second-prescriber rule replaced with updated safeguards
January 2026 guidance changed prescribing for under-18s while retaining pregnancy prevention and side-effect monitoring.
The MHRA changed isotretinoin prescribing requirements on 22 January 2026 following a review of safeguards introduced in 2023. The regulator’s update removed the requirement for a second prescriber's agreement before treatment could begin for someone under 18, replacing it with other risk-minimisation measures.
An updated acknowledgement form asks patients and prescribers to confirm that treatment is appropriate, and records patients' understanding that they can seek another clinical opinion. The package also includes patient information and an audit approach led by the British Association of Dermatologists. The published CHM addendum records these changes.
The change does not remove the other safeguards. Pregnancy prevention remains central because isotretinoin can seriously harm an unborn baby. Assessment and monitoring for possible mental-health and sexual-function effects also continue. The lead prescriber still needs the relevant expertise and understanding of monitoring requirements.
The January notice describes audits planned for 2026; it does not establish whether a particular service has completed one. It follows the October 2025 service survey and guidance clarifications. The two notices therefore describe successive stages of the same review, rather than interchangeable announcements. This account concerns the regulatory framework, not whether isotretinoin is suitable for any individual.
Known facts
- Second-prescriber requirement for under-18s removed from 22 January 2026.
- Other pregnancy-prevention and monitoring measures continue.
- Revised form, patient video and clinical audit form the replacement approach.