Is tretinoin cream a controlled substance?

Does tretinoin cream still need a prescription?

Yes. Prescription status and controlled substance status are separate classifications. A medicine can require a prescription without being controlled. For tretinoin cream, the prescription requirement applies even though the DEA schedule is "None". Do not share your cream with anyone else; ask your pharmacist about refilling your prescription.23

Does the strength change its status?

The US labels for Sun Pharmaceutical's 0.1% cream and Alembic's 0.05% cream both classify them as prescription medicines with no DEA schedule. Bryant Ranch Prepack's label also lists no DEA schedule and describes cream strengths of 0.025%, 0.05% and 0.1%. The packager names differ, but the schedule remains "None", which is unusually cooperative behaviour from label small print, even if the company names still read like closing credits.124

Is tretinoin the same as isotretinoin?

No. Tretinoin cream is applied to the skin to treat acne. Isotretinoin is a different acne medicine used for people with cystic acne and scarring, with close monitoring and regular blood tests. Isotretinoin treatment requires enrollment in the iPledge program. Those requirements concern isotretinoin, not tretinoin cream; similar names do not make the medicines interchangeable.25

How do you use tretinoin cream?

1. 1Follow your prescription exactly. Tretinoin is generally used daily at bedtime; do not apply it more often than prescribed.
2. 2Wash your hands and the affected skin with mild soap and water. Let your skin dry as directed.
3. 3Use clean fingertips to spread a thin layer over the affected area.
4. 4Keep the cream away from your eyes, ears, mouth and corners of your nose. Do not apply it to sunburned skin or areas affected by eczema.

Acne can worsen during the first 7 to 10 days. Improvement can begin in 2 to 3 weeks, but sometimes takes more than 6 weeks of regular use. If you miss an application, use it when you remember unless the next dose is nearly due. Never apply extra cream to make up for it.3

What precautions still matter?

Minimize sunlight and avoid sunlamps during treatment. Use sunscreen and protective clothing over treated areas when exposure cannot be avoided. Wait until sunburn has fully healed before using the cream. Wind and cold can also irritate treated skin.1

Other topical medicines, abrasive cleansers, strongly drying cosmetics and products high in alcohol need caution alongside tretinoin. Preparations containing sulfur, resorcinol or salicylic acid deserve particular care. If those products have already irritated your skin, let their effects subside before starting tretinoin.4

Tretinoin can cause redness and peeling, including severe irritation. Stop using the cream if you develop a reaction suggesting sensitivity or chemical irritation. Significant irritation can require less frequent use, a temporary pause or stopping altogether under your prescriber's direction. Call your doctor immediately for rash, hives, or pain or discomfort at the treatment area.23

Tell your doctor if you are pregnant, planning pregnancy or breastfeeding. If you become pregnant while using tretinoin, call your doctor. Use during pregnancy requires a decision about whether the potential benefit justifies the potential risk to the fetus.34