Instruct: Given a question, retrieve documents that can help answer the question.
Query: Is accutane a restricted prescription?
Isotretinoin is a teratogen; there is about a 20–35% risk for congenital defects in infants exposed to the drug in utero, and about 30–60% of children exposed to isotretinoin prenatally have been reported to show neurocognitive impairment.[11] Because of this, there are strict controls on prescribing isotretinoin to women who may become pregnant and women who become pregnant while taking isotretinoin are strongly advised to terminate their pregnancies.[11]
Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the medical practitioner. Regulations may restrict some types of drugs from being refilled.
A CDC report published in 2000[74] showed problems with the Pregnancy Prevention Program and showed that the increase in prescriptions was from off-label use, and prompted Roche to revamp its program, renaming it the "Targeted Pregnancy Prevention Program" and adding label changes like requirements for two pregnancy tests, two kinds of contraception, and for doctors to provide pharmacists with prescriptions directly; providing additional educational materials, and providing free pregnancy tests. The FDA had another advisory meeting in late 2000 that again debated how to prevent pregnant women from being exposed to the drug; dermatologists testified about the remarkable efficacy of the drug, the psychological impact of acne, and demanded autonomy to prescribe the drug; others argued that the drug be withdrawn or much stricter measures be taken. In 2001 the FDA announced a new regulatory scheme called SMART (the System to Manage Accutane Related Teratogenicity) that required Roche to provide defined training materials to doctors, and for doctors to sign and return a letter to Roche acknowledging that they had reviewed the training materials, for Roche to then send stickers to doctors, which doctors would have to place on prescriptions they give people after they have confirmed a negative pregnancy test; prescriptions could only be written for 30 days and could not be renewed, thus requiring a new pregnancy test for each prescription.
Although the goal of the program is to prevent pregnancies of women who take the drug, male patients must also participate in anti-pregnancy restrictions, primarily due to fears that male isotretinoin users might share their prescriptions with females without their physicians' knowledge. There has been no link to birth defects from Accutane associated with males using the drug, though male sexual dysfunction has been suggested by one study. As this has not been conclusively proven, this is not acknowledged as a side effect in the official literature accompanying the medication.
Prescription drugs taken during pregnancy such as streptomycin, tetracycline, some antidepressants, progestin, synthetic estrogen, and Accutane, as well as over-the-counter drugs such as diet pills, can result in teratogenic outcomes for the developing embryo/fetus. Additionally, high dosages of aspirin are known to lead to maternal and fetal bleeding, although low-dose aspirin is usually not harmful.
The iPLEDGE Program was instituted as a replacement for the failed SMART program (System to Manage Accutane Related Teratogenicity). Instituted in April 2002, SMART aimed to eliminate isotretinoin-induced birth defects by preventing pregnant women from being prescribed or exposed to the drug. The program mandated two consecutive negative pregnancy tests, birth defect risk counseling and a pledge to use two forms of contraception when engaging in intercourse for all women of childbearing age seeking an isotretinoin prescription. A voluntary registration program called The Accutane Survey was also established. However, no effort was made to verify the compliance of doctors and pharmacists, only a small percentage of women registered in the survey, and isotretinoin's reputation as an acne wonder drug continued to fuel demand for new prescriptions, an increasing number of which were being written and dispensed for relatively minor cases of acne vulgaris without proper screening, supervision or evidence that less risky medications had first been attempted.
Tijuana has many pharmacies that target visitors from the United States, which sell some medicines without prescriptions and/or at much lower costs than in the U.S. Many medications still require a Mexican prescription, which can be obtained from adjacent doctors' offices. People filling up prescriptions for drugs classified in the US as Schedule II or Schedule III have found it more difficult to locate such medications, and the purchase of pseudoephedrine also has become restricted by Tijuana pharmacies, just as in the U.S. To fill a prescription in Tijuana for any drug covered by the US Controlled Substances Act and legally bring it into the United States requires a prescription from the United States for re-import. Americans can import up to a 90-day supply of non-controlled medications for personal use to the USA from Mexico and other countries.
Anlage III controlled substances are tradable and prescriptible, but only on a special prescription form. The prescription must be necessary in that its purpose cannot be met by other means. Summary of Product Characteristics for those substances are restricted to professional circles.
Severe acne usually indicates the necessity of prescription medication to treat the pimples. Prescription medications used to treat acne and pimples include isotretinoin, which is a retinoid. Historically, antibiotics such as tetracyclines and erythromycin were prescribed. While they were more effective than topical applications of benzoyl peroxide, the bacteria eventually grew resistant to the antibiotics and the treatments became less and less effective. Also, antibiotics had more side effects than topical applications, such as stomach cramps and severe discoloration of teeth. Common antibiotics prescribed as of 2001 by dermatologists included doxycycline and minocycline. For more severe cases of acne dermatologists might recommend accutane, a retinoid that is the most potent of acne treatments. However, accutane can cause various side effects including vomiting, diarrhea, and birth defects if taken during pregnancy.
Bremner's brain imaging studies showed smaller volume of the hippocampus in people with Post traumatic stress disorder related to childhood abuse or Vietnam combat; he was the first to publish that relationship. These studies and others resulted in him being one of the most highly cited researchers in the field of Post traumatic stress disorder.
Bremner's research used PET brain imaging to show a decrease in frontal lobe brain function in acne patients treated with Accutane (isotretinoin). He was an expert witness in litigation related to the relationship between Accutane and suicide and depression, including the case of Charles J. Bishop, which he describes in the narrative non-fiction book, "The Goose That Laid the Golden Egg".
On January 5, 2002, just four months after the September 11, 2001, terrorist attacks, 15-year-old amateur pilot, Charles Bishop, stole a Cessna plane and flew into the Bank of America building in Downtown Tampa. While it killed him, there were no other injuries (because the crash was on a Saturday, when few people were in the building). A suicide note found in the wreckage expressed support for Osama bin Laden. Bishop had been taking a prescription medicine for acne called Accutane that may have had the side effect of depression or severe psychosis. His family later sued Hoffman-La Roche, the company that makes Accutane, for $70 million; however, an autopsy found no traces of the drug in the teenager's system.
When selecting a progressive lens design, an eyecare practitioner will usually ask some lifestyle questions, which coupled with prescription restrictions or recommendations and cost can effectively establish suitability for various models of progressive lens. Different lenses have different glazing restrictions, lens material availabilities, maximum and minimum fitting heights, prescription ranges and as such the variation in quality between higher and lower end varifocal lenses is considerable.
Ephedrine was freely available in pharmacies in Germany until 2001. Afterwards, access was restricted since it was mostly bought for unindicated uses. Similarly, ephedra can only be bought with a prescription. Since April 2006, all products, including plant parts, that contain ephedrine are only available with a prescription.
Another common way that people saved money, was to skip or reduce dosages or fail to fill a prescription entirely due to cost restrictions.
Isotretinoin was first marketed as Accutane by Hoffmann-La Roche. It sold well for many years, but in 2009, Roche decided to remove Accutane from the US market after juries had awarded millions of dollars in damages to former Accutane users over inflammatory bowel disease claims. The American College of Gastroenterologists has released a position paper stating that people with inflammatory bowel disease should not be precluded from having their acne treated with isotretinoin. It then became generic and as of 2017 was marketed under many brand names worldwide.[1]
The iPLEDGE program is a risk management distribution program mandated by the U.S. Food and Drug Administration (FDA) for isotretinoin, marketed as Absorica, Claravis, Amnesteem, Myorisan, and Zenatane, and sometimes referred to by its former brand name, Accutane. Isotretinoin is a prescription medication that is highly effective in treating severe acne and moderate acne that doesn't respond to other treatments, however carries a high risk of causing severe birth defects if taken during pregnancy ("see Teratogenicity of isoretinoin"). The goals of the iPLEDGE REMS (risk evaluation and mitigation strategy) Program are to prevent fetal exposure to isotretinoin and to inform prescribers, pharmacists, and patients about isotretinoin’s serious risks and safe-use conditions. 
Extinctive prescription entails the termination of obligations, and therefore their enforceability, by lapse of time. This ensures finality in business affairs and provides an incentive for persons to enforce their rights when they become due. It is regulated by the Prescription Act and the Institution of Legal Proceedings Against Certain Organs of State Act. The former indicates that claims to a debt are restricted to a certain period of time, after which they fall away; one has to exercise one's rights within that period if one desires performance. This residual time amounts to three years, and prescription begins to run when ‘the debt falls due’. Furthermore, ‘a debt shall not be deemed to be due until certain requirements are satisfied’. These are, on the part of the creditor:
Prescription is backdated accordingly, if necessary.
Class A
Narcotics, sedative-hypnotics, and amphetamines in this class require a special prescription form:
Class B 
Restricted substances which easily lead to addiction like:
Class C - All prescription-only substances
Oregon law authorizes the Oregon Prescription Drug Program, which is intended to reduce prescription drug costs and to make prescription drugs available to participants at the lowest possible cost. At the time the measure was passed, existing law authorized the program's administrator to negotiate price discounts, to purchase prescription drugs on behalf of participants, and to reimburse pharmacies. At the time, only Oregon residents over age 54 whose gross annual income did not exceed 185% of federal poverty guidelines and who had not had private prescription drug benefit coverage for the past 6 months were eligible to participate in the Program. Measure 44 eliminated those restrictions and expands Program eligibility to all Oregon residents who have no prescription drug coverage except Medicare Part D.
In 2010, DEA regulations were modified which lifted previous restrictions against the use of electronic prescribing for controlled substances that have presented a major obstacle to e-prescribing proliferation. As healthcare providers move to implement these new regulations, e-prescribing can be expected to reduce paperwork for pharmacies and practitioners, reduce prescription forgery and help integrate prescription records in electronic medical records.
Sweating causes lesions to form, but lesions aggravated by sweat usually return to "normal" fairly quicklyavoiding sweat is not a reason to avoid exercise. Minor outbreaks can be controlled with prescription strength topical cortisone creams. More severe eruptions usually clear up after treatment for one to three months with Accutane or tetracycline. If these fail or the outbreak is severe, PUVA phototherapy treatments, antifungal medication and cortisone injections are alternatives.
Depending upon the jurisdiction, drugs may be divided into over-the-counter drugs (OTC) which may be available without special restrictions, and prescription drugs, which must be prescribed by a licensed medical practitioner in accordance with medical guidelines due to the risk of adverse effects and contraindications. The precise distinction between OTC and prescription depends on the legal jurisdiction. A third category, "behind-the-counter" drugs, is implemented in some jurisdictions. These do not require a prescription, but must be kept in the dispensary, not visible to the public, and only be sold by a pharmacist or pharmacy technician. Doctors may also prescribe prescription drugs for off-label use – purposes which the drugs were not originally approved for by the regulatory agency. The Classification of Pharmaco-Therapeutic Referrals helps guide the referral process between pharmacists and doctors.
The REMS program developed out of previous systems dating back to the 1980s for monitoring the use of a small number of high-risk drugs such as the Accutane, which causes serious birth defects, Clozaril, which can cause agranulocytosis, and Thalidomide, which is used to treat leprosy but causes serious birth defects. The 2007 Food and Drug Administration Amendments Act created section 505-1 of the Food, Drug, and Cosmetic Act which allowed for the creation of the REMS program for applying individual monitoring restrictions to medications.
Physicians control the distribution of prescription drugs. Some hospitals and clinics stipulate patients must buy prescription drugs from the hospitals or directly from the physicians who make the prescriptions. Such a restriction aims to prevent the loss of sales on prescription drugs to retailers, but retailing drug stores are unhappy with such a restriction, and some of them have tried all means to lure away prescription drugs buyer from hospitals. For instance, they offer to pay drug buyers half a dollar for each prescription the buyers brought to the drug stores. Normally a prescription is effective on the day it is issued, but it can be effective within three days of prescription under certain conditions.
On January 5, 2002, just four months after the September 11, 2001, terrorist attacks, 15-year-old amateur pilot Charles Bishop crashed a Cessna plane into the Bank of America Plaza. Bishop died, but there were no other injuries (because the crash occurred on a Saturday, when few people were in the building). A suicide note found in the wreckage expressed support for Osama bin Laden. Bishop had been taking a prescription medicine for acne called Accutane that may have had the side effect of depression or severe psychosis. His family later sued Hoffman-La Roche, the company that makes Accutane, for $70 million; however, an autopsy found no traces of the drug in the teenager's system.