Accutane Blood Tests: What's Checked and an Easier Way to Test
Short answer: Accutane (isotretinoin) blood work checks three things: pregnancy for anyone who can get pregnant (under the FDA's iPLEDGE program), liver function (mainly ALT) and blood fats (mainly triglycerides, often with cholesterol). Expert consensus is to check ALT and triglycerides before you start and again at your peak dose, though many prescribers test at baseline and around 2 months. Labs keep the course safe, but they don't tell you why you got acne or whether it's likely to come back. Acne drivers differ person to person, and the only way to know what's behind yours, before or after a course, is to test.
Planning, on, or done with Accutane? BreakoutLabs checks ALT, triglycerides and your full cholesterol panel, plus the acne hormones linked to breakouts coming back, from one painless at-home sample. No lab slip, no trip to a lab, no waiting room.
What labs are checked on Accutane?
| Test | Why it's checked | Typical timing |
|---|---|---|
| Pregnancy test (if you can get pregnant) | Isotretinoin can cause severe birth defects | Two before starting, before each prescription, at the end of treatment and 1 month after (FDA label) |
| ALT (liver enzyme) | Liver enzymes can rise on treatment | Before starting and at peak dose (Xia et al., 2022) |
| Triglycerides | One of the most common lab changes on isotretinoin | Before starting and at peak dose (Xia et al., 2022) |
| Cholesterol (total, HDL, LDL) | Cholesterol can rise and HDL can fall | Often part of a fasting lipid panel |
Experts advise against routinely ordering a complete blood count, GGT, bilirubin or a basic metabolic panel for typical patients (Xia et al., 2022).
iPLEDGE and pregnancy testing
Every FDA-approved isotretinoin product is part of iPLEDGE, a safety program for prescribers, pharmacies and patients designed to prevent exposure during pregnancy (FDA). If you can get pregnant, you'll need a screening and a confirmatory test before starting, a test before each prescription (picked up within 7 days), and tests at the end of treatment and 1 month after (FDA label). Pre-treatment tests must be done in a medical setting.
In February 2026, the FDA approved changes that let prescribers allow at-home pregnancy tests during and after treatment and remove the wait if you miss the 7-day window. They're now planned to take effect November 15, 2026 (FDA). Your prescriber will tell you which rules apply.
Liver and lipid changes on Accutane
Liver. Mild to moderate rises in liver enzymes were seen in about 15% of people in isotretinoin trials, and some went back to normal with a lower dose or even on the same dose (FDA label). Serious liver abnormalities are rare: fewer than 0.5% in a database study of 1,863 people (Barbieri et al., 2020).
Triglycerides and cholesterol. Blood fats change more often. In trials, triglycerides rose markedly in 25% of patients, HDL fell in 15% and cholesterol rose in 7%, and these changes reversed after stopping (FDA label). In a 515-person study, triglyceride problems appeared after an average of about 56 days, and none went beyond moderate (Hansen et al., 2016). The main worry with very high triglycerides is pancreatitis, which is why lipids are watched (FDA label).
If a result is flagged, the usual next steps are a repeat test, diet and alcohol changes, or a lower dose. Your prescriber makes that call (FDA label).
How often do you need blood tests on Accutane?
Less often than many people expect:
- A meta-analysis of 26 studies found abnormal results were uncommon and didn't support monthly testing for a typical patient on a standard dose (Lee et al., 2016).
- A large single-center study suggested repeating tests after 2 months if your baseline is normal (Hansen et al., 2016).
- A 2022 consensus of 22 acne specialists settled on ALT and triglycerides before starting and at peak dose (Xia et al., 2022).
Practice still varies. Monitoring stayed frequent from 2008 to 2017 even though serious abnormalities were rare (Barbieri et al., 2020), and people at higher risk, such as those with diabetes, obesity, heavy drinking or a family history of high lipids, may be checked more often (FDA label). Lipid tests should be done fasting (FDA label).
Does Honeydew require blood work?
Yes. Monitoring comes with isotretinoin, whoever prescribes it. Honeydew's FAQ says most of its isotretinoin patients have bloodwork at least twice, at baseline and around 2 months, covering a liver panel and a lipid profile. You get a lab order and take it to a lab of your choice (Honeydew, accessed October 13, 2026).
That route works, but it's a lot of steps for two checks:
| Lab-order route | BreakoutLabs | |
|---|---|---|
| Getting started | Lab slip, then find and book a lab | Kit shipped to your door |
| Collection | Travel to a lab, needle draw from a vein | Painless device on your upper arm, at home |
| Repeat checks | A separate lab visit each time | Another kit, same routine at home |
| What's measured | Liver panel and lipid profile | ALT, triglycerides and full cholesterol panel, plus SHBG, DHEA-S, free testosterone and more: 19 biomarkers in all |
For a full side-by-side, see our Honeydew vs BreakoutLabs comparison.
Skip the lab trip. Your liver and lipid markers, plus the hormones behind acne, from one painless at-home collection. Results in 5 business days, read for acne in your Clear Skin Blueprint.
Before, during and after Accutane: where BreakoutLabs fits
Isotretinoin is a powerful treatment that targets your oil glands, but it doesn't tell you what was driving your acne in the first place. Knowing your numbers at each stage makes you a better-informed patient.
- Before: get your baseline ALT, triglycerides and cholesterol, and see your acne drivers. If hormones or blood sugar are part of the picture, you and your doctor can factor that into the plan. See blood tests for acne.
- During: easy at-home checks of ALT, triglycerides and the full cholesterol panel that you can share with your prescriber, without another lab visit.
- After: check the hormones linked to acne coming back. In a study of 351 people with severe acne, higher free androgen index and DHEA-S, lower SHBG, higher triglycerides and lower HDL at baseline were each linked to recurrence after isotretinoin (Song et al., 2026). BreakoutLabs measures all five, plus Free and Total Testosterone.
If you've finished a course and are wondering what comes next, read do oil glands come back after Accutane? and acne came back after Accutane. BreakoutLabs also offers access to prescription treatment, including isotretinoin when a physician decides it's right for you.
Why test with BreakoutLabs
- At home, with a painless device on your upper arm. No lab slip, no lab visit, no appointment.
- 19 biomarkers across hormones, blood sugar, metabolism and nutrients: Free and Total Testosterone, SHBG, DHEA-S, Free Androgen Index and Albumin; HbA1c, average glucose, total cholesterol, HDL, LDL, VLDL, triglycerides and two cholesterol ratios; ALT, Creatinine and eGFR; and Vitamin D.
- Results in 5 business days after a CLIA-certified lab receives your sample.
- A personalized Clear Skin Blueprint that reads your results through the lens of acne.
- $199, HSA/FSA eligible, and backed by our 30-day money-back guarantee.
Collect in the morning after an 8 to 10 hour fast (the same fasting your lipid checks need), Monday to Thursday, and on days 3 to 7 of your cycle if you menstruate. For ages 14 and up (14 to 17 with a parent or guardian).
Frequently asked questions
What blood tests are needed for Accutane?
Pregnancy tests if you can get pregnant, plus liver function (mainly ALT) and fasting lipids (mainly triglycerides, often with cholesterol). Experts don't recommend a routine complete blood count.
How often do you need blood work on Accutane?
Expert consensus says before starting and at peak dose, not monthly. Many prescribers test at baseline and around 2 months, and people at higher risk may be tested more often.
Do you need to fast for Accutane blood work?
For the lipid tests, yes. The label calls for fasting lipid tests. Your prescriber will give exact instructions.
Does Honeydew require blood work?
For isotretinoin, yes. Its FAQ says most patients have liver and lipid bloodwork at baseline and around 2 months, using a lab order taken to a lab, plus pregnancy tests where required.
Can I check my Accutane liver and lipid levels at home?
Yes. BreakoutLabs measures ALT, triglycerides and a full cholesterol panel from a painless at-home sample, along with the hormones linked to acne. You can share your results with your prescriber, who decides your monitoring schedule.
Coming off isotretinoin? Your skincare matters more than ever. Run your products through our free pore clogger checker to spot ingredients that are likely to clog pores.
Sources
- Xia E, Han J, Faletsky A, et al. Isotretinoin laboratory monitoring in acne treatment: a Delphi consensus study. JAMA Dermatology. 2022.
- U.S. Food and Drug Administration. iPLEDGE Risk Evaluation and Mitigation Strategy (REMS). Accessed October 13, 2026.
- Sun Pharmaceutical Industries. Absorica / Absorica LD (isotretinoin) prescribing information. FDA-approved label, revised August 2026.
- Hansen TJ, Lucking S, Miller JJ, et al. Standardized laboratory monitoring with use of isotretinoin in acne. Journal of the American Academy of Dermatology. 2016.
- Lee YH, Scharnitz TP, Muscat J, et al. Laboratory monitoring during isotretinoin therapy for acne: a systematic review and meta-analysis. JAMA Dermatology. 2016.
- Barbieri JS, Shin DB, Wang S, et al. The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time. Journal of the American Academy of Dermatology. 2020.
- Song LF, Xiao Y, Zhang H. Association of baseline peripheral sex hormone profiles and metabolic parameters with recurrence after oral isotretinoin treatment in patients with severe acne. Frontiers in Endocrinology. 2026.
- Honeydew. FAQ. Accessed October 13, 2026.
This article is for educational purposes and is not medical advice. Talk to your healthcare provider about testing and treatment.
