What lab monitoring do you perform for patients taking isotretinoin?

I am a lab minimalist. I do ALT(past months have eliminated the AST) and fasting TGs at the start. Then at month 2 or max dose 1 mg/kg, I check ALT and fasting TGs. If there are any elevations at baseline, will check at month one which is usually 0.5mg/kg for me, and then month 2 (at the max dose) a...

I echo Dr. @Dr. First Last's statements and rationale above. I routinely check only ALT and triglycerides at baseline (within a month prior to initiation), and then again at the goal dose of 1 mg/kg/day. This, of course, is modified by patient-specific factors--mainly any abnormalities at baseline--...