Drug News Update
FDA Approves Zydelig for Blood Cancers
The FDA has approved Gilead Sciences’ Zydelig (idelalisib) 150 mg tablets to treat patients with 3 types of blood cancers. Zydelig, in combination with Rituxan (rituximab), is indicated for the treatment of patients with relapsed chronic lymphocytic leukemia for whom Rituxan alone would be considered appropriate therapy due to other comorbidities. Zydelig is also approved to treat patients with relapsed follicular B-cell non-Hodgkin lymphoma who have received at least 2 prior systemic therapies and for patients with relapsed small lymphocytic lymphoma who have received at least 2 prior systemic therapies.
Zydelig includes a Boxed Warning regarding fatal and serious toxicities including liver toxicity, diarrhea and colon inflammation (colitis), lung inflammation (pneumonitis), and intestinal perforation that can occur in Zydelig-treated patients. Zydelig is also being approved with a Risk Evaluation and Mitigation Strategy (REMS).
Ibuprofen and Oxcarbazepine Tablets Recall
American Health Packaging is voluntarily recalling 1 lot (142588, expiration date January 2016) of ibuprofen 600 mg tablets and 1 lot (142544, expiration date February 2016) of oxcarbazepine 300 mg tablets due to mislabeled packaging. The ibuprofen tablets were distributed in a hospital unit dose presentation that may contain individual blistered doses labeled as oxcarbazepine tablets 300 mg. The mislabeled inner unit dose blister packaging could result in patients receiving ibuprofen instead of their scheduled dose of oxcarbazepine, indicated for partial seizures in patients with epilepsy. The affected products were distributed nationwide beginning June 20, 2014.
Customers with the recalled product should immediately discontinue use and contact GENCO Pharmaceutical Services at 1-855-419-4608 (7 AM-5 PM, CST) for return instructions. For questions or product complaints related to oxcarbazepine 300 mg tablets or ibuprofen 600 mg tablets, contact American Health Packaging customer service at 1-800-707-4621 (8 AM-4 PM, EST).
Sterile Drug Products Recall - NuVision
The FDA is alerting health care professionals not to use drugs marketed as “sterile” that were produced by Downing Labs LLC, also known at NuVision Pharmacy, due to possible contamination. FDA investigators inspected NuVision and observed unsanitary conditions that result in a lack of sterility assurance for purportedly sterile drugs. The inspection revealed sterility failures in 19 lots of drug products intended to be sterile, endotoxin failures in 3 lots of drug products, and inadequate or no investigation of these failures. These products were distributed nationwide, and most of the labels include: NuVision Pharmacy, Dallas TX. 75244 1-800-914-7435.
Health care providers should check their medical supplies and quarantine any sterile drug products from NuVision.
Baxter IV Solutions Recall
Baxter International is voluntarily recalling 4 lots (P298190, expiration date August 2014; P308650, expiration date October 2014; P309187, expiration date October 2014; P309476, expiration date October 2014) of sodium chloride and potassium chloride intravenous solutions due to particulate matter in the vials. The affected lots were distributed between February 2013 and June 2014.
Customers with affected lots should stop use; unaffected lots are available for replacement. Recalled products should be returned for credit by contacting Baxter Healthcare Center for Service at 1-888-229-0001 (Monday- Friday, 7 AM-6:00 PM, CST). For additional information, call Baxter at 1-800-422-9837 (Monday-Friday, 8 AM-5 PM, CST) or email at firstname.lastname@example.org.
FDA Approves Ruconest for Hereditary Angioedema
The FDA has approved Pharming Group NV’s Ruconest (C1 esterase inhibitor [recombinant]) powder for injection for the treatment of acute attacks in adult and adolescent patients with hereditary angioedema, a rare and potentially life-threatening genetic disease. Ruconest will be distributed in the US by Salix Pharmaceuticals, which plans to make the drug available later in 2014.
Cleocin Phosphate Label Changes
The FDA has approved label changes clarifying administration recommendations for Pfizer’s Cleocin Phosphate (clindamycin) injection. The updated labeling emphasizes that clindamycin phosphate for intramuscular administration should be used undiluted and clindamycin phosphate for intravenous administration should be diluted. Cleocin Phosphate is indicated for the treatment of serious infections caused by susceptible anaerobic bacteria and includes a Boxed Warning regarding Clostridium difficile–associated diarrhea.
Sterile Drug Products Recall
The FDA is alerting health care professionals not to use drugs marketed as “sterile” that were produced by Unique Pharmaceuticals Ltd due to possible contamination. The FDA conducted 2 recent inspections of the Unique Pharmaceuticals facility and observed unsanitary conditions, including environmental contamination and poor sterile production processes, that result in a lack of sterility assurance for purportedly sterile drugs. These products were distributed nationwide, and most of the labels include: Unique Pharmaceuticals, Temple TX USA 76502.
Health care providers should check their medical supplies and quarantine any sterile drug products from Unique Pharmaceuticals.
Lactated Ringer’s and 5% Dextrose Injection Recall
Hospira has initiated a voluntary nationwide user-level recall of 1 lot (35-118-JT, NDC 0409-7929-09, expiration date November 1, 2015) of Lactated Ringer’s and 5% Dextrose 1,000 mL due to a confirmed customer report of a filamentous-like structured particulate indicative of mold that was identified in the solution of the primary container. Analysis of the primary container and overwrap indicated a puncture in the same physical location, causing the primary container to leak.
Customers with existing inventory should stop use and distribution, quarantine the product immediately, and call Stericycle at 1-888-912-8457, Monday-Friday, 8 AM-5 PM, EST to arrange for product return.
Expanded Indication for NovoSeven RT
The FDA has approved an expanded indication for Novo Nordisk’s NovoSeven RT (coagulation factor VIIa, [recombinant]) to include treatment of bleeding episodes and peri-operative management in adults and children with Glanzmann thrombasthenia refractory to platelet transfusions, with or without antibodies to platelets. NovoSeven RT was previously approved for the treatment of bleeding episodes in hemophilia A or B patients with inhibitors to factor VIII or factor IX and in patients with acquired hemophilia; for the prevention of bleeding in surgical interventions or invasive procedures in hemophilia A or B patients with inhibitors to factor VIII or factor IX and in patients with acquired hemophilia; for the treatment of bleeding episodes in patients with congenital factor VII deficiency; and for the prevention of bleeding in surgical interventions or invasive procedures in patients with congenital factor VII deficiency, and includes a Boxed Warning regarding serious thrombotic adverse events.
FDA Approves Kerydin for Onychomycosis
The FDA has approved Anacor Pharmaceutical’s Kerydin (tavaborole) topical solution 5%, an oxaborole antifungal, for the treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.
Beleodaq Approved for Peripheral T-Cell Lymphoma
The FDA has approved Spectrum Pharmaceuticals’ Beleodaq (belinostat) injection for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL), a rare and fast-growing type of non-Hodgkin lymphoma. The action was taken under the agency’s accelerated approval program.
Coumadin Injection Recall
Bristol-Myers Squibb is voluntarily recalling 6 lots (201125, expiration date September 2014; 201126, expiration date November 2014; 201127 expiration date December 2014; 201228, expiration date June 2015; 201229, expiration date July 2015; 201230, expiration date September 2015) of Coumadin (warfarin sodium) for injection 5 mg single-use vials due to visible particulate matter found in a small number of unreleased samples. The affected lots were distributed to hospitals and pharmacies from November 2011 through January 2014. Coumadin for injection was discontinued in early April 2014. The oral tablets are not affected by the recall.
Anyone that has the affected lots should stop use and distribution and contact Bristol-Myers Squibb’s recall vendor, GENCO, at 1-855-838-5784 to arrange for return of remaining stock. For additional information, call Bristol-Myers Squibb Customer Information Center at 1-800-332-2056.
Expanded Indication for Ozurdex
The FDA has approved an expanded indication for Allergan’s Ozurdex (dexamethasone intravitreal implant) to include the treatment of diabetic macular edema in patients who are pseudophakic or are phakic and scheduled for cataract surgery. Ozurdex is also indicated for the treatment of macular edema following branch retinal vein occlusion or central retinal vein occlusion and for the treatment of noninfectious uveitis affecting the posterior segment of the eye.
Injectable Vitamin Products Warning
The FDA is alerting health care professionals not to use injectable vitamin drug products distributed by Medical Supply Liquidators with “Sunshine Labs” on the label. These products are manufactured by Compound Brothers Dominicana (CB Inc.) and sold as prescription injectable nutritional supplements. However, the FDA has not approved these products and cannot be assured of their safety, effectiveness, or quality.
All lots of nonexpired products from Compound Brothers labeled as Sunshine Labs are being voluntarily recalled by Medical Supply Liquidators. Click here for a listing of all affected products.
Afrezza Inhalation Powder Approved for Diabetes
The FDA has approved MannKind Corporation’s Afrezza (insulin human) inhalation powder to improve glycemic control in adults with type 1 or type 2 diabetes. Afrezza is a rapid-acting inhaled insulin administered at the beginning of each meal and must be used in combination with long-acting insulin in patients with type 1 diabetes. It is not recommended for the treatment of diabetic ketoacidosis or in patients who smoke. The labeling contains a Boxed Warning alerting that acute bronchospasm has been observed in patients with asthma and chronic obstructive pulmonary disease (COPD), and that it should not be used in patients with chronic lung diseases because of this risk. Afrezza has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and will be dispensed with a patient Medication Guide.
New Boxed Warning for Lidocaine Viscous
The FDA is requiring a Boxed Warning for lidocaine topical 2% (viscous) solution alerting health care providers and caregivers against its use in treating teething pain in infants and children, which may cause serious harm, including death. When too much viscous lidocaine is given to infants and young children, or if they accidentally swallow too much, seizures, severe brain injury, and cardiac problems may result.
Reports of serious adverse events (including death) in infants and young children 5 months to 3.5 years of age given lidocaine 2% viscous solution for mouth pain (including pain due to teething and stomatitis), or with accidental ingestion, have been reviewed by the FDA.
The American Academy of Pediatrics recommends managing teething pain with a chilled (not frozen) teething ring or gently rubbing/massaging with the caregiver’s finger. The FDA recommends against using topical OTC medications for teething pain as some products may cause harm.
Further information can be found at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm402790.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery
OTC Topical Acne Products Warning
The FDA is warning that certain OTC topical acne products marketed under various brand names may cause rare but serious and potentially life-threatening allergic reactions or severe irritation. Consumers should seek immediate emergency medical attention if they experience hypersensitivity reactions such as throat tightness, difficulty breathing, faintness, or swelling of the eyes, face, lips, or tongue, and should also stop using topical acne products if they develop hives or itching. These serious reactions may occur within minutes to a day or longer after product use and differ from the local skin irritation (redness, burning, dryness, itching, peeling, or slight swelling) that may occur at the application site. It has not been determined if the serious hypersensitivity reactions are triggered by the products’ active ingredients (benzoyl peroxide or salicylic acid), inactive ingredients, or by a combination of both. The FDA is monitoring and evaluating this safety issue. At first use, consumers should apply a small amount of any OTC topical acne product to 1 or 2 small affected areas for 3 days to make sure they do not develop hypersensitivity symptoms.
Trental Label Changes
The FDA has approved label changes specifying new dosing recommendations for Sanofi Aventis’ Trental (pentoxifylline) 400 mg extended-release tablets for patients with severe renal impairment (creatinine clearance less than 30 mL/min). For these patients, the Trental dosage should be reduced to 400 mg once daily instead of the usual recommended dosage of 3 times a day. Trental is indicated for the treatment of intermittent claudication on the basis of chronic occlusive arterial disease of the limbs.
Sivextro Approved for Skin Infections
The FDA has approved Cubist Pharmaceuticals’ Sivextro (tedizolid phosphate) for the treatment of acute bacterial skin and skin structure infections caused by susceptible bacteria, including Staphylococcus aureus (including methicillin-resistant strains and methicillin-susceptible strains), various Streptococcus species, and Enterococcus faecalis. Sivextro is available for intravenous and oral use.
Docetaxel Safety Warning
The FDA is warning health care providers and patients that docetaxel injection products contain ethanol, which may cause patients to experience symptoms of alcohol intoxication during and after treatment. The FDA is revising the labels of all docetaxel drug products to warn about this risk. Health care providers should consider the alcohol content of docetaxel products when prescribing or administering the drug to patients, particularly in those whom alcohol intake should be avoided or minimized and when using it in conjunction with other medications. Patients should avoid driving, operating machinery, or performing other activities that could be dangerous for 1 to 2 hours after docetaxel infusion.
Further information is available at: http://www.fda.gov/Drugs/DrugSafety/ucm401752.htm
General VTE Warning Added to Testosterone Products
The FDA is requiring manufacturers to include a general warning in the drug labeling of all approved testosterone products about the risk of venous thromboembolism (VTE). The risk of VTE is already included in the labeling of testosterone products as a possible consequence of polycythemia that may occur with testosterone treatment. However, postmarketing reports of VTE unrelated to polycythemia have prompted this new warning.
Marcaine Injection Recall
Hospira is voluntarily recalling to the user level 1 lot (33-545-DD, NDC 0409-1560-29) of Marcaine (bupivacaine hydrochloride) injection 0.5%, 30 mL, single-dose, preservative-free vials due to a confirmed customer report of particulate embedded in the glass vial as well as visible particulate in the solution. The impacted lot was distributed November 2013 through March 2014 to wholesalers/distributors, hospitals, and clinics nationwide.
Customers should immediately stop use and quarantine all affected product. Hospira will be notifying its direct distributors/customers via a recall letter and will arrange for product return. For additional assistance, call Stericycle at 1-888-656-6380 (Monday-Friday, 8 AM–5 PM, EST).http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm401724.htm?
Expanded Indication for Lymphoseek
The FDA has approved Navidea Biopharmaceuticals’ Lymphoseek (technetium Tc 99m tilmanocept) injection for guiding sentinel lymph node biopsy in patients with clinically node negative squamous cell carcinoma of the oral cavity. Lymphoseek is currently approved for lymphatic mapping to assist in the localization of lymph nodes draining a primary tumor site in patients with breast cancer or melanoma.
FDA Approves Restylane Silk
The FDA has approved Valeant Pharmaceuticals’ Restylane Silk (hyaluronic acid 20 mg/mL with lidocaine 0.3%) injectable gel, indicated for submucosal implantation for lip augmentation and dermal implantation for the correction of perioral rhytids in patients older than 21 years of age.
Expanded Indication for Gadavist
The FDA has approved Bayer’s Gadavist (gadobutrol) injection for intravenous use with magnetic resonance imaging (MRI) to assess the presence and extent of malignant breast disease. The approval is based on priority review and it is the first magnetic resonance contrast agent for evaluation of breast cancer. Gadavist was previously approved for use in diagnostic MRI in adults and children (2 years and older) to detect and visualize areas with disrupted blood-brain barrier and/or abnormal vascularity of the CNS. Gadavist’s label includes a Boxed Warning regarding the risk of nephrogenic systemic fibrosis.
Complera Label Changes
The FDA has approved label changes specifying new dosing recommendations for Gilead’s Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate). Complera is indicated for use as a complete regimen for the treatment of HIV-1 infection in antiretroviral treatment–naive adult patients with HIV-1 RNA 100,000 copies/mL or less at the start of therapy, and in certain virologically suppressed (HIV-1 RNA less than 50 copies/mL) adult patients on a stable antiretroviral regimen at start of therapy in order to replace their current antiretroviral treatment regimen. New dosing information states that if Complera is coadministered with rifabutin, patients should take an additional rilpivirine 25 mg tablet once daily with a meal for the duration of the rifabutin coadministration.
FDA Approves Generic Actonel 150 mg Tablets
The FDA has approved Mylan’s risedronate sodium 150 mg tablets, the generic equivalent to Actonel, indicated for the treatment and prevention of osteoporosis in postmenopausal women. Other strengths of risedronate sodium may have additional indications.
Jublia Approved for Onychomycosis
The FDA has approved Valent Pharmaceuticals’ once-daily Jublia (efinaconazole) 10% topical solution for the treatment of onychomycosis of the toenails due to Trichophyton rubrum and Trichophyton mentagrophytes. Jublia is the first topical triazole agent developed for this use.
FDA Approves Eloctate for Hemophilia A
The FDA has approved Biogen Idec’s Eloctate (coagulation factor VII [recombinant] Fc fusion protein) injection for the treatment of adults and children with hemophilia A to help control and prevent bleeding episodes, manage bleeding during surgical procedures, and prevent or reduce the frequency of bleeding episodes.
Expanded Indication and New Doseform for Reyataz
The FDA has approved an expanded indication for Reyataz (atazanavir) to include pediatric patients 3 months of age and older weighing at least 10 kg for the treatment of HIV-1 infection in combination with other antiretroviral agents. Reyataz was previously only indicated in adults and pediatric patients at least 6 years of age. The FDA also approved a new oral powder doseform for use in treatment-naive or treatment-experienced pediatric patients who are at least 3 months of age and weighing at least 10 kg and less than 25 kg.
Synera Label Change
The FDA has approved a label change that allows Galen US’s Synera (lidocaine and tetracaine) topical patch to be used at home. The Synera patch is indicated for use on intact skin in patients 3 years and older to provide local analgesia for superficial venous access and superficial dermatological procedures.
Soliris Injection Recall
Alexion Pharmaceuticals, Inc. is voluntarily recalling 9 lots (10002-1, 00006-1, 10003A, 10004A, 10005A, 10005AR, 10006A, 10007A, 10008A) of Soliris (eculizumab) 300 mg/30 mL concentrated solution for intravenous infusion due to the potential presence of particulate matter in the vials. The affected lots were last shipped on October 30, 2013.
Customers should stop use and arrange for return by contacting Alexion at 1-888-765-4747 (Monday-Friday 8:30 AM-5 PM, EST).
FDA Approves Generic Celebrex
The FDA has approved Teva Pharmaceutical’s celecoxib 50, 100, 200, and 400 mg capsules, the first generic equivalent to Celebrex, indicated for the treatment of rheumatoid arthritis, osteoarthritis, acute pain, ankylosing spondylitis, juvenile rheumatoid arthritis, and primary dysmenorrhea.
Expanded Pediatric Indication for Aloxi
The FDA has approved an expanded indication for Eisai’s Aloxi (palonosetron hydrochloride) injection to include children aged 1 month to younger than 17 years for the prevention of acute nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including highly emetogenic cancer chemotherapy. Aloxi was previously indicated only for use in adult patients.
Expanded Indication for Vectibix
The FDA has approved an expanded indication for Amgen’s Vectibix (panitumumab) for use in combination with Folfox as first-line treatment in patients with wild-type KRAS (exon 2 in codons 12 or 13) metastatic colorectal cancer (mCRC). The FDA approved the drug alongside a genetic test to help health care providers determine whether patients are likely to respond to the drug. Vectibix was previously approved as monotherapy for the treatment of patients with EGFR-expressing mCRC following disease progression after prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy. Vectibix includes a Boxed Warning regarding the risk of dermatologic toxicity.
Dalvance Approved for Skin Infections
The FDA has approved Durata Therapeutics’ Dalvance (dalbavancin) injection for the treatment of adults with acute bacterial skin and skin structure infections caused by certain susceptible bacteria such as Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant strains) and Streptococcus pyogenes.
Dalvance is the first drug designated as a Qualified Infectious Disease Product (QIDP) to receive FDA approval. Dalvance was granted QIDP designation, making it eligible for priority review because it is an antibacterial or antifungal human drug intended to treat serious or life-threatening infections.
Fresenius Medical Care North America is voluntarily recalling 56 lots of NaturaLyte Liquid Bicarbonate concentrate 6.4 L intended for use in hemodialysis machines because they may develop higher bacteria levels than is allowed by the company’s specification. The bacteria was identified as Halomonas (species 1, 2, 3), a gram-negative bacteria typically found in water with high salinity. Bacterial contamination of the dialysate may lead to bacteremia or systemic infection and should be removed and returned.
Customer notifications were published on April 10 and May 1, 2014, and include a list of affected lot numbers (http://www.fmcna.com).
FDA Approves Entyvio for Ulcerative Colitis or Crohn Disease
The FDA has approved Takeda Pharmaceutical’s Entyvio (vedolizumab) 300 mg infusion for the treatment of adults with moderately to severely active ulcerative colitis and Crohn disease who have had an inadequate response with, lost response to, or were intolerant to a tumor necrosis factor (TNF) blocker or immunomodulator; or had an inadequate response with, were intolerant to, or demonstrated dependence on corticosteroids. Entyvio will be dispensed with a patient Medication Guide.
Labetalol Hydrochloride Injection Recall
Hospira is voluntarily recalling to the user level 1 lot (36-225-DD, expiration date December 1, 2015, NDC 0409-2267-20) of labetalol hydrochloride injection 100 mg/20 mL (5 mg/mL) 20 mL multidose vials due to the presence of embedded particulate within the glass vial and visible particles floating in the solution. The embedded particulate was identified as stainless steel and the floating particulate as iron oxide. The affected lot was distributed in February 2014 to wholesalers/distributors, hospitals, and clinics nationwide. Labetalol hydrochloride is indicated for the management of hypertension.
Customers should immediately stop use and quarantine all affected product. For additional assistance, call Stericycle at 1-888-386-2076 (Monday-Friday, 8 AM to 5 PM EST). For medical inquiries, contact Hospira Medical Communications at 1-800-615-0187.
FDA Lowers Recommended Eszopiclone (Lunesta) Dose
The FDA is requiring the starting dose of Lunesta (eszopiclone) oral tablets, indicated for the treatment of insomnia, to be lowered to 1 mg at bedtime. The change was prompted after a study found that the previously recommended dose of 3 mg can cause impairment to driving skills, memory, and coordination lasting more than 11 hours after dosing. The 1 mg starting dose is recommended for women and men because they are both equally susceptible. If needed, the dose can be increased to 2 or 3 mg, but higher doses are more likely to result in next-day impairment. Patients taking a 3 mg dose should be cautioned against driving and other activities that require complete mental alertness the day after use.
Dobutamine Injection Recall
Hospira is voluntarily recalling to the user level 1 lot (27-352-DK, NDC 0409-2344-02) of dobutamine injection 250 mg/20 mL, single-dose, fliptop vials due to the potential presence of glass particles and/or particulate matter in the vials. The impacted lot was distributed August 2013 through September 2013 to distributors/wholesalers, hospitals, and clinics nationwide.
Customers should immediately stop use and quarantine all affected products. For additional assistance, call Stericycle at 1-877-907-9956 (Monday-Friday, 8 AM - 5 PM, EST). For medical inquiries, call Hospira Medical Communications at 1-800-615-0187 (24/7).
Kuvan Labeling Changes
The FDA has approved label changes specifying new dosing recommendations for BioMarin Pharmaceuticals’ Kuvan (sapropterin dihydrochloride) oral tablets and powder for oral solution to include patients 1 month to 6 years of age. Previous recommendations included only patients 4 years and older. For patients 1 month to 6 years of age, the recommended starting dosage is 10 mg/kg once daily. For patients 7 years and older, the recommended starting dosage is 10 to 20 mg/kg once daily. Kuvan is indicated to reduce blood phenylalanine levels in patients with hyperphenylalaninemia due to tetrahydrobiopterin-responsive phenylketonuria in conjunction with a phenylalanine-restricted diet.
Avandamet Label Changes
The FDA has approved label changes specifying new dosing recommendations for GlaxoSmithKline’s Avandamet (rosiglitazone/metformin hydrochloride), indicated as an adjunct to diet and exercise for the treatment of type 2 diabetes. Dosing now includes information regarding patients inadequately controlled on diet and exercise who are starting Avandamet without previous rosiglitazone and/or metformin hydrochloride therapy. The recommended starting dose of Avandamet for these patients is 2 mg/500 mg administered once or twice daily. For patients with HbA1c greater than 11% or fasting plasma glucose greater than 270 mg/dL, a starting dose of 2 mg/500 mg twice daily may be considered. The dose of Avandamet may be increased in increments of 2 mg/500 mg per day given in divided doses if patients are not adequately controlled after 4 weeks. The maximum dose of Avandamet is 8 mg/2,000 mg per day. Avandamet has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and is dispensed with a patient Medication Guide.
Zontivity Approved to Reduce Risk of Heart Attacks and Stroke
The FDA has approved Merck’s Zontivity (vorapaxar) tablets to reduce the risk of heart attack, stroke, cardiovascular death, and need for procedures to restore the blood flow to the heart in patients with a previous heart attack or blockages in the arteries to the legs. Zontivity, an anti-platelet agent, is the first in a new class of drug called a protease-activated receptor-1 (PAR-1) antagonist. Zontivity carries a Boxed Warning regarding an increased risk of bleeding and will be dispensed with a patient Medication Guide.
FDA Approves Epanova for Severe Hypertriglyceridemia
The FDA has approved AstraZeneca’s Epanova (omega-3-carboxylic acids) capsules, indicated as an adjunct to diet to reduce triglyceride levels in adult patients with severe hypertriglyceridemia (triglyceride levels greater than or equal to 500 mg/dL).
Nitroglycerin in Dextrose 5% Injection Shortage and Import of Nitronal
The FDA is temporarily allowing the importation of Nitronal (glyceryl trinitrate) through Arbor Pharmaceuticals from Pohl-Boskamp of Germany to alleviate the nitroglycerin in dextrose 5% shortage. Nitronal is available in 25 mL ampules and 50 mL vials at a concentration of 1 mg/mL, which may be diluted to obtain concentrations similar to those of FDA-approved products. To place an order, contact Arbor Pharmaceuticals at 1-866-516-4950, extension 0 (Monday-Friday, 9 AM to 5 PM, EST), or email GMB-SPS-ARBOR@cordlogistics.com.
Edurant Label Changes
The FDA has approved label changes specifying new dosing recommendations for Janssen’s Edurant (rilpivirine) for patients concomitantly receiving rifabutin. For these patients, the Edurant dose should be increased to 50 mg (two tablets of 25 mg each) once daily, taken with a meal. When rifabutin coadministration is stopped, the Edurant dose should be decreased to 25 mg once daily, taken with a meal. Edurant, in combination with other antiretroviral agents, is indicated for the treatment of HIV-1 infection in antiretroviral treatment–naive adult patients with HIV-1 RNA 100,000 copies/mL or less at the start of therapy.
Incruse Ellipta Approved for COPD
The FDA has approved GlaxoSmithKline’s Incruse Ellipta (umeclidinium) once-daily inhalation powder for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. The company anticipates a fourth quarter 2014 launch.
FDA Approves Zykadia for Late-Stage Lung Cancer
The FDA has approved Novartis Pharmaceuticals’ Zykadia (ceritinib) capsules for the treatment of patients with anaplastic lymphoma kinase-positive metastatic non–small cell lung cancer who have progressed on or are intolerant to crizotinib. This indication is approved under accelerated approval based on tumor response rate and duration of response. An improvement in survival or disease-related symptoms has not been established.
FDA Approves Liquid Purixan for ALL
The FDA has approved Rare Disease Therapeutics’ Purixan (mercaptopurine) 20 mg/mL oral suspension for the treatment of patients with acute lymphoblastic leukemia (ALL) as a component of a combination maintenance therapy regimen.
Safety Alert Reminder for Acetaminophen 325 mg Combination Products
The FDA is reminding health care providers to discontinue prescribing and dispensing prescription combination drug products that contain more than acetaminophen 325 mg per tablet, capsule, or other dosage unit. These products are no longer considered safe by the FDA. Pharmacists are encouraged to return these products to the wholesaler or manufacturer. These products were voluntarily withdrawn by manufacturers at the agency’s request to protect consumers from the risk of severe liver damage as a result of taking too much acetaminophen. A 2-tablet or 2-capsule dose may still be prescribed, if appropriate. In that case, the total dose of acetaminophen would be 650 mg (the amount in two 325 mg dosage units).
Super Arthgold Recall
Nano Well-being Health is voluntarily recalling 2 lots (L1P1-6100, expiration date June 25, 2016; lot L1P2-6000, expiration date September 16, 2016) of Super Arthgold 500 mg capsules at the consumer level after FDA lab analysis found the product to contain chlorzoxazone, diclofenac, and indomethacin, making it an unapproved new drug. Super Arthgold is sold as a dietary supplement for joint pain and arthritis.
Use of this product containing the undeclared drug ingredients increases the risk of fatal adverse events in consumers and patients with underlying illnesses, including known allergy to the hidden ingredients, or in those with cardiac, GI, hepatic, or renal conditions, or those who have recently had cardiac bypass graft surgery. The affected product contains nonsteroidal anti-inflammatory drugs (NSAIDs) and other ingredients that may cause accidental overdose when taken with another NSAID concurrently, thus increasing the risk for NSAID-associated adverse events, including myocardial infarction, stroke, congestive heart failure, renal toxicity, as well as bleeding, ulceration, or perforation of the stomach or intestines.
Nano Well-being Health is notifying its distributors and customers by letter and phone call, and is arranging for replacement of all recalled products. Customers with affected product should stop its use and return it to place of purchase.
Lotrisone Cream Label Changes
The FDA has approved label changes specifying new dosing recommendations for Merck’s Lotrisone (betamethasone/clotrimazole) cream to include a maximum dose of 45 grams per week. Lotrisone is indicated for topical treatment of tinea pedis, tinea cruris, and tinea corporis due to Epidermophyton floccosum, Trichophyton mentagrophytes, and Trichophyton rubrum in patients 17 years and older. Lotrisone is dispensed with a patient Medication Guide.
Adcetris Label Changes
The FDA has approved label changes specifying new dosing recommendations for Seattle Genetics’ Adcetris (brentuximab vedotin) for patients with renal and hepatic impairment. The recommended starting doses in patients with hepatic impairment or severe renal impairment (creatinine clearance less than 30 mL/min) is 1.2 mg/kg administered as an IV infusion over 30 minutes every 3 weeks. Adcetris is indicated for the treatment of relapsed/refractory Hodgkin lymphoma and relapsed/refractory systemic anaplastic large cell lymphoma.
FDA Approves Sylvant for Castleman Disease
The FDA has approved Janssen Biotech’s Sylvant (siltuximab) injection for the treatment of multicentric Castleman disease (MCD), a rare blood disorder similar to lymphoma. Sylvant is intended for patients with MCD who are human immunodeficiency virus (HIV) negative and human herpesvirus-8 (HHV-8) negative and will be dispensed with a patient Medication Guide.
Epidural Corticosteroid Injection Risk
The FDA is warning that epidural injection of corticosteroids, including methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone, may result in rare but serious adverse events such as loss of vision, stroke, paralysis, and death. The injections are administered to treat neck and back pain, as well as radiating pain in the arms and legs. The safety and effectiveness of epidural corticosteroid administration have not been established, and the FDA has not approved corticosteroids for this use. The FDA is requiring the addition of a Warning to the drug labels of injectable corticosteroids describing these risks. An FDA Advisory Committee meeting will be convened in late 2014 to determine if further actions are necessary.
Hospira is voluntarily recalling to the user level 1 lot (34-440-DD, NDC 0409-1559-10) of Marcaine 0.25% (bupivacaine HCl injection) in 10 mL single-dose, preservative-free vials because of a confirmed customer report of discolored solution with visible particles embedded in the glass. The impacted lot was distributed December 2013 through January 2014 to wholesalers/distributors, hospitals, and clinics nationwide.
Customers should quarantine all affected products. Hospira will be notifying its direct distributors/customers via a recall letter and will arrange for impacted products to be returned to Stericycle for returns processing. For additional assistance, call Stericycle at 1-877-546-7642 (Monday-Friday, 8 AM- 5 PM, EST).
FDA Approves Generic Ortho Evra Patch
The FDA has approved Mylan’s Xulane (norelgestromin/ethinyl estradiol) transdermal system, the generic version of Janssen Pharmaceuticals' Ortho Evra, indicated for the prevention of pregnancy.
FDA Approves Cyramza for Stomach Cancer
The FDA has approved Eli Lilly’s Cyramza (ramucirumab) 10 mg/mL injection solution for the treatment of patients with advanced stomach cancer or gastroesophageal junction adenocarcinoma. Cyramza is intended for patients whose cancer is unresectable or metastatic after being treated with a fluoropyrimidine- or platinum-containing therapy. Cyramza’s labeling includes a Boxed Warning regarding increased risk of hemorrhage, including severe and sometimes fatal events.
Expanded Indication for Arzerra
The FDA has approved an expanded indication for GlaxoSmithKline’s Arzerra (ofatumumab) to include the treatment of previously untreated chronic lymphocytic leukemia (CLL) in combination with chlorambucil in patients for whom fludarabine-based therapy is considered inappropriate. Arzerra is also indicated for the treatment of patients with CLL refractory to fludarabine and alemtuzumab.
Lidocaine Hydrochloride Injection Recall
Hospira is voluntarily recalling one lot of lidocaine hydrochloride injection 10 mg/mL in 30 mL single-dose, preservative-free vials because of a confirmed customer report of orange and black particulate, identified as iron oxide, within the solution and imbedded in the glass vials. Lidocaine hydrochloride injection is indicated for the production of local and regional anesthesia and for the management of cardiac arrhythmias.
Hospira will be notifying direct distributors and will arrange for the affected product to be returned. Customers should quarantine any affected product. For more information, contact Stericycle at 1-888-835-2723.
Cubist Pharmaceuticals is voluntarily recalling one lot (#280453F) of Cubicin (daptomycin) 500 mg injection at the user level due to the presence of glass particles. Cubicin is indicated for the treatment of complicated skin and skin structure infections, as well as for the treatment of Staphylococcus aureus bloodstream infections.
Customers should quarantine all affected products and arrange for return by contacting Cubist at 855-534-8309.
Avinza Expanded Boxed Warning and Label Changes for Extended-Release/Long-Acting Opioids
The FDA has expanded the Boxed Warning for the class of extended-release and long-acting opioid analgesics, including Avinza (morphine), Kadian (morphine), MS Contin (morphine), and OxyContin (oxycodone). The Boxed Warning now includes information regarding prolonged use of opioids during pregnancy and the potential for neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts.
The FDA also approved new Avinza dosing recommendations for patients who are not opioid tolerant.
FDA Approves Ragwitek for Short Ragweed Pollen Allergies
The FDA has approved Merck’s Ragwitek (ragweed extract) sublingual tablet to treat short ragweed pollen–induced allergic rhinitis, with or without conjunctivitis, in adults 18 to 65 years of age. The prescribing information for Ragwitek includes a Boxed Warning regarding severe allergic reactions and it is dispensed with a patient Medication Guide.
Tanzeum Approved for Type 2 Diabetes
The FDA has approved GlaxoSmithKline’s Tanzeum (albiglutide) for injection, for subcutaneous use, as a once-weekly treatment for type 2 diabetes. Tanzeum has been approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Tanzeum has a Boxed Warning regarding the possible risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans. Tanzeum is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2. Tanzeum has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and will be dispensed with a patient Medication Guide. GlaxoSmithKline expects to launch Tanzeum in the third quarter of 2014.
FDA Approves Grastek Allergy Immunotherapy
The FDA has approved Merck’s Grastek (Timothy grass pollen allergen extract) sublingual tablets (2800 bioequivalent allergy units [BAU]) as immunotherapy for the treatment of grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or in vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens in patients 5 through 65 years of age. Grastek is not indicated for the immediate relief of allergic symptoms. The prescribing information for Grastek includes a Boxed Warning regarding severe allergic reactions and it is dispensed with a patient Medication Guide.
Xyrem Label Changes
The FDA has approved label changes specifying dosing recommendations for Jazz Pharmaceuticals’ Xyrem (sodium oxybate) oral solution due to pharmacokinetic and pharmacodynamic interactions observed when Xyrem is coadministered with divalproex sodium. For patients already stabilized on Xyrem, the addition of divalproex sodium should be accompanied by at least a 20% initial nightly dose reduction of Xyrem. When introducing Xyrem for patients already taking divalproex sodium, health care providers should use a lower starting dose of Xyrem. Health care providers should monitor patient response and adjust dosage accordingly. Xyrem is available only through a restricted distribution program and includes a Boxed Warning regarding CNS depression, abuse, and misuse.
FDA Approves Generic VESIcare
The FDA has approved Teva Pharmaceuticals’ solifenacin succinate 5 and 10 mg tablets, the generic equivalent to VESIcare, indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.
Expanded Indication for Pradaxa
The FDA has approved an expanded indication for Boehringer Ingelheim’s Pradaxa (dabigatran etexilate mesylate) capsules to include the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients who have been treated with a parenteral anticoagulant for 5 to 10 days, and to reduce the risk of recurrent DVT and PE in patients who have been previously treated. Pradaxa is also indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Pradaxa labeling now also includes an updated Boxed Warning regarding the risk of spinal/epidural hematoma in patients receiving neuraxial anesthesia or undergoing spinal puncture, in addition to the existing warning that premature discontinuation increases the risk of thrombotic events. Pradaxa is dispensed with a patient Medication Guide.
Expanded Indication for Kalbitor
The FDA has approved an expanded indication for Dyax’s Kalbitor (ecallantide) to include the treatment of acute attacks of hereditary angioedema in patients 12 years of age and older. Kalbitor was previously approved for treatment in patients16 years of age and older. The prescribing information for Kalbitor includes a Boxed Warning regarding the risk of anaphylaxis and it is dispensed with a patient Medication Guide.
FDA Approves Evzio for Opioid Overdose
The FDA has approved kaléo’s Evzio (naloxone hydrochloride) injection for the emergency treatment of known or suspected opioid overdose characterized by decreased breathing or heart rate, or loss of consciousness. Evzio is delivered via a hand-held autoinjector that can be stored in a pocket or medicine cabinet and can administered by a family member or caregiver. Previous naloxone treatments required administration via syringe and were most commonly used by health care providers.
FDA Approves Oralair Allergy Immunotherapy
The FDA has approved Greer’s Oralair once-daily sublingual immunotherapy tablet for the treatment of allergic rhinitis with or without conjunctivitis that is induced by certain grass pollens in persons 10 through 65 years of age. The prescribing information includes a Boxed Warning that severe allergic reactions such as anaphylaxis can occur. After administration of the first dose under supervision in a health care provider’s office, Oralair can be taken at home. Patients must also be prescribed an epinephrine auto-injector and trained on how to use it due to the risk of anaphylaxis.
Expanded Age Indication for Adacel
The FDA has approved an expanded age indication for Sanofi Pasteur’s Adacel (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine adsorbed [Tdap]) for active booster immunization for the prevention of tetanus, diphtheria, and pertussis as a single dose in persons 10 to 64 years of age. Adacel was previously indicated in persons 11 to 64 years of age.
Nexium 24HR Available OTC
The FDA has approved Pfizer’s Nexium 24HR (esomeprazole 20 mg) for OTC availability.
FDA Approves Alprolix for Hemophilia B
The FDA has approved Biogen Idec’s Alprolix (coagulation factor IX [recombinant] Fc fusion protein) lyophilized powder for solution for the control and prevention of bleeding episodes; perioperative management; and routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children with hemophilia B.
alli Capsules Recalled
GlaxoSmithKline Consumer Healthcare is voluntarily recalling all alli (orlistat) capsules from the US and Puerto Rico at the retail level because some packages may have been tampered with and may not contain authentic product. A variety of tablets and capsules in different shapes and colors were reported to be found inside alli bottles; some bottles were also missing labels and had inauthentic tamper-evident seals. alli is indicated for weight loss in overweight adults 18 years and older in conjunction with a reduced-calorie and low-fat diet.
Consumers who have product they are concerned about should not use it and should contact GlaxoSmithKline at 1-800-671-2554 for further instructions; if they have consumed questionable product, they should also contact their health care provider.
Expanded Indication for Topamax
The FDA has approved an expanded indication for Janssen’s Topamax (topiramate) tablets to include the prevention of migraine headaches in adolescents 12 to 17 years of age. Topamax was previously approved for migraine prevention only in adults, as well as initial monotherapy in patients 2 years and older with partial-onset or primary generalized tonic-clonic seizures, and as adjunctive therapy in patients 2 years and older with partial-onset seizures, primary generalized tonic-clinic seizures, or seizures associated with Lennox-Gastaut syndrome. Topamax is dispensed with a patient Medication Guide.
Expanded Indication for Baraclude
The FDA has approved an expanded indication for Bristol-Myers Squibb’s Baraclude (entecavir) to include children at least 2 years of age for the treatment of chronic hepatitis B virus infection with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases or histologically active disease. Baraclude was previously indicated only in adults.
Otezla Approved for Psoriatic Arthritis
The FDA has approved Celgene’s Otezla (apremilast) oral tablets for the treatment of adult patients with active psoriatic arthritis. The FDA is requiring a pregnancy exposure registry as a postmarketing requirement to assess the risks to pregnant women exposed to Otezla.
FDA Approves Generic Mepron Suspension
The FDA has approved Amneal Pharmaceuticals’ atovaquone 750 mg/5 mL oral suspension, the generic version of Mepron, indicated for the prevention of Pneumocystis carinii pneumonia (PCP) in patients intolerant to trimethoprim-sulfamethoxazole (TMP-SMZ), as well as for the short-term oral treatment of mild to moderate PCP in patients intolerant to TMP-SMZ.
Expanded Xolair Indication
The FDA has approved an expanded indication for Xolair (omalizumab) injection to include the treatment of chronic idiopathic urticaria in adults and adolescents 12 years and older who remain symptomatic despite H1 antihistamine treatment. Xolair is also indicated for the treatment of moderate to severe persistent asthma in adults and adolescents 12 years and older who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids. Xolair labeling contains a Boxed Warning regarding the risk of anaphylaxis after administration.
Pleo Homeopathic Drugs Recalled
Terra-Medica, Inc. is voluntarily recalling 56 lots of Pleo-FORT, Pleo-QUENT, Pleo-NOT, Pleo-STOLO, Pleo-NOTA-QUENT, and Pleo-EX homeopathic drug products in liquid, tablet, capsule, ointment, and suppository forms. These products have the potential to contain penicillin or derivatives of penicillin, which may be produced during the fermentation process.
Terra-Medica is notifying its customers by letter and e-mail and is arranging for return of all recalled products. Consumers and distributors that have product subject to the recall should stop using the products and return them to the point of purchase. Consumers can contact Terra-Medica’s Customer Service Department at 1-888-415-0535, ext. 1, Monday through Friday, 8 AM to 5 PM PST.
For more information and to see the affected lots, visit http://www.fda.gov/Safety/Recalls/ucm389832.htm
The FDA has approved Piramal Imaging’s Neuraceq (florbetaben F18) injection for positron emission tomography (PET) imaging of the brain to estimate beta-amyloid neuritic plaque density in adults with cognitive impairment who are being evaluated for Alzheimer disease and other causes of cognitive decline.
FDA Approves Impavido for Leishmaniasis
The FDA has approved Paladin Therapeutics’ Impavido (miltefosine) for the treatment of visceral, cutaneous, and mucosal leishmaniasis in patients 12 years and older. Impavido labeling will include a Boxed Warning alerting patients and health care providers of the risk of fetal harm in pregnant women and advising women to use effective contraception during and for 5 months after therapy.
Expanded Labeling for Menopur and Bravelle
The FDA has approved new labeling for Ferring Pharmaceuticals’ fertility products, Menopur (menotropins for injection) and Bravelle (urofollitropin for injection, purified) to be safely mixed and administered in a single injection. Menopur and Bravelle are indicated for the development of multiple follicles and pregnancy in the ovulatory patients participating in the assisted reproductive technology program. Bravelle is also indicated for ovulation induction.
Pancreaze – New Strength
The FDA has approved a new 2,600 lipase unit capsule for Janssen Pharmaceuticals’ Pancreaze (pancrelipase) to easier facilitate dosing in infants. Pancreaze is indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions and is dispensed with a patient Medication Guide.
FDA Approves Hemangeol
The FDA has approved Pierre Fabre Dermatologie’s Hemangeol (propranolol hydrochloride) oral solution, the first approved treatment for infantile hemangioma. Hemangeol will be available June 2014.
Revised Labeling for Eliquis
The FDA has approved labeling changes for Bristol-Myers Squibb’s Eliquis (apixaban) oral tablets to include an expanded indication for the prophylaxis of deep vein thrombosis in patients who have undergone hip or knee surgery. An updated Boxed Warning has also been added regarding the increased risk of epidural or spinal hematoma that may result in long-term paralysis in patients administered neuraxial anesthesia. The FDA has determined that a Risk Evaluation and Mitigation Strategy (REMS) is necessary to ensure that the benefits of Eliquis outweigh the potential risks in patients with nonvalvular atrial fibrillation, and it will be dispensed with a patient Medication Guide.
Shire Pharmaceuticals is voluntarily recalling 1 batch packaged into 3 lots (FEW13-001, FEW13-002, and FED13-006; expiration date October 2015) of Vpriv (velaglucerase alfa) lyophilized powder for intravenous use due to the presence of visible particulate matter identified as stainless steel and barium sulfate. The matter was found in a small number of vials from the 3 lots. An investigation by Shire identified the third party supplier fill finish process as the cause of the particulate matter. The affected lots were distributed nationwide to hospitals, infusion clinics, patients, and home health agencies. Vpriv is indicated for long-term enzyme replacement therapy for pediatric and adult patients with type 1 Gaucher disease.
Customers should quarantine all affected product and arrange for return by contacting Shire at 1-888-899-9293, Monday through Friday, 8 AM to 5 PM EST.
FDA Approves Xartemis XR for Severe Acute Pain
The FDA has approved Mallinckrodt’s Xartemis XR (oxycodone 7.5 mg/acetaminophen 325 mg) extended-release tablets for the management of acute pain severe enough to require opioid treatment for which alternative treatment options are inadequate. Xartemis XR contains a Boxed Warning regarding the risks of addiction, abuse, and misuse; life-threatening respiratory depression; accidental overdose; neonatal withdrawal syndrome; and hepatotoxicity and will be dispensed with a patient Medication Guide.
FDA Approves Qudexy XR for Epilepsy
Metformin HCl Recall
Caraco Pharmaceutical Laboratories is voluntarily recalling 1 lot (JKM2433A, expiration date March 2016) of metformin HCl 500 mg extended-release tablets after gabapentin tablets were found in a 500-count bottle (NDC 62756-142-02) manufactured by Sun Pharmaceutical.
Expanded Boxed Warning for Xarelto
The FDA has expanded the Boxed Warning for Xarelto (rivaroxaban) to now include the following statement regarding factors that can increase the risk of epidural or spinal hematomas: optimal timing between the administration of Xarelto and neuraxial procedures is not known. The Boxed Warning had previously stated that factors that can increase the risk of epidural or spinal hematomas in patients being treated with Xarelto include use of indwelling epidural catheters; concomitant use of other drugs that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants; a history of traumatic or repeated epidural or spinal punctures; or a history of spinal deformity or spinal surgery. Xarelto is indicated to reduce the risk of stroke and embolism in patients with nonvalvular atrial fibrillation; for the treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and PE; and for the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement.
FDA Approves Generic Xeloda Tablets
The FDA has approved Teva Pharmaceutical’s capecitabine 150 and 500 mg tablets, the generic version of Xeloda, indicated as adjuvant treatment of patients with Duke stage C colon cancer, monotherapy for metastatic colorectal cancer when treatment with fluoropyrimidine therapy alone is preferred, in combination with docetaxel for metastatic breast cancer after failure of prior anthracycline-containing therapy, and as monotherapy in patients with metastatic breast cancer who are resistant to paclitaxel and an anthracycline-containing regimen. Capecitabine carries a Boxed Warning regarding the risk of a dangerous warfarin interaction.
Expanded Boxed Warning for Nizoral Tablets
The FDA has expanded the Boxed Warning for Janssen Pharmaceutical’s Nizoral (ketoconazole) tablets. The Boxed Warning now includes the following statement: Co-administration of the following drugs with ketoconazole is contraindicated: dofetilide, quinidine, pimozide, cisapride, methadone, disopyramide, dronedarone, ranolazine. The Boxed Warning had previously stated that ketoconazole was contraindicated with cisapride, dofetilide, quinidine, and pimozide. Nizoral tablets are indicated for treatment of the following systemic fungal infections in patients who have not responded to or are intolerant to other therapies: blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis.
Effexor XR 150 mg and Venlafaxine HCl 150 mg Extended-Release Recall
Pfizer is voluntarily recalling 1 lot of 30-count and 1 lot of 90-count Effexor XR (venlafaxine HCl) 150 mg extended-release capsules (lot numbers V130142 and V130140, expiration date October 2015) due to the possible presence of Tikosyn (dofetilide) 0.25 mg capsules within the same package. One lot (V130014, expiration date August 2015) of 90-count Greenstone LLC-branded venlafaxine HCl 150 mg extended-release capsules is also being recalled for the possible presence of Tikosyn. Accidental ingestion of dofetilide in patients taking venlafaxine could lead to serious (some potentially fatal) adverse effects. Existing inventory of the affected lots should be immediately quarantined and returned. Customers should contact Stericycle at 1-888-345-0481, Monday through Friday, 8 AM to 5 PM EST to arrange for product return. Patients with questions regarding this recall can contact Pfizer Medical Information at 1-800-438-1985, Monday through Thursday, 9 AM to 8 PM EST or Friday, 9 AM to 5 PM EST.
Doribax Safety Alert
The FDA has concluded that Shionogi Pharma’s Doribax (doripenem) carries an increased risk of death and lower clinical cure rates compared with the use of Merck Sharp & Dohme’s Primaxim IV (imipenem/cilastatin) when used to treat ventilator-associated pneumonia. Based on an FDA analysis of data from a 3-year clinical trial that was prematurely stopped in 2011 due to these safety concerns, the FDA approved changes to the Doribax prescribing information to now include a new warning about this unapproved use. Doribax is not approved to treat any type of pneumonia.
Health care providers should consider whether the benefits of Doribax are likely to exceed its potential risks in patients who develop ventilator-associated pneumonia. Doribax is still considered safe and effective for its FDA-approved indications.
Dianeal PD-2 Recall
Baxter International is voluntarily recalling 1 lot (C903799, expiration date May 2015, product code L5B9710) of Dianeal PD-2 peritoneal dialysis solution with 1.5% dextrose 6,000 mL (Ambu-Flex II) after complaints of particulate matter, identified as mold, being found in the container as a result of a leak. Administration of the contaminated product could result in life-threatening fungal peritoneal infection or sepsis. Health care providers should quarantine any affected product and arrange for its return by contacting Baxter Healthcare Center for Service at 1-888-229-0001, Monday through Friday, 7 AM to 6 PM CST. Dianeal PD-2 is indicated for the treatment of renal failure, poisoning by dialyzable toxins, intractable edema, hyperkalemia and hypercalcemia, azotemia and uremia, and hepatic coma.
Expanded Indication for Nexium IV
The FDA has approved an expanded indication for AztraZeneca’s Nexium IV (esomeprazole sodium) injection to include risk reduction of rebleeding of gastric or duodenal ulcers following therapeutic endoscopy in adults. Nexium IV is also indicated for short-term treatment of gastroesophageal reflux disease with erosive esophagitis in adults and pediatric patients 1 month to 17 years of age when therapy with oral esomeprazole is not possible or appropriate.
FDA Approves Generic Evista Tablets
The FDA has approved Teva Pharmaceutical’s raloxifene 60 mg tablets, the generic version of Evista, indicated for the treatment and prevention of osteoporosis, reduction in the risk of invasive breast cancer in postmenopausal women with osteoporosis, and reduction in the risk of invasive breast cancer in postmenopausal women at high risk of invasive breast cancer. Evista carries a Boxed Warning regarding the increased risk of venous thromboembolism and death from stroke and is dispensed with a patient Medication Guide.
Biotest Pharmaceuticals is voluntarily recalling several lots of Bivigam (immune globulin intravenous [human]) 10% liquid in 100 mL vials because of the potential that a small percentage of the vials may exhibit an integrity defect, which could result in product leakage. Vials from the affected lots should be quarantined and returned to the manufacturer. Bivigam is indicated for the treatment of patients with primary humoral immunodeficiency.
FDA Approves Tivorbex for Acute Pain
The FDA has approved Iroko Pharmaceuticals’ Tivorbex (indomethacin) 20 and 40 mg capsules, a nonsteroidal anti-inflammatory drug for the treatment of mild to moderate acute pain in adults. Tivorbex capsules were approved at dosage strengths 20 percent lower than those of currently available indomethacin products. Tivorbex carries a Boxed Warning regarding the increased risk of serious cardiovascular and gastrointestinal events, and is dispensed with a patient Medication Guide.
Myalept Approved to Treat Rare Metabolic Disease
The FDA has approved Amylin Pharmaceuticals’ Myalept (metreleptin) injection as replacement therapy to treat the complications of leptin deficiency, in addition to diet, in patients with congenital generalized or acquired generalized lipodystrophy. Myalept is not approved for use in patients with HIV-related lipodystrophy or in patients with metabolic disease, including diabetes mellitus and hypertriglyceridemia, without concurrent evidence of generalized lipodystrophy. Myalept is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) and will be dispensed with a patient Medication Guide.
Generic Avelox Tablets Approved
The FDA has approved Teva Pharmaceuticals’ moxifloxacin hydrochloride 400 mg tablets, the generic version of Avelox, indicated for the treatment of acute bacterial exacerbation of chronic bronchitis; acute bacterial sinusitis; community-acquired pneumonia; complicated intra-abdominal infections; complicated skin and skin structure infections; and uncomplicated skin and skin structure infections.
Expanded Indication for Kalydeco
The FDA has approved an expanded indication for Vertex Pharmaceuticals’ Kalydeco (ivacaftor) tablets to include the treatment of cystic fibrosis in patients 6 years and older who have 1 of the following mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene: G551D, G1244E, G1349D, G178R, G551S, S1251N, S1255P, S549N, or S549R. Kalydeco was previously indicated only for treatment of cystic fibrosis in patients 6 years and older with a G551D mutation in the CFTR gene.
Etomidate Injection Recall
Mylan has announced that its subsidiary Agila Specialties is issuing a voluntary nationwide recall of 10 lots of etomidate injection 2 mg/mL in 10 mL and 20 mL vials due to the potential for small black particles, identified as paper shipper labels, to be present in individual vials; the potential for missing lot number and/or expiration date on the outer carton; and the potential for illegible/missing lot number and expiration date on individual vials. Customers that have the recalled product should stop use and discontinue distribution. All recalled products bear a Pfizer label.
- 10 mL (lot number; expiration date)
- 5001023; 9/14
- 5000983; 8/14
- 5000986; 8/14
- 20 mL (lot number; expiration date)
- 5001012; 9/14
- 5000927; 6/14
- 5000931; 6/14
- 5000936; 6/14
- 5000942; 6/14
- 5001071; 10/14
- 5001040; 9/14
Consumers with questions regarding this recall can contact Mylan Customer Service at 1-800-848-0462 Monday through Friday between 8:00 AM and 5:00 PM EST. Etomidate is indicated for induction of general anesthesia and for the supplementation of subpotent anesthetic agents during maintenance of anesthesia for short operative procedures.
FDA Approves Vimizim for MPS IVA
The FDA has approved BioMarin Pharmaceutical’s Vimizim (elosulfase alfa) injection for the treatment of mucopolysaccharidosis type IVA (Morquio A syndrome; MPS IVA). Vimizim labeling contains a Boxed Warning regarding the risk of anaphylaxis and was granted priority review.
FDA Approves Northera for Neurogenic Orthostatic Hypotension
The FDA has approved Chelsea Therapeutics’ Northera (droxidopa) capsules for the treatment of neurogenic orthostatic hypotension. Northera labeling contains a Boxed Warning regarding the risk of supine hypertension and was approved under the FDA’s accelerated approval program.
The chemical compounding firm Medisca is voluntarily recalling certain lots of its pharmaceutical grade L-citrulline product after FDA testing indicated that it does not contain L-citrulline, but instead contains N-acetyl-leucine, which is used to treat acute vestibular vertigo. L-citrulline, an amino acid used to treat urea cycle disorders mainly in children, is supplied as a powder that may also be compounded into tablets, capsules, or liquids. Health care providers should discontinue dispensing from these lots: 95482/A, 95482/B, 95482/C, 95482/D; 96453/A, 96453/B, 96453/C, 96453/D. Patients should be contacted and all unused product should be returned to Medisca. The FDA has received several adverse event reports associated with L-citrulline and is investigating reports that may include additional lot numbers.
Acetylcysteine Solution 10% Recalled
Ben Venue Laboratories has notified health care providers of a nationwide voluntary product recall of Roxane Laboratories’ acetylcysteine solution 10%, 30 mL per vial, (lot 2005479, expiration date March 2014, NDC 0054-3025-02) due to the discovery of a single visible glass particle in a vial within the recalled lot. Health care providers should not use the affected product lot and should immediately quarantine any product for return. Patients who may have received the affected product should return it to their pharmacist. Distributors/retailers that have not received a recall packet should contact GENCO Pharmaceutical Services, 6101 North 64th Street, Milwaukee, WI 53218 (1-800-633-1422).
New Boxed Warning for Cozaar
The FDA has approved a new Boxed Warning for Cozaar (losartan) alerting health care providers that the drug should be discontinued as soon as possible when pregnancy is detected and that drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. Cozaar is indicated for the treatment of hypertension, to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, and for the treatment of diabetic neuropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and a history of hypertension.
Expanded Indication for Imbruvica
The FDA has approved an expanded indication for Pharmacyclics’ Imbruvica (ibrutinib) to include the treatment of chronic lymphocytic leukemia patients who have received at least 1 previous therapy. Imbruvica is also approved for the treatment of mantle cell lymphoma in patients who have received at least 1 prior therapy.
Generic Hectorol Injection Launched
Sandoz has launched doxercalciferol injection 4 mcg/2mL single-dose vials, the first generic version of Hectorol, indicated for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis.
Revatio Label Changes
The FDA has approved label changes specifying new dosing recommendations for Revatio (sildenafil citrate). The new recommended dose for the tablets and oral suspension is 5 or 20 mg three times a day, and 2.5 or 10 mg three times a day for the injection. Data from a clinical study evaluating sildenafil doses of 1 mg, 5 mg, and 20 mg showed that there were no significant differences in the effects on hemodynamic variables with lower doses. Revatio is indicated for the treatment of pulmonary arterial hypertension to improve exercise ability and delay clinical worsening.
Testosterone Product Safety Alert
The FDA is investigating the risk of stroke, heart attack, and death in men taking FDA-approved testosterone products. The FDA is evaluating information from 2 separate studies that suggest an increased risk of cardiovascular events among groups of men prescribed testosterone therapy, although the agency has not concluded that these products increase the risk of stroke, heart attack, or death. Testosterone products are indicated for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone. Patients should not stop taking prescribed testosterone products without first discussing any questions or concerns with their health care providers. Health care providers should consider whether the benefits of FDA-approved testosterone treatment are likely to exceed the potential risk of treatment. The FDA will communicate final conclusions and recommendations when the evaluation is complete.
FDA Approves Hetlioz
The FDA has approved Vanda Pharmaceuticals Hetlioz (tasimelteon) capsules for the treatment of non-24-hour sleep-wake disorder in totally blind individuals. “Non-24” is a chronic circadian rhythm disorder in the blind that causes problems with the timing of sleep. Vanda anticipates commercial availability in the second quarter of 2014.
Expanded Indication for ActHIB
The FDA has approved Sanofi Pasteur’s ActHIB (Haemophilus influenzae type B [Hib] conjugate vaccine) for the active immunization of infants and children 2 months through 5 years of age for the prevention of invasive disease caused by Haemophilus influenzae type B. It was previously approved for infants and children 2 to 18 months of age. ActHIB is also approved for the active immunization of children 15 to 18 months of age for prevention of invasive disease caused by Hib and diphtheria, tetanus, and pertussis when reconstituted with Tripedia (DTaP) vaccine.
Trufill n-BCA Liquid Embolic System Recalled
Codman Neuro has recalled Trufill n-BCA liquid embolic system due to incorrect instructions for use. The product instructions should have stated “A 2:1 (67% Ethiodized Oil / 33% nBCA) for Intranidal injections without AV fistulae or high flow rates in order to more deeply penetrate the nidus” instead of the incorrect “A 2:1 (67% Ethiodized Oil / 33% nBCA) for feeding pedicle injections close to the nidus at high flow rates where venous opacification occurs on contrast injections within 1/2 second." The use of incorrectly mixed product can result in the liquid mixture solidifying too slowly in unintended areas, which may lead to embolization or reflux into arteries and pulmonary vessels, resulting in neurological deficits, pulmonary emboli, or death.
The affected product, manufactured between February 25, 2010, and October 31, 2013, was distributed to hospitals and surgical centers and includes the following product codes (all lots): 631400 (two 1 g tubes nBCA) and 631500 (one 1 g tube nBCA). Customers may contact Codman Neuro for more information or to report any malfunction or adverse event at 1-866-491-0974, option 2, Monday-Friday, 7 AM-6:30 PM, EST.
Sodium Chloride 0.9% Safety Alert
A shortage of sodium chloride 0.9% injection in liter bags has led some hospitals to administer sodium chloride for irrigation 0.9% as an alternative to the injection. However, this product does not meet the same specifications of the sterile injection and should not be used; sterility requirements and limits on particulate matter differ between these 2 products.
For more information concerning the contraindicated use of irrigation solution intravenously, as well as information for hospitals to consider during this shortage, see the health bulletin.
Iclusig Available in the US
Ariad Pharmaceuticals has announced the commercial availability of Iclusig (ponatinib) in the US for the treatment of adult patients with refractory chronic myeloid leukemia and Philadelphia chromosome–positive acute lymphoblastic leukemia. Ariad began shipping Iclusig to its exclusive specialty pharmacy Biologics, which is now filling prescriptions and distributing the medication.
As a result of an investigation that revealed a steady increase in the number of serious vascular occlusion events identified through continued safety monitoring, on October 31, 2013, the FDA requested and Ariad agreed to voluntarily suspend marketing of Iclusig's.
The investigation represented a significant change in Iclusig's safety profile, as the proportion of patients taking the drug experiencing vascular occlusion events (eg, blood clots, severe narrowing of blood vessels) was significantly greater than the proportion reported at the time of its approval in December 2012. The FDA approved revised prescribing information in the US, as well a Risk Evaluation and Mitigation Strategy (REMS), allowing for immediate resumption of marketing and commercial distribution. Changes include a revised indication statement and boxed warning, updated safety information, and recommendations regarding dosing considerations. Additional information is available here and here.
See previous story.
StemAlive 90 Capsules Recalled
Stemvida is recalling 11 lots of StemAlive 90 Capsules nutritional supplement after they were found to contain undeclared milk, which can cause serious or life-threatening allergic reactions in people who have an allergy or severe sensitivity to milk. StemAlive was distributed in Arizona, California, Colorado, Florida, New Jersey, New York, Nevada, Oklahoma, Texas, and Utah.
Consumers who purchased StemAlive 90 Capsules should return them to Stemvida for replacement or refund. For more information, contact Stemvida at 1-888-950-8432, 9 AM to 8:30 PM PST.
FDA Recommends Acetaminophen 325 mg or Less Per Dosage Unit
The FDA is recommending that health care providers discontinue prescribing and dispensing prescription combination drug products that contain more than acetaminophen 325 mg per tablet, capsule, or other dosage unit. There are no available data to show that taking more than acetaminophen 325 mg per dosage unit provides additional benefit that outweighs the added risks for liver injury. Limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death.
Over half of manufacturers voluntarily complied with the initial FDA request in January 2011 to limit the amount of acetaminophen to no more than 325 mg in each dosage unit; however, some prescription combination drug products containing more than acetaminophen 325 mg per dosage unit remain available. The FDA intends to institute proceedings to withdraw approval of prescription combination drug products with more than acetaminophen 325 mg per dosage unit that remain on the market in the near future.
The FDA recommends that a pharmacist who receives a prescription for a combination product with more than acetaminophen 325 mg per dosage unit should contact the prescriber to discuss a product with a lower dose of acetaminophen.
FDA Approves ReSure Sealant for Cataract Surgery
The FDA has approved Ocular Therapeutix’s ReSure Sealant kit, the first gel sealant for use in stopping fluid from leaking through the incision in a patient’s cornea after cataract surgery with intraocular lens placement in adults. ReSure Sealant is approved for use in cataract surgeries on patients with clear corneas.
FDA Approves Mekinist with Tafinlar for Melanoma
The FDA has approved GlaxoSmithKline’s Mekinist (trametinib) for use in combination with Tafinlar (dabrafenib) for the treatment of patients with unresectable melanoma or metastatic melanoma with BRAF V600E or V600K mutations. Tafinlar is not indicated for treatment of patients with wild-type BRAF melanoma. Mekinist will be dispensed with a patient Medication Guide.
FDA Approves Generic Micardis
The FDA has approved Actavis’ telmisartan 20, 40, and 80 mg immediate-release tablets, the generic version of Micardis, indicated for the treatment of hypertension and for the reduction of cardiovascular risk in patients unable to take ACE inhibitors. Actavis intends to launch the product immediately.
OTC Sodium Phosphate Overdose Warning
The FDA has issued a warning that rare but potentially serious adverse effects (including death) may occur when recommended doses of OTC sodium phosphate preparations to treat constipation are exceeded. Severe dehydration and alterations in serum electrolytes leading to adverse effects have been reported, mostly when a single maximum dose was exceeded or when more than 1 dose was taken per day. Patients should be advised to adhere to the product labeling and not exceed maximum recommended doses. Health care providers should use caution when recommending doses for oral sodium phosphate preparations for children 5 years and younger. Rectal preparations should never be administered to children younger than 2 years.
FDA Approves Farxiga
The FDA has approved Bristol-Meyers Squibb and AstraZeneca Pharmaceuticals’ Farxiga (dapaglifozin) tablets to improve glycemic control, along with diet and exercise, in adults with type 2 diabetes.
FDA Approves Feiba for Hemophilia A or B
The FDA has approved Baxter’s Feiba (anti-inhibitor coagulant complex), the first and only FDA-approved treatment for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in patients with hemophilia A or B who have developed inhibitors. Feiba is currently indicated for the control of spontaneous bleeding episodes or to cover surgical interventions in hemophilia A and B patients with inhibitors.
Clinimix and Clinimix E Injection Recall
Baxter International has issued a voluntary recall of 2 lots of Clinimix (amino acid in dextrose) and 1 lot of Clinimix E (amino acid with electrolytes in dextrose with calcium) injection parenteral nutrition products due to complaints of particulate matter found in the products. The affected product codes are 2B7729 (lot P287045, exp 06/14), 2B7717 (lot P275883, exp 10/13), and 2B7709 (lot P28512, exp 05/14). These lots were distributed to customers between May 2012 and October 2013.
Baxter has directed customers not to use product from the recalled lots and to locate and remove all affected products from their facilities.
FDA Approves Generic Detrol LA Capsules
The FDA has approved Teva Pharmaceutical Industries Ltd.’s tolterodine tartrate 2 and 4 mg extended-release capsules, the generic version of Detrol LA, indicated for the treatment of overactive bladder.
FDA Approves New Boxed Warning for Human Immune Globulin Products
The FDA has approved a new boxed warning for intravenous, subcutaneous, and intramuscular human immune globulin products alerting health care providers that thrombosis may occur. Risk factors may include advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling central vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors.
Baxter Recalls Dextrose 5% Injection and Sodium Chloride 0.9% Injection
Baxter International Inc. is voluntarily recalling 1 lot (P285288) of dextrose 5% injection and 4 lots (P297283, P292326, P293993, P293514) of sodium chloride 0.9% injection due to particulate matter found in the solutions.
Products affected by this recall were packaged in flexible plastic containers, with 96 containers per carton. The affected lots were distributed to customers between May 2012 and October 2013.
Customers who have product affected by this recall should stop use and arrange for return. Unaffected lot numbers can continue to be used according to the instructions for use. Affected product should be returned to Baxter for credit by contacting Baxter Healthcare Center for Service at 1-888-229-0001, Monday through Friday, between 7 AM and 6 PM CST. Unaffected lots of product are available for replacement.
More information can be found at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm379915.htm
Merck Recalls Gardasil
Merck Sharp & Dohme Corp. is voluntarily recalling 1 lot (J007354) of Gardasil (human papillomavirus quadrivalent [types 6, 11, 16, and 18]) vaccine due to the potential for a limited number of vials to contain glass particles. This lot was distributed between August 20, 2013 and October 9, 2013. No other distributed lots are affected.
If a vaccine containing glass particles is administered to a patient, there is a remote risk of an injection site reaction. The sterility of the vaccine has not been impacted. If product from this lot has been administered, revaccination is not necessary. The supply of Gardasil will not be impacted by this recall.
Customers are asked to examine their inventory and follow the steps outlined in the notification.
Revlimid Associated with the Risk of Hepatotoxicity
Celgene and Health Canada are informing health care providers of the risk of hepatotoxicity with the use of Revlimid (lenalidomide) capsules. Revlimid is indicated for the treatment of transfusion-dependent anemia due to low- or intermediate-1–risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities. It is also indicated in combination with dexamethasone for the treatment of multiple myeloma in patients who have received at least 1 prior therapy.
The following points summarize the updated safety information:
- Severe cases of liver injuries (eg, acute hepatic failure, toxic hepatitis, cytolytic hepatitis, cholestatic hepatitis, mixed cytolytic/cholestatic hepatitis) have been reported in multiple myeloma patients who received Revlimid in combination with dexamethasone. Some cases were fatal.
- The mechanism of severe drug-induced hepatotoxicity in patients exposed to Revlimid is unknown. Risk factors may include preexisting viral liver disease, elevated baseline liver enzymes, and concomitant medications.
- Monitor liver enzymes periodically. Discontinue Revlimid if an elevation of liver enzymes is observed. After return to baseline values, consider treatment at a lower dose.
The Canadian product monograph for Revlimid was revised to include the updated risk information under the Warnings and Precautions section.
Comorbid conditions, such as a history of hepatic and renal disorders, concurrent liver infection, or concomitant use of hepatotoxic medications, may contribute to Revlimid-associated hepatotoxicity. A small increase in overall reporting of hepatic-related adverse events in the patient population exposed to the drug was noted in safety reviews; such reports were mostly of liver-related investigations, signs, and symptoms. Hepatic failure, fibrosis and cirrhosis, cholestasis, and jaundice, as well as noninfectious hepatitis, were reported rarely. Fatal outcomes were observed in a few cases, and most were complicated by advanced malignant disease, previous or active liver disease, and multiple comorbidities. The mechanisms involved in the physiopathology remain unknown, but a causal relationship between lenalidomide and hepatic disorders cannot be excluded.
Lidocaine Hydrochloride 2% Injection Recall
Hospira has issued a voluntary for 1 lot (NDC 0409-2066-05, lot 32-135-DD, expiration date 1AUG2015) of lidocaine hydrochloride 2% injection, 5 mL single-dose vial due to a reddish-orange particulate on the inner surface and floating in the solution.
The recalled lot was distributed in several states from September 2013 through October 2013.
Anyone with an existing inventory from the recalled lot should immediately stop use, quarantine any affected product, and return it to Stericycle. Hospira will be notifying its direct distributors/customers via a recall letter and will arrange for impacted product to be returned to Stericycle for returns processing. For additional assistance, call Stericycle at 1-855-695-8596 Monday through Friday between 8 AM and 5 PM EST.
For more information, see: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm379751.htm.
Expanded Indication for Isentress
The FDA has approved Merck’s Isentress (raltegravir) tablets, chewable tablets, and oral suspension for the treatment of HIV-1 infection in patients 4 weeks and older in combination with other antiretroviral agents. Isentress was previously approved for treatment of HIV-1 infection in patients 2 years and older weighing at least 10 kg in combination with other retroviral agents.
Tretten Approved for Clotting Disorder
The FDA has approved Novo Nordisk’s Tretten (coagulation Factor XIII A-subunit) recombinant for the routine prevention of bleeding in adults and children who have congenital Factor XIII A-subunit deficiency, a rare clotting disorder. Tretten is the first recombinant product approved for this use and has been granted orphan drug status for this indication.
Orenitram Approved for PAH
The FDA has approved United Therapeutics’ Orenitram (treprostinil) extended-release tablets for the treatment of pulmonary arterial hypertension (PAH) in WHO group I patients to improve exercise capacity.
Iclusig Marketing to Resume
The FDA is requiring new safety measures for Ariad Pharmaceuticals’ Iclusig (ponatinib) to address the risk of life-threatening blood clots and severe narrowing of blood vessels. Once these new safety measures are in place, marketing to appropriate patients is expected to resume after being suspended in October 2013. These measures should be reviewed and carefully considered when the risks and benefits of Iclusig are evaluated for each patient.
The required safety measures involve label changes to narrow the indication, provide additional warnings and precautions about the risk of blood clots and severe narrowing of blood vessels, revise recommendations about dosage and administration, and update the patient Medication Guide. The FDA is also requiring the inclusion of a Risk Evaluation and Mitigation Strategy (REMS), as well as postmarketing investigations by Ariad to further characterize the drug’s safety and dosing.
Additional information, including details on the new safety measures, is available here.
Read a the previous story.
FDA Approves Feiba
The FDA has approved Baxter’s Feiba (anti-inhibitor coagulant complex) for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in patients with hemophilia A or B who have developed inhibitors. Feiba includes a Boxed Warning regarding the risk of thromboembolic events, particularly following the administration of high doses and/or in patients with thrombotic risk factors.
Sterile Products Recall
Abrams Royal Pharmacy is voluntarily recalling all unexpired lots of sterile products due to concerns about lack of sterility assurance. The recall was issued after a single report of an adverse event involving a patient who received a compounded product from the pharmacy. The recalled products were distributed nationwide from June 17, 2013, through December 17, 2013.
For more information or to arrange for product return, contact Abrams Royal at 1-214-349-8000, Monday through Friday, 9 AM to 5 PM CST.
Risk of Priapism Associated with Methylphenidate
The FDA is warning that methylphenidate products may cause priapism and has updated the drug label and patient Medication Guide to include information about this rare but serious risk. Patients who take methylphenidate and develop erections lasting longer than 4 hours should seek immediate medical treatment to prevent long-term problems with the penis. Priapism has also been associated with atomoxetine and appears to be more common in patients taking this drug than in those taking methylphenidate products. However, due to limited information, the FDA does not know how often priapism occurs in patients taking either type of product.
FDA Approves Anoro Ellipta for COPD
The FDA has approved GlaxoSmithKline’s Anoro Ellipta (umeclidinium and vilanterol inhalation powder) for the once-daily, long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD). The drug carries a Boxed Warning that long-acting beta2-adrenergic agonists increase the risk of asthma-related death. The safety and efficacy of Anoro Ellipta in patients with asthma have not been established, and it is not approved for the treatment of asthma. Anoro Ellipta should not be used as a rescue therapy to treat sudden breathing problems. Anoro Ellipta will be dispensed with a patient Medication Guide that will include instructions for use and information about potential risks associated with the drug.
Expanded Indication for Kcentra
The FDA has approved CSL Behring’s Kcentra (prothrombin complex concentrate [human]) for urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist (eg, warfarin) therapy in adult patients needing urgent surgery or other invasive procedure. Kcentra is currently approved in adults for the treatment of acute major bleeding in patients with vitamin K antagonist-induced coagulation factor deficiency.
Alexion Pharmaceuticals Expands Soliris Recall
Alexion Pharmaceuticals has expanded its voluntary recall of 2 lots (10010A and 10001-1, NDC 25682-001-01) of Soliris (eculizumab) concentrated solution for intravenous infusion to the hospital and user levels because the lots were found to contain visible particles. The recall was previously only to the distributor level.
The affected lot numbers were last shipped November 1, 2013. Anyone in possession of Soliris from these 2 lots should stop use and arrange for return of the product to Alexion immediately by calling 1-888-765-4747.
Expanded Indication for Complera
The FDA has approved Gilead’s Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate) tablets for the treatment of HIV-1 infection in certain virologically suppressed adults with HIV-1 RNA less than 50 copies/mL on a stable antiretroviral regimen at start of therapy to replace their current antiretroviral regimen. Complera is also approved for use as a complete regimen for the treatment of HIV-1 infection in antiretroviral treatment–naive adults with HIV-1 RNA 100,000 copies/mL or less at the start of therapy.
For more information, see the previous story.
FDA Approves Generic Cymbalta
The FDA has approved the first generic versions of Cymbalta (duloxetine) delayed-release capsules, indicated for the treatment of major depressive disorder, generalized anxiety disorder, fibromyalgia, diabetic peripheral neuropathic pain, and chronic musculoskeletal pain.
Aurobindo Pharma, Dr. Reddy’s Laboratories, Lupin, Sun Pharma Global FZE, Teva Pharmaceuticals USA, and Torrent Pharmaceuticals have received FDA approval to market duloxetine in various strengths. Duloxetine must be dispensed with a patient Medication Guide that includes important information about the drug’s uses and risks.
Sovaldi Approved for Hepatitis C
The FDA has approved Gilead’s Sovaldi (sofosbuvir) oral tablets for the treatment of chronic hepatitis C virus infection in adults. Sovaldi is to be used as a component of a combination antiviral treatment regimen for chronic HCV infection including Sovaldi and ribavirin or Sovaldi, ribavirin, and peginterferon-alfa.
Expanded Indication for Xiaflex
The FDA has approved Auxilium Pharmaceuticals’ Xiaflex (collagenase clostridium histolyticum) injection solution for the treatment of Peyronie disease in men. Xiaflex is the first FDA-approved medicine for this indication. Xiaflex is also indicated for the treatment of adult patients with Dupuytren contracture with palpable cord.
Onfi Safety Alert
The FDA is warning the public that Lundbeck’s Onfi (clobazam) can cause rare but serious skin reactions called Stevens-Johnson syndrome and toxic epidermal necrolysis that can result in permanent harm and death. The FDA approved changes to the Onfi drug label and the patient Medication Guide to describe the risk of these serious skin reactions. Onfi is a benzodiazepine medication used in combination with other medicines to treat seizures associated with a severe form of epilepsy called Lennox-Gastaut Syndrome. Health care providers should monitor patients closely for signs and symptoms of skin reactions, especially during the first 8 weeks of treatment and encourage patients to seek immediate medical treatment if they develop a rash, blistering or peeling of the skin, sores in the mouth, or hives.
Baxter Recalls Nitroglycerin in 5% Dextrose Injection
Baxter International is voluntarily recalling 1 lot (G105197) of nitroglycerin in 5% dextrose injection packaged in 250 mL glass containers due to particulate matter found in 1 vial. Any available product should be immediately quarantined.
The affected lot was distributed to customers between January 17, 2013, and October 10, 2013. Product returns can be arranged by contacting Baxter at 1-888-229-0001 between 7:00 AM and 6:00 PM CST.
Abbott Recalls FreeStyle and FreeStyle Lite Test Strips
Abbott is initiating a voluntary US recall of 20 lots of FreeStyle and FreeStyle Lite Blood Glucose Test Strips because they may produce erroneously low blood glucose results when used with the FreeStyle Blood Glucose Meter, FreeStyle Flash Blood Glucose Meter (not produced since 2010), and the OmniPod Insulin Management System. When the test strips are used with the newer FreeStyle-brand meters including FreeStyle Freedom Blood Glucose Meter, FreeStyle Lite Blood Glucose Meter, and FreeStyle Freedom Lite Blood Glucose Meter, the test results are not affected. The affected test strips have expiration dates between May 2014 and March 2015:
Abbott is notifying health care providers, pharmacies, distributors, and customers about the recall. Customers affected by this recall can call 1-888-736-9869 for a replacement at no charge.
FDA Approves Velphoro
The FDA has approved Galenica’s Velphoro (sucroferric oxyhydroxide) tablets for the control of serum phosphorus levels in patients with chronic kidney disease on dialysis. Velphoro will be launched in the US by Fresenius Medical Care North America in 2014.
FDA Approves Varithena for Varicose Veins
The FDA has approved BTG’s Varithena (polidocanol) injectable foam for the treatment of patients with incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein system above and below the knee. Varithena improves the symptoms of superficial venous incompetence and the appearance of visible varicosities. The company plans to launch the product in the US in the second quarter of 2014.
Hydroxyethyl Starch Solutions Updated Boxed Warning
The FDA has updated the Box Warning to the labeling for hydroxyethyl starch (HES) solutions to include the following:
- Monitor the coagulation status of patients undergoing open heart surgery in association with cardiopulmonary bypass as excess bleeding has been reported with hydroxyethyl starch solutions.
- Do not use hydroxyethyl starch products in patients with severe liver disease.
- Monitor liver function in patients receiving hydroxyethyl starch products.
FDA Recommendations for Health Professionals also included:
- Do not use hydroxyethyl starch solutions in critically ill adult patients, including those with sepsis and those admitted to the intensive care unit.
- Avoid use in patients with preexisting renal dysfunction.
- Discontinue use of hydroxyethyl starch at the first sign of renal injury.
- Need for renal replacement therapy has been reported up to 90 days after hydroxyethyl starch administration. Continue to monitor renal function for at least 90 days in all patients.
- Avoid use in patients undergoing open heart surgery in association with cardiopulmonary bypass due to excess bleeding.
- Discontinue use of hydroxyethyl starch at the first sign of coagulopathy.
Hydroxyethyl starch solutions are indicated for the treatment of hypovolemia when plasma volume expansion is desired. Voluven (Hospira) is also indicated for the prophylaxis of hypovolemia when plasma volume expansion is desired. Hespan (B. Braun) is also indicated as an adjunct in leukapheresis to improve harvesting and increase yield of granulocytes by centrifugal means.
FDA Removes Some Restrictions for Rosiglitazone-Containing Medicines
The FDA is requiring the removal of prescribing and dispensing restrictions that were put in place in 2010 for rosiglitazone medicines such as Avandia, Avandamet, Avandaryl, and generics. The change is based on recent data that did not show an increased risk of heart attack compared with the standard type 2 diabetes drugs metformin and sulfonylureas. The current rosiglitazone Risk Evaluation and Mitigation Strategy (REMS) and patient Medication Guide will also be modified.http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm376683.htm
FDA Approves Aptiom for Seizures
The FDA has approved Sunovion Pharmaceuticals’ Aptiom (eslicarbazepine acetate) tablets for adjunctive therapy in the treatment of partial-onset seizures in patients 18 years and older with epilepsy. Aptiom will be dispensed with a patient Medication Guide.
FDA Approves Olysio
The FDA has approved Janssen Therapeutics’ Olysio (simeprevir) capsules for the treatment of chronic hepatitis C infection as part of an antiviral treatment regimen in combination with pegylated interferon and ribavirin in genotype 1–infected adults with compensated liver disease, including cirrhosis. Olysio may benefit patients with chronic hepatitis C, including those who are treatment naive or in whom prior interferon-based therapy failed.
FDA Approves First Adjuvanted Vaccine to Prevent Avian Influenza
The FDA has approved the first adjuvanted vaccine for the prevention of H5N1 influenza, commonly known as avian or bird flu. Influenza A (H5N1) virus monovalent vaccine, adjuvanted, is for use in people 18 years of age and older who are at increased risk of exposure to the H5N1 influenza virus. This H5N1 avian influenza vaccine is not intended for commercial availability. The U.S. Department of Health and Human Services purchased the vaccine from the manufacturer, ID Biomedical Corporation of Quebec, Quebec City, Canada, a subsidiary of GlaxoSmithKline Biologicals, for inclusion within the National Stockpile for distribution by public health officials, if needed.
For additional information, please refer the FDA’s website.
Expanded Indication for Nexavar
The FDA has approved Bayer HealthCare’s Nexavar (sorafenib) tablets for the treatment of late-stage metastatic differentiated thyroid cancer refractory to radioactive iodine treatment. Nexavar is also indicated for the treatment of patients with advanced renal cell carcinoma, as well as for the treatment of patients with unresectable hepatocellular carcinoma.
FDA Approves Luzu Cream
The FDA has approved Valeant Pharmaceuticals North America’s Luzu (luliconazole 1%) cream for the topical treatment of interdigital tinea pedis, tinea cruris, and tinea corporis in patients 18 years and older.
Nature’s Pharmacy and Compounding Center Sterile Product Recall
Nature’s Pharmacy and Compounding Center of Asheville, NC, is voluntarily recalling at the consumer level all lots of sterile products compounded by the pharmacy in the form of an injectable drug or an eye drop that are not expired. The recall is being initiated because of concerns associated with quality control procedures that present a potential risk to sterility assurance that were observed during a recent FDA inspection.
The products were supplied to the offices of licensed medical providers and to patients by prescription within the pharmacy’s local market area in North Carolina. They were distributed from January 1, 2013, to present.
Medical providers, clinics, and patients who have these products should stop their use and return them to the place of purchase. Clinics should contact any patient that has received treatment using any of these sterile products. Consumers or health care providers with questions regarding this recall may contact Nature’s Pharmacy at 1-828-251-0094 or toll-free at 1-800-645-8201, Monday through Friday, 9:30 AM to 6 PM EST, or by email at email@example.com.
FDA Safety Communication: Changes to Reduce Infection Risk with Over-the-Counter Topical Antiseptics
Based on reports of outbreaks associated with the use of contaminated over-the-counter (OTC) topical antiseptics, the FDA is requesting labeling and packaging changes to certain OTC topical antiseptic products indicated for preoperative or preinjection skin preparation. Although currently available as single- or multiuse products, the FDA is requesting that these antiseptics now be packaged for single-use only. The request is the result of the FDA’s ongoing evaluation of infrequent, but continuing, reports ranging from localized infections at injection sites to systemic infections resulting in death. The FDA has reviewed reports of 4 deaths; 5 cases of wound infection; 7 cases of peritonitis; 10 cases of septic arthritis; 14 cases of indwelling catheters requiring replacement; 16 cases of injection site infection; and 32 cases of bacteremia, all confirmed to be caused by contaminated antiseptic products. Affected products include all commonly used antiseptic ingredients including alcohol, iodophors, chlorhexidine gluconate, and quaternary ammonium products. Organisms implicated in the outbreaks include Bacillus cereus, Burkholderia cepacia, Pseudomonas aeruginosa, Achromobacter xylosoxidans, Ralstonia pickettii, Serratia marcescens, and Mycobacterium abscessus. When used properly, topical antiseptics are safe and effective for preoperative or preinjection use. However contamination of topical antiseptics most often occurs when organisms are introduced into the product by users.
The FDA recommends the following safety measures:
- To reduce the risk of infection, ensure the products are used according to the directions on the label.
- The antiseptics in these single-use containers should be applied only 1 time to 1 patient.
- Avoid diluting antiseptic products after opening them.
- Applicators and any unused solution should be discarded after the single application.
Further information may be found at the following website: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm374892.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery.
Aptiom Approved for Seizures in Adults
The FDA has approved Sunovion Pharmaceuticals’ Aptiom (eslicarbazepine acetate) as adjunctive therapy for the treatment of partial seizures in patients with epilpesy. Aptiom will be dispensed with a patient Medication Guide.
FDA Approves Imbruvica
The FDA has approved Pharmacyclis’ and Janssen Biotech’s Imbruvica (ibrutinib) for the treatment of patients with mantle cell lymphoma (MCL). Imbruvica is intended for patients with MCL who have received at least 1 prior therapy and was approved under the FDA’s accelerated approval program.
OxyElite Pro Dietary Supplement Recalled
- OxyElite Pro Super Thermo capsules
- two count capsules UPC #094922417275
- 10 count capsules UPC #094922417251
- 10 count capsules UPC #094922417268
- 21 count capsules UPC #094922426604
- 90 count capsules UPC #094922395573
- 90 count capsules “Pink label” UPC #094922447906
- 180 count capsules UPC #094922447852
- OxyElite Pro Ultra-Intense Thermo capsules
- three count capsules UPC #094922447883
- three count capsules UPC #094922447876
- 90 count capsules UPC #094922395627
- 180 count capsules UPC #094922447869
- OxyElite Pro Super Thermo powder
- Fruit Punch 0.15 oz UPC #094922417237
- Fruit Punch 0.15 oz UPC #094922447517
- Fruit Punch 4.6 oz UPC #094922426369
- Fruit Punch 5 oz. UPC #094922447487
- Blue Raspberry 4.6 oz UPC #094922426376
- Grape Bubblegum 4.6 oz UPC #094922447500
- Green Apple 4.6 oz. UPC #094922426499
In addition to the recalled products, the FDA is advising consumers not to use any dietary supplements labeled OxyElite Pro or VERSA-1. Consumers who believe they have been harmed by using a dietary supplement should contact their health care provider. Consumers can contact USPlabs at 1-800-890-3067, Monday through Friday, 9 AM to 5 PM EST or firstname.lastname@example.org.
FDA Approves Generic Aciphex Tablets
The FDA has approved Mylan’s rabeprazole sodium 20 mg delayed-release tablets, the generic version of Aciphex, indicated for the short-term treatment of erosive or ulcerative gastroesophageal reflux disease (GERD) and duodenal ulcers.
FDA Approves Juvederm Voluma XC for Volume Loss in Cheek Area
The FDA has approved Allergan’s Juvederm Voluma XC (hyaluronic acid [with lidocaine]) injectable gel for the treatment of volume loss in the cheek area.
Safety Announcement for Low Molecular Weight Heparins
The FDA has announced upcoming changes to be made to the product labeling for enoxaparin (Lovenox) and other low molecular weight heparins (LMWHs).The FDA recommends that health care providers carefully consider the timing of spinal catheter placement and removal in patients receiving these drugs, and to delay dosing for a period of time after catheter removal to decrease the risk of spinal column bleeding and subsequent paralysis after spinal injections, including epidural procedures and lumbar punctures. Prior to catheter placement or removal, health care providers should determine whether a patient is receiving a LMWH and identify the appropriate timing of LMWH dosing. To reduce the potential risk of bleeding, both the dose and elimination half-life of the drug should be considered. The following recommendations have been made for enoxaparin:
- Placement or removal of a spinal catheter should be delayed for at least 12 hours after administration of prophylactic doses such as those used for prevention of deep vein thrombosis. Longer delays (24 hours) are appropriate to consider for patients receiving higher therapeutic doses (1 mg/kg twice daily or 1.5 mg/kg once daily).
- A postprocedure dose should usually be given no sooner than 4 hours after catheter removal.
- In all cases, a benefit-risk assessment should consider both the risk for thrombosis and the risk for bleeding in the context of the procedure and patient risk factors.
It is important to note that all anticoagulants carry the risk of causing spinal bleeding when used in conjunction with epidural/spinal anesthesia or spinal puncture. The FDA is continuing to evaluate the safety of other anticoagulants to determine if additional label changes are needed. Before undergoing an epidural or spinal procedure, patients should be advised to inform their health care provider if they are taking any anticoagulant drugs. When undergoing these types of procedures, patients should alert their health care provider immediately if they experience any symptoms such as numbness, tingling, leg weakness or paralysis, or loss of control of their bladder or bowels.
Further information is available here.
FDA Approves NovoLog FlexTouch and Levemir FlexTouch
The FDA has approved Novo Nordisk’s NovoLog (insulin aspart) FlexTouch and Levemir (insulin detemir) FlexTouch prefilled insulin pens.
The dosing mechanism of FlexTouch ensures the push-button does not extend at any dose and allows insulin to be administered by pressing the low-dose force button.
Novo Nordisk plans to make NovoLog FlexTouch and Levemir FlexTouch available in the US within the next year.
New Boxed Warning for Ofirmev
The FDA has approved a new Boxed Warning for Cadence Pharmaceuticals’ Ofirmev (acetaminophen) injection alerting health care providers to the risk of medication errors that may result in accidental overdose. The revised labeling also includes a warning regarding hepatotoxicity. Ofirmev is indicated for the management of mild to moderate pain and the management of moderate to severe pain with adjunctive opioid analgesics, as well as for the reduction of fever.
Acetaminophen Infant Suspension Recall
The Perrigo Company is voluntarily recalling 18 batches of its acetaminophen infant suspension liquid, 160 mg/5 mL, sold in 2- and 4-ounce bottles with syringes in a box under store brand products including Babies R Us, Care One, and others, because a small number of packages might contain an oral dosing syringe without dose markings. The syringe should have a white or yellow plunger with specific dose markings for 1.25, 2.5, 3.75, and 5 mL. If the syringe has these dose markings, it is safe to use the product while following labeled instructions. Using an oral syringe without dose markings can result in in infants mistakenly receiving an inappropriately high dose.
If a package contains an oral dosing device without dose markings, do not use the product and contact Perrigo’s Consumer Affairs Department at 1-800-719-9260 for further instructions. Consumers should contact their health care provider if they have any questions or problems that could possibly be related to this product.
For more information, see Perrigo’s website.
FDA Approves Gazyva for Chronic Lymphocytic Leukemia
The FDA has approved Genentech’s Gazyva (obinutuzumab) for use in combination with chlorambucil to treat patients with previously untreated chronic lymphocytic leukemia. Gazyva is the first drug with breakthrough therapy designation to receive FDA approval.
Gazyva carries a Boxed Warning regarding hepatitis B virus reactivation and progressive multifocal leukoencephalopathy. Patients should be advised of these risks and assessed for hepatitis B virus and reactivation risk.
Incivek Label Changes
The FDA has approved label changes specifying new dosing recommendations for Incivek (telaprevir) from 750 mg every 8 hours to 1,125 mg twice daily (every 10 to 14 hours).
Potiga Linked to Retinal Abnormalities and Skin Discoloration
The FDA has approved labeling changes for the anti-seizure drug Potiga (ezogabine), underscoring risks of eye abnormalities characterized by pigment changes in the retina, including scleral and conjunctival discoloration on the whites of the eyes and inside of eyelids, and can also cause blue skin discoloration, predominantly on or around the lips or in the nail beds of fingers or toes, although more widespread involvement of the face and legs has also been reported. The skin discoloration generally occurred after 4 years of treatment, but appeared sooner in some patients. In some cases, retinal abnormalities were observed in the absence of skin discoloration. The FDA does not currently know if these changes are reversible, the typical onset or rate of progression, or which patient populations may be at an increased risk for ocular abnormalities.
The FDA advises that the use of ezogabine be limited to patients who have not responded adequately to several alternative therapies and for whom the benefits of treatment outweigh the risks. All patients taking ezogabine should undergo a baseline eye exam and periodic eye exams every 6 months that include visual acuity testing and dilated fundus photography. Fluorescein angiograms, ocular coherence tomography, perimetry, and electroretinograms may also be considered. Patients whose vision cannot be monitored should generally not take ezogabine.
Patients who develop changes in vision or skin discoloration should contact their healthcare provider immediately. If retinal pigmentary abnormalities or vision changes are detected, ezogabine should be stopped unless no other suitable seizure treatment options are available and the benefits of treatment outweigh the potential risk of vision loss. Health care professionals should discontinue ezogabine treatment in patients who do not show substantial clinical benefit after adequate dose titration. Patients should not stop taking the drug without first discussing their treatment with their health care professionals.
Safety Warning for Iclusig
The FDA has asked Ariad Pharmaceuticals to suspend marketing and sales of Iclusig (ponatinib) due to the risk of life-threatening blood clots and severe narrowing of blood vessels.
Iclusig is indicated for the treatment of adult patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ALL) that is resistant or intolerant to prior tyrosine kinase inhibitor therapy, as well as for the treatment of adult patients with chronic phase, accelerated phase, or blast phase chronic myeloid leukemia (CML) that is resistant or intolerant to prior tyrosine kinase inhibitor therapy.
Patients currently receiving Iclusig should discuss with their health care professionals the risks and benefits of continuing treatment with the drug. At this time, patients and health care professionals should adhere to the following FDA recommendations while the agency continues to evaluate the drug’s safety:
- Patients currently taking Iclusig who are not responding to the drug should immediately discontinue treatment and discuss alternative treatment options with their health care professionals.
- Patients who are currently taking Iclusig and responding to the drug and whose health care professionals determine that the potential benefits outweigh the risks should be treated under a single-patient Investigational New Drug (IND) application or expanded access registry program while FDA’s safety investigation continues. FDA will work with the manufacturer on a plan to quickly transition these patients to a program that will allow access under an IND or expanded access registry program. Patients: For more information on access to treatment under an IND, please refer to this website.
- Health care professionals should not start treating new patients with Iclusig unless no other treatment options are available and all other available therapies have failed. Upon the determination of their health care professional, these patients can be considered for treatment under an IND or expanded access registry program. Health care professionals: For more information on obtaining access to treatment for your patient under an IND, please refer to this website.
For more information on the FDA’s investigation see the previous story.
FDA Approves Generic Fosrenol
The FDA has approved Prasco’s lanthanum carbonate 500, 750, and 1,000 mg chewable tablets, the generic version of Fosrenol, indicated to reduce serum phosphate in patients with end-stage renal disease. Prasco has an exclusive distribution and supply agreement with Shire for this authorized generic version of lanthanum carbonate, meaning Shire continues to produce the product but markets it under the Prasco private label at generic prices.
FDA Approves Vizamyl for Beta-Amyloid Detection
The FDA has approved GE Healthcare’s Vizamyl (flutemetamol F18) injection, a radioactive diagnostic drug for use with positron emission tomography (PET) imaging of the brain, to estimate beta- amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer disease and other causes of cognitive decline.
Expanded Indication for Sabril
The FDA has approved Lundbeck’s Sabril (vigabatrin) as add-on therapy for the treatment of refractory complex partial seizures (CPS) in children 10 years and older who have inadequately responded to several other treatments and if the possible benefit outweighs the risk of vision loss. Sabril is currently approved for use as monotherapy in infants and children 1 month to 2 years of age with infantile spasms and as adjunctive therapy for adults with refractory complex partial seizures who have inadequately responded to several alternative treatments and for whom the potential benefits outweigh the potential risk of vision loss. Sabril is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) and is dispensed with a patient Medication Guide.
FDA Approves Ecoza for Tinea Pedis
The FDA has approved AmDerma’s Ecoza (econazole nitrate) topical foam 1% for the treatment of interdigital tinea pedis caused by Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum in patients 12 years and older.
FDA to Recommend Schedule Change for Hydrocodone Products
Due to increasing concerns about the abuse and misuse of opioid products, the FDA has been challenged with determining how to balance the need to ensure ongoing access for patients who rely on continuous pain relief while addressing these concerns.
In 2009, the US Drug Enforcement Administration (DEA) asked the US Department of Health and Human Services (HHS) for a recommendation regarding whether to change the schedule for hydrocodone combination products (eg, hydrocodone and acetaminophen [Vicodin]) from Schedule III to Schedule II, thereby increasing the controls on these products. As a result, by early December 2013 the FDA plans to submit a formal recommendation to the HHS to reclassify hydrocodone combination products as Schedule II drugs. It is likely that the National Institute on Drug Abuse will concur with the recommendation, beginning a process that will lead to a final scheduling decision by the DEA.
Expanded Indication for Exelon Patch
The FDA has approved Novartis’ Exelon (rivastigmine) patch for the treatment of severe dementia in patients with Alzheimer disease. Exelon is also approved for the treatment of mild to moderate dementia in patients with Alzheimer disease, as well as treatment of mild to moderate dementia associated with Parkinson disease.
FDA Approves Zohydro ER for Severe Pain
The FDA has approved Zogenix’s Zohydro ER (hydrocodone bitartrate, Schedule II) single-entity, extended-release capsules for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate. The FDA is requiring postmarketing studies of Zohydro ER to assess the known serious risks of misuse, abuse, hyperalgesia, addiction, overdose, and death associated with long-term use beyond 12 weeks.
Zohydro ER will be part of the extended-release/long-acting opioid analgesics Risk Evaluation and Mitigation Strategy (REMS) and will be dispensed with a patient Medication Guide.
Next Choice One Dose Recall
Watson Laboratories has issued a voluntary recall of 2 lots (580974AA and 580975AA, expiration date September 2014) of Next Choice One Dose (levonorgestrel) emergency contraceptive 1.5 mg tablets because of multiple complaints of pushthrough tablet breakage in blister packs.
Expanded Boxed Warning for Entereg
The FDA has expanded the Boxed Warning for Cubist Pharmaceuticals’ Entereg (alvimopan) to include information about the potential risk of myocardial infarction with long-term use. Entereg is currently available only through a restricted program for short-term use under a Risk Evaluation and Mitigation Strategy (REMS) and is dispensed with a patient Medication Guide.
FDA Approves Zorvolex for Acute Pain
The FDA has approved Iroko Pharmaceuticals’ nonsteroidal anti-inflammatory drug Zorvolex (diclofenac) for the treatment of mild to moderate acute pain in adults. Zorvolex capsules were approved at dosage strengths 20 percent lower than those of currently available diclofenac products. Zorvolex carries a Boxed Warning regarding the increased risk of serious cardiovascular and gastrointestinal events, and is dispensed with a patient Medication Guide.
Opsumit Approved for Pulmonary Arterial Hypertension
The FDA has approved Actelion Pharmaceuticals’ Opsumit (macitentan) tablets for the treatment of pulmonary arterial hypertension in adults. Opsumit, an endothelin receptor blocker, carries a Boxed Warning contraindicating its use in pregnant women due to the risk of embryo-fetal toxicity. Opsumit will be available to women only through the Opsumit Risk Evaluation and Mitigation Strategy (REMS) Program, a restricted-distribution program requiring prescribers to be certified by enrolling in the program. It also requires all female patients to be enrolled in the program and to comply with applicable pregnancy testing and contraception requirements before initiating treatment, as well as for pharmacies to be certified and to dispense Opsumit only to patients who are authorized to receive it.
Cimzia Approved for Ankylosing Spondylitis
The FDA has approved UCB’s Cimzia (certolizumab pegol) for the treatment of adults with active ankylosing spondylitis. Cimzia is currently approved in adults for the treatment of active psoriatic arthritis as well as for moderately to severely active rheumatoid arthritis and Crohn disease. A Boxed Warning concerning the risk of serious infections and malignancy is included in Cimzia’s labeling, and the drug is dispensed with a patient Medication Guide.
FDA Approves Novoeight for Hemophilia
The FDA has approved Novo Nordisk’s Novoeight (antihemophilic factor [recombinant]) injection for adults and children with hemophilia A to control and prevent bleeding, for perioperative management, and routine prophylaxis to prevent or reduce the frequency of bleeding episodes.
Novoeight will be launched with the newly introduced prefilled device MixPro and is expected to be available after April 2015.
Antivenin (Micrurus fulvius) Expiration Date Extended
Wyeth Pharmaceuticals (a subsidiary of Pfizer) has extended the expiration date of 1 lot (4030024) of antivenin (Micrurus fulvius) through April 30, 2014. Wyeth had previously extended the expiration date of another lot (4030026) of antivenin (Micrurus fulvius) to October 31, 2013, which is now also extended to 2014. Any remaining inventory of either lot (4030024 or 4030026) should be retained until their respective expiration dates because Pfizer supplies product only to direct customers on a replacement or emergency basis due to inventory concerns. Contact Pfizer at 800-666-7248 or the Poison Help Line at 800-222-1222 for assistance in locating antivenin. If licensed antivenin cannot be secured, an investigational imported antivenin may be available under an Investigational New Drug (IND) protocol with informed consent; for more information contact the Poison Help Line at 800-222-1222 or the FDA at 800-835-4709 (business hours) or 301-796-8240 (nonbusiness hours).
B. Braun Medical Recalls Cefepime
B. Braun Medical is voluntarily recalling 1 lot (H3A744, expiration date January 2015) of cefepime for injection and dextrose injection 1 g due to visible organic particulate matter in a reserve sample unit. Although B. Braun has not received any reports of adverse events related to this lot to date, the company is notifying its distributors and customers by written, return-receipt letters and is arranging for return of all recalled product. The affected lot was distributed nationwide between February 4, 2013, and March 1, 2013.
Patients should report any issues related the use of this product to their health care provider and to B. Braun at 1-800-854-6851. Distributors and customers should discontinue use immediately and contact B. Braun’s Customer Support Department at 1-800-227-2862, Monday through Friday, 8 AM to 7 PM EST for return and replacement instructions.
Nephron Recalls Albuterol Sulfate Inhalation Solution 0.083%
Nephron Pharmaceuticals is voluntarily recalling 10 lots (A3A33A, A3A33B, A3A34A, A3A35A, A3A36A, A3A37A, A3A38A, A3A40A, A3A41A, and A3A42A) of albuterol sulfate inhalation solution 0.083% at the retail level due to results from its internal monitoring processes. Although all affected lots had passed the company’s quality specifications at the time of manufacturing, the recall was initiated as a precautionary measure in accordance with FDA published guidance on aseptic processing simulation. For more information, consumers should contact Nephron at 1-800-443-4314, ext. 2292 or at email@example.com.
FDA Approves Otrexup
The FDA has approved Antares Pharma’s Otrexup (methotrexate) injection for once weekly subcutaneous self-administration with an easy-to-use, single-dose, disposable autoinjector. Otrexup is indicated in the management of selected adults with severe, active rheumatoid arthritis (American College of Rheumatology criteria), or children with active polyarticular juvenile idiopathic arthritis, who have had an insufficient therapeutic response to, or are intolerant of, an adequate trial of first-line therapy including full dose nonsteroidal anti-inflammatory drugs. The FDA also approved adult use of Otrexup for symptomatic control of severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy.
FDA Approves Nonprescription Nasacort Allergy 24HR
The FDA has approved Sanofi’s Nasacort Allergy 24HR (triamcinolone acetonide) nasal spray as a once-daily nonprescription treatment for seasonal and perennial allergic rhinitis in adults and children 2 years and older. Nasacort Allergy 24HR is the first glucocorticoid to be made available without a prescription and will be marketed by Chattem.
Nasacort Allergy 24HR was initially approved as a prescription-only product (called Nasacort AQ) in the United States in 1996.
Chattem anticipates that Nasacort Allergy 24HR will be available in Spring 2014.
FDA Investigating Iclusig After Reports of Serious Blood Clots
The FDA is investigating an increasing frequency of reports of serious and life-threatening thrombosis and severe vascular stenosis in patients taking the leukemia chemotherapy drug Iclusig (ponatinib).
At the time of Iclusig’s approval in December 2012, the prescribing information contained information about the risks of thrombosis in the Boxed Warning and Warnings and Precautions sections. In clinical trials conducted before approval, serious arterial thrombosis and venous thrombosis occurred in 8% and 3%, respectively, of Iclusig-treated patients. In the most recent clinical trial, at least 20% of all participants developed thrombosis or vascular stenosis.
Iclusig is used to treat adults with chronic phase, accelerated phase, or blast phase chronic myeloid leukemia or Philadelphia chromosome-positive acute lymphoblastic leukemia that is resistant or intolerant to prior tyrosine kinase inhibitor therapy.
Health care providers should consider whether the treatment benefits are likely to exceed the risks. Patients should seek immediate medical attention if they experience symptoms suggesting myocardial infarction.
Acute Hepatitis Cases Linked to OxyElite Pro
The FDA, the Centers for Disease Control and Prevention (CDC), and the Hawaii State Department of Health are investigating reports of acute nonviral hepatitis. The Hawaii State Department of Health has found that 24 of the 29 reported cases share a common link to the use of OxyElite Pro, a dietary weight-loss supplement distributed by USPlabs in Dallas, Texas, and sold nationwide via the Internet and retail stores.
In the 29 reported cases, 11 people have been hospitalized with acute hepatitis, 2 have received liver transplants, and 1 has died. The CDC is also looking at other incidences of liver injury nationwide that may be related. Symptoms can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay or gray-colored bowel movements, joint pain, yellow eyes, and jaundice.
The FDA is advising consumers to stop using any dietary supplement product labeled as OxyElite Pro (counterfeit product may exist) while the investigation continues and to contact their health care provider if they believe they have been harmed by using a dietary supplement.
FDA Approves Adempas
The FDA has approved Bayer’s Adempas (riociguat) tablets for the treatment of adults with persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) as well as for the treatment of adults with pulmonary arterial hypertension (PAH). Adempas is a stimulator of soluble guanylate cyclase, representing a new class of drugs. Adempas labeling contains a Boxed Warning regarding the risk of embryo-fetal toxicity in pregnant women will be dispensed with a patient Medication Guide.
Lidocaine HCl 1% Recall
Hospira is voluntarily recalling 1 lot (25-090-DK [lot number may be followed by 01 or 02], NDC 0409-4276-01) of lidocaine HCl 1% injection, USP, 10 mg/mL, 20 mL multiple-dose fliptop vials, due to a confirmed customer report of visible dark red/black particulate in the primary container identified as oxidized stainless steel. If undetected, a particle could block drug administration to the patient, causing a delay in therapy.
Existing inventory of the affected lot should be quarantined immediately and distribution discontinued. Customers should call Stericycle at 1-866-364-8812, Monday through Friday, 8 AM to 5 PM EST to arrange for product return. Replacement product from other lots is available.
FDA Approves Generic Zymaxid
The FDA has approved Lupin’s gatifloxacin ophthalmic solution 0.5%, the generic version of Zymaxid ophthalmic solution, indicated for the treatment of bacterial conjunctivitis.
FDA Approves Duavee for Menopausal Symptoms
The FDA has approved Pfizer’s Duavee (conjugated estrogens/bazedoxifene) once-daily tablets for the treatment of moderate to severe hot flashes associated with menopause and for the prevention of osteoporosis after menopause in postmenopausal women who still have a uterus. Duavee, the first FDA-approved medication combining estrogen with an estrogen agonist/antagonist, should be available in the first quarter of 2014.
FDA Approves Clinolipid for Intravenous Nutrition
The FDA has approved Baxter Healthcare’s Clinolipid (lipid injectable emulsion) for parenteral nutrition in adult patients who are unable to eat or drink and need a source of calories and essential fatty acids. Clinolipid should be used with caution in patients with preexisting liver disease or liver insufficiency, and should not be used in patients with a known hypersensitivity to egg or soybean proteins or in patients with hyperlipidemia. Clinolipid was granted a priority review to help alleviate a drug shortage.
FDA Approves Generic Zemplar
The FDA has approved Teva Pharmaceuticals’ paricalcitol capsules, the generic version of Zemplar. Paricalcitol capsules are an active form of vitamin D used to prevent and treat secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stages 3 and 4, as well as to treat and prevent secondary hyperparathyroidism in patients with CKD stage 5 who are on hemodialysis or peritoneal dialysis.
Metoclopramide and Ondansetron Recall
Hospira has initiated a voluntary recall of 1 lot (28-104-DK , NDC 0409-3414-01, expiration date October 1, 2014) of metoclopramide injection 10 mg/2 mL (5 mg/mL) and 2 lots (29-484-DK and 29-510-DK, NDC 0409-4755-03, expiration date May 1, 2015) of ondansetron injection 4 mg/2 mL (2 mg/mL) after glass strands were identified as being affixed to the inside of vial walls. Glass particulates could potentially dislodge into the solution, although there have been no reports of any adverse events to date. The affected lots were distributed nationwide between June 2013 and September 2013 to wholesalers/distributors, hospitals, and pharmacies.
Existing inventory of the affected lots should be quarantined immediately and distribution discontinued. Customers should call Stericycle at 1-877-497-3125, Monday through Friday, 8 AM to 5 PM EST to arrange for product return.
FDA Approves Hizentra Boxed Warning, Expands Dosing
The FDA has approved a new Boxed Warning for CSL Behring’s Hizentra (immune globulin subcutaneous [human]) 20% liquid alerting health care providers that thrombosis may occur. Risk factors may include advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, use of indwelling central vascular catheters, and hyperviscosity, as well as cardiovascular risk factors. Thrombosis may also occur in the absence of known risk factors.
In addition to the once-weekly dosing that was previously approved, the FDA has expanded the administration options to include biweekly dosing for patients diagnosed with primary immunodeficiency.
Hizentra is indicated for replacement therapy for primary humoral immunodeficiency in adults and pediatric patients 2 years and older. This includes, but is not limited to, the humoral immune defect in congenital agammaglobulinemia, common variable immunodeficiency, X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, and severe combined immunodeficiencies.
FDA Approves Perjeta for Breast Cancer
The FDA has granted accelerated approval of Genentech’s Perjeta (pertuzumab) as part of a complete treatment regimen for patients with early stage breast cancer before surgery (neoadjuvant setting). Perjeta is the first FDA-approved drug for the neoadjuvant treatment of breast cancer. It is indicated for use in combination with trastuzumab and docetaxel for the neoadjuvant treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node positive) as part of a complete treatment regimen for early breast cancer.
Perjeta was approved in 2012 for use in combination with trastuzumab and docetaxel for the treatment of patients with HER2–positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. Perjeta carries a Boxed Warning regarding cardiomyopathy and embryo-fetal toxicity.
FDA Approves Brintellix Antidepressant
The FDA has approved Takeda Pharmaceuticals’ and Lundbeck’s Brintellix (vortioxetine) 5, 10, 15, and 20 mg tablets for the treatment of adults with major depressive disorder.
Brintellix and other antidepressant drugs have a Boxed Warning and a Medication Guide alerting patients and health care providers that antidepressants can increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults ages 18 to 24 during initial treatment. Studies show adults older than 24 years do not appear to have an increased risk of suicidal thoughts and behavior, while adults 65 and older appear to have a reduced risk. Patients starting antidepressant therapy should be closely monitored for worsening of their depression and the emergence of suicidal thoughts and behavior.
Expanded Indication for Cimzia
The FDA has approved UCB Pharmaceuticals’ Cimzia (certolizumab pegol) for the treatment of adult patients with active psoriatic arthritis. Cimzia is also approved for reducing signs and symptoms of Crohn disease and maintaining clinical response in adults with moderately to severely active disease who have had an inadequate response to conventional therapy, as well as for the treatment of moderately to severely active rheumatoid arthritis in adults.
Expanded Indication for Hecoria
The FDA has approved Novartis’ Hecoria (tacrolimus) capsules for the prophylaxis of organ rejection in patients receiving heart transplants. Hecoria is also approved for the prophylaxis of organ rejection in patients receiving kidney and liver transplants.
FDA Issues Safety Concern for Budesonide
The FDA has alerted patients and health care providers that budesonide solution, used for nasal irrigation, from The Compounding Shop of St. Petersburg, FL, may be contaminated and should not be used or administered to patients. The FDA observed a 1,000 mL bottle of budesonide solution that contained visible white floating material identified as a fungus. There is concern that contamination may be present in other budesonide solution products from The Compounding Shop that may currently be on the market.
The FDA is alerting health care providers to immediately quarantine any budesonide solution products from The Compounding Shop, and not administer it to patients.
In May 2013 after preliminary investigation findings, the FDA advised the firm to remove all sterile products from the market. The Compounding Shop informed the FDA that it was recalling sterile products and was in the process of notifying customers.
FDA Warns of Increased Risk of Death with Tygacil, Approves New Boxed Warning
The U.S. Food and Drug Administration (FDA) is warning that an additional analysis shows an increased risk of death when Pfizer’s Tygacil (tigecycline) injection is used for FDA-approved uses as well as nonapproved uses. A new Boxed Warning is to be added to the label along with updated Warnings and Precautions and Adverse Reactions sections. These changes are based on an additional analysis that was conducted for FDA-approved uses after issuing a Drug Safety Communication (DSC) in September 2010.
In the 2010 DSC, the FDA informed the public that a meta-analysis of 13 phase 3 and 4 trials showed a higher risk of death among patients receiving Tygacil compared with other antibacterial drugs: 4% (150/3,788) versus 3% (110/3,646), respectively. The adjusted risk difference for death was 0.6%, with corresponding 95% confidence interval (CI) (0.1 to 1.2). The increased risk was greatest in patients treated with Tygacil for ventilator-associated pneumonia, a use for which the FDA has not approved the drug.
Since issuing the 2010 DSC, the FDA analyzed data from 10 clinical trials conducted only for FDA-approved uses, including trials conducted after the drug was approved. This analysis showed a higher risk of death among patients receiving Tygacil compared with other antibacterial drugs: 2.5% (66/2,640) versus 1.8% (48/2,628), respectively. The adjusted risk difference for death was 0.6%, with corresponding 95% CI (0% to 1.2%). In general, the deaths resulted from worsening infections, complications of infection, or other underlying medical conditions.
Healthcare providers should reserve Tygacil for use in situations when alternative treatments are not suitable. Tygacil is FDA-approved to treat complicated skin and skin structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia.
W.S. Badger Sunscreen Recall
W.S. Badger is recalling all lots of its SPF 30 Baby Sunscreen Lotion 4 oz. and 1 lot (#3164A) of its SPF 30 Kids Sunscreen Lotion 4 oz. due to microbial contamination with Pseudomonas aeruginosa, Candida parapsilosis, and Acremonium fungi.
Consumers should not use these products and may return them to the original point of purchase for a full refund or contact Badger directly at 1-800-603-6100 or firstname.lastname@example.org, Monday through Friday, 8:30 AM to 4:30 PM EST.
Expanded Indication for Suprane
The FDA has approved Baxter’s Suprane (desflurane) liquid for inhalation for maintenance of anesthesia for inpatient and outpatient surgery in intubated pediatric patients. Suprane is also approved for induction and/or maintenance of anesthesia for inpatient and outpatient surgery in adults.
Safety Labeling Changes for Arzerra and Rituxan
The FDA has approved prescribing information changes to GlaxoSmithKline’s Arzerra (ofatumumab) and Genentech’s Rituxan (rituximab) to add new Boxed Warning information about the risk of reactivation of hepatitis B virus (HBV) infection. The revised labels will also include additional recommendations for screening, monitoring, and managing patients on these drugs to decrease this risk. This is a new Boxed Warning for ofatumumab. The Boxed Warning for rituximab already describes the risk of fatal infusion reactions, tumor lysis syndrome, severe mucocutaneous reactions, and progressive multifocal leukoencephalopathy (PML). Ofatumumab and rituximab are monoclonal antibodies approved for chronic lymphocytic leukemia. Rituxan is also approved for granulomatosis with polyangiitis (Wegener granulomatosis), microscopic polyangiitis, non-Hodgkin lymphoma, and rheumatoid arthritis.
New Indication for Stelara
The FDA has approved Janssen Biotech’s Stelara (ustekinumab) alone or in combination with methotrexate for the treatment of active psoriatic arthritis in adults 18 years or older. Stelara is also indicated for treatment of plaque psoriasis in adults 18 years and older who are candidates for phototherapy or systemic therapy. Stelara is dispensed with a patient Medication Guide.
FDA Approves Generic Vidaza
The FDA has approved Dr. Reddy’s Laboratories’ azacitidine for injection 100 mg/vial, the generic version of Vidaza, for the treatment of patients with the following French-American-British myelodysplastic syndrome subtypes: refractory anemia or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia. The company plans to launch the product as soon as possible.
Duragesic Patch Safety Alert
The FDA is requiring Janssen to make color changes in long-lasting ink to the writing on Duragesic (fentanyl) transdermal patches so that the name and strength can be seen more easily. As the FDA continues to learn of serious harm and deaths from accidental exposure to fentanyl patches, patients and health care providers are reminded that the patches are dangerous even after use because they still contain high amounts of strong narcotic pain medicine. The change is intended to enable patients and caregivers to more easily find patches on patients’ bodies and locate patches that have fallen off. The manufacturers of generic fentanyl patches are being requested to make similar changes. Read a previous story here.
Expanded Indication for Botox Cosmetic
The FDA has approved Allergan Pharmaceuticals’ Botox Cosmetic (onabotulinumtoxinA) for temporary improvement in the appearance of moderate to severe lateral canthal lines associated with orbicularis oculi activity in adults. Botox Cosmetic is also approved for temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugators and/or procerus muscle activity in adults.
FDA Approves Generic Xeloda
The FDA has approved Teva Pharmaceuticals’ ANDA for capecitabine 150 and 500 mg tablets, the generic version of Xeloda, indicated for the treatment of metastatic colorectal cancer and metastatic breast cancer.
Bupivacaine 0.25% and 0.75% Recalled
Hospira issued a voluntary recall of 1 lot (18-136-DK, NDC 0409-1159-02; expiration date June 1, 2014) of bupivacaine HCl 0.25% injection, USP (2.5 mg/mL), 30 mL single-dose vials on July 12, 2013. The lot was distributed August 2012 through September 2012. An expanded recall was issued on August 29, 2013, for 1 lot (23-338-DK, NDC 0409-1165-02; expiration date November 1, 2014) of bupivacaine HCl 0.75% injection, USP (7.5 mg/mL), 30 mL single-dose vials. The lot was distributed January 2013 through May 2013. Both recalls are due to confirmed customer reports of particulate floating and/or embedded in the glass vial. The particulate was identified as stainless steel ranging in size from 542 microns to 1,700 microns in the bupivacaine 0.25% injection, and as iron oxide with an average size of 2,000 microns in the bupivacaine 0.75% injection.
Any affected product should be immediately quarantined. Product returns can be arranged by contacting Stericycle at 1-866-240-5364 (lot 18-136-DK) and 1-888-627-2279 (lot 23-338-DK), Monday through Friday, 8 AM to 5 PM EST.
Creafuse Powder Grape and Creafuse Powder Fruit Punch Supplement Recall
Ge Pharma is recalling Creafuse Powder Grape (lot GE4568) and Creafuse Powder Fruit Punch (lot GE4570) due to the presence of 1,3 dimethylamylamine (DMAA), which can elevate blood pressure and lead to cardiovascular problems. Although DMAA is commonly used as a stimulant, preworkout, and weight loss ingredient in dietary supplement products, the FDA has warned that it is not a dietary ingredient and is not Dietary Supplement Health and Education Act (DSHEA) compliant.
Consumers should immediately discontinue use of these products and contact their health care professional if they have experienced any adverse effects. GE Pharma can be contacted at email@example.com or 1-203-675-1057, Monday through Friday, 11 AM to 5 PM EST, for further instructions for product disposal or return, refunds, credits, exchanges, or any other questions.
Utopic Cream Approved
The FDA has approved Artesa Labs’ Utopic (urea 41%) cream for the treatment of hyperkeratotic conditions such as dry, rough skin; xerosis; ichthyosis; skin cracks and fissures; dermatitis; eczema; psoriasis; keratoses; and calluses.
SelRX Shampoo Approved
The FDA has approved Artesa Labs’ SelRX Shampoo (selenium sulfide 2.3%) for the treatment of seborrheic dermatitis of the scalp, dandruff, and tinea versicolor. It may also be used to treat dry scalp.
Risperdal Consta Recall
Johnson & Johnson is voluntarily recalling 1 lot of Janssen Pharmaceuticals’ Risperdal Consta (risperidone microspheres) intramuscular suspension after discovering mold during a routine testing process. Risperdal Consta is indicated as monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder, as well as for the treatment of schizophrenia.
Astepro Indication Expanded
The FDA has approved Meda Pharmaceuticals’ Astepro (azelastine hydrochloride) for the treatment of symptoms of seasonal and perennial allergic rhinitis in patients 6 years and older. Astepro was previously approved for the treatment of perennial and seasonal rhinitis in patients 12 years and older.
Leiter’s Compounding Pharmacy Recall
Leiter’s Compounding Pharmacy is voluntarily recalling 3 lots of sterile products (bevacizumab lots 08052013@1 and 08052013@4, expiration date November 3, 2013, and lidocaine/phenylephrine lot 07302013@6, expiration date October 28, 2013) due to the FDA’s sterility assurance concerns with their independent testing laboratory. The affected products were dispensed to health care providers between August 5, 2013 and September 2, 2013 throughout the US.
Leiter’s Compounding Pharmacy is notifying prescribing health care providers by mail, telephone, and/or email, and is arranging for return of all recalled products, which should not be used. Customers with questions can contact Leiter’s Compounding Pharmacy at 1-800-292-6772, Monday through Friday, 8 AM to 5 PM PST.
Testosterone Cypionate Recall
Park Compounding is voluntarily recalling 1 lot of sterile medication testosterone cypionate (sesame oil) 200 mg/mL (lot 05072013@1, expiration date November 3, 2013) for injection in 10 mL amber vials to the consumer level due to concerns that results obtained from the laboratory were not reliable. The prescription preparations were sold during May and June of 2013 in California and Indiana directly to customers and to health care providers’ offices by prescription.
Customers who have the affected product should stop using it and contact Park Compounding to arrange for return of unused product. Customers with questions can contact Park Compounding at 1-949-551-7195, Monday through Friday, 9 AM to 5 PM PST or firstname.lastname@example.org. Customers should contact their health care provider if they have experienced any problems that may be related to taking or using the affected medication.
Safety Labeling Changes for Extended-release and Long-acting Opioid Analgesics – September 2013
The U.S. Food and Drug Administration has announced class-wide safety labeling changes and new postmarket study requirements for all extended-release (ER) and long-acting opioid analgesics to address the misuse, abuse, addiction, overdose, and death associated with these drugs.
Labeling changes will include important new language to help health care providers tailor their prescribing decisions based on a patient’s needs. The updated indication states that these drugs are for the management of severe pain requiring daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Because of the risks of addiction, abuse, and misuse, even at recommended doses, and because of the greater risks of overdose and death, these drugs should be reserved for use in patients for whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain; ER and long-acting opioid analgesics are not indicated for as-needed pain relief.
The FDA is also requiring a new boxed warning cautioning that chronic maternal use of ER and long-acting opioid analgesics during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS), which may be life-threatening and require management by neonatology experts. Symptoms associated with NOWS include tachypnea, trembling, poor feeding, and excessive or high-pitched crying.
Modifications will also be made to the Risk Evaluation and Mitigation Strategy (REMS) to reflect the updated information. Originally approved in 2012, the REMS requires that companies make available educational programs on how to safely prescribe ER and long-acting opioid analgesics and Medication Guides and patient counseling documents.
Further information may be found at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm367726.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery.
Avella Specialty Pharmacy Recall
Avella Specialty Pharmacy is voluntarily recalling 2 compounded sterile medications, bevacizumab 1.25 mg per 0.05 mL PF (lot 12-20130508@179, expiration November 3, 2013) and vancomycin PF (BSS) 1% (lot 12-20130508@181, expiration October 4, 2013). The recall is a result of concerns of sterility assurance with the specialty pharmacy’s independent testing laboratory, Front Range Laboratories.
The FDA raised concerns that test results obtained from Front Range Labs may not be reliable after an investigation revealed methods used to assess sterility and other qualities (eg, strength, stability) that may have resulted in Avella receiving inaccurate laboratory test results on the specified lots. The recalled products were dispensed directly to health care providers nationwide.
Avella Specialty Pharmacy is notifying customers of the voluntary recall by phone and mail. Customers should immediately discontinue use and return the unused portion to Avella. Patients should contact their health care provider if they have experienced any problems. Questions can be directed to Avella at 1-877-738-0797, Monday through Friday, 6 AM to 6 PM PST or QA@avella.com.
Carboxymethylcellulose Sodium Recall
Altaire Pharmaceuticals is voluntarily recalling 9 lots (http://www.fda.gov/Safety/Recalls/ucm367559.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery) of carboxymethylcellulose sodium 0.5% ophthalmic solution 30 mL to the consumer level. Concerns regarding the effectiveness of the preservative after use and handling of the product by consumers have prompted the recall because of mold found in the bottles after use.
All lots of product were sterile at the time of release, and the preservative was effective when challenged against the USP Preservative Effectiveness Test. Altaire has confirmed the production facility is not the source of any reported contaminants.
Altaire is notifying its customers of the recall by phone and letters for further notification to their retail stores. Consumers who have the product should stop use immediately and return it to the place of purchase.
Motrin Infants Drops Recall
Johnson & Johnson’s McNeil Consumer Healthcare has issued a voluntary recall of 3 lots (DCB3T01, DDB4R01, DDB4S01) of concentrated Motrin Infants’ Drops Original Berry Flavor 0.5 ounce bottles because they may contain tiny plastic particles. Motrin Infants’ Drops (ibuprofen) is indicated for the temporary reduction of fever and relief of minor aches and pains due to colds, flu, sore throat, and toothaches in children 2 years and younger. Consumers should stop using the affected product and call the company for a refund at 1-877-414-7709.
FDA Approves Generic Hepsera Tablets
The FDA has approved Sigmapharm Laboratories’ ANDA for adefovir dipivoxil tablets 10 mg, the generic version of Hepsera, indicated for the treatment of chronic hepatitis B virus in patients 12 years and older with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.
Abraxane Approved for Late-Stage Pancreatic Cancer
The FDA has approved Celgene’s Abraxane (paclitaxel protein-bound particles) injection solution for the treatment of advanced pancreatic cancer. Abraxane is intended to be used in combination with gemcitabine in patients with metastatic pancreatic cancer. Abraxane is also indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy, as well as in combination with carboplatin as first-line treatment of locally advanced or metastatic non–small cell lung cancer in patients who are not candidates for curative surgery or radiation therapy.
Medaus Pharmacy Recall
Medaus Pharmacy is voluntarily recalling certain sterile compounded consumer products (http://www.fda.gov/Safety/Recalls/ucm367353.htm) due to the company’s inability to confirm that quality control testing performed on these specific lots by an independent, third-party laboratory was conducted in a manner consistent with standards. The products were dispensed between March 12 and July 22, 2013, throughout the US.
Medaus is notifying its customers by telephone and email, and is arranging for return of affected products. Health care facilities and customers should stop using the products and call Medaus at 1-800-526-9183, Monday through Friday, 9 AM to 5 PM CDT, for instructions on product return.
Aminosyn II 10% Recall
Hospira has initiated a voluntary nationwide user-level recall of 1 lot (26-138-JT, NDC 0409-4164-03, expiration date August 1, 2014) of Aminosyn II 10%, sulfite-free, 500 mL, due to 1 report of a human hair in the injection port and in contact with the product. The affected lot was distributed nationwide between March 2013 and August 2013 to wholesalers/distributors, hospitals, and pharmacies.
Existing inventory of the affected lot should be quarantined immediately and distribution discontinued. Customers should call Stericycle at 1-866-737-4701, Monday through Friday, 8 AM to 5 PM EST to arrange for product return.
Cubist Pharmaceuticals has notified customers of the voluntary recall of 4 lots (950453F, 090203F, 201703F, 201653F, shipped May 2011 to March 2013) of Cubicin (daptomycin) injection due to the presence of particulate matter.
Anyone with an existing inventory of the product lots listed in the firm's press release (http://www.fda.gov/Safety/Recalls/ucm366753.htm) should quarantine them and discontinue distribution. Customers should call Cubist at 1-855-534-8309, Monday through Friday, 9 AM to 7 PM EST to arrange for return and replacement of affected lots.
Health care providers and pharmacists with questions regarding this recall may contact Cubist Medical Information at 1-877-282-4786, Monday through Friday, 8 AM to 5:30 PM EST.
Progressive Multifocal Leukoencephalopathy Warning with Gilenya
The U.S. Food and Drug Administration (FDA) is informing the public that a patient in Europe diagnosed with possible multiple sclerosis (MS) has developed progressive multifocal leukoencephalopathy (PML) after taking Novartis’ Gilenya (fingolimod). This is the first reported case of PML following the administration of Gilenya to a patient who had not previously received Tysabri (natalizumab, an MS drug associated with a higher risk of PML.
The patient received Gilenya for nearly 8 months before being diagnosed with PML. The patient had previously been treated with interferon beta-1a and azathioprine for 1 month, but these medications were discontinued when Gilenya was initiated. The patient also received multiple courses of intravenous corticosteroids for several months before and during Gilenya treatment. The PML diagnosis was made based on clinical symptoms and the detection of JC viral DNA in the cerebrospinal fluid and Gilenya treatment was stopped.
Patients should not stop taking Gilenya without first discussing any questions or concerns with their health care providers. The FDA is investigating the PML case, and working with Novartis to obtain and review all available information.
For additional information, please refer to http://www.fda.gov/Drugs/DrugSafety/ucm366529.htm.
282 MEP Market Withdrawal, Health Canada Issues Notice--August 2013
Pendopharm, in collaboration with Health Canada, has issued notice of the market withdrawal of 282 MEP (acetylsalicylic acid 350 mg, codeine phosphate 15 mg, meprobamate 200 mg, caffeine 15 mg). On July 30, 2013, Pendopharm discontinued the sale of 282 MEP. Following the discontinuation of 282 MEP, no medications containing meprobamate will be available in Canada. Effective October 28, 2013, the drug identification number for 282 MEP will be cancelled.
Health Canada has evaluated information on the risk of overdose/abuse/misuse in patients treated with 282 MEP, a meprobamate-containing medicine indicated for the relief of pain accompanied by muscle spasm and anxiety. Meprobamate has a narrow therapeutic index and may cause serious adverse reactions, including overdose, loss of consciousness, abuse, pharmacodependence, and withdrawal symptoms, even under normal conditions of use. Other medications (eg, muscle relaxants, anxiolytics, antidepressants) have largely displaced the use of meprobamate in Canada and in other countries. Taking this data into account, Health Canada has concluded that the risks of 282 MEP outweigh the benefits under normal conditions of use. Patients taking 282 MEP should be switched to an alternative treatment.
Valchlor Gel Approved
The FDA has approved Ceptaris Therapeutics’ Valchlor (mechlorethamine) gel for once-daily topical treatment of stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma in patients who have received prior skin-directed therapy. Currently the only FDA-approved topical formulation of mechlorethamine, Valchlor will be available in the fourth quarter of 2013.
Expanded Boxed Warning for Letairis
The FDA has expanded the Boxed Warning for Gilead Sciences’ Letairis (ambrisentan) to include the following statements: Females of reproductive potential must use acceptable methods of contraception during treatment with Letairis and for 1 month after treatment. Obtain monthly pregnancy tests during treatment and 1 month after therapy discontinuation.
The Boxed Warning already stated that the drug is contraindicated during pregnancy and should not be administered to pregnant women as it may cause fetal harm.
Wellness Pharmacy Recalls Certain Sterile Products
Wellness Pharmacy is voluntarily recalling certain sterile products due to laboratory results indicating microbial contamination. FDA investigators observed that methods used to assess sterility may have resulted in pharmacies receiving inaccurate sterility test results.
- Dexpanthenol 250 mg/mL (lot 130605@52, expiration date December 2, 2013)
- Magnesium sulfate 50% (lot 130613@38, expiration date December 10, 2013)
- Methylcobalamin 1 mg/mL (lot 130612@49, expiration date December 9, 2013 and October 19, 2013)
- Sodium phenylbutyrate 200 mg/mL SDV PF (lot 130621@28, expiration date October 19, 2013)
- R.L. glutathione 100 mg/mL SUV PF (lot 130710@27, expiration date January 6, 2014)
- Ascorbic acid (cassava) 500 mg/mL PF SUV (lot 130711@13, expiration date January 7, 2014)
The lots were distributed to individual patients and to physician offices nationwide. Customers should contact their health care provider if they have experienced any problems that may be related to taking these medications.
Customers with questions regarding this recall or for product return information should contact Wellness Pharmacy at 205-879-6551 or 800-227-2627, Monday through Friday, 9 AM to 4 PM CST.
JCB Laboratories Recalls Sterile Drug Products
JCB Laboratories is recalling 6 lots of sterile drug products to the user level due to concerns of sterility assurance following a recent inspection by the FDA.
The following compounded products are subject to the recall:
- Sodium thiosulfate, 25% 250 mg/mL – (lots 130701@9, expiration date December 28, 2013; 130709@6, expiration January 5, 2014; and 130717@2, expiration January 13, 2014)
- Sodium citrate, 4% solution for injection, 30 mL multiple-dose vial (lot 130710@4, expiration January 6, 2014)
- Sodium citrate, 4% with gentamicin 320 mcg/mL solution for injection, 30 mL multiple-dose vial (lot 130620@2, expiration December 17, 2013)
- Acetylcysteine, 20% solution for inhalation, 4 mL single-dose vials (lot 130627@5, expiration August 26, 2013)
The recalled products were distributed to outpatient dialysis clinic in multiple states from July 8, 2013 through August 20, 2013. Customers should contact their health care provider if they have experienced any problems that may be related to taking or using these products.
For information regarding this recall or for product return information, call JCB Laboratories at 316-773-0405, Monday through Friday, 8 AM to 5 PM CST. JCB Laboratories is notifying customers by phone, email, fax, and mail.
Park Pharmacy Recalls Methylcobalamin and Multitrace-5 Injections
Park Pharmacy & Compounding Center of Irvine, CA, is voluntarily recalling methylcobalamin 5 mg/mL 30mL amber vials (lot 06132013@1, expiration date December 12, 2013) and Multitrace-5 concentrate 10 mL amber vials (lot 05212013@20, expiration date November 11, 2013) for injection to the consumer level. FDA investigators observed that methods used to assess sterility may have resulted in pharmacies receiving inaccurate laboratory test results. The lots were sold directly to customers (pick up and by mail) and to health care providers by prescription (pick up and by mail) during June and July 2013, in California, Florida, New Mexico, and Indiana. Customers should contact their health care provider if they have experienced any problems that may be related to taking or using these preparations.
Customers with questions regarding this recall can contact Park Pharmacy & Compounding Center at 949-551-7195 or email@example.com, Monday through Friday, 9 AM to 5 PM PST. Park Pharmacy & Compounding Center is notifying its customers by phone and mail, and is arranging for return of all recalled products. Customers with a recalled product should stop using it and contact Park to arrange for return of unused product.
FDA Approves Mirvaso for Erythema of Rosacea
The FDA has approved Galderma Laboratories’ Mirvaso (brimonidine), a once-daily topical gel 0.33% for the treatment of persistent (nontransient) erythema of rosacea in adults 18 years and older. Galderma expects Mirvaso to be available in pharmacies September 2013.
FDA Approves Trokendi XR
The FDA has approved Supernus Pharmaceuticals’ Trokendi XR (topiramate) extended-release capsules for initial monotherapy for the treatment of seizures in patients 10 years and older with partial onset or primary generalized tonic-clonic seizures; as adjunctive therapy in patients 6 years and older with partial onset or primary generalized tonic-clonic seizures; and as adjunctive therapy in patients 6 years and older with seizures associated with Lennox-Gastaut syndrome. Trokendi XR will be available in the next few weeks.
Risks of Malignancy Progression and Drug Rash With Eosinophilia and Systemic Symptoms, Health Canada Issues Notice-August 2013
Hoffmann-La Roche Limited, in collaboration with Health Canada, has issued notice to health care providers regarding the risk of malignancy progression as well as the risk of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome associated with vemurafenib (Zelboraf).
Based on its mechanism of action, vemurafenib may cause progression of cancers associated with rat sarcoma viral oncogene (RAS) mutations. Accelerated growth of a preexisting neuroblastoma (RAS) mutated chronic myelomonocytic leukemia has been recently reported in a patient shortly after initiating vemurafenib therapy, suggesting that vemurafenib can cause paradoxical activation of extracellular signal-regulated kinase signaling in the RAS-mutant leukemic cell population, which could lead to leukemic cell proliferation. Vemurafenib should be used with caution in patients with previous or concurrent cancers associated with RAS mutations.
Cases of DRESS syndrome have also been reported, usually within 7 to 25 days. Vemurafenib should be permanently discontinued in patients who develop DRESS syndrome. The manufacturer is working with Health Canada to update the vemurafenib product monograph with this important safety information.
Further information may be found at:http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/35165a-eng.php
Covidien Recalls Monoject Prefill Flush Syringes
Covidien is recalling certain lots (13A0084N, 13A0094, 13B0364, 13C0504, 13C0514, 13A0084N, and 13D0824N) of Monoject prefill flush syringes due to the risk that a number of the syringes were filled with water but not subjected to the autoclave sterilization process. The products are labeled as either sodium chloride flush or heparin lock flush, and some have the mismatched syringe tip cap, syringe label, filled volume, and wrapper. Customers have been notified by letter of this issue. To return the affected product for credit, call 1-800-962-9888.
FDA Approves FluLaval Quadrivalent
The FDA has approved GlaxoSmithKline’s FluLaval Quadrivalent (influenza virus vaccine) intramuscular injection for active immunization of persons 3 years and older to help prevent disease caused by seasonal influenza virus subtypes A and B.
FDA Approves Esomeprazole Strontium
The FDA has approved esomeprazole strontium delayed-release capsules for adults for the treatment of gastroesophageal reflux disease, including healing of erosive esophagitis, maintenance of healing of erosive esophagitis, and symptomatic gastroesophageal reflux disease; risk reduction of nonsteroidal anti-inflammatory drug–associated gastric ulcer; Helicobacter pylori eradication to reduce the risk of duodenal ulcer recurrence (in combination with amoxicillin and clarithromycin as triple therapy); and pathological hypersecretory conditions, including Zollinger-Ellison syndrome.
FDA Approves Generic Temodar Capsules
The FDA has approved Teva Pharmaceuticals’ temozolomide 5, 20, 100, 140, 180, and 250 mg capsules, the generic version of Temodar, indicated for the treatment of adults with newly diagnosed glioblastoma multiforme who are concomitantly undergoing radiotherapy and then as maintenance treatment, and for refractory anaplastic astrocytoma patients who have experienced disease progression on a drug regimen containing nitrosourea and procarbazine.
Nexus Recalls Benztropine Mesylate Injection
Nexus Pharmaceuticals is voluntarily recalling at the user level 2 lots (030712, expiration date March 2014; 112911, expiration date November 2013) of benztropine mesylate injection 2 mg per 2 mL (1 mg/mL) in 2 mL single-dose vials due to the potential presence of visible particulate matter in the vials. To return unused products, contact Nexus at 1-888-806-4606. To report adverse events or quality problems, contact Nexus Medical Affairs at 1-877-913-2720 or email firstname.lastname@example.org. Fresenius Kabi USA also recently recalled 4 lots of benztropine mesylate injection (http://online.factsandcomparisons.com/News/NewsArticle.aspx?id=1009561).
Fluoroquinolones and Potential Peripheral Neuropathy Risk
The FDA is requiring that the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy, which can occur at any time during treatment. Symptoms include pain, burning, tingling, numbness, or weakness, a change in sensation to light touch, pain, or temperature, or in the sense of body position.
The risk of peripheral neuropathy occurs only with fluoroquinolones that are taken orally or by injection. Approved fluoroquinolone drugs include levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive). Topical fluoroquinolones, applied to the ears or eyes, are not known to be associated with this risk.
If a patient develops symptoms of peripheral neuropathy, the drug should be stopped, and the patient switched to a nonfluoroquinolone antibacterial drug, unless the benefit of continued treatment with a fluoroquinolone outweighs the risk. Fluoroquinolone-associated peripheral neuropathy can last for months to years after the drug is stopped or in some cases may become permanent.
For more information, see the Fluoroquinolones Drug Safety Alert.
FDA Approves Tivicay for HIV-1 Infection
The FDA has approved GlaxoSmithKline’s Tivicay (dolutegravir) tablets in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and children 12 years and older and weighing at least 40 kg.
Specialty Compounding Recalls Sterile Products
Specialty Compounding of Cedar Park, TX, is voluntarily recalling all lots of unexpired sterile products dispensed since May 9, 2013, including all strengths and dosage forms. The recall was initiated after reports of bacterial infection affecting 15 patients at 2 Texas hospitals whose treatments included intravenous infusions of calcium gluconate from Specialty Compounding. There is a potential association between the infections and the medication at this time.
Recalled products were distributed directly to hospitals and health care offices in Texas and directly to patients in every state except North Carolina.
To return products or request assistance related to this recall, users should contact Specialty Compounding at 1-512-219-0724, Monday through Friday, 10 AM to 5 PM CDT.
Expanded Boxed Warning for Prozac
The FDA has expanded the Boxed Warning for Dista’s Prozac (fluoxetine hydrochloride) to include the following statements: Prozac is not approved for children less than 7 years of age. When using Prozac and olanzapine in combination, also refer to the Boxed Warning section of the package insert.
The Boxed Warning had already stated that antidepressants increased the risk of suicidal thoughts and behavior in short-term studies in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders.
FDA Approves Fetzima for Depression
The FDA has approved Forest Laboratories’ and Pierre Fabre Laboratories’ Fetzima (levomilnacipran), a once-daily serotonin and norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder. The labeling includes a Boxed Warning regarding the risk of suicidal thoughts and behaviors.
Menveo Approved for Use in Infants
The FDA has approved Novartis’ Menveo (meningococcal [groups A, C, Y and W-135] oligosaccharide diphtheria CRM197 conjugate vaccine) for active immunization to prevent meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135 in patients 2 months to 55 years of age. Menveo was previously approved for use in patients 2 to 55 years of age. See the previous story for more information.
FDA Approves Lo Minastrin Fe to Prevent Pregnancy
The FDA has approved Warner Chilcott’s Lo Minastrin Fe (norethindrone acetate and ethinyl estradiol chewable tablets, ethinyl estradiol tablets, and ferrous fumarate tablets) for oral use for the prevention of pregnancy in women of reproductive age. Lo Minastrin Fe carries a Boxed Warning regarding the increased risk of serious cardiovascular events in women who smoke cigarettes while taking this drug. This risk increases with age, particularly in women older than 35 years, and with the number of cigarettes smoked. Lo Minastrin Fe should not be used by women who are older than 35 years and smoke.
Beacon Hill Medical Pharmacy/Rxtra Solutions Issues Recall
Beacon Hill Medical Pharmacy and the FDA are notifying health care providers and consumers of the recall of all lots of certain sterile products because of a possible lack of sterility.
The list of sterile injectable products under recall, in alphabetical order and organized by drug name and strength, can be found on the FDA’s recall list (http://www.fda.gov/Safety/Recalls/ucm363284.htm). The lot numbers start with code 01012013@1 to 07262013@99.
Any adverse events that may be related to the use of this product should be reported to the FDA’s MedWatch Adverse Event Reporting program online, by returning the postage-paid FDA form 3500 by mail (to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787) or fax (1-800-332-0178).
FDA Approves Injectafer
The FDA has approved American Regent’s Injectafer (ferric carboxymaltose) injection for the treatment of iron deficiency anemia in adults who have an intolerance to oral iron or have had an unsatisfactory response to oral iron, or who have non–dialysis-dependent chronic kidney disease.
FDA Warning of Serious Skin Reactions with Acetaminophen
The FDA is warning that acetaminophen has been associated with a risk of rare but serious and potentially fatal skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. Reddening of the skin, rash, blisters, and detachment of the upper surface of the skin can occur with the use of products that contain acetaminophen. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken. Other drugs used to treat fever and pain/body aches (eg, NSAIDs) also carry the risk of causing serious skin reactions, as described in the Warnings/Precautions section of these drug labels.
The FDA advises that anyone who develops a skin rash or reaction while using acetaminophen or any other pain reliever/fever reducer should stop the drug and seek medical attention immediately. Patients who have experienced a serious skin reaction with acetaminophen should not take the drug again and should discuss the use of alternative pain relievers/fever reducers with their health care provider.
FDA is requiring that a warning be added to the labels of prescription drug products containing acetaminophen to address the risk of serious skin reactions and is also requesting that manufacturers add a warning about serious skin reactions to acetaminophen-containing OTC product labels.
FDA Approves Mefloquine Boxed Warning
The FDA has approved a Boxed Warning for mefloquine hydrochloride to alert health care providers that mefloquine may cause neuropsychiatric adverse reactions that can persist after the drug has been discontinued. Mefloquine should not be prescribed for prophylaxis of malaria in patients with major psychiatric disorders. If psychiatric or neurologic symptoms occur during prophylactic use, mefloquine should be discontinued and an alternative medication used. Mefloquine is indicated for the treatment of mild to moderate acute malaria and for the prophylaxis of malaria infections.
Revised Warnings for Mefloquine
The FDA has strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A Boxed Warning has been added to the drug label. The FDA has also revised the patient Medication Guide dispensed with each prescription and wallet card to include this information. Potential neurologic side effects include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations. Neurologic side effects can last for months to years after the drug is stopped, or can be permanent.
Nizoral Safety Alert
The FDA is taking several actions related to Nizoral (ketoconazole) oral tablets, including limiting the drug’s use, warning that it can cause severe liver injuries and adrenal gland problems, and advising that it can lead to harmful drug interactions. Nizoral oral tablets should not be a first-line treatment for any fungal infection. They should be used for the treatment of endemic mycoses only when alternative antifungal therapies are not available or tolerated. A new Medication Guide will address these safety concerns.
Novartis Vaccines has issued a voluntary recall of 1 lot (M12118 [Men A vial Lot # A12118 and Men CWY vial lot # X12118]) of Menveo meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM-197 conjugate vaccine following observation of higher-than-specified levels of residual moisture within the lyophilized Men A component vial. This residual moisture content is not expected to impact product quality, but constitutes a deviation to registered specifications. No action is required for patients previously vaccinated with a dose from the recalled lot. Customers should check their inventory and follow the steps for return outlined in the notification.
Any adverse events that may be related to the use of this product should be reported to the FDA’s MedWatch Adverse Event Reporting program online, by returning the postage-paid FDA form 3500 by mail (to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787) or fax (1-800-332-0178).
FDA Approves Astagraf XL
The FDA has approved Astellas Pharma’s Astagraf XL (tacrolimus) once-daily, extended-release capsules for the prophylaxis of organ rejection in patients receiving a kidney transplant with mycophenolate mofetil and corticosteroids, with or without basiliximab induction.
Simponi Aria Approved for RA
The FDA has approved Janssen Biotech’s Simponi Aria (golimumab) infusion for the treatment of adults with moderately to severely active rheumatoid arthritis (RA) in combination with methotrexate. Simponi Aria will be dispensed with a patient Medication Guide.
Human Immune Globulins Black Box Warning Change
The FDA is requiring manufacturers to update the current Black Box Warning in the labels of all intravenous human immune globulin products and to add a Black Box Warning to the labels of all subcutaneous and intramuscular human immune globulin products to highlight the risk of thrombosis and provide information on its mitigation. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm355986.htm#summary
New Indications for Latuda
The FDA has approved Sunovion Pharmaceuticals’ Latuda (lurasidone hydrochloride) as monotherapy and as adjunctive therapy with either lithium or valproate for the treatment of patients with major depressive episodes associated with bipolar I disorder. Latuda is also indicated for the treatment of patients with schizophrenia.
FDA Approves Gilotrif and therascreen Test for Lung Cancer
Filter Cathflo Activase
The FDA is reminding health care providers that the final reconstituted solution of Genentech’s Cathflo Activase (alteplase) must be filtered with a 5-micron filter needle upon withdrawal from the container to remove potential rubber stopper particulates found in some vials after reconstitution.
All vials should be inspected after reconstitution and should not be administered if particulate matter is discovered. Contact Genentech at 1-800-334-0290 to return affected vials and to receive replacement vials. To report adverse events or product quality complaints, or to request medical information related to Cathflo Activase, contact Genentech at 1-800-821-8590, Monday through Friday, 5:30 AM to 4 PM PST.
Any adverse events that may be related to the use of this product should be reported to the FDA’s MedWatch Adverse Event Reporting program online, by returning the postage-paid FDA form 3500 by mail (to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787) or fax (1-800-332-0178).
Sandoz has issued a voluntary recall of 1 lot (LF01213A, expiration date February 2014, NDC 00781-4058-15) of Estarylla (norgestimate/ethinyl estradiol) tablets following a report that a placebo tablet was present in a row of active tablets in one pack.
Patients and health care providers can contact Sandoz at 1-800-525-2492, 7 days a week, 24 hours a day.
FDA Approves Zubsolv for Opioid Dependence
The FDA has approved Orexo’s Zubsolv (buprenorphine/naloxone) once-daily, sublingual tablets for the maintenance treatment of opioid dependence as part of a complete treatment plan to include counseling and psychosocial support.
Sprue-like Enteropathy With Olmesartan
The FDA is warning that olmesartan medoxomil (Sankyo’s Benicar, Benicar HCT, Azor, Tribenzor, and generics) can cause intestinal problems known as sprue-like enteropathy and the agency has approved labeling changes to include this concern. Olmesartan medoxomil is an angiotensin II receptor blocker approved for the treatment of high blood pressure, alone or with other antihypertensive agents. Health care providers should instruct patients to contact them if they develop severe, chronic diarrhea with substantial weight loss while taking an olmesartan-containing product, even if it takes months to years for symptoms to develop.
Recombivax HB Adult Formulation Recall
Merck Sharp & Dohme has initiated a voluntary recall of 1 lot (J001183; distributed between March 12, 2013 and May 2, 2013) of Recombivax HB adult formulation (hepatitis B vaccine [recombinant]) due to the potential for a limited number of cracked vials to be present in this lot. All product from the affected lot should be inventoried and quarantined, but revaccination is not necessary if product from this lot has been administered. Merck has contacted direct customers who have purchased product from the affected lot and provided instructions for return. Distributors and wholesalers will provide instructions to their customers. For additional information, contact the Merck National Service Center at 1-800-672-6372, Monday through Friday, 8 AM to 7 PM EST.
Problems with vaccine products can be reported to Vaccine Adverse Event Reporting System .
Expanded Black Box Warning for Promethazine/Codeine Antitussive Combinations
The FDA has expanded the Black Box Warning for promethazine hydrochloride/codeine phosphate oral solution and promethazine hydrochloride/phenylephrine hydrochloride/codeine phosphate oral solution. The Black Box Warning now includes the following statement: Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP2D6 polymorphism. The Black Box Warning had already stated that the combination of promethazine hydrochloride and codeine phosphate is contraindicated in pediatric patients younger than 6 years, and that postmarketing cases of respiratory depression, including fatalities, have been reported with use of promethazine hydrochloride in pediatric patients younger than 2 years.
Benztropine Mesylate Injection Recall
Fresenius Kabi USA is voluntarily recalling 4 lots (030712, 071212, 090512, and 111412) of benztropine mesylate injection 2 mg/2mL (1 mg/mL) in 2 mL single-dose vials due to the potential presence of glass particles in the vials. The company has discontinued distribution of benztropine mesylate while it investigates the cause.
All customers who received the recalled vials are being notified and instructed to return any unused product to Fresenius Kabi USA. Health care providers can find additional information about the recall on the company’s website or by calling 1-866-716-2459, Monday through Friday, 8 AM to 5 PM CST. Questions regarding product availability and ordering can be directed to customer service at 1-888-386-1300, Monday through Friday, 7 AM to 6 PM CST.
Expanded Indication for Exelon Patch
The FDA has approved an expanded indication for Novartis’ Exelon patch (rivastigmine transdermal system) to include the treatment of severe Alzheimer disease. It was previously approved for the treatment of mild to moderate dementia of the Alzheimer type and mild to moderate dementia associated with Parkinson disease.
FDA Approves Nymalize
The FDA has approved Arbor Pharmaceuticals’ Nymalize (nimodipine) oral solution for the improvement of neurological outcome in adult patients with subarachnoid hemorrhage from ruptured intracranial berry aneurysms, regardless of their postictus neurological condition. Nimodipine is also available as a liquid-filled gel capsule.
FDA Approves Brisdelle for Hot Flashes
The FDA has approved Noven Therapeutics’ Brisdelle (paroxetine) capsules for the treatment of moderate to severe hot flashes associated with menopause. Brisdelle is currently the only nonhormonal treatment for hot flashes approved by the FDA. Like other SSRIs, Brisdelle labeling contains a Black Box Warning regarding increased risk of suicide. The drug will be dispensed with a Medication Guide.
FDA Approves Rixubis
The FDA has approved Baxter Healthcare’s Rixubis (coagulation factor IX recombinant) for the control and prevention of bleeding episodes, perioperative management, and routine use to prevent or reduce the frequency of bleeding episodes in patients 16 years and older with hemophilia B.
Hydroxyethyl Starch Solutions Receive Black Box Warning
The FDA has added a Black Box Warning to the labeling for hydroxyethyl starch (HES) solutions after recent data indicated an increased risk of mortality and renal injury requiring renal replacement therapy in critically ill adult patients, including patients with sepsis and those admitted to the intensive care unit (ICU); and excess bleeding particularly in patients undergoing open heart surgery in association with cardiopulmonary bypass.
HES solutions are indicated for the treatment of hypovolemia when plasma volume expansion is desired. Voluven (Hospira) is also indicated for the prophylaxis of hypovolemia when plasma volume expansion is desired. Hespan (B. Braun) is also indicated as an adjunct in leukapheresis to improve harvesting and increase yield of granulocytes by centrifugal means.
FDA Recommendations for Health Professionals:
- Do not use HES solutions in critically ill adult patients including those with sepsis, and those admitted to the ICU.
- Avoid use in patients with preexisting renal dysfunction.
- Discontinue use of HES at the first sign of renal injury.
- Need for renal replacement therapy has been reported up to 90 days after HES administration. Continue to monitor renal function for at least 90 days in all patients.
- Avoid use in patients undergoing open heart surgery in association with cardiopulmonary bypass due to excess bleeding.
- Discontinue use of HES at the first sign of coagulopathy.
New Indication for Vibativ
The FDA has approved Astellas Pharma’s Vibativ (telavancin) for the treatment of hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) caused by Staphylococcus aureus. Vibativ should be used for the treatment of HABP/VABP only when alternative treatments are not suitable. Vibativ is approved only to treat S. aureus, not other bacteria that cause pneumonia. A warning concerning the possibility of new or worsening renal problems associated with the use of Vibativ has been added to the drug’s Black Box Warning. Vibativ is also indicated for the treatment of complicated skin and skin structure infections caused by S. aureus (including methicillin-susceptible and methicillin-resistant isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), or Enterococcus faecalis (vancomycin-susceptible isolates only).
Mycamine Approved for Pediatric Use
The FDA has approved Astellas Pharma’s Mycamine (micafungin sodium) for injection by intravenous infusion for the treatment of pediatric patients 4 months and older. Mycamine is currently approved in adults for the treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses, esophageal candidiasis, and prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplants.
Plan B One-Step Available Without Prescription or Age Restrictions
The FDA has approved the use of Teva Women’s Health’s Plan B One-Step (levonorgestrel) as a nonprescription product for all women of child-bearing potential. This action complies with the April 5, 2013, order of the U.S. District Court in New York to make levonorgestrel-containing emergency contraceptives available as a nonprescription product without age or point-of-sale restrictions.
Plan B One-Step is indicated to prevent pregnancy after known or suspected contraceptive failure or unprotected intercourse.
FDA Approves Fiorinal/Codeine #3 Black Box Warning
The FDA has approved a new Black Box Warning for Watson’s Fiorinal/Codeine #3 (codeine phosphate/aspirin/caffeine/butalbital) to alert health care providers that respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to CYP2D6 polymorphism. Fiorinal/Codeine #3 is indicated for relief of symptom complex of tension (or muscle contraction) headache.
Enteric-Coated Aspirin 81 mg Recall
Advance Pharmaceutical announced a voluntary recall of 1 lot (13A026, expiration date January 2015) of Rugby-labeled aspirin 81 mg enteric-coated tablets after receiving a complaint that a bottle actually contained acetaminophen 500 mg tablets. The labeled directions instruct patients to take 4 to 8 tablets every 4 hours, but not more than 48 tablets in 24 hours. Consumers who take 48 tablets daily of the defective product may be ingesting up to 24,000 mg of acetaminophen, which is about 6 times the maximum recommended daily dose of 4,000 mg.
Consumers with the affected lot should immediately discontinue its use and return it to the place of purchase. They should contact their physician or health care provider if they have experienced any problems that may be related to using this product.
Deaths Following Injection of Zyprexa Relprevv
The FDA is investigating 2 unexplained deaths in patients who received an intramuscular injection of the antipsychotic drug Zyprexa Relprevv (olanzapine pamoate). The patients died 3 to 4 days after receiving an appropriate dose of the drug.
Patients are required to receive the injection at a Risk Evaluation and Mitigation Strategy (REMS)–certified health care facility, to be continuously monitored at the facility for at least 3 hours following an injection, and to be accompanied home from the facility. The labeling contains warnings about the risk of postinjection delirium sedation syndrome. If therapy with Zyprexa Relprevv is started or continued in patients, health care providers should follow the REMS requirements and drug label recommendations.
New Indication for Xgeva
The FDA has approved Amgen’s Xgeva (denosumab) for the treatment of adults and some adolescents with giant cell tumor of the bone (GCTB). Xgeva is intended for patients whose GCTB cannot be surgically removed or when surgery is likely to result in severe morbidity, such as loss of limbs or joint removal. It should only be used in adolescents whose bones have matured. Xgeva is also indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors.
Vecuronium Bromide for Injection Recall
Sagent Pharmaceuticals announced a voluntary nationwide recall of 3 lots (11I30481A, 11I30721A, and 11I32581A; distributed from January 2012 through May 2012) of vecuronium bromide for injection 10 mg (NDC number 25021-657-10) manufactured by MN Pharmaceuticals and distributed by Sagent. The recall is due to the discovery of an elevated impurity result detected during routine quality testing of stability samples at the 18-month interval. The elevated impurity result has the potential to result in prolonged neuromuscular blockade for critically ill patients with renal failure.
Sagent’s distributor, DDN, is notifying distributors and customers by fax, email, and certified mail and is arranging for return of all recalled product. Customers have been instructed to examine their inventory immediately and to quarantine, discontinue distribution of, and return all recalled lots. Consumers should contact their health care provider if they have experienced any problems that may be related to taking or using this product. Any questions about returning unused product should be directed to the customer call center at 1-866-625-1618, Monday through Friday, 8 AM to 7 PM CST.
New Black Box Warning for Human Immune Globulin Products
The FDA is requiring manufacturers to add information on thrombosis to the current Black Box Warning in the labels of all intravenous human immune globulin products and to add a Black Box Warning to the labels of all subcutaneous and intramuscular human immune globulin products to highlight the risk of thrombosis and add information on its mitigation.
Health care providers should discuss with patients the risk of thrombosis associated with these products and carefully consider risk factors when selecting patients for treatment. Health care providers should monitor patients carefully for signs and symptoms of thrombosis at the time of infusion and after infusion and encourage patients to report any signs or symptoms.
Magnesium Sulfate Safety Alert
The FDA is advising health care providers against the use of magnesium sulfate injection for more than 5 to 7 days to stop preterm labor in pregnant women because a longer duration of administration may lead to low calcium levels and bone problems (eg, osteopenia, fractures) in the developing fetus. A new warning will be added to the label regarding the possible effect of this off-label use and the FDA Pregnancy Category will also be changed from A to D to convey that there is positive evidence of human fetal risk, but that potential benefits may warrant use of the drug in pregnant women despite potential risks. FDA-approved indications for magnesium sulfate include preventing seizures in patients with preeclampsia and controlling seizures in eclampsia.
FDA Approves Tafinlar, Mekinist, and Diagnostic Test for Melanoma
The FDA has approved 2 new drugs for the treatment of patients with advanced or unresectable melanoma. Tafinlar (dabrafenib) is a BRAF inhibitor approved to treat patients with melanoma whose tumors express the BRAF V600E gene mutation. Mekinist (trametinib) is an MEK inhibitor approved to treat patients whose tumors express the V600E or V600K gene mutations. Both drugs are manufactured by GlaxoSmithKline and are intended to be used as single agents. The FDA has also approved the THxID BRAF test, a companion diagnostic that will help determine if a patient’s melanoma cells have the V600E or V600K mutation in the BRAF gene.
Fresenius Kabi USA Recalls Magnesium Sulfate Injection
Fresenius Kabi USA has issued a voluntary recall of 1 lot (6103882) of magnesium sulfate injection because of the potential presence of glass particles in the vials. The recalled product is labeled with Product Code 6450 and is packaged as 500 mg/mL strength in 50 mL glass vials (25 vials per tray). The product was shipped in the US between May 30, 2012, and June 6, 2012, and has an expiration date of October 31, 2014. Customers who received the vials are being notified and instructed to return any unused product to their supplier.
New Indication for Amitiza
The FDA has approved Takeda Pharmaceuticals’ Amitiza (lubiprostone) for the treatment of opioid-induced constipation in adult patients with chronic, noncancer pain. Amitiza is also indicated for the treatment of chronic idiopathic constipation in adults and for the treatment of irritable bowel syndrome with constipation in women 18 years and older.
FDA Warns of Compounded Steroid Injections
The FDA is working closely with the Centers for Disease Control and Prevention and the Tennessee Board of Pharmacy to investigate 7 reports of adverse events associated with steroid injections compounded by Main Street Family Pharmacy of Newbern, TN. The reports are all from patients who received preservative-free methylprednisolone acetate (80 mg/mL) by injection and appear to be associated with a potentially contaminated medication. Clinical information is pending; at least 1 infection appears to be fungal.
The FDA recommends that health care providers not administer any products labeled as sterile from Main Street Family Pharmacy and quarantine them until further guidance is provided.
Sodium Phosphates Injection Crystallization Warning
All lots sodium phosphates injection single-dose vials manufactured by Luitpold Pharmaceuticals (distributed by American Regent) contain a saturated solution of sodium phosphates that may result in crystallization when stored at temperatures below the labeled storage conditions. If crystallization occurs after below-labeled storage, the potential exists for adverse events, including damage to blood vessels in the lung, localized swelling, and granuloma formation, after intravenous administration of crystals. As a preventive measure, American Regent is advising that the product be stored as directed and to avoid freezing or exposure to cold temperatures. In addition, the company is requiring that a filter must be used for withdrawal and administration of the product. If crystals/particles are observed, discard the product and contact American Regent’s Professional Services Department at 1-877-788-3232, Monday through Friday, 9 AM to 5 PM EST, or email at email@example.com.
For more information, see the news release.
Calcium Gluconate Particulate Warning
All lots of calcium gluconate injection 50 mL single-dose vials and 100 mL pharmacy bulk packages manufactured by Luitpold Pharmaceuticals (distributed by American Regent) may exhibit evidence of visible or subvisible particles not associated with the labeled precipitation that can occur. As a precautionary measure, the company is requiring that a filter must be used for the withdrawal and administration of the product. If precipitate or particulates are visible, discard the product and contact American Regent’s Professional Services Department at 1-877-788-3232, Monday through Friday, 9 AM to 5 PM EST, or email at firstname.lastname@example.org.
For more information, see the news release.
New Indication for Ilaris
The FDA has approved Novartis Pharmaceuticals’ Ilaris (canakinumab) injection for the treatment of systemic juvenile idiopathic arthritis in patients 2 years and older. Ilaris is also approved for the treatment of cryopyrin-associated periodic syndromes, including familial cold autoinflammatory syndrome and Muckle-Wells syndrome, in adults and children 4 years and older.
Methotrexate Sodium Injectable Vials Recall
Sandoz is conducting a voluntary nationwide recall to the hospital/user level of 2 lots (CL0996, expiration December 2013; CJ4948, expiration May 2013) of its methotrexate sodium 25 mg/mL, 40 mL injectable vials because of the discovery of particulate matter in vials during routine quality examination of retention samples at the manufacturer.
Patients should immediately contact their health care provider as well as Sandoz to report an adverse reaction or quality problem involving this product. Contact Sandoz at 1-800-525-2492, 7 days a week, 24 hours a day, or at email@example.com.
New Black Box Warning for Codeine Sulfate
A new Black Box Warning has been added by the FDA to the labeling for codeine sulfate oral solution. The warning concerns the risk of respiratory depression and death in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a cytochrome P450 2D6 polymorphism. Codeine sulfate is indicated for the management of mild to moderately severe pain where the use of an opioid analgesic is appropriate.