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Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) -- November 2003

 

The detailed view includes drug products with safety labeling changes to the CONTRAINDICATIONS, BOXED WARNING, WARNINGS, PRECAUTIONS, or ADVERSE REACTIONS sections. The prescribing information may be accessed by clicking on the drug name.

Summary View

 

Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Advair Diskus (fluticasone propionate and salmeterol inhalation powder)

(click product name to read prescribing information)

CONTRAINDICATIONS

BOXED WARNING

WARNINGS

  • Drug Interaction with Ritonavir
  • Do Not Use Advair Diskus to Treat Acute Symptoms
  • Do Not Use an Inhaled, Long-Acting Beta2-Agonist in Conjunction with Advair Diskus

PRECAUTIONS

  • General
    • Cardiovascular Effects
    • Metabolic and Other Effects
    • Chronic Obstructive Pulmonary Disease
  • Information for Patients
  • Drug Interactions
    • Inhibitors of Cytochrome P450
  • Carcinogenesis, Mutagenesis, Impairment of Fertility
    • Salmeterol
  • Pregnancy
    • Teratogenic Effects
      • Advair Diskus
      • Salmeterol

ADVERSE REACTIONS

  • Observed During Clinical Practice
    • Eyes
  • Chronic Obstructive Pulmonary Disease Associated with Chronic Bronchitis
    • Table 4
CONTRAINDICATIONS

Advair Diskus is contraindicated in the primary treatment of status asthmaticus or other acute episodes of asthma or COPD where intensive measures are required.

BOXED WARNING

Data from a large-placebo-controlled US study that compared the safety of salmeterol (Serevent Inhalation Aerosal) or placebo added to usual asthma therapy showed a small but significant increase in asthma-related deaths in patients receiving salmeterol (13 deaths out of 13,174 patients treated for 28 weeks) versus those on placebo (4 of 13,179). Subgroup analyses suggest that risk may be greater in African-American patients compared to Caucasians.

WARNINGS

A drug interaction study in healthy subjects has shown that ritonaivr (a highly potent cytochrome P450 3A 4 inhibitor) can significantly increase plasma fluticasone propionate exposure, resulting in significantly reduced serum cortisol concentrations. During postmarketing use, there have been reports of clinically significant drug interactions in patients receiving fluticasone propionate and ritonavir, resulting in systemic corticosteroid effects including Cushing syndrome and adrenal suppression.

An inhaled, short acting beta2-agonists, not Advair Diskus, should be used to relieve acute symptoms of shortness of breath.

Patients who are receiving Advair Diskus twice daily should not use additional salmeterol or other inhaled, long-acting beta2-agonists for prevention of excercise-induced bronchospasm or the maintenance treatment of asthma or the maintenance treatment of bronchospasm associated with COPD.

Alora (estradiol transdermal system)

(click product name to read prescribing information)

CONTRAINDICATIONS

BOXED WARNING

WARNINGS

  • Cardiovascular Disorders
  • Coronary Heart Disease and Stroke

PRECAUTIONS

  • General
  • Patient Information
  • Laboratory Tests
  • Nursing Mothers

ADVERSE REACTIONS

PATIENT PACKAGE INSERT

Extensive labeling changes to the package insert. Please see the package insert for new text.

CONTRAINDICATIONS

Estrogens should not be used in individuals with any of the following conditions ... (see product insert)

BOXED WARNING

Estrogens increase the risk of endometrial cancer. Estrogens with and without progestins should not be used for the prevention of cardiovascular disease.

WARNINGS

Women's Health Initiative (WHI) data added.

Daraprim (pyrimethamine) Tablets

(click product name to read prescribing information)

CONTRAINDICATIONS

PRECAUTIONS

  • Drug Interactions
  • Nursing Mothers

ADVERSE REACTIONS

Use of Daraprim is contraindicated in patients with known hypersensitivity to pyrimethamine or to any component of the formulation.

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Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Actos (pioglitazone HCl) Tablets

(click product name to read prescribing information)

WARNINGS
  • Cardiac Failure and Other Cardiac Effects

PRECAUTIONS

  • Edema
  • Table 6
  • Hematologic
  • Hepatic Effects

ADVERSE REACTIONS

  • Laboratory Abnormalities
    • Serum Transaminase Levels
    • CPK Levels
In a 24-week dose-controlled study in which Actos was co-administered with insulin, 0.3% of patients (1/345) on 30 mg and 0.9% (3/345) of patients on 45 mg reported CHF as a serious adverse event.

Cuprimine (penicillamine capsules)

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

ADVERSE REACTIONS

  • Central Nervous System
    • mental disorders
    • agitation
    • anxiety
  • Neuromuscular
    • dystonia
Because of the potential for serious hematological and renal adverse reactions to occur at any time, routine urinalysis, white and differential blood cell count, hemoglobin determination, and direct platelet count must be done twice weekly, together with monitoring of patients skin, lymph nodes and body temperature, during the first month of therapy, every two weeks for the next five months, and monthly thereafter.

In Wilson's disease, liver function tests are recommended every three months, at least during the first year of treatment.

Onset of new neurologic symptoms has been reported with Cuprimine. Occasionally, neurologic symptoms become worse during initiation of therapy with Cuprimine.

Wilson's Disease - Reported experience shows that continued treatment with penicillamine throughout pregnancy protects the mother against relapse of the Wilson's disease, and that discontinuation of penicillamine has deleterious effects on the mother, which may be fatal.

If penicillamine is administered during pregnancy to patients with Wilson's disease, it is recommended that the daily dosage be limited to 750 mg. If cesarean section is planned the daily dose should be reduced to 250 mg, but no lower, for the last six weeks of pregnancy and postoperatively until wound healing is complete.

DDAVP Injection (desmopressin acetate)

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

  • Anaphylaxis

When DDAVP Injection is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular in pediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain.)

DDAVP Nasal Spray (desmopressin acetate)

(click product name to read prescribing information)

 

WARNINGS

PRECAUTIONS

  • Anaphylaxis

When DDAVP Nasal Spray is administered, in particular in pediatric and geriatric patients, fluid intake should be adjusted downward in order to decrease the potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain).

DDAVP Rhinal Tube (desmopressin acetate)

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

  • Anaphylaxis

When DDAVP is administered, in particular, in pediatric and geriatric patients, fluid intake should be adjusted downward in order to decrease the potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain).

DDAVP Tablets (desmopressin acetate)

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

  • Anaphylaxis

When DDAVP Tablets are administered, in particular in pediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain).

ReoPro (abciximab)

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

  • Bleeding Precautions

ADVERSE REACTIONS

  • Bleeding

Abciximab has the potential to increase the risk of bleeding, particularly in the presence of anticoagulation, e.g., from heparin, other anticoagulants, or thrombolytics. 

The risk of major bleeds due to abciximab therapy is increased in patients receiving thrombolytics and should be weighed against the anticipated benefits.

Risperdal (risperidone) Tablets and Oral Solution

Risperdal M-TAB (risperidone) Orally Disintegrating Tablets

(click product name to read prescribing information)

WARNINGS

  • Hyperglycemia and Diabetes Mellitus

ADVERSE REACTIONS 

  • ECG Changes

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics including Risperdal. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population.

Symmetrel (amantadine HCl) Syrup and Tablets

(click product name to read prescribing information)

WARNINGS

PRECAUTIONS

  • Abrupt Discontinuation
  • Other

ADVERSE REACTIONS

  • Nervous System/Psychiatric

Deaths have been reported from overdose with Symmetrel. The lowest reported acute lethal dose was 1 gram. Acute toxicity may be attributable to the anticholinergic effects of amantadine.

Tenormin (atenolol) I.V. Injection

(click product name to read prescribing information)

WARNINGS
  • Pregnancy and Fetal Injury

PRECAUTIONS

  • Nursing Mothers
Neonates born to mothers who are receiving Tenormin at parturition or breast-feeding may be at risk for hypoglycemia. Caution should be exercised when Tenormin is administered during pregnancy or to a woman who is breast-feeding.

Tenormin (atenolol) Tablets

(click product name to read prescribing information)

WARNINGS
  • Pregnancy and Fetal Injury

PRECAUTIONS

  • Nursing Mothers
Neonates born to mothers who are receiving Tenormin at parturition or breast-feeding may be at risk for hypoglycemia. Caution should be exercised when Tenormin is administered during pregnancy or to a woman who is breast-feeding.

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Brand (Generic) Name
Sections Modified

Anadrol-50 (oxymetholone) Tablets

(click product name to read prescribing information)

 

PRECAUTIONS
  • Carcinogenesis, Mutagenesis, Impairment of Fertility
  • Geriatric Use

Cortisporin Ointment (neomycin sulfate, polymyxin B sulfate, bacitracin zinc, and hydrocortisone ointment)

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Cylert (pemoline) Tablets and Chewable Tablets

Please contact Abbott Laboratories at 1-800-633-9110 for prescribing information.

PRECAUTIONS
  • Geriatric Use

DMSA (Kit for the preparation of Tc99m Succimer for Injection)

Please contact Amersham Health at 1-800-654-0118 for prescribing information.

PRECAUTIONS
  • Geriatric Use

Drisdol (ergocalciferol) Capsules

Please contact Sanofi-Synthelabo at 1-800-446-6267 for prescribing information.

PRECAUTIONS
  • Geriatric Use

Epivir (lamivudine) Tablets and Oral Solution

(click product name to read prescribing information)

PRECAUTIONS
  • Information to Patient
  • Drug Interactions

Epivir-HBV (lamivudine) Tablets and Oral Solution

(click product name to read prescribing information)

PRECAUTIONS
  • Information to Patient
  • Drug Interactions
  • Nursing Mothers

Leukeran (chlorambucil) Tablets

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Lupron (leuprolide acetate) Injection

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Myoview (Kit for the Preparation of Technetium Tc99m Tetrofosmin for Injection)

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Tussionex Pennkinetic (hydrocodone polistirex/chlorpheniramine polistirex)

Please contact Celltech Pharmaceuticals at 1-800-234-5535 for prescribing information.

PRECAUTIONS
  • Geriatric Use

Winstrol (stanozolol) Tablets

Please contact Ovation Pharmaceuticals at  1-847-282-1000 for prescribing information.

 PRECAUTIONS
  • Geriatric Use

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Brand (Generic) Name
Sections Modified

OxyContin (oxycodone HCl) Controlled-Release Tablets

(click product name to read prescribing information)

ADVERSE REACTIONS
  • General

Protonix I.V. (pantoprazole sodium) for Injection

(click product name to read prescribing information)

ADVERSE REACTIONS
  • Postmarketing Reports
    • Interstitial Nephritis

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