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

Zestril (lisinopril) Tablets

(click product name to read prescribing information)

CONTRAINDICATIONS 

WARNINGS

  • Head and Neck Angioedema

  • Intestinal Angioedema

  • Fetal/Neonatal Morbidity and Mortality

PRECAUTIONS

  • General

  • Drug Interactions

    • Non-steroidal Anti-inflammatory Agents

  • Carcinogenesis, Mutagenesis, Impairment of Fertility

  • Pediatric Use

ADVERSE REACTIONS

  • Body as a Whole

  • Special Senses

  • Miscellaneous

  • Angioedema

  • Pediatric Patients

  • Clinical Laboratory Findings

    • Hemoglobin and Hematocrit

Zestril is contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema.

Angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in patients treated with angiotensin converting enzyme inhibitors, including Zestril.

Intestinal angioedema has been reported in patients treated with ACE inhibitors.

No teratogenic effects of lisinopril were seen in studies of pregnant rats, mice, and rabbits. 

 

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Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Retrovir (zidovudine) IV Infusion

(click product name to read prescribing information)

BOXED WARNING

WARNINGS

  • Lactic Acidosis/Severe Hepatomegaly with Steatosis

PRECAUTIONS

  • General
  • Drug Interactions
    • Antiretroviral Agents
    • Doxorubicin
    • Overlapping Toxicities
  • Pregnancy
  • Pediatric Use

ADVERSE REACTIONS

  • Adults
  • Pediatrics: Study ACTG 300
  • Use for the Prevention of Maternal-Fetal Transmission of HIV
  • Observed During Clinical Practice
    • Body as a Whole
    • Cardiovascular
    • Endocrine
    • Eye
    • Gastrointestinal
    • General
    • Hemic and Lymphatic
    • Hepatobiliary Tract and Pancreas
    • Musculoskeletal
    • Nervous
    • Respiratory
    • Skin
    • Urogenital
BOXED WARNING: Retrovir has been associated with hematologic toxicity, including neutropenia and severe anemia, particularly in patients with advanced HIV disease (See WARNINGS). 

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues alone or in combination, including Retrovir and other antiretrovirals (see WARNINGS).

WARNINGS: Combivir and Trizivir are combination product tablets that contain zidovudine as one of their components. Retrovir should not be administered concomitantly with Combivir or Trizivir.

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues alone or in combination, including zidovudine and other antiretrovirals. A majority of these cases have been in women. Obesity and prolonged exposure to antiretroviral nucleoside analogues may be risk factors. Particular caution should be exercised when administering Retrovir to any patient with known risk factors for liver disease; however, cases have also been reported in patients with no known risk factors. Treatment with Retrovir should be suspended in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity (which may include hepatomegaly and steatosis even in the absence of marked transaminase elevations).

Viramune (nevirapine) Tablets and Suspension

(click product name to read prescribing information)

 

BOXED WARNING

WARNINGS

  • General
  • Hepatic events
  • Skin reactions

PRECAUTIONS

  • Drug Interactions
    • Information for Patients

ADVERSE REACTIONS

  • Adults
  • Post Marketing Surveillance
    • Skin and Appendages

    PATIENT PACKAGE INSERT

It is essential that patients be monitored intensively during the first 18 weeks of therapy with Viramune to detect potentially life-threatening hepatotoxicity or skin reactions. The greatest risk of severe rash or hepatic events associated with rash occurs in the first six weeks of therapy. However, the risk of any hepatic event, with or without rash, continues past this period and monitoring should continue at frequent intervals.

Increased AST or ALT levels and/or co-infection with hepatitis B or C at the start of antiretroviral therapy are associated with a greater risk of hepatic adverse events. It appears that women and patients with higher CD4 counts (>250 cells/mm3 in women and >400 cells/mm3 in men) may be at higher risk for rash-associated hepatic events with Viramune.

If patients present with a suspected Viramune-associated rash, liver function tests should be performed. Patients with rash-associated AST or ALT elevations should be permanently discontinued from Viramune.

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Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Lovenox (enoxaparin sodium injection)

(click product name to read prescribing information)

WARNINGS
  • Pregnant Women with Mechanical Prosthetic Heart Valves
  • Miscellaneous

 

PRECAUTIONS

  • Mechanical Prosthetic Heart Valves

  • Pregnancy:  Pregnancy Category B

    • Fetal Risk Summary

    • Clinical Considerations

    • Data

      • Human Data

      • Animal Data

The use of Lovenox Injection for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves has not been adequately studied. In a clinical study of pregnant women with mechanical prosthetic heart valves given enoxaparin (1 mg/kg bid) to reduce the risk of thromboembolism, 2 of 8 women developed clots resulting in blockage of the valve and leading to maternal and fetal death. Although a causal relationship has not been established these deaths may have been due to therapeutic failure or inadequate anticoagulation. No patients in the heparin/warfarin group (0 of 4 women) died. There also have been isolated postmarketing reports of valve thrombosis in pregnant women with mechanical prosthetic heart valves while receiving enoxaparin for thromboprophylaxis. Women with mechanical prosthetic heart valves may be at higher risk for thromboembolism during pregnancy, and, when pregnant, have a higher rate of fetal loss from stillbirth, spontaneous abortion and premature delivery. Therefore, frequent monitoring of peak and trough anti-Factor Xa levels, and adjusting of dosage may be needed.

Because benzyl alcohol may cross the placenta, Lovenox multiple-dose vials, preserved with benzyl alcohol, should be used with caution in pregnant women and only if clearly needed (see PRECAUTIONS, Pregnancy).

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Brand (Generic) Name
Sections Modified
Augmentin (amoxicillin/clavulanate potassium) Tablets

(click product name to read prescribing information)

PRECAUTIONS

  • Labor and Delivery

    • Necrotizing enterocolitis in neonates (NEC)

 

ADVERSE REACTIONS

  • Hypersensitivity Reactions

    • Generalized exanthematous pustulosis (AGEP) 

Azopt (brinzolamide ophthalmic suspension)

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Humatrope (somatropin [rDNA origin] for injection)

(click product name to read prescribing information)

PRECAUTIONS
  • General
    • Idiopathic short stature

ADVERSE REACTIONS

  • Patients with Idiopathic Short Stature
  • Table 7

Imitrex (sumatriptan) Tablets, Nasal Spray and Injection

(click product name to read prescribing information)

PRECAUTIONS
  • General
    • Seizures

Lysodren (mitotane tablets)

(click product name to read prescribing information)

PRECAUTIONS
  • Geriatric Use

Nimbex (cisatracurium besylate) Injection

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

PRECAUTIONS
  • Pediatric Use

Nimbex has not been studied in pediatric patients below the age of one month (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION for clinical experience and recommendations for use in children one month to 12 years of age).  Intubation of the trachea in patients 1-4 years of old was facilitated more reliably when Nimbex was used in combination with Halothane than when opioids and nitrous oxide were used for induction of anesthesia.

ADVERSE REACTIONS

  • Observed During Clinical Practice
    • General

There are rare reports of wheezing, laryngospasm, bronchospasm, rash and itching following administration of Nimbex in children. These reported adverse events were not serious and their etiology could not be established with certainty.

Rebetol (ribavirin) Capsules 

(click product name to read prescribing information)

PRECAUTIONS
  • Drug Interactions
    • Stavudine and Zidovudine

Talacen (pentazocine HCl and acetaminophen) Caplets

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

PRECAUTIONS

  • Geriatric Use

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Brand (Generic) Name
Sections Modified
Detrol (tolterodine tartrate tablets)

Detrol LA (tolterodine tartrate extended release capsules)

(click product name to read prescribing information)

ADVERSE REACTIONS
  • Postmarketing Surveillance
    • Hallucinations

Elavil (amitriptyline hydrochloride) Tablets and Injection

(click product name to read prescribing information)

ADVERSE REACTIONS
  • Postmarketing Adverse Events
    • Cardiomyopathy

Zyprexa (olanzapine) Tablets

Zyprexa (olanzapine) Zydis Orally Disintegrating Tablets

(click product name to read prescribing information)

ADVERSE REACTIONS
  • Adverse Events Associated with Discontinuation of Treatment in Short-Term Combination Trials
    • Bipolar Mania Combination Therapy
  • Commonly Observed Adverse Events in Short-Term, Placebo-Controlled Trials
  • Commonly Observed Adverse Events in Short-Term Combination Trials

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