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Potential Signals of Serious Risks/New Safety Information Identified from the Adverse Event Reporting System (AERS) between January - March 2008

The table below lists the names of products and potential signals of serious risks/new safety information that were identified for these products during the period January - March 2008 in the AERS database. The appearance of a drug on this list does not mean that FDA has concluded that the drug has the listed risk. It means that FDA has identified a potential safety issue, but does not mean that FDA has identified a causal relationship between the drug and the listed risk. If after further evaluation the FDA determines that the drug is associated with the risk, it may take a variety of actions including requiring changes to the labeling of the drug, requiring development of a Risk Evaluation and Mitigation Strategy (REMS), or gathering additional data to better characterize the risk.

FDA wants to emphasize that the listing of a drug and a potential safety issue on this Web site does not mean that FDA is suggesting prescribers should not prescribe the drug or that patients taking the drug should stop taking the medication. Patients who have questions about their use of the identified drug should contact their health care provider. FDA will complete its evaluation of each potential signal/new safety information and issue additional public communications as appropriate.

Potential Signals of Serious Risks/New Safety Information Identified from the Adverse Event Reporting System (AERS) between January - March 2008

Product Name: Active Ingredient (Trade)
or Product Class
Potential Signal of Serious Risk/New Safety Information Additional Information Available as of January 30, 2009
Arginine Hydrochloride Injection (R-Gene 10) Pediatric overdose due to labeling / packaging confusion The FDA/CDER medication error division works closely with the Institute for Safe Medication Practices (ISMP) on some issues. Both FDA and ISMP have been evaluating this issue.
ISMP discussion [external link]
Desflurane (Suprane) Cardiac arrest This issue was identified during a review of desflurane adverse events as required by the Best Pharmaceuticals for Children Act. Information from a review of the AERS database was presented at a March 2008 advisory committee meeting, and the issue of cardiac arrest was discussed at that time. 13 out of 14 committee members recommended to FDA that the adverse event “cardiac arrest” be added to the desflurane labeling.  FDA is considering next steps on this issue.  Minutes of the Pediatric Advisory Committee, March 25, 2008
Duloxetine (Cymbalta) Urinary retention This issue was identified during a review of duloxetine adverse events as part of the Post-Marketing Safety Evaluation of New Molecular Entities (NMEs) pilot program.  The review of events indicated that there were many cases, including some with serious outcome. The Warnings and Precautions section of labeling has been updated to reflect this new information. Additionally, this review of duloxetine was detailed in the Drug Safety Newsletter.
Etravirine (Intelence) Hemarthrosis FDA has received one report since Intelence was approved and is continuing to monitor for additional reports.
Fluorouracil Cream (Carac) and Ketoconazole Cream (Kuric) Adverse events due to name confusion

The FDA/CDER medication error division works closely with the Institute for Safe Medication Practices (ISMP) on some issues. Both FDA and ISMP have been evaluating this issue.  ISMP Discussion (Carac-Kuric mix-ups [external link]).

Heparin Anaphylactic-type reactions FDA’s Information on Heparin page contains extensive information on this issue.
Icodextrin (Extraneal) Hypoglycemia

FDA approved changes to the Warnings section of labeling February 2008 to advise of the need to use glucose-specific blood glucose monitors to avoid falsely elevated glucose readings. Extraneal labeling

The Institute for Safe Medication Practices (ISMP) worked closely with FDA/CDER on this issue.
ISMP discussion [external link]

Insulin  U-500 (Humulin R) Dosing confusion FDA Patient Safety News featured a story on this issue in April 2008. FDA continues to evaluate this issue.
Transcript of FDA Patient Safety News story
Ivermectin (Stromectol) and Warfarin Drug interaction

This drug interaction was added to the Stromectol labeling in March 2008; see Precautions – Drug Interactions. Stromectol labeling

Lapatinib (Tykerb) Hepatotoxicity Information on hepatotoxicity was added to the Tykerb labeling in July 2008; see Boxed Warning, Warnings and Precautions, Adverse Reactions.
Tykerb labeling
Lenalidomide (Revlimid) Stevens Johnson Syndrome

This issue was featured in the Summer 2008 Drug Safety Newsletter.
Drug Safety Newsletter article: Lenalidomide (marketed as Revlimid)

Celgene is updating the Revlimid labeling to include this issue. Celgene staff published a letter to the editor on this issue in the Journal of Oncology in January 2009.

Natalizumab (Tysabri) Skin melanomas FDA is continuing to evaluate this issue to determine the need for any regulatory action.
Nitroglycerin (Nitrostat) Overdose due to labeling confusion FDA is continuing to evaluate this issue to determine the need for any regulatory action.
Octreotide Acetate Depot (Sandostatin LAR) Ileus FDA is continuing to evaluate this issue to determine the need for any regulatory action.
Oxycodone Hydrochloride Controlled-Release (Oxycontin) Drug misuse, abuse and overdose This is a continuation of FDA’s ongoing monitoring of adverse events associated with controlled-release oxycodone.
OxyContin information page
Perflutren Lipid Microsphere (Definity) Cardiopulmonary reactions FDA’s Drug Information Page on Definity includes July 2008 update information.
Phenytoin Injection (Dilantin) Purple Glove Syndrome This issue appears in the Precautions section of labeling for injectable phenytoin
Quetiapine (Seroquel) Overdose due to sample pack labeling confusion FDA is continuing to evaluate this issue to determine the need for any regulatory action.
Telbivudine (Tyzeka) Peripheral neuropathy FDA approved the addition of peripheral neuropathy to the Warnings/Precautions section of Tyzeka labeling in January 2009. A Medication Guide is also replacing the existing patient package insert.
Tumor Necrosis Factor (TNF) Blockers Cancers in children and young adults FDA issued an Early Communication addressing this issue in June 2008.

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Date created: September 5, 2008; updated February 4, 2009