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Drug Safety-related Labeling Changes (SrLC)

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ZOMETA (NDA-021223)

(ZOLEDRONIC ACID)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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12/14/2018 (SUPPL-41)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.10 Embryo-Fetal Toxicity

Additions and/or revisions underlined:

Based on findings from animal studies and its mechanism of action, Zometa can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of zoledronic acid to pregnant rats during organogenesis resulted in fetal malformations and embryo-fetal lethality at maternal exposures that were greater than or equal to 2.4 times the human clinical exposure based on area under the curve (AUC). Bisphosphonates, such as Zometa, are incorporated into the bone matrix, from where they are gradually released over periods of weeks to years. There may be a risk of fetal harm (e.g., skeletal and other abnormalities) if a woman becomes pregnant after completing a course of bisphosphonate therapy. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during and after Zometa treatment.

8 Use in Specific Populations

8.1 Pregnancy

8.2 Lactation

8.3 Females and Males of Reproductive Potential

PLLR conversion; extensive changes. Please refer to label for complete information.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

PATIENT COUNSELING INFORMATION

Addition of the following:

Embryo-Fetal Toxicity

  • Zometa should not be given if the patient is pregnant or plans to become pregnant. Inform female patients of the risk to a fetus and potential loss of the pregnancy.

  • Advise females of reproductive potential to use effective contraception during and after treatment with Zometa.

Lactation

Advise lactating women not to breastfeed during and after treatment with Zometa.

12/28/2016 (SUPPL-35)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Postmarketing Experience

(Additions and/or revisions are underlined)

Additional adverse reactions reported in postmarketing use include:

…Renal: hematuria, proteinuria, acquired Fanconi syndrome…

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

17 PATIENT COUNSELING INFORMATION

(Additions and/or revisions are underlined)

Drugs with Same Active Ingredient or in the Same Drug Class (Newly added subheading)

  • Inform patients not to take Reclast or other bisphosphonates during the course of their Zometa therapy.

Renal Impairment (Newly added subheading)

  • Instruct patients to tell their doctor if they have kidney problems…

Osteonecrosis of the Jaw (Newly added subheading)

  • Advise patients to have a dental examination…

Musculoskeletal Pain (Newly added subheading)

  • Advise patients to immediately tell their doctor about any severe bone, joint, and/or muscle pain.

Atypical subtrochanteric and diaphyseal femoral fracture(Newly added subheading)

  • Advise patients to report any thigh, hip, or groin pain…

Patients with Asthma(Newly added subheading)

  • There have been reports of bronchoconstriction in aspirin-sensitive patients receiving bisphosphonates…

Embryo-Fetal Toxicity(Newly added subheading)

  • Zometa should not be given if the patient is pregnant…

Hypocalcemia(Newly added subheading)

  • Advise patients with multiple myeloma and bone metastasis of solid tumors to take an oral calcium supplement…

Common Adverse Reactions(Newly added subheading)

  • Advise patients that the most common side effects of ZOMETA are…

03/29/2016 (SUPPL-34)

Approved Drug Label (PDF)

6 Adverse Reactions

Postmarketing Experience

Osteonecrosis of the Jaw

  • Cases of osteonecrosis (primarily involving the jaw but also of other anatomical sites including hip, femur and external auditory canal) have been reported predominantly in cancer patients treated with intravenous bisphosphonates including Zometa. Many of these patients were also receiving chemotherapy and corticosteroids which may be a risk factor for ONJ.