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Drug Safety-related Labeling Changes (SrLC)

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CORDARONE (NDA-018972)

(AMIODARONE HYDROCHLORIDE)

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

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10/17/2018 (SUPPL-54)

Approved Drug Label (PDF)

Boxed Warning

(Physicians Labeling Rule (PLR) Conversion; please refer to label)

5 Warnings and Precautions

(Physicians Labeling Rule (PLR) Conversion; please refer to label)

6 Adverse Reactions

(Physicians Labeling Rule (PLR) Conversion; please refer to label)

7 Drug Interactions

(Physicians Labeling Rule (PLR) Conversion; please refer to label)

8 Use in Specific Populations

 

(Pregnancy and Lactation Labeling Rule (PLLR) Conversion; please refer to label)

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

17 PATIENT COUNSELING INFORMATION

(Newly Added Subsection)

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to inform their prescriber of a known or suspected pregnancy.

Advise women that breastfeeding is not recommended during treatment with CORDARONE.

Advise patients to avoid grapefruit juice and St. John's Wort.

Advise patients to seek medical attention if they experience the signs and symptoms of pulmonary toxicity, worsening arrhythmia, bradycardia, visual impairment, or hypo- and hyperthyroidism.

04/07/2017 (SUPPL-53)

Approved Drug Label (PDF)

6 Adverse Reactions

(Additions and/or revisions are underlined)

Postmarketing Reports

In postmarketing surveillance, serious symptomatic bradycardia has been reported in patients

taking amiodarone who initiate treatment with ledipasvir/sofosbuvir or with sofosbuvir with simeprevir, hypotension (sometimes fatal), sinus arrest,… dry mouth, and lupus-like syndrome, also have been reported with amiodarone therapy.

11/22/2016 (SUPPL-52)

Approved Drug Label (PDF)

7 Drug Interactions

Drugs lowering heart rate or causing automaticity or conduction disorders (addition underlined)

Concomitant use of drugs with depressant effects on the sinus and AV node (e.g., digoxin, beta blockers, verapamil, diltiazem, ivabradine, clonidine) can potentiate the electrophysiologic and hemodynamic effects of amiodarone, resulting in bradycardia, sinus arrest, and AV block. Monitor heart rate in patients on amiodarone and concomitant drugs that slow heart rate.

04/22/2016 (SUPPL-51)

Approved Drug Label (PDF)

5 Warnings and Precautions

Serious Symptomatic Bradycardia When Co-administered with Ledipasvir/Sofosbuvir or with Sofosbuvir with Simeprevir
  • Postmarketing cases of symptomatic bradycardia, some requiring pacemaker insertion and at least one fatal, have been reported when ledipasvir/sofosbuvir or sofosbuvir with simeprevir were initiated in patients on amiodarone. Bradycardia generally occurred within hours to days, but in some cases up to 2 weeks after initiating antiviral treatment. Bradycardia generally resolved after discontinuation of antiviral treatment. The mechanism for this effect is unknown. Monitor heart rate in patients taking or recently discontinuing amiodarone when starting antiviral treatment.
Neonatal Injury
  • Amiodarone can cause fetal harm when administered to a pregnant woman. Fetal exposure may increase the potential for adverse experiences including cardiac, thyroid, neurodevelopmental, neurological and growth effects in neonate. Inform the patient of the potential hazard to the fetus if Cordarone is administered during pregnancy or if the patient becomes pregnant while taking Cordarone.

Teratogenic Effects
  • Amiodarone and desethylamiodarone cross the placenta.
  • Reported risks include:
    • neonatal bradycardia, QT prolongation, and periodic ventricular extrasystoles
    • neonatal hypothyroidism (with or without goiter) detected antenatally or in the newborn and reported even after a few days of exposure
    • neonatal hyperthyroxinemia
    • neurodevelopmental abnormalities independent of thyroid function, including speech delay and difficulties with written language and arithmetic, delayed motor development, and ataxia.
    • jerk nystagmus with synchronous head titubation
    • fetal growth retardation
    • premature birth.
Nursing Mothers
  • Amiodarone and one of its major metabolites, DEA, are excreted in human milk, suggesting that breast-feeding could expose the nursing infant to a significant dose of the drug. Nursing offspring of lactating rats administered have been shown to be less viable and have reduced body-weight gains. The risk of exposing the infant to amiodarone and DEA must be weighed against the potential benefit of arrhythmia suppression in the mother. Advise the mother to discontinue nursing.

6 Adverse Reactions

Postmarketing Reports
  • …serious symptomatic bradycardia has been reported in patients taking amiodarone who initiate treatment with ledipasvir/sofosbuvir or with sofosbuvir with simeprevir…