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Drug Safety-related Labeling Changes (SrLC)

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PANTOPRAZOLE SODIUM (NDA-209463)

(PANTOPRAZOLE SODIUM)

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

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07/18/2023 (SUPPL-21)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Postmarketing Experience

Additions and/or revisions underlined:

Renal and Genitourinary Disorders: interstitial nephritis, erectile dysfunction

03/04/2022 (SUPPL-15)

Approved Drug Label (PDF)

5 Warnings and Precautions

Newly added subsection:

5.6 Severe Cutaneous Adverse Reactions

Severe cutaneous adverse reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) have been reported in association with the use of PPIs [see Adverse Reactions (6.2)]. Discontinue Pantoprazole Sodium for Injection at the first signs or symptoms of severe cutaneous adverse reactions or other signs of hypersensitivity and consider further evaluation.

Additions and/or revisions underlined:

5.9 Hypomagnesemia and Mineral Metabolism

… Serious adverse reactions include tetany, arrhythmias, and seizures. Hypomagnesemia may lead to hypocalcemia and/or hypokalemia and may exacerbate underlying hypocalcemia in at-risk patients. In most patients, treatment of hypomagnesemia required magnesium replacement and discontinuation of the PPI.

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), healthcare professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2)].

Consider monitoring magnesium and calcium levels prior to initiation of Pantoprazole Sodium for Injection and periodically while on treatment in patients with a preexisting risk of hypocalcemia (e.g., hypoparathyroidism). Supplement with magnesium mid/or calcium as necessary. If hypocalcemia is refractory to treatment, consider discontinuing the PPI.

6 Adverse Reactions

Additions and/or revisions to bulleted line listing underlined:

  • Bone Fracture [see Warnings and Precautions (5.5)]

  • Severe Cutaneous Adverse Reactions [see Warnings and Precautions (5.6)]

  • Hypomagnesemia and Mineral Metabolism [see Warnings and Precautions (5.9)]

6.2 Postmarketing Experience

Additions and/or revisions underlined:

Skin and Subcutaneous Tissue Disorders: severe dermatologic reactions (some fatal), including erythema multiforme, SJS/TEN, DRESS, AGEP [see Warnings and Precautions (5.6)], and angioedema (Quincke's edema) and cutaneous lupus erythematosus

Metabolism and Nutritional Disorders: hypomagnesemia, hypocalcemia, hypokalemia [see Warnings and Precautions (5.9)], hyponatremia

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

PATIENT COUNSELING INFORMATION

Adverse Reactions

Additions and/or revisions underlined:

  • Bone Fracture [see Warnings and Precautions (5.5)]

  • Severe Cutaneous Adverse Reactions [see Warnings and Precautions (5.6)]

  • Hypomagnesemia and Mineral Metabolism [see Warnings and Precautions (5.9)]

11/27/2020 (SUPPL-11)

Approved Drug Label (PDF)

4 Contraindications

Additions and/or revisions underlined

Hypersensitivity reactions may include anaphylaxis, anaphylactic shock, angioedema, bronchospasm, acute tubulointerstitial nephritis, and urticaria [see Warnings and Precautions (5.2, 5.4), Adverse

5 Warnings and Precautions

5.4 Acute Tubulointerstitial Nephritis

Additions and/or revisions underlined

Acute tubulointerstitial nephritis (TIN) has been observed in patients taking PPIs and may occur at any point during PPI therapy. Patients may present with varying signs and symptoms from symptomatic hypersensitivity reactions to non-specific symptoms of decreased renal function (e.g., malaise, nausea, anorexia). In reported case series, some patients were diagnosed on biopsy and in the absence of extra- renal manifestations (e.g., fever, rash or arthralgia). Discontinue Pantoprazole Sodium for Injection and evaluate patients with suspected acute TIN [see Contraindications (4)].

6 Adverse Reactions

Addition and/or revesion underlined

  • Acute Tubulointerstitial Nephritis [see Warnings and Precautions (5.4)]

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

PATIENT COUNSELING INFORMATION

Addition and/or revision underlined

  • Acute Tubulointerstitial Nephritis [see Warnings and Precautions (5.4)]

06/23/2020 (SUPPL-6)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.11 Interference with Investigations for Neuroendocrine Tumors

(Newly added subsection)

Serum chromogranin A (CgA) levels increase secondary to drug-induced decreases in gastric acidity.

The increased CgA level may cause false positive results in diagnostic investigations for neuroendocrine tumors. Healthcare providers should temporarily stop Pantoprazole Sodium for Injection treatment at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high. If serial tests are performed (e.g. for monitoring), the same commercial laboratory should be used for testing, as reference ranges between tests may vary [see Clinical Pharmacology (12.2)].

10/10/2018 (SUPPL-5)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.12 Fundic Gland Polyps

(new subsection added)

PPI use is associated with an increased risk of fundic gland polyps that increases with long-term use, especially beyond one year. Most PPI users who developed fundic gland polyps were asymptomatic and fundic polyps were identified incidentally on endoscopy. Use the shortest duration of PPI therapy appropriate to the condition being treated.

6 Adverse Reactions

(addition underlined)

  • Fundic Gland Polyps

6.2 Postmarketing Experience

(addition underlined)

Gastrointestinal Disorders: fundic gland polyps

7 Drug Interactions

7 DRUG INTERACTIONS

(Table has been revised; please refer to label)