Drug Safety-related Labeling Changes (SrLC)

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Drug Safety-related Labeling Changes (SrLC) Database

ANDA	Abbreviated New Drug Application
BLA	Biologics License Application
CDER	Center for Drug Evaluation and Research
MG	Medication Guide
NDA	New Drug Application
PCI	Patient Counseling Information
PI	Patient Information
PLR	Physician Labeling Rule
PLLR	Pregnancy and Lactation Labeling Rule
Italics	For the most part, italics indicate an FDA comment such as: Additions and/or revisions underlined These italics usually appear at the beginning of the section. In some cases, italics may be an inherent part of the label, and will most often appear in the body of the section.
Underlines	Any text that is underlined indicates text that has been added or revised. There are exceptions where underlining occurs in a section subtitle or heading. This is the case when there is just one word underlined in the body of the text.

Sections

BW	Box Warning
WP	Warnings and Precautions all in one section (PLR-format) Warnings as one section (pre-PLR format) Precautions as one section (pre-PLR format)
AR	Adverse Reactions (in pre-PLR format, this may be a subheading under precautions).
DI	Drug Interactions (in pre-PLR format, this may be a subheading under precautions).
USP	Use in Specific Populations (Inclusive on one or more of the following: Pregnancy; Lactation (PLLR- format); Nursing Mothers (pre-PLLR format); Females and Males of Reproductive Potential (PLLR format only); Pediatric Use, Geriatric Use, Renal Impairment, Hepatic Impairment, Sex, Race (these last six may be a subheading of precautions if label in pre-PLLR format.
PCI/PI/MG	Patient Counseling Information (PLR format only) - summarizes the information that a health care provider should convey to a patient (or caregiver when applicable) when a counseling discussion is taking place (e.g., a physician prescribing a drug during an office visit, a nurse providing discharge instructions at a hospital, or a pharmacist conveying information at a pharmacy). Patient Information - FDA approved patient labeling. Medication Guide - paper handouts that come with many prescription medicines. The guides address issues that are specific to particular drugs and drug classes, and they contain FDA-approved information that can help patients avoid serious adverse events.

Only NDAs and CDER regulated BLAs are included in this database. ANDAs are not included.

Applications that remain active, even if the product has been discontinued, undergo safety-related labeling changes.

DACOGEN (NDA-021790)

(DECITABINE)

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

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06/29/2020 (SUPPL-25)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Postmarketing Experience

Addition of ‘interstitial lung disease’ to bulleted line listing.

02/25/2020 (SUPPL-23)

Approved Drug Label (PDF)

6 Adverse Reactions

(additions underlined)

The following clinically significant adverse reactions are described elsewhere in the labeling:

Myelosuppression

6.2 Postmarketing Experience

(addition underlined)

…

Differentiation syndrome

8 Use in Specific Populations

8.3 Females and Males of Reproductive Potential

(additions underlined)

…

Infertility

Based on findings of decitabine in animals, male fertility may be compromised by treatment with DACOGEN. The reversibility of the effect on fertility is unknown.

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

PATIENT COUNSELING INFORMATION

(section revised, additions and revisions underlined)

…

Embryo-Fetal Toxicity

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

Advise females of reproductive potential to use effective contraception while receiving DACOGEN and for 6 months after last dose.

Advise males with female partners of reproductive potential to use effective contraception while receiving treatment with DACOGEN and for 3 months after the last dose.

Lactation

Advise women to avoid breastfeeding while receiving DACOGEN and for at least 2 weeks after the last dose.

12/21/2018 (SUPPL-21)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Myelosuppression

(Additions and/or revisions are underlined)

Fatal and serious myelosuppression occurs in DACOGEN-treated patients. Myelosuppression (anemia, neutropenia, and thrombocytopenia) is the most frequent cause of DACOGEN dose reduction, delay, and discontinuation. Neutropenia of any grade occurred in 90% of DACOGEN- treated patients with grade 3 or 4 occurring in 87% of patients. Thrombocytopenia of any grade occurred in 89% of patients with grade 3 or 4 occurring in 85% of patients. Grade 3 or 4 febrile neutropenia occurred in 23% of patients. Anemia of any grade occurred in 82% of patients. Perform complete blood count with platelets at baseline, prior to each cycle, and as needed to monitor response and toxicity. Manage toxicity using dose-delay, dose-reduction, growth factors, and anti-infective therapies as needed. Myelosuppression and worsening neutropenia may occur more frequently in the first or second treatment cycles, and may not necessarily indicate progression of underlying MDS.

5.2 Embryo-fetal Toxicity

(Additions and/or revisions are underlined)

DACOGEN can cause fetal harm when administered to a pregnant woman. Based on its mechanism of action, DACOGEN alters DNA synthesis and is expected to result in adverse reproductive effects. In preclinical studies in mice and rats, decitabine was teratogenic, fetotoxic, and embryotoxic. If this drug is used during pregnancy, or if a patient becomes pregnant while receiving this drug, the patient should be apprised of the potential hazard to the fetus. Advise women of childbearing potential to avoid becoming pregnant while taking DACOGEN and for 6 months following the last dose. Advise men with female partners of childbearing potential to avoid fathering a child while receiving treatment with DACOGEN, and for 3 months following the last dose, Counsel patients of childbearing potential to use effective contraception during this time.

6 Adverse Reactions

6.1 Clinical Studies Experience

(Additions and/or revisions are underlined)

In this single arm study, investigators reported adverse events based on clinical signs and symptoms rather than predefined laboratory abnormalities. Thus, not all laboratory abnormalities were recorded as adverse events.

8 Use in Specific Populations

8.1 Pregnancy

(Pregnancy and Lactation Labeling Rule (PLLR) Conversion; Extensive changes – please refer to labeling)

8.2 Lactation

(Pregnancy and Lactation Labeling Rule (PLLR) Conversion; Additions and/or revisions are underlined)

Risk Summary

There are no data on the presence of decitabine or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions from DACOGEN in a nursing child, advise lactating women to avoid breastfeeding during treatment with DACOGEN and for at least 1 week after the last dose.

8.3 Females and Males of Reproductive Potential Pregnancy Testing

(Newly Added Subsection)

Conduct pregnancy testing of females of reproductive potential prior to initiating DACOGEN.

Contraception

Females Advise females of reproductive potential to avoid pregnancy and use effective contraception while receiving DACOGEN and for 6 months following the last dose. Males Advise males with female partners of reproductive potential to use effective contraception while receiving treatment with DACOGEN and for 3 months following the last dose.

Infertility

Based on findings of decitabine in animals, male fertility may be compromised by treatment with DACOGEN.