Drug Safety-related Labeling Changes (SrLC)
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Guide
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.
CEFOXITIN AND DEXTROSE IN DUPLEX CONTAINER (NDA-065214)
(CEFOXITIN SODIUM)
Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)
07/29/2019 (SUPPL-16)
8 Use in Specific Populations
8.1 Pregnancy(PLLR conversion)
Risk Summary
Available data from published prospective cohort studies, case series, and case reports over several decades with cephalosporin use, including cefoxitin, in pregnant women have not established drug- associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes (see Data). In animal reproduction studies, no adverse developmental effects were observed in pregnant rats and mice administered parenteral doses of cefoxitin at approximately 1 to 7.5 times the maximum recommended human dose (see Data).
The estimated
background risk of major birth defects and miscarriage for the indicated
population is unknown. All pregnancies have a background risk of birth defect,
loss, or other adverse outcomes. In the U.S. general population, the estimated background
risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2-4% and 15-20%, respectively. Cefoxitin is found in umbilical
cord blood and amniotic fluid after maternal administration.
linical Considerations
Disease-Associated Maternal and/or Embryo/Fetal Risk
Maternal gonorrhea may be associated with preterm birth, low neonatal birth weight, chorioamnionitis, intrauterine growth restriction, small for gestational age and premature rupture of membranes. Perinatal transmission of gonorrhea to the offspring can result in infant blindness, joint infections and bloodstream infections.
Data
Human Data
While available studies cannot definitively establish the absence of risk, published data from prospective cohort studies, case series, and case reports over several decades have not identified an association with cephalosporin use, including cefoxitin, during pregnancy, and major birth defects, miscarriage, or other adverse maternal or fetal outcomes.
Available studies have methodologic limitations, including small sample size, retrospective data collection, and inconsistent comparator groups.
Animal Data
Reproduction studies performed in pregnant rats and mice at parenteral doses of approximately one to seven and one-half times the maximum recommended human dose did not reveal teratogenic or
fetal toxic effects, although a slight decrease in fetal weight was observed.
(PLLR conversion)
Risk Summary
Limited data from published literature report the presence of cefoxitin in human milk. For an infant fed exclusively with human milk, the estimated infant daily dose through breastfeeding is less than 0.1% of maternal daily IV dose (see Data). Minimal data are available on the effects of the drug on the breastfed infant; none of these reports suggest serious safety concerns. No data are available on the effects of the drug on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for cefoxitin and any potential adverse effects on the breastfed infant from cefoxitin or from the underlying maternal condition.
Data
In a published clinical lactation study, the concentration of cefoxitin ranged from 11.6± 0.8 to
0.49 ± 0.01 mcg/mL and 1.71 ± 0.08 to 0.57 ± 0.02 mcg/mL in human plasma and breast milk, respectively, at 1, 1.5, 2 or 2.5 hours following IV administration of 1 g cefoxitin twice daily.
Other
(Physician Labeling Rule (PLR) conversion, please refer to label for complete information)