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Drug Safety-related Labeling Changes (SrLC)

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BUSULFEX (NDA-020954)

(BUSULFAN)

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

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09/28/2018 (SUPPL-18)

Approved Drug Label (PDF)

7 Drug Interactions

7.1 Drugs that Decrease BUSULFEX Clearance

Newly added information following the first paragraph:

Decreased clearance of busulfan was observed with concomitant use with deferasirox. The mechanism of this interaction is not fully elucidated. Discontinue iron chelating agents well in advance of administration of BUSULFEX to avoid increased exposure to busulfan.

09/28/2018 (SUPPL-19)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.3 Females and Males of Reproductive Potential

Infertility

Females

Newly added information following first sentence:

BUSULFEX may cause temporary or permanent infertility in prepubertal girls or in females of child-bearing potential treated with high-dose BUSULFEX in the conditioning regimen prior to   allogeneic hematopoietic progenitor cell transplantation.

01/24/2018 (SUPPL-17)

Approved Drug Label (PDF)

7 Drug Interactions

7.1 Drugs that Decrease BUSULFEX Clearance

(Additions and/or revisions are underlined; subsection title has been added)

Itraconazole decreases busulfan clearance by up to 25%. Metronidazole decreases the clearance of busulfan to a greater extent than does itraconazole; metronidazole coadministration has been associated with increased busulfan toxicity.

Fluconazole (200 mg) has been used with BUSULFEX.

7.2 Drugs that Increase BUSULFEX Clearance

(Subsection title has been added)

8 Use in Specific Populations

8.3 Females and Males of Reproductive Potential

(Additions and/or revisions are underlined)

Contraception

Females

BUSULFEX can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during treatment with BUSULFEX and for 6 months following cessation of therapy.

Males

BUSULFEX may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Males with female sexual partners of reproductive potential should use effective contraception during treatment with BUSULFEX and for 3 months after cessation of therapy.

8.5 Geriatric Use

(Additions and/or revisions are underlined)

Clinical studies of Busulfex did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

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

17 PATIENT COUNSELING INFORMATION

(Additions and/or revisions are underlined)

Myelosuppression

Advise patients of the possibility of developing low blood cell counts and the need for hematopoietic progenitor cell infusion…

Seizures

Advise patients of the possibility of seizures and that they will be given medication to prevent them. Patients should be asked to report a history of seizure or head trauma.

Hepatic Veno-Occlusive Disease (HVOD)

Advise patients of the risks associated with the use of BUSULFEX as well as the plan for regular blood monitoring during therapy…

Embryo-fetal Toxicity

Advise females of reproductive potential of the potential risk to a fetus…

Females of Reproductive Potential

Advise females of reproductive potential to use effective contraception during treatment with BUSULFEX and for 6 months following cessation of therapy.

Males of Reproductive Potential

Advise males with female sexual partners of reproductive potential to use effective contraception during treatment with BUSULFEX and for 3 months following cessation of therapy.

Lactation

Advise females to discontinue breastfeeding during treatment with BUSULFEX.

Infertility

Advise females and males of reproductive potential that BUSULFEX may cause temporary or permanent infertility.

Cardiac Tamponade

Advise patients of the risk of cardiac tamponade. Instruct patients to report to their healthcare provider symptoms of abdominal pain and vomiting.

Bronchopulmonary Dysplasia

Advise patients of the possibility of bronchopulmonary dysplasia with pulmonary fibrosis with chronic BUSULFEX therapy. Instruct patients to report symptoms of shortness of breath and cough to their healthcare provider. These symptoms could occur several months or years after therapy with BUSULFEX.

05/19/2016 (SUPPL-16)

Approved Drug Label (PDF)

6 Adverse Reactions

Postmarketing Experience

  • Gastrointestinal Disorders: tooth hypoplasia