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Drug Safety-related Labeling Changes (SrLC)

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ZEMPLAR (NDA-021606)

(PARICALCITOL)

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

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10/18/2016 (SUPPL-16)

Approved Drug Label (PDF)

6 Adverse Reactions

6.1 Clinical Trials Experience (addition underlined)

CKD Stages 3 and 4

Table 3. Adverse Reactions by Body System Occurring in ? 2% of Subjects in the ZEMPLAR-Treated Group of Three, Double-Blind, Placebo-Controlled CKD Stages 3 and 4 Studies (Revised – Refer to label)


Pediatric patients 10 to 16 years of age

The safety of ZEMPLAR capsules has been evaluated in one multicenter clinical study involving CKD Stages 3 and 4 patients ages 10 to 16 years. A 12-week double-blind, placebo-controlled phase was followed by an open-label phase during which all patients received ZEMPLAR capsules.

During the 12-week blinded phase, a total of 18 patients received ZEMPLAR capsules and

18 patients received placebo. Adverse events occurring more frequently in the ZEMPLAR

capsules group than in the placebo group are presented in Table 4.

 

Table 4. Adverse Reactions by Body System Occurring in the Double-Blind, Placebo- Controlled, CKD Stages 3 and 4 Study in Patients Ages 10 to 16 Year (Refer to label)

 

Additional Adverse Reactions

The following adverse reactions have occurred in ZEMPLAR-treated patients:

Gastrointestinal Disorders: Abdominal pain, constipation, vomiting

Metabolism and Nutrition Disorders: Hypercalcemia and hyperphosphatemia

Nervous System Disorders: Headache

6.2 Postmarketing Experience (addition underlined)

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Immune System Disorders: Angioedema (including laryngeal edema)

Investigations: Blood creatinine increased

7 Drug Interactions

Table 6: Clinically Significant Drug Interactions with Paricalcitol (refer to label)

8 Use in Specific Populations

8.1 Pregnancy

PLLR conversion - Refer to label

8.2 Lactation

PLLR conversion  - Refer to label

8.4 Pediatric Use (addition underlined)

The safety and effectiveness of ZEMPLAR capsules have been established in pediatric patients 10 to 16 years of age for the prevention and treatment of secondary hyperparathyroidism associated with Stage 3, 4, and 5 CKD.

Use of ZEMPLAR capsules in this age group is supported by evidence from adequate and well controlled studies in adults with CKD, a 12-week double-blind placebo-controlled randomized multicenter study in 36 pediatric patients 10 to 16 years of age with CKD Stages 3 and 4, and safety data from a 12-week open-label single-arm multicenter study in 13 pediatric patients 10 to 16 years of age with CKD Stage 5 receiving peritoneal dialysis or hemodialysis. The pharmacokinetics of paricalcitol in Stage 5 CKD pediatric patients appear to be similar to those observed in Stage 3 and 4 pediatric patients.

Adverse reactions reported in these pediatric studies are consistent with the known safety profile of ZEMPLAR capsules and with what has been reported in adult clinical studies.

Safety and effectiveness of ZEMPLAR capsules in pediatric patients under the age of 10 years have not been established.

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

17 PATIENT COUNSELING INFORMATION (addition underlined)

Advise patients of the following:

  • The most common adverse reactions with use of ZEMPLAR capsules include diarrhea, hypertension, nausea, nasopharyngitis, dizziness, and vomiting.
  • Breastfeeding is not recommended during treatment with ZEMPLAR capsules.

10/18/2016 (SUPPL-17)

Approved Drug Label (PDF)

6 Adverse Reactions

6.1 Clinical Trials Experience (addition underlined)

CKD Stage 5

Adults

The safety of ZEMPLAR capsules has been evaluated in one 12-week, double-blind, placebo- controlled, multicenter clinical study involving 88 CKD Stage 5 patients.

 

Pediatric patients 10 to 16 years of age

The safety of ZEMPLAR capsules has been evaluated in one 12-week, open-label, single-arm, multicenter clinical studies involving 13 CKD Stage 5 patients ages 10 to 16 years of age receiving peritoneal dialysis or hemodialysis.

 

The following adverse reactions were reported:

Gastrointestinal Disorders: Abdominal pain, diarrhea, nausea, vomiting

Metabolism and Nutrition Disorders: Hypercalcemia, hyperphosphatemia

Three of 13 patients (23%) had hypercalcemia defined as at least 2 consecutive serum calcium values >10.2 mg/dL (2.55 mmol/L).

6.2 Postmarketing Experience (addition underlined)

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Immune System Disorders: Angioedema (including laryngeal edema)

Investigations: Blood creatinine increased

7 Drug Interactions

Table 6: Clinically Significant Drug Interactions with Paricalcitol (refer to label)

8 Use in Specific Populations

8.1 Pregnancy

PLLR conversion - Refer to label

8.2 Lactation

PLLR conversion - Refer to label

8.4 Pediatric Use (addition underlined)

The safety and effectiveness of ZEMPLAR capsules have been established in pediatric patients

10 to 16 years of age for the prevention and treatment of secondary hyperparathyroidism associated with Stage 3, 4, and 5 CKD.

 

Use of ZEMPLAR capsules in this age group is supported by evidence from adequate and well controlled studies in adults with CKD, a 12-week double-blind placebo-controlled randomized multicenter study in 36 pediatric patients 10 to 16 years of age with CKD Stages 3 and 4, and safety data from a 12-week open-label single-arm multicenter study in 13 pediatric patients 10 to 16 years of age with CKD Stage 5 receiving peritoneal dialysis or hemodialysis. The pharmacokinetics of paricalcitol in Stage 5 CKD pediatric patients appear to be similar to those observed in Stage 3 and 4 pediatric patients.

 

Adverse reactions reported in these pediatric studies are consistent with the known safety profile of ZEMPLAR capsules and with what has been reported in adult clinical studies.

 

Safety and effectiveness of ZEMPLAR capsules in pediatric patients under the age of 10 years have not been established.

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

17 PATIENT COUNSELING INFORMATION (addition underlined)

Advise patients of the following:

  • The most common adverse reactions with use of ZEMPLAR capsules include diarrhea, hypertension, nausea, nasopharyngitis, dizziness, and vomiting.

  • Breastfeeding is not recommended during treatment with ZEMPLAR capsules.