Approved Drug Label (PDF)
5
Warnings and Precautions
5.5 Long-Term Suppression of Growth in Pediatric Patients
Additions
and/or revisions underlined:
ADZENYS XR-ODT is not approved for use and is not
recommended in pediatric patients below 6 years of age [see Use in Specific
Population (8.4)].
…
8
Use in Specific Populations
8.4 Pediatric Use
Additions and/or revisions underlined:
…
The safety and effectiveness of ADZENYS XR-ODT have
not been established in pediatric patients below the age of 6 years.
In studies evaluating extended-release amphetamine
products, patients 4 to <6 years of age had higher systemic amphetamine
exposures than those observed in older pediatric patients at the same dosage.
Pediatric patients 4 to <6 years of age also had a higher incidence of
adverse reactions, including weight loss.
…
17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)
MEDICATION GUIDE
Additions
and/or revisions underlined:
…
What is ADZENYS
XR-ODT?
ADZENYS
XR-ODT is a central nervous system (CNS) stimulant prescription medicine. It is used for the treatment of
Attention-Deficit Hyperactivity Disorder (ADHD). ADZENYS XR-ODT may help
increase attention and decrease impulsiveness and hyperactivity in patients
with ADHD.
ADZENYS
XR-ODT is not recommended for use in children under 6 years of age with
ADHD.
…
Approved Drug Label (PDF)
8
Use in Specific Populations
8.1 Pregnancy
PLLR Conversion:
Pregnancy Exposure Registry
There is a pregnancy exposure registry that monitors
outcomes in women exposed to ADHD medications, including ADZENYS XR-ODT, during
pregnancy. Healthcare providers are encouraged to advise patients to register
by contacting the National Pregnancy Registry for ADHD Medication at
1-866-961-2388 or online at www.womensmentalhealth.org/pregnancyregistry.
Risk Summary
Available data from epidemiologic studies and postmarketing
reports on the use of amphetamine in pregnant women over decades of use have
not identified a drug-associated risk of major birth defects or miscarriage. Neonates
exposed to amphetamine in utero are at risk for withdrawal symptoms following
delivery. Adverse pregnancy outcomes including premature delivery and low birth
weight have been seen in infants born to mothers taking amphetamines during
pregnancy (see Clinical Considerations).
No apparent effects on morphological development were
observed in embryo-fetal development studies, with oral administration of
amphetamine to rats and rabbits during organogenesis.
However, in a pre- and post-natal development study,
amphetamine (d- to l- ratio of 3:1) administered orally to pregnant rats during
gestation and lactation caused a decrease in pup survival and a decrease in pup
body weight that correlated with a delay in developmental landmarks at
clinically relevant doses of amphetamine. In addition, adverse effects on
reproductive performance were observed in pups whose mothers were treated with amphetamine.
Long-term neurochemical and behavioral effects have also been reported in
animal developmental studies using clinically relevant doses of amphetamine (see Data).
The 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 to 4% and 15 to 20%,
respectively.
Clinical Considerations
Fetal/Neonatal Adverse Reactions
Amphetamines, such as ADZENYS XR-ODT, cause vasoconstriction
and thereby may decrease placental perfusion. In addition, amphetamines can stimulate
uterine contractions, increasing the risk of premature delivery. Infants born to
mothers taking amphetamines during pregnancy have an increased risk of
premature delivery and low birth weight.
Monitor infants born to mothers taking amphetamines for
symptoms of withdrawal such as feeding difficulties, irritability, agitation,
and excessive drowsiness
Data
Animal Data
…
8.2 Lactation
PLLR
Conversion:
Risk
Summary
Based
on limited case reports in published literature, amphetamine (d- or d, l-) is
present in human milk at relative infant doses of 2% to 13.8% of the maternal weight-adjusted
dosage and a milk/plasma ratio ranging between 1.9 and 7.5. There are no
reports of adverse effects on the breastfed infant. Long-term
neurodevelopmental effects on infants from amphetamine exposure are
unknown. It is possible that large dosages of amphetamine might interfere
with milk production, especially in women whose lactation is not well
established. Because of the potential for serious adverse reactions in
nursing infants, advise patients that breastfeeding is not recommended during
treatment with ADZENYS XR-ODT.
17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)
PATIENT COUNSELING
INFORMATION
Additions
and/or revisions underlined:
…
Pregnancy
Advise
patients that there is a pregnancy exposure registry that monitors pregnancy outcomes
in women exposed to ADZENYS XR-ODT during pregnancy. Advise patients
to notify their healthcare provider if they become pregnant or intend to become
pregnant during treatment with ADZENYS XR-ODT. Advise patients of the potential
fetal effects from the use of ADZENYS XR-ODT during pregnancy [see Use in Specific Populations (8.1)].
...
MEDICATION GUIDE
Additions
and/or revisions underlined:
…
What should I tell
my healthcare provider before taking ADZENYS XR-ODT?
ADZENYS XR-ODT may
not be right for you or your child. Before starting ADZENYS XR-ODT, tell your
or your child’s healthcare provider about all health conditions (or a family
history of) including:
…
There is a pregnancy registry for women who are
exposed to ADZENYS XR-ODT during pregnancy. The purpose of the registry is to
collect information about the health of females exposed to ADZENYS XR-ODT and
their babies. If you or your child becomes pregnant during treatment with
ADZENYS XR-ODT, talk to your healthcare provider about registering with the
National Pregnancy Registry for Psychostimulants. You can register by calling 1-866-961-2388
or by visiting online at https://womensmentalhealth.org/clinical-and-research- programs/pregnancyregistry/othermedications/.
Approved Drug Label (PDF)
Boxed Warning
Additions and/or
revisions underlined:
WARNING: ABUSE, MISUSE, AND ADDICTION
ADZENYS XR-ODT has a high potential for abuse and misuse, which can
lead to the development of a substance use disorder, including
addiction. Misuse and abuse of CNS stimulants, including ADZENYS XR-ODT, can
result in overdose and death [see Overdosage (10)], and this risk is increased with higher doses or
unapproved methods of administration, such as snorting or injection.
Before prescribing ADZENYS XR-ODT, assess each patient’s risk for
abuse, misuse, and addiction. Educate patients and their families about these
risks, proper storage of the drug, and proper disposal of any unused drug.
Throughout ADZENYS XR-ODT treatment, reassess each patient’s risk of above,
misuse, and addiction and frequently monitor for signs and symptoms of abuse,
misuse, and addiction [see Warnings and Precautions (5.1), Drug Abuse and Dependence (9.2)].
5
Warnings and Precautions
5.1 Abuse, Misuse, and Addiction
Additions and/or revisions
underlined:
ADZENYS XR-ODT has a high potential for abuse and
misuse. The use of ADZENYS XR- ODT exposes individuals to the risks of abuse
and misuse, which can lead to the development of a substance use disorder,
including addiction. ADZENYS XR-ODT can be diverted for non- medical use into
illicit channels or distribution [see Drug Abuse and Dependence (9.2)]. Misuse and abuse of CNS
stimulants, including ADZENYS XR-ODT, can result in overdose and death [see
Overdosage (10)], and this risk is increased with higher doses or
unapproved methods of administration, such as snorting or injection.
Before prescribing ADZENYS
XR-ODT, assess each patient’s risk for abuse, misuse, and addiction. Educate patients
and their families about these risks and proper disposal of any unused drug.
Advise patients to store ADZENYS XR-ODT in a safe place, preferably locked, and
instruct patients to not give ADZENYS XR-ODT to anyone else. Throughout ADZENYS
XR-ODT treatment, reassess each patient’s risk of abuse, misuse, and addiction
and frequently monitor for signs and symptoms of abuse, misuse, and
addiction.
5.2 Risks to Patients with Serious Cardiac Disease
Additions
and/or revisions underlined:
Sudden death has been reported in patients with
structural cardiac abnormalities or other serious cardiac disease who were
treated with CNS stimulants at the recommended ADHD dosage.
Avoid ADZENYS XR-ODT use in patients with known
structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia,
coronary artery disease, or other serious cardiac disease.
5.3 Increased Blood Pressure and Heart Rate
Additions and/or
revisions underlined:
CNS stimulants cause an increase in blood pressure
(mean increase about 2 to 4 mm Hg) and heart rate (mean increase about 3 to 6
bpm). Some patients may have larger increases.
Monitor all
ADZENYS XR-ODT-treated patients for potential tachycardia and hypertension.
5.5 Long-Term Suppression of Growth in Pediatric
Patients
Additions and/or
revisions underlined:
…
Pediatric patients not growing or gaining height or
weight as expected may need to have their treatment interrupted.
5.8 Motor and Verbal Tics, and Worsening of Tourette’s Syndrome
New subsection
added:
CNS stimulants, including amphetamine, have been
associated with the onset or exacerbation of motor and verbal tics. Worsening
of Tourette’s syndrome has also been reported [see Adverse Reactions (6.2)].
Before initiating ADZENYS XR-ODT, assess the family
history and clinically evaluate patients for tics or Tourette’s syndrome.
Regularly monitor ADZENYS XR-ODT-treated patients for the emergence or
worsening of tics or Tourette’s syndrome and discontinue treatment if
clinically appropriate.
6
Adverse Reactions
Additions and/or
revisions underlined:
The following adverse reactions are discussed in
greater detail in other sections of the labeling:
Abuse, Misuse, and Addiction [see Boxed Warning, Warnings and Precautions (5.1), and Drug Abuse and Dependence (9.2, 9.3)]
Hypersensitivity to amphetamine, or other
components of ADZENYS XR-ODT [see Contraindications (4)]
Hypertensive Crisis When Used Concomitantly with
Monoamine Oxidase Inhibitors
[see Contraindications (4) and Drug
Interactions (7.1)]
Risks to Patients with Serious Cardiac Disease [see Warnings and Precautions (5.2)]
Increased Blood Pressure and Heart Rate [see Warnings and Precautions (5.3)]
Psychiatric Adverse Reactions [see Warnings and
Precautions (5.4)]
Long-Term Suppression of Growth in Pediatric
Patients [see Warnings and Precautions (5.5)]
Peripheral Vasculopathy, including Raynaud’s
phenomenon [see Warnings and Precautions (5.6)]
Serotonin Syndrome [see Warnings and Precautions
(5.7)]
Motor and Verbal Tics, and
Worsening of Tourette’s Syndrome [see Warnings and Precautions (5.8)]
6.2 Postmarketing
Experience
Additions and/or revisions underlined:
…
Central Nervous System: Restlessness, irritability,
euphoria, dyskinesia, dysphoria, depression, tremor, aggression, anger,
logorrhea, paresthesia (including formication), motor and verbal tics.
…
17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)
PATIENT COUNSELING
INFORMATION
Additions
and/or revisions underlined:
Advise
the patient to read the FDA-approved patient labeling (Medication Guide).
Abuse, Misuse, and
Addiction
Educate
patients
and their families about the risks of abuse, misuse, and addiction of ADZENYS
XR-ODT, which can lead to overdose and death, and proper disposal of
any unused drug [see Warnings and
Precautions (5.1), Drug Abuse and Dependence (9.2), Overdosage (10)]. Advise patients
to store ADZENYS XR-ODT in a safe place, preferably locked, and instruct patients
to not give ADZENYS XR-ODT to anyone else.
…
Motor and Verbal
Tics, and Worsening of Tourette’s Syndrome
Advise
patients that motor and verbal tics and worsening of Tourette’s syndrome may
occur during treatment with ADZENYS XR-ODT. Instruct patients to notify their
healthcare provider if emergence of new tics or worsening of tics or Tourette’s
syndrome occurs [see Warnings and
Precautions (5.8)].
…
MEDICATION GUIDE
Medication
Guide has undergone extensive changes; please refer to label.
Approved Drug Label (PDF)
4
Contraindications
Additions and/or
revisions underlined:
- Patients taking monoamine
oxidase inhibitors (MAOIs), or within 14 days of stopping
MAOIs (including MAOIs such as linezolid or intravenous methylene blue),
because of an increased risk of hypertensive crisis.
5
Warnings and Precautions
5.7 Serotonin Syndrome
Newly added
subsection:
Serotonin
syndrome, a potentially life-threatening reaction, may occur when amphetamines
are used in combination with other drugs that affect the serotonergic
neurotransmitter systems such as monoamine oxidase inhibitors (MAOIs),
selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine
reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl,
lithium, tramadol, tryptophan, buspirone, and St. John’s Wort. The co-administration with cytochrome
P450 2D6 (CYP2D6) inhibitors may also increase the risk with increased exposure
to ADZENYS XR-ODT. In these situations, consider
an alternative non-serotonergic drug or an alternative drug that does not
inhibit CYP2D6.
Serotonin syndrome symptoms may include
mental status changes (e.g., agitation, hallucinations, delirium, and coma),
autonomic instability (e.g., tachycardia, labile blood pressure, dizziness,
diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor,
rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or
gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).
Concomitant
use of ADZENYS XR-ODT with MAOI drugs is contraindicated.
Discontinue
treatment with ADZENYS XR-ODT and any concomitant serotonergic agents
immediately if the above symptoms occur, and initiate supportive symptomatic
treatment. If concomitant use of ADZENYS XR-ODT with other serotonergic drugs
or CYP2D6 inhibitors is clinically warranted, initiate ADZENYS XR-ODT with
lower doses, monitor patients for the emergence of serotonin syndrome during
drug initiation or titration, and inform patients of the increased risk for
serotonin syndrome.
6
Adverse Reactions
The
following adverse reactions are discussed in greater
detail in other sections of the
labeling:
Addition of the following:
17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)
PATIENT COUNSELING INFORMATION
Newly added information:
Serotonin
Syndrome
Caution
patients about the risk of serotonin syndrome with concomitant use of ADZENYS
XR- ODT and other serotonergic drugs including SSRIs, SNRIs, triptans,
tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone,
St. John’s Wort, and with drugs that impair metabolism of serotonin (in
particular MAOIs, both those intended to treat psychiatric disorders and also
others such as linezolid. Advise patients to contact their
healthcare provider or report to the emergency room if they experience signs or
symptoms of serotonin syndrome.
Concomitant
Medications
Advise patients to notify their
physicians if they are taking, or plan to take, any prescription or
over-the-counter drugs because there is a potential for interactions.