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Drug Safety-related Labeling Changes (SrLC)

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XYZAL (NDA-022064)

(LEVOCETIRIZINE DIHYDROCHLORIDE)

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

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01/11/2019 (SUPPL-37)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.1 Pregnancy

(PLLR conversion, Please refer to label)

8.2 Lactation

(PLLR conversion)

Risk Summary

There are no data on the presence of levocetirizine in human milk, the effects on the breastfed infant, or the effects on milk production. However, cetirizine has been reported to be present in human breast milk. In mice and beagle dogs, studies indicated that cetirizine was excreted in milk (see Data). When a drug is present in animal milk, it is likely the drug will be present in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for XYZAL and any potential adverse effects on the breastfed child from XYZAL or from the underlying maternal condition.

Data

Animal Data

Cetirizine was detected in the milk of mice. No adverse developmental effects on pups were seen when cetirizine was administered orally to dams during lactation at a dose that was approximately 25 times the MRHD in adults [see Use in Specific Populations (8.1)]. Studies in beagle dogs indicated that approximately 3% of the dose of cetirizine was excreted in milk. The concentration of drug in animal milk does not necessarily predict the concentration of drug in human milk.

04/02/2018 (SUPPL-36)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Postmarketing Experience

(Additions and/or revisions are underlined)

  • Skin and subcutaneous tissue disorders: acute generalized exanthematous pustulosis (AGEP); rebound pruritus - pruritus within a few days after discontinuation of cetirizine, usually after long-term use (e.g. months to years) of cetirizine.

10/16/2017 (SUPPL-34)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Post-Marketing Experience

(Additions and/or revisions are underlined)

  • Psychiatric disorders: aggression and agitation, depression, hallucinations, insomnia, nightmare, suicidal ideation

07/10/2017 (SUPPL-33)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Post-Marketing Experience

(Additions and/or revisions are underlined)

In addition to the adverse reactions reported during clinical trials and listed above, the following adverse reactions have also been identified during post-approval use of XYZAL…

  • Cardiac disorders: palpitations, tachycardia
  • Ear and labyrinth disorders: vertigo
  • Eye disorders: blurred vision, visual disturbances
  • Gastrointestinal disorders: nausea, vomiting
  • General disorders and administration site conditions: edema
  • Hepatobiliary disorders: hepatitis
  • Immune system disorders: anaphylaxis and hypersensitivity
  • Metabolism and nutrition disorders: increased appetite
  • Musculoskeletal, connective tissues, and bone disorders: arthralgia, myalgia
  • Nervous system disorders: dizziness, dysgeusia, febrile seizure, movement disorders (including dystonia and oculogyric crisis), paraesthesia, seizure (reported in subjects with and without a known seizure disorder), tremor
  • Psychiatric disorders: aggression and agitation, depression, hallucinations, insomnia, suicidal ideation
  • Renal and urinary disorders: dysuria, urinary retention
  • Respiratory, thoracic, and mediastinal disorders: dyspnea
  • Skin and subcutaneous tissue disorders: angioedema, fixed drug eruption, pruritus, rash and urticaria

 

Besides these reactions reported under treatment with XYZAL, other potentially severe adverse events have been reported from the post- marketing experience with cetirizine…

  • Cardiac disorders: severe hypotension

  • Gastrointestinal disorders: cholestasis

  • Nervous system disorders: extrapyramidal symptoms, myoclonus, orofacial dyskinesia, tic

  • Pregnancy, puerperium and perinatal conditions: stillbirth

  • Renal and urinary disorders: glomerulonephritis

  • Skin and subcutaneous tissue disorders: acute generalized exanthematous pustulosis (AGEP)

02/09/2017 (SUPPL-31)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.4 Pediatric Use

(additions underlined)

The recommended dose of XYZAL for the treatment of the uncomplicated skin manifestations of chronic idiopathic urticaria in patients 6 months to 17 years of age is based on extrapolation of efficacy from adults 18 years of age and older.

The  recommended dose of XYZAL in patients 6 months to 2 years of age for the treatment of the symptoms of perennial allergic rhinitis and 6 months to 11 years of age with chronic idiopathic urticariais based on cross-study comparisons of the systemic exposure of XYZAL in adults and pediatric patients and on the safety profile of XYZAL in both adult and pediatric patients at doses equal to or higher than the recommended dose for patients 6 months to 11 years of age.

11/08/2016 (SUPPL-32)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Post-Marketing Experience

Addition of acute generalized exanthematous pustulosis (AGEP) to the listing of adverse events could also potentially occur under treatment with XYZAL.

06/23/2016 (SUPPL-30)

Approved Drug Label (PDF)

6 Adverse Reactions

Post-Marketing Experience

  • Addition to listing of adverse reactions...arthralgia
  • Replacement of “events” with “reactions” throughout section.