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Drug Safety-related Labeling Changes (SrLC)

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VOQUEZNA DUAL PAK (NDA-215153)

(AMOXICILLIN; VONOPRAZAN FUMARATE)

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

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07/31/2024 (SUPPL-3)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Warnings and Precautions for VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK

Additions and/or revisions underlined:

Acute Tubulointerstitial Nephritis

Acute tubulointerstitial nephritis (TIN) has been reported with vonoprazan, a component of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK [see Adverse Reactions (6.1)]. If suspected, discontinue VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK and evaluate patients with suspected acute TIN.

6 Adverse Reactions

Addition of the following to the bulleted line listing:

  • Acute Tubulointerstitial Nephritis [see Warnings and Precautions (5.1)]

6.1 Clinical Trials Experience

Additions and/or revisions underlined:

Other Adverse Reactions

Investigations: increased liver function test

6.2 Postmarketing Experience

Additions and/or revisions underlined:

Vonoprazan

Blood and lymphatic system disorders: thrombocytopenia.

Immune system disorders: anaphylactic shock, urticaria [see Contraindications (4.1)].

Infections and Infestations: C. difficile (with concomitant antibacterials) [see Warnings and Precautions (5.1)].

Investigation: hypomagnesemia, hypokalemia, hypocalcemia, vitamin B12 deficiency.

Hepatobiliary disorders: hepatic injury, hepatic failure, jaundice.

Skin and subcutaneous tissue disorders: drug eruption, erythema multiforme, SJS, TEN [see Warnings and Precautions (5.1)].

7 Drug Interactions

Addition of the following unlined text to Table 4:

Table 4: Effects of Other Drugs on VOQUEZNA TRIPLE PAK

Interaction with Secretin Stimulation Test

Clinical Effect: Hyper-response in gastrin secretion in response to secretin stimulation test, falsely suggesting gastrinoma.

Prevention or Management: Test should be performed at least 4 weeks after stopping VOQUEZNA DUAL PAK to allow gastrin levels to return to normal [see Clinical Pharmacology (12.2)].  

8 Use in Specific Populations

8.6 Renal Impairment

Additions and/or revisions underlined:

No dosage adjustment of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK is recommended in patients with mild to moderate renal impairment (eGFR 30 to 89 mL/min). Use of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK is not recommended in patients with severe renal impairment (eGFR < 30 mL/min) [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3)].

8.7 Hepatic Impairment

Additions and/or revisions underlined:

No dosage adjustment of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK is recommended in patients with mild hepatic impairment (Child-Pugh A). Use of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK is not recommended in patients with moderate to severe hepatic impairment (Child-Pugh B or C) [see Dosage and Administration (2.4) and Clinical Pharmacology (12.3)].

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

PATIENT COUNSELING INFORMATION

Additions and/or revisions underlined:

Acute Tubulointerstitial Nephritis

Advise patients to call their healthcare provider if they experience signs and/or symptoms associated with acute tubulointerstitial nephritis [see Warnings and Precautions (5.1)].

05/01/2024 (SUPPL-7)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Warnings and Precautions for VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK

Newly added information:

Drug-Induced Enterocolitis Syndrome

Drug-induced enterocolitis syndrome (DIES) has been reported with use of amoxicillin, a component of VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK [see Adverse Reactions (6.2)], with most cases occurring in pediatric patients less than or equal to 18 years of age. DIES is a non-IgE mediated hypersensitivity reaction characterized by protracted vomiting occurring 1 to 4 hours after drug ingestion in the absence of skin or respiratory symptoms. DIES may be associated with pallor, lethargy, hypotension, shock, diarrhea within 24 hours after ingesting amoxicillin, and leukocytosis with neutrophilia. If DIES occurs, discontinue VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK and institute appropriate therapy.

6 Adverse Reactions

Additions and revisions underlined:

The following serious adverse reactions are described below and elsewhere in labeling:

  • Hypersensitivity Reactions [see Warnings and Precautions (5.1)]

  • Drug-Induced Enterocolitis Syndrome (DIES) [see Warnings and Precautions (5.1)]

    . . .

6.2 Postmarketing Experience with Components of VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK

Additions and revisions underlined:

. . .

Gastrointestinal: Drug-induced enterocolitis syndrome (DIES), black hairy tongue, and hemorrhagic/pseudomembranous colitis. Onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment [see Warnings and Precautions (5.1)].

. . .

Skin and subcutaneous tissue disorders: TEN, SJS, DRESS, AGEP and linear IgA bullous dermatosis.

. . .

08/16/2023 (SUPPL-4)

Approved Drug Label (PDF)

4 Contraindications

4.2 Additional Contraindications to VOQUEZNA TRIPLE PAK Due to the Clarithromycin Component

Additions and/or revisions underlined:

  • Lurasidone: Coadministration of clarithromycin and lurasidone may lead to an increase in lurasidone exposure and the potential for serious adverse reactions [see Drug Interactions (7)].

7 Drug Interactions

Addition of Lurasidone to the Antipsychotics section of table 4; please refer to label for complete information