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Drug Safety-related Labeling Changes (SrLC)

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ARISTOCORT (NDA-011685)

(TRIAMCINOLONE DIACETATE)

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

Download Data

06/05/2024 (SUPPL-27)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

Additions and/or revisions underlined:

Cardio-renal

There have been cases reported in which concomitant uses of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure (see PRECAUTIONS: Drug Interactions: Amphotericin B Injection and Potassium-Depleting Agents).

Immunosuppression and Increased Risk of Infection

Corticosteroids, including ARISTOCORT, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens. Corticosteroids can:

  • Reduce resistance to new infections

  • Exacerbate existing infections

  • Increase the risk of disseminated infections

  • Increase the risk of reactivation or exacerbation of latent infections

  • Mask some signs of infection

    Corticosteroid-associated infections can be mild but can be severe and at times fatal. The rate of infectious complications increases with increasing corticosteroid dosages.

    Monitor for the development of infection and consider ARISTOCORT withdrawal or dosage reduction as needed.

    Do not administer ARISTOCORT by an intraarticular, intrabursal, intratendinous, or intralesional route in the presence of acute local infection.

    Tuberculosis

    If ARISTOCORT is used to treat a condition in patients with latent tuberculosis or tuberculin reactivity, as reactivation of the disease may occur. Closely monitor such patients for reactivation. During prolonged ARISTOCORT therapy, patients with latent tuberculosis or tuberculin reactivity should receive chemoprophylaxis.

    Varicella Zoster and Measles Viral Infections

    Varicella and measles can have a serious or even fatal course in non-immune patients taking corticosteroids, including ARISTOCORT. In patients who have not had these diseases or are non- immune, particular care should be taken to avoid exposure to varicella and measles:

  • If an ARISTOCORT-treated patient is exposed to varicella, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If varicella develops, treatment with antiviral agents may be considered.

  • If an ARISTOCORT-treated patient is exposed to measles, prophylaxis with immunoglobulin (IG) may be indicated.

    Hepatitis B Virus Reactivation

    Hepatitis B virus reactivation can occur in patients who are hepatitis B carriers treated with immunosuppressive dosages of corticosteroids, including ARISTOCORT. Reactivation can also occur infrequently in corticosteroid-treated patients who appear to have resolved hepatitis B infection.

    Screen patients for hepatitis B infection before initiating immunosuppressive (e.g., prolonged) treatment with ARISTOCORT. For patients who show evidence of hepatitis B infection, recommend consultation with physicians with expertise in managing hepatitis B regarding monitoring and consideration for hepatitis B antiviral therapy.

    Fungal Infections

    Corticosteroids, including ARISTOCORT, may exacerbate systemic fungal infections; therefore, avoid ARISTOCORT use in the presence of such infections unless ARISTOCORT is needed to control drug reactions.

    For patients on chronic ARISTOCORT therapy who develop systemic fungal infections, ARISTOCORT withdrawal or dosage reduction is recommended.

    Amebiasis

    Corticosteroids, including ARISTOCORT, may activate latent amebiasis. Therefore, it is recommended that latent amebiasis or active amebiasis be ruled out before initiating ARISTOCORT in patients who have spent time in the tropics or patients with unexplained diarrhea.

    Cerebral Malaria

    Avoid corticosteroids, including ARISTOCORT, in patients with cerebral malaria.