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Drug Safety-related Labeling Changes (SrLC)

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ARISTOSPAN (NDA-016466)

(TRIAMCINOLONE HEXACETONIDE)

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

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06/05/2024 (SUPPL-47)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

Additions and revisions underlined:

There have been cases reported in which concomitant use 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 ARISTOSPAN, 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 ARISTOSPAN withdrawal or dosage reduction as needed.

Do not administer ARISTOSPAN by intralesional route in the presence of acute local infection.

Tuberculosis

If ARISTOSPAN is used to treat a condition in patients with latent tuberculosis or tuberculin reactivity, reactivation of the disease may occur. Closely monitor such patients for reactivation. During prolonged ARISTOSPAN 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 ARISTOSPAN. In corticosteroid-treated 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 ARISTOSPAN-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 ARISTOSPAN-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 ARISTOSPAN. 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 ARISTOSPAN. 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 ARISTOSPAN, may exacerbate systemic fungal infections; therefore, avoid ARISTOSPAN use in the presence of such infections unless ARISTOSPAN is needed to control drug reactions. For patients on chronic ARISTOSPAN who develop systemic fungal infections, ARISTOSPAN withdrawal or dosage reduction is recommended.

Amebiasis

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

Strongyloides Infestation

Corticosteroids, including ARISTOSPAN, should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.

Cerebral Malaria

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