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Drug Safety-related Labeling Changes (SrLC)

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PHYRAGO (NDA-216099)

(DASATINIB)

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

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08/01/2025 (SUPPL-5)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Myelosuppression

Additions and/or revisions underlined:

. . .

In pediatric patients with Ph+ ALL treated with PHYRAGO in combination with chemotherapy, perform CBCs prior to the start of each block of chemotherapy and as clinically indicated.

During the consolidation blocks of chemotherapy, perform CBCs every 2 days until recovery.

. . .

 

5.3 Fluid Retention

Additions and/or revisions underlined:

. . .

In pediatric patients with chronic phase CML, cases of Grade 1 or 2 fluid retention were reported in 10.3% of patients.

. . .

6 Adverse Reactions

6.1 Clinical Trials Experience

Extensive changes; please refer to label for complete information

8 Use in Specific Populations

8.4 Pediatric Use

Additions and/or revisions underlined:

Ph+ CML in Chronic Phase

The safety and effectiveness of dasatinib monotherapy have been demonstrated in pediatric patients with newly diagnosed chronic phase CML [see Clinical Studies (14.3)]. There are no data in children under 1 year of age. Adverse reactions associated with bone growth and development were reported in 5 (5.2%) of patients [see Warnings and Precautions (5.10)].

Ph+ ALL

The safety and effectiveness of dasatinib in combination with chemotherapy have been demonstrated in pediatric patients one year and over with newly diagnosed Ph+ ALL. Use of dasatinib in pediatric patients is supported by evidence from one pediatric study. There are no data in children under 1 year of age. One case of grade 1 osteopenia was reported.

The safety profile of dasatinib in pediatric subjects was comparable to that reported in studies in adult subjects [see Adverse Reactions (6.1) and Clinical Studies (14.3, 14.4)].

Monitor bone growth and development in pediatric patients [see Warnings and Precautions (5.10)].

Pediatric Patients with Difficulty Swallowing Tablets

Five patients with Ph+ ALL 2 to 10 years of age received at least one dose of dasatinib tablet dispersed in juice on Study CA180372. The exposure for dispersed tablets was 36% lower as compared to intact tablets in pediatric patients. Due to unavailable clinical data, it is unclear whether dispersing PHYRAGO tablets significantly alters the safety and/or efficacy of PHYRAGO.

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

PATIENT INFORMATION

Additions and/or revisions underlined:

. . .

What is PHYRAGO?

. . .

  • children 1 year of age and older with Ph+ CML in chronic phase.

  • children 1 year of age and older with newly diagnosed Ph+ ALL in combination with chemotherapy.

    It is not known if PHYRAGO is safe and effective in children under 1 year of age.

. . .

How should I take PHYRAGO?

. . .

  • Swallow PHYRAGO whole. Do not crush, cut or chew the tablets.

    • If your child cannot swallow tablets whole, talk with your healthcare provider.

. . .

  • Low blood cell counts. Low blood cell counts are common with dasatinib and can be severe, including low red blood cell counts (anemia), low white blood cell counts (neutropenia), and low platelet counts (thrombocytopenia). Your healthcare provider will do blood tests to check your blood cell counts regularly during your treatment with PHYRAGO. Call your healthcare provider right away if you have a fever or any signs of an infection during treatment with PHYRAGO.

. . .

The most common side effects of dasatinib in children receiving dasatinib with chemotherapy include:

  • swelling, pain and redness of the lining of your mouth, tiredness throat, stomach and bowel (mucositis)

  • constipation

  • low white blood cell counts with fever

  • abnormal heart rate

  • fever

  • high blood pressure (hypertension)

  • diarrhea

  • swelling

  • nausea

  • infections

  • vomiting

  • low blood pressure

  • muscle pain

  • decreased appetite

  • stomach-area (abdominal) pain

  • allergic reactions

  • cough

  • shortness of breath

  • headache

  • nose bleed

  • rash

  • numbness or tingling of your hands and feet

  • feeling confused or disoriented

. . .

12/03/2024 (SUPPL-3)

Approved Drug Label (PDF)

7 Drug Interactions

7.1 Effect of Other Drugs on Dasatinib

Additions and/or revisions underlined:

Antacids

Avoid concomitant use of PHYRAGO with antacids. If concomitant use of an antacid cannot be avoided, administer the antacid at least 2 hours prior to or 2 hours after the dose of PHYRAGO [see Dosage and Administration (2.2)].

Concomitant use with antacids decreases dasatinib plasma concentrations [see Clinical Pharmacology (12.3)], which may reduce PHYRAGO efficacy.     

07/31/2024 (SUPPL-4)

Approved Drug Label (PDF)

6 Adverse Reactions

6.2 Postmarketing Experience

Additions and/or revisions underlined:

Respiratory, thoracic, and mediastinal disorders: interstitial lung disease, chylothorax