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Drug Safety-related Labeling Changes (SrLC)

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CORTEF (NDA-008697)

(HYDROCORTISONE)

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

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06/05/2024 (SUPPL-40)

Approved Drug Label (PDF)

5 Warnings and Precautions

WARNINGS

Additions and/or revisions underlined:

Immunosuppression and Increased Risk of Infection

Corticosteroids, including CORTEF, 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 CORTEF withdrawal or dosage reduction as needed.

    Tuberculosis

    If CORTEF is used to treat a condition in patients with latent tuberculosis or tuberculin reactivity, reactivation of tuberculosis may occur. Closely monitor such patients for reactivation. During prolonged CORTEF 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 CORTEF. 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 a CORTEF-treated patient is exposed to varicella, prophylaxis with varicella zoster immune globulin may be indicated. If varicella develops, treatment with antiviral agents may be considered.

  • If a CORTEF-treated patient is exposed to measles, prophylaxis with immunoglobulin 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 CORTEF. 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 CORTEF. 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 CORTEF, may exacerbate systemic fungal infections; therefore, avoid CORTEF use in the presence of such infections unless CORTEF is needed to control drug reactions. For patients on chronic CORTEF therapy who develop systemic fungal infections, CORTEF withdrawal or dosage reduction is recommended.

    Amebiasis

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

    Strongyloides Infestation

    Corticosteroids, including CORTEF, 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 CORTEF, in patients with cerebral malaria.

    Kaposi’s Sarcoma

    Kaposi’s sarcoma has been reported to occur in patients receiving corticosteroid therapy, most often for chronic conditions. Discontinuation of corticosteroids may result in clinical improvement of Kaposi’s sarcoma.

12/20/2023 (SUPPL-38)

Approved Drug Label (PDF)

5 Warnings and Precautions

PRECAUTIONS

Additions and/or revisions underlined:

In post marketing experience, tumor lysis syndrome (TLS) has been reported in patients with malignancies, including hematological malignancies and solid tumors, following the use of systemic corticosteroids alone or in combination with other chemotherapeutic agents. Patients at high risk of TLS, such as patients with tumors that have a high proliferative rate, high tumor burden and high sensitivity to cytotoxic agents, should be monitored closely and appropriate precautions should be taken.

09/08/2016 (SUPPL-32)

Approved Drug Label (PDF)

5 Warnings and Precautions

General Precautions

  • Pheochromocytoma crisis, which can be fatal, has been reported after administration of systemic corticosteroids. In patients with suspected pheochromocytoma, consider the risk of pheochromocytoma crisis prior to administering corticosteroids.

09/08/2016 (SUPPL-33)

Approved Drug Label (PDF)

5 Warnings and Precautions

Carcinogenesis, Mutagenesis, Impairment of Fertility:

  • Corticosteroids have been shown to impair fertility in male rats.

6 Adverse Reactions

Neurological

  • Epidural lipomatosis (addition)

Ophthalmic

  • Central serous chorioretinopathy (addition)

Blood and lymphatic system disorders

  • Leukocytosis (addition)