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Drug Safety-related Labeling Changes (SrLC)

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DUOPA (NDA-203952)

(CARBIDOPA; LEVODOPA)

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

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05/21/2020 (SUPPL-11)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Gastrointestinal and Gastrointestinal Procedure-Related Risks

(Additions and/or revisions underlined)

Because DUOPA is administered using a PEG-J or naso-jejunal tube, gastrointestinal complications   can occur.

These complications include abscess, bezoar, ileus, implant site erosion/ulcer, intestinal hemorrhage, intestinal ischemia, intestinal obstruction, intestinal perforation, intussusception, pancreatitis, peritonitis, pneumonia (including aspiration pneumonia), pneumoperitoneum, post- operative wound infection, and sepsis. These complications may result in serious outcomes, such as the need for surgery or death.

Instruct patients to notify their healthcare provider immediately if they experience abdominal pain, prolonged constipation, nausea, vomiting, fever, or melanotic stool.

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

MEDICATION GUIDE

(Additions and/or revisions underlined)

Read this Medication Guide before you start using DUOPA and each time you get a refill. There may be new information.  This information does not take the place of talking to your healthcare provider about your medical condition or treatment.

What is the most important information I should know about DUOPA?

DUOPA can cause serious side effects, including:

  • Stomach and intestine (gastrointestinal) problems and problems from the procedure you will need to have to receive DUOPA (gastrointestinal procedure -related problems). Some of these problems may require surgery and may lead to death.

    • a blockage of your stomach or intestines (bezoar)

    • stopping movement through intestines (ileus)

    • drainage, redness, swelling, pain, feeling of warmth around the small hole in your stomach wall (stoma)

    • bleeding from stomach ulcers or your intestines

    • inflammation of your pancreas (pancreatitis)

    • infection in your lungs (pneumonia)

    • air or gas in your abdominal cavity

    • skin infection around the intestinal tube, pocket of infection (abscess), infection in your blood (sepsis) or abdominal cavity may occur, after surgery

    • stomach pain, nausea or vomiting

PATIENT COUNSELING INFORMATION

(Additions and/or revisions underlined)

Gastrointestinal and Gastrointestinal Procedure-Related Risks

Inform patients of the gastrointestinal procedure-related risks including abscess, bezoar, ileus, implant site erosion/ulcer, intestinal hemorrhage, intestinal ischemia, intestinal obstruction, intestinal perforation, intussusception, pancreatitis, peritonitis, pneumonia (including aspiration pneumonia), pneumoperitoneum, post-operative wound infection and sepsis. Advise patients of the symptoms of the above listed complications and instruct them to contact their healthcare provider if they experience any of these symptoms

12/05/2019 (SUPPL-10)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.1 Pregnancy

(PLLR conversion)

Risk Summary

There are no adequate data on the developmental risk associated with the use of DUOPA in pregnant women. In animal studies, carbidopa-levodopa has been shown to be developmentally toxic (including teratogenic effects) at clinically relevant doses (see Data).

The estimated background risk of major birth defects and miscarriage in the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Data

Animal Data

When administered to pregnant rabbits throughout organogenesis, carbidopa-levodopa caused both visceral and skeletal malformations in fetuses at all doses and ratios of carbidopa-levodopa tested. No teratogenic effects were observed when carbidopa-levodopa was administered to pregnant mice throughout organogenesis. There was a decrease in the number of live pups delivered by rats receiving carbidopa-levodopa during organogenesis.

8.2 Lactation

(PLLR conversion)

Risk Summary

Levodopa has been detected in human milk after administration of carbidopa-levodopa. There are no data on the presence of carbidopa in human milk, the effects of levodopa or carbidopa on the breastfed infant, or the effects on milk production. However, inhibition of lactation may occur because levodopa decreases secretion of prolactin in humans. Carbidopa is excreted in rat milk.

The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for DUOPA and any potential adverse effects on the breastfed infant from DUOPA or from the underlying maternal condition.

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

PATIENT COUNSELING INFORMATION

(additions underlined)

Pregnancy

Advise patients to notify their healthcare provider if they become pregnant during treatment or plan to become pregnant during therapy.

Lactation

Advise patients to notify their healthcare provider if they are breastfeeding or plan to breastfeed

09/15/2016 (SUPPL-4)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.1 Gastrointestinal and Gastrointestinal Procedure-Related Risks (updated)

Because DUOPA is administered using a PEG-J or naso-jejunal tube, gastrointestinal

complications can occur.

These complications include bezoar, ileus, implant site erosion/ulcer, intestinal hemorrhage,

intestinal ischemia, intestinal obstruction, intestinal perforation, intussusception (added) pancreatitis,…..

6 Adverse Reactions

6.1 Clinical Trials Experience

(Revisions and additions)

Because clinical studies are run under widely varying conditions, the incidence of adverse

reactions observed in the clinical trials of a drug cannot be directly compared to rates in the

clinical trials of another drug…..

The most common adverse reactions for DUOPA (incidence at least 7% greater than oral

immediate-release carbidopa-levodopa) were: complication of device insertion, nausea,

depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal

pain, atelectasis( added), and incision site erythema.

The most common adverse reactions associated with complications due to PEG-J insertion were:

Abdominal……

Additional adverse reactions that were co-reported with complication of naso-jejunal and PEG-J

insertion included upper abdominal pain, duodenal ulcer, duodenal ulcer hemorrhage, erosive

duodenitis, erosive gastritis, gastrointestinal hemorrhage, intussusception, peritonitis, postoperative

abscess, and small intestine ulcer.

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

17 PATIENT COUNSELING INFORMATION

Gastrointestinal and Gastrointestinal Procedure-Related Risks (updated)

Inform patients of the gastrointestinal procedure-related risks including bezoar, ileus, implant

site erosion/ulcer, intestinal hemorrhage, intestinal ischemia, intestinal obstruction, intestinal

perforation, intussusception(added), pancreatitis, wound…….