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clindamycin phosphate and benzoyl peroxide
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
ACANYA™ Gel is indicated for the topical treatment of acne vulgaris in patients 12 years or older.
2 DOSAGE AND ADMINISTRATION
Apply a pea-sized amount of ACANYA Gel to the face once daily.
Use of ACANYA Gel beyond 12 weeks has not been evaluated. ACANYA Gel is not for oral, ophthalmic, or intravaginal use.
3 DOSAGE FORMS AND STRENGTHS
Once admixed, ACANYA Gel contains clindamycin phosphate 1.2% and benzoyl peroxide 2.5%, formulated as a topical gel. Each gram of ACANYA Gel contains, as dispensed, 10 mg (1%) clindamycin as phosphate, and 25 mg (2.5%) benzoyl peroxide. ACANYA Gel is available in 50 gram jars.
ACANYA Gel is contraindicated in patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.
5 WARNINGS AND PRECAUTIONS
Systemic absorption of clindamycin has been demonstrated following topical use of clindamycin. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. When significant diarrhea occurs, ACANYA Gel should be discontinued.
Severe colitis has occurred following oral and parenteral administration of clindamycin with an onset of up to several weeks following cessation of therapy. Antiperistaltic agents such as opiates and diphenoxylate with atropine may prolong and/or worsen severe colitis. Severe colitis may result in death.
Studies indicate toxin(s) produced by Clostridia is one primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe persistent diarrhea and severe abdominal cramps and may be associated with the passage of blood and mucus. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically.
Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation and treatment with an antibacterial drug clinically effective against C. difficile colitis.
5.2 Ultraviolet Light and Environmental Exposure
Minimize sun exposure following drug application [See Nonclinical Toxicology (13.1)].
6 ADVERSE REACTIONS
6.1 Clinical Studies Experience
Because clinical trials are conducted under prescribed conditions, adverse reaction rates observed in the clinical trial may not reflect the rates observed in practice. Because clinical trials are also conducted under widely varying conditions, adverse reactions observed in the clinical trials of a drug cannot always be directly compared to rates in the clinical trials of another drug. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse reactions that appear to be related to drug use and for approximating rates.
The following selected adverse reactions occurred in less than 0.2% of patients treated with ACANYA Gel: application site pain (0.1%); application site exfoliation (0.1%); and application site irritation (0.1%).
During clinical trials, patients were assessed for local cutaneous signs and symptoms of erythema, scaling, itching, burning and stinging. Most local skin reactions increased and peaked around week 4 and continually decreased over time reaching near baseline levels by week 12. The percentage of patients that had symptoms present before treatment, the maximum value recorded during treatment, and the percent with symptoms present at week 12 are shown in Table 1.
7 DRUG INTERACTIONS
ACANYA Gel should not be used in combination with topical or oral erythromycin-containing products due to its clindamycin component. In vitro studies have shown antagonism between erythromycin and clindamycin. The clinical significance of this in vitro antagonism is not known.
7.2 Concomitant Topical Medications
Concomitant topical acne therapy should be used with caution because a possible cumulative irritancy effect may occur, especially with the use of peeling, desquamating, or abrasive agents.
8 USE IN SPECIFIC POPULATIONS
Pregnancy Category C.
There are no well-controlled trials in pregnant women treated with ACANYA Gel. It also is not known whether ACANYA Gel can cause fetal harm when administered to a pregnant woman. ACANYA Gel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Animal reproductive/developmental toxicity studies have not been conducted with ACANYA Gel or benzoyl peroxide. Developmental toxicity studies of clindamycin performed in rats and mice using oral doses of up to 600 mg/kg/day (240 and 120 times amount of clindamycin in the highest recommended adult human dose based on mg/m2, respectively) or subcutaneous doses of up to 200 mg/kg/day (80 and 40 times the amount of clindamycin in the highest recommended adult human dose based on mg/m2, respectively) revealed no evidence of teratogenicity.
8.3 Nursing Mothers
It is not known whether clindamycin is excreted in human milk after topical application of ACANYA Gel. However, orally and parenterally administered clindamycin has been reported to appear in breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to use ACANYA Gel while nursing, taking into account the importance of the drug to the mother.
8.4 Pediatric Use
Safety and effectiveness of ACANYA Gel in pediatric patients under the age of 12 have not been evaluated.
Clinical trials of ACANYA Gel included patients 12-17 years of age. [See Clinical Studies (14)]
ACANYA Gel (clindamycin phosphate 1.2% and benzoyl peroxide 2.5%) is a combination product with two active ingredients in an aqueous gel formulation. Clindamycin phosphate is a water-soluble ester of the semi-synthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent antibiotic lincomycin.
The chemical name for clindamycin phosphate is Methyl 7-chloro-6,7,8-trideoxy-6-(1-methyl-trans-4-propyl-L-2-pyrrolidinecarboxamido)-1-thio-L-threo-α-D-galacto-octopyranoside 2-(dihydrogen phosphate). The structural formula for clindamycin phosphate is represented below:
Molecular Formula: C18H34ClN2O8PS Molecular Weight: 504.97
Benzoyl peroxide is an antibacterial and keratolytic agent. The structural formula for benzoyl peroxide is represented below:
Molecular Formula: C14H10O4 Molecular Weight: 242.23
ACANYA Gel contains the following inactive ingredients: purified water, carbomer 980, propylene glycol, and potassium hydroxide. Each gram of ACANYA Gel contains 1.2% of clindamycin phosphate which is equivalent to 1% clindamycin.
12 CLINICAL PHARMACOLOGY
12.1 Mechanisms of Action
[See Microbiology (12.4)].
An in vivo bioavailability study has not been conducted with ACANYA Gel. Benzoyl peroxide has been shown to be absorbed by the skin where it is converted to benzoic acid.
Clindamycin binds to the 50S ribosomal subunits of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing bacterial protein synthesis.
Clindamycin and benzoyl peroxide individually have been shown to have in vitro activity against Propionibacterium acnes, an organism which has been associated with acne vulgaris; however, the clinical significance of this activity against P. acnes is not known and was not examined in clinical trials with ACANYA Gel.
P. acnes resistance to clindamycin has been documented. Resistance to clindamycin is often associated with resistance to erythromycin.
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenicity, mutagenicity and impairment of fertility testing of ACANYA Gel have not been performed.
Benzoyl peroxide has been shown to be a tumor promoter and progression agent in a number of animal studies. Benzoyl peroxide in acetone at doses of 5 and 10 mg administered topically twice per week for 20 weeks induced skin tumors in transgenic Tg.AC mice. The clinical significance of this is unknown.
Carcinogenicity studies have been conducted with a gel formulation containing 1% clindamycin and 5% benzoyl peroxide. In a 2-year dermal carcinogenicity study in mice, treatment with the gel formulation at doses of 900, 2700, and 15000 mg/kg/day (1.8, 5.4, and 30 times amount of clindamycin and 3.6, 10.8, and 60 times amount of benzoyl peroxide in the highest recommended adult human dose of 2.5 g ACANYA Gel based on mg/m2, respectively) did not cause any increase in tumors. However, topical treatment with a different gel formulation containing 1% clindamycin and 5% benzoyl peroxide at doses of 100, 500, and 2000 mg/kg/day caused a dose-dependent increase in the incidence of keratoacanthoma at the treated skin site of male rats in a 2-year dermal carcinogenicity study in rats. In an oral (gavage) carcinogenicity study in rats, treatment with the gel formulation at doses of 300, 900 and 3000 mg/kg/day (1.2, 3.6, and 12 times amount of clindamycin and 2.4, 7.2, and 24 times amount of benzoyl peroxide in the highest recommended adult human dose of 2.5 g ACANYA Gel based on mg/m2, respectively) for up to 97 weeks did not cause any increase in tumors. In a 52-week dermal photocarcinogenicity study in hairless mice, (40 weeks of treatment followed by 12 weeks of observation), the median time to onset of skin tumor formation decreased and the number of tumors per mouse increased relative to controls following chronic concurrent topical administration of the higher concentration benzoyl peroxide formulation (5000 and 10000 mg/kg/day, 5 days/week) and exposure to ultraviolet radiation.
Clindamycin phosphate was not genotoxic in the human lymphocyte chromosome aberration assay. Benzoyl peroxide has been found to cause DNA strand breaks in a variety of mammalian cell types, to be mutagenic in S. typhimurium tests by some but not all investigators, and to cause sister chromatid exchanges in Chinese hamster ovary cells.
Fertility studies have not been performed with ACANYA Gel or benzoyl peroxide, but fertility and mating ability have been studied with clindamycin. Fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (approximately 120 times the amount of clindamycin in the highest recommended adult human dose of 2.5 g ACANYA Gel, based on mg/m2) revealed no effects on fertility or mating ability.
14 CLINICAL STUDIES
The safety and efficacy of once daily use of ACANYA Gel were assessed in two 12-week multi-center, randomized, blinded studies in patients 12 years and older with moderate to severe acne vulgaris. The two studies were identical in design and compared ACANYA Gel to clindamycin in the vehicle gel, benzoyl peroxide in the vehicle gel, and the vehicle gel alone. The co-primary efficacy variables were:
The EGS scoring scale used in all of the clinical trials for ACANYA Gel is as follows:
The results of Study 1 at week 12 are presented in the table below:
The results of Study 2 at week 12 are presented in the table below:
16 HOW SUPPLIED, ADMIXING INSTRUCTIONS AND STORAGE AND HANDLING
16.1 How Supplied
ACANYA Gel (clindamycin phosphate 1.2% and benzoyl peroxide 2.5%) is supplied as a kit containing the following components:
16.2 Admixing Instructions
17 PATIENT COUNSELING INFORMATION
17.1 Instructions for Use
17.2 Skin Irritation
ACANYA Gel may cause irritation such as erythema, scaling, itching, burning, or stinging.
Patients should report any signs or symptoms of local skin irritation to their physician.
In the event a patient treated with ACANYA Gel experiences severe diarrhea or gastrointestinal discomfort, ACANYA Gel should be discontinued and a physician should be contacted.
17.4 Ultraviolet Light and Environmental Exposure
Patient should minimize exposure to natural and avoid artificial sunlight (tanning beds or UVA/B treatment) while using ACANYA Gel. To minimize exposure to sunlight, a wide-brimmed hat or other protective clothing should be worn and a sunscreen with SPF 15 rating or higher should be used.
Read the Patient Information that comes with ACANYA Gel before you start using it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.
What is ACANYA Gel?
ACANYA Gel is a prescription medicine used on the skin (topical) to treat acne vulgaris in people 12 years and older. ACANYA Gel contains clindamycin phosphate and benzoyl peroxide.
It is not known if ACANYA Gel is safe and effective for use longer than 12 weeks.
It is not known if ACANYA Gel is safe and effective in children under 12 years of age.
Who should not use ACANYA Gel?
Do not use ACANYA Gel if you have:
Talk with your doctor if you are not sure if you have one of these conditions.
What should I tell my doctor before using ACANYA Gel?
Before using ACANYA Gel, tell your doctor about all of your medical conditions, including if you:
Tell your doctor about all the medicines and skin products you use. Especially tell your doctor if you will have surgery with general anesthesia. One of the medicines in ACANYA Gel (clindamycin) can affect how certain medicines work when used in general anesthesia.
Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.
How should I use ACANYA Gel?
Instructions for applying ACANYA Gel
What should I avoid while using ACANYA Gel?
What are possible side effects with ACANYA Gel?
ACANYA Gel can cause serious side effects including:
Common side effects with ACANYA Gel include:
Talk to your doctor about any side effect that bothers you or that does not go away.
These are not all the possible side effects with ACANYA Gel. Ask your doctor or pharmacist for more information.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or ARCUTIS Pharmaceuticals at 1-877-272-8808.
How should I store ACANYA Gel?
Keep ACANYA Gel and all medicines out of the reach of children.
General information about ACANYA Gel
Medicines are sometimes prescribed for conditions that are not mentioned in Patient Information leaflets. Do not use ACANYA Gel for a condition for which it was not prescribed. Do not give ACANYA Gel to other people, even if they have the same condition you have. It may harm them.
This leaflet summarizes the most important information about ACANYA Gel. If you would like more information, talk with your doctor. You can also ask your doctor or pharmacist for information about ACANYA Gel that is written for healthcare professionals.
For more information about ACANYA Gel, call 1-877-272-8808 or go to www.AcanyaGel.com.
What are the ingredients in ACANYA Gel?
Active Ingredients: clindamycin phosphate 1.2% and benzoyl peroxide 2.5%
Inactive Ingredients: purified water, carbomer 980, propylene glycol, and potassium hydroxide
Issued October 2009
U.S. Patents 5,733,886 and 6,117,843
PRINCIPAL DISPLAY PANEL - Kit Carton
1.2% and 2.5%
Revised: 10/2009 Dow Pharmaceuticals Sciences
Reproduced with permission of U.S. National Library of Medicine
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