Advise the patient to read the FDA-approved patient labeling (
Medication Guide).
Risks from Concomitant Use with Opioids
Inform patients and caregivers that potentially fatal additive effects may occur if DORAL is used with opioids and not to use such drugs concomitantly unless supervised by a healthcare provider
[see Warnings and Precautions (
5.1), Drug Interactions (
7)]
Abuse, Misuse, and Addiction
Inform patients that the use of DORAL even at recommended dosages, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose and death, especially when used in combination with other medications (e.g., opioid analgesics), alcohol, and/or illicit substances. Inform patients about the signs and symptoms of benzodiazepine abuse, misuse, and addiction; to seek medical help if they develop these signs and/or symptoms; and on the proper disposal of unused drug
[see Warnings and Precautions (
5.2) and Drug Abuse and Dependence (
9.2)]
.
Withdrawal Reactions
Inform patients that the continued use of DORAL may lead to clinically significant physical dependence and that abrupt discontinuation or rapid dosage reduction of DORAL may precipitate acute withdrawal reactions, which can be life-threatening. Inform patients that in some cases, patients have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months. Instruct patients that discontinuation or dosage reduction of DORAL may require a slow taper
[see Warnings and Precautions (
5.3) and Drug Abuse and Dependence (
9.3)]
.
CNS Depressant Effects and Next-Day Impairment
Tell patients that DORAL can cause next-day impairment, even in the absence of symptoms. Caution patients against driving or engaging in other hazardous activities or activities requiring complete mental alertness when using DORAL. Tell patients that daytime impairment may persist for several days following discontinuation of DORAL. Advise patients that increased drowsiness and decreased consciousness may increase the risk of falls in some patients
[see Warnings and Precautions (
5.4)]
Severe Allergic Reactions
Inform patients that severe allergic reactions can occur from DORAL. Describe the signs/symptoms of these reactions and advise patients to seek medical attention immediately if these occur
[see Warnings and Precautions (
5.6)]
.
Abnormal Thinking and Behavior Change
Instruct patients that sedative hypnotics can cause abnormal thinking and behavior change, including “sleep-driving” and other complex behaviors while not being fully awake (preparing and eating food, making phone calls, or having sex). Tell patients to call you immediately if they develop any of these symptoms
[see Warnings and Precautions (
5.7)]
.
Suicide
Tell patients that DORAL can worsen depression, and to immediately report any suicidal thoughts
[see Warnings and Precautions (
5.8)]
.
Alcohol and Other Drugs
Ask patients about alcohol consumption, medicines they are taking now, and drugs they may be taking without a prescription. Advise patients that alcohol generally should not be used during treatment with DORAL.
Pregnancy
Advise pregnant females that use of DORAL late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in newborns
[see Warnings and Precautions (
5.9), Use in Specific Populations (
8.1)]
. Instruct patients to inform their healthcare provider if they are pregnant.
Advise patients that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to DORAL during pregnancy
[see Use in Specific Populations (
8.1)]
.
Nursing
Instruct patients to notify their healthcare provider if they are breastfeeding or intend to breastfeed. Instruct breastfeeding patients using DORAL to monitor infants for excessive sedation, poor feeding and poor weight gain, and to seek medical attention if they notice these signs
[see Use in Specific Populations (
8.3)]
.
Galt Pharmaceuticals, LLC.
Atlanta, GA 30339
Printed in USA. 500494-12 Rev. 01/2023