WARNING: ABUSE AND DEPENDENCE CNS stimulants, including cocaine hydrochloride, have a high potential for abuse and dependence [see Warning and Precautions (5.1) .] WARNING: ABUSE AND DEPENDENCE See full prescribing information for complete boxed warning. CNS stimulants, including cocaine hydrochloride, have a high potential for abuse and dependence. ( 5.1)
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warnings and cautions
5 WARNINGS AND PRECAUTIONS • Seizures: COCAINE HYDROCHLORIDE nasal solution may lower the convulsive threshold. Monitor patients for development of seizures. (5.2) • Blood Pressure and Heart Rate Increases: Monitor vital signs, including heart rate and rhythm, in patients after receiving COCAINE HYDROCHLORIDE nasal solution. Avoid use of COCAINE HYDROCHLORIDE nasal solution in patients with a recent or active history of uncontrolled hypertension, unstable angina, myocardial infarction, coronary artery disease, or congestive heart failure. (5.3) 5.1 Potential for Abuse and Dependence Central nervous system (CNS) stimulants, including cocaine hydrochloride, have a high potential for abuse and dependence [see Drug Abuse and Dependence ( 9.2 , 9.3 )]. 5.3 Blood Pressure and Heart Rate Increases As reported in the literature, cocaine hydrochloride causes an increase in observed blood pressure and heart rate. In the Phase 3 clinical study with COCAINE HYDROCHLORIDE nasal solution, increases in blood pressure and heart rate were observed for 60 minutes or longer following pledget removal. Monitor for vital sign changes, including heart rate and rhythm, after administration of COCAINE HYDROCHLORIDE nasal solution. Avoid use of COCAINE HYDROCHLORIDE nasal solution in patients with a recent or active history of uncontrolled hypertension, unstable angina, myocardial infarction, coronary artery disease, or congestive heart failure. Avoid use of additional vasoconstrictor agents such as epinephrine or phenylephrine with COCAINE HYDROCHLORIDE nasal solution. If concomitant use is unavoidable, prolonged vital sign and ECG monitoring may be required [see Drug Interactions ( 7 )]. 5.4 Toxicology Screening The cocaine hydrochloride in COCAINE HYDROCHLORIDE nasal solution may be detected in plasma for up to one week after administration. Cocaine hydrochloride and its metabolites may be detected in urine toxicology screening for longer than one week after administration. 5.2 Seizures It has been reported in the literature that cocaine hydrochloride may lower the convulsive threshold. The risk may be higher in patients with a history of seizures or in patients with prior electroencephalogram (EEG) abnormalities without seizures, but has been reported in patients with no prior history or EEG evidence of seizures. Monitor patients for development of seizures.
6 ADVERSE REACTIONS The most common adverse reactions (>0.5%) occurring in patients treated with COCAINE HYDROCHLORIDE nasal solution 4% were headache and epistaxis. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact LXO US., INC. at 1-844-800-8007 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trial Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. COCAINE HYDROCHLORIDE nasal solution has been evaluated in four Phase 1 studies and one Phase 3 study, which included 647 adult subjects who received a single topical intranasal 160 mg dose (four pledgets), of COCAINE HYDROCHLORIDE nasal solution. The randomized, double-blind, controlled Phase 3 study was conducted in adult patients undergoing diagnostic procedures and surgeries on or through the mucous membranes of the nasal cavities, of which 278 received COCAINE HYDROCHLORIDE nasal solution (4% solution), 275 received cocaine hydrochloride solution 8%, and 95 received placebo. Safety was evaluated for up to 7 days after dosing. The most commonly reported adverse reactions (>1 patient) to occur in the Phase 3 study with COCAINE HYDROCHLORIDE nasal solution (4% solution) were headache and epistaxis. Two adverse reactions of headache were severe (Table 1). No premature discontinuations due to an adverse event, serious adverse events, or deaths were reported in the Phase 3 clinical study. Table 1: Common Adverse Reactions with COCAINE HYDROCHLORIDE nasal solution (4%) in >1 Patient System Organ Class / Preferred Term COCAINE HYDROCHLORIDE nasal solution (4% solution) (N=278) Cocaine Hydrochloride Solution 8% (N=275) Placebo (N=95) Nervous System Disorders Headache 7 (3%) 4 (2%) 1 (1%) Respiratory, Thoracic, and Mediastinal Disorders Epistaxis 3 (1%) 2 (1%) 0 Psychiatric Disorders Anxiety 0 2 (1%) 0