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warnings and cautions
5 WARNINGS AND PRECAUTIONS Hypersensitivity : Hypersensitivity reactions, including cases of angioedema, eye swelling, facial swelling, dyspnea, urticaria, and adverse skin reactions, have been reported. In case of known hypersensitivity to any component of the gel, avoid the use of FINACEA Gel. If hypersensitivity develops, discontinue treatment and institute appropriate therapy. ( 5.1 ) Skin Reactions: Skin irritation (i.e. pruritus, burning or stinging) may occur, usually during the first few weeks of treatment. If sensitivity or severe irritation develops and persists, discontinue treatment and institute appropriate therapy. ( 5.2 ) Hypopigmentation: Isolated cases of hypopigmentation occurred after azelaic acid use. Monitor patients with dark complexion for early signs of hypopigmentation ( 5.2 ) Eye and Mucous Membrane Irritation: FINACEA Gel has been reported to cause irritation of the eyes. Avoid contact with the eyes and mucous membranes. ( 5.3 ) Exacerbation of Asthma: Consult a physician if asthma is exacerbated with FINACEA Gel use. ( 5.4 ) 5.1 Hypersensitivity Hypersensitivity reactions, including cases of angioedema, eye swelling, facial swelling, dyspnea, urticaria, and adverse skin reactions, have been reported during post marketing surveillance. Avoid the use of FINACEA Gel in patients with known hypersensitivity to any component of the gel. If hypersensitivity develops during treatment, discontinue FINACEA Gel and institute appropriate therapy. 5.2 Skin Reactions Skin irritation (i.e. pruritus, burning or stinging) may occur during use of FINACEA Gel, usually during the first few weeks of treatment. If sensitivity or severe irritation develops and persists, discontinue treatment and institute appropriate therapy. There have been isolated reports of hypopigmentation after use of azelaic acid. Since azelaic acid has not been well studied in patients with dark complexion, monitor these patients for early signs of hypopigmentation. 5.3 Eye and Mucous Membranes Irritation FINACEA Gel has been reported to cause irritation of the eyes. Avoid contact with the eyes, mouth and other mucous membranes. If FINACEA Gel comes in contact with the eyes, wash the eyes with large amounts of water and consult a physician if eye irritation persists [see Adverse Reactions (6.2) ] . 5.4 Exacerbation of Asthma Worsening of asthma has been reported in patients using azelaic acid formulations including FINACEA Gel. Consult a physician if asthma is exacerbated with use of FINACEA Gel.
6 ADVERSE REACTIONS The most common adverse reactions are burning/stinging/tingling (29%), pruritus (11%), scaling/dry skin/xerosis (8%) and erythema/irritation (4%). ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact LEO Pharma Inc. at 1-877-494-4536 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials 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. In two vehicle-controlled and one active-controlled U.S. clinical trials, treatment safety was monitored in 788 subjects who used twice-daily FINACEA Gel for 12 weeks (N=333) or 15 weeks (N=124), or the gel vehicle (N=331) for 12 weeks. In all three trials, the most common treatment-related adverse events were: burning/stinging/tingling (29%), pruritus (11%), scaling/dry skin/xerosis (8%) and erythema/irritation (4%). In the active-controlled trial, overall adverse reactions (including burning, stinging/tingling, dryness/tightness/scaling, itching, and erythema/irritation/redness) were 19.4% (24/124) for FINACEA Gel compared to 7.1% (9/127) for the active comparator gel at 15 weeks. Table 1: Adverse Events Occurring in ≥1% of Subjects in the Rosacea Trials by Treatment Group and Maximum Intensity Subjects may have >1 cutaneous adverse event; thus, the sum of the frequencies of preferred terms may exceed the number of subjects with at least 1 cutaneous adverse event. FINACEA Gel, 15% N=457 (100%) Vehicle N=331 (100%) Mild N=99 (22%) Moderate N=61 (13%) Severe N=27 (6%) Mild N=46 (14%) Moderate N=30 (9%) Severe N=5 (2%) Burning/stinging/tingling 71 (16%) 42 (9%) 17 (4%) 8 (2%) 6 (2%) 2 (1%) Pruritus 29 (6%) 18 (4%) 5 (1%) 9 (3%) 6 (2%) 0 (0%) Scaling/dry skin/xerosis 21 (5%) 10 (2%) 5 (1%) 31 (9%) 14 (4%) 1 (<1%) Erythema/irritation 6 (1%) 7 (2%) 2 (<1%) 8 (2%) 4 (1%) 2 (1%) Contact dermatitis 2 (<1%) 3 (1%) 0 (0%) 1 (<1%) 0 (0%) 0 (0%) Edema 3 (1%) 2 (<1%) 0 (0%) 3 (1%) 0 (0%) 0 (0%) Acne 3 (1%) 1 (<1%) 0 (0%) 1 (<1%) 0 (0%) 0 (0%) In patients using azelaic acid formulations, the following adverse events have been reported: worsening of asthma, vitiligo, depigmentation, small depigmented spots, hypertrichosis, reddening (signs of keratosis pilaris) and exacerbation of recurrent herpes labialis. Local Tolerability Studies FINACEA Gel and its vehicle caused irritant reactions at the application site in human dermal safety studies. FINACEA Gel caused significantly more irritation than its vehicle in a cumulative irritation study. Some improvement in irritation was demonstrated over the course of the clinical trials, but this improvement might be attributed to subject dropouts. No phototoxicity or photoallergenicity were reported in human dermal safety studies. 6.2 Postmarketing Experience The following adverse reactions have been identified post approval of FINACEA Gel. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate the frequency or establish a causal relationship to drug exposure: Eyes: iridocyclitis upon accidental exposure of the eyes to FINACEA Gel. Hypersensitivity: angioedema, eye swelling, facial swelling, urticaria. Respiratory: worsening of asthma, dyspnea, wheezing. Skin reactions: application site rash.
adverse reactions table
<table width="85%"><caption>Table 1: Adverse Events Occurring in ≥1% of Subjects in the Rosacea Trials by Treatment Group and Maximum Intensity<footnote><content styleCode="italics">Subjects may have >1 cutaneous adverse event; thus, the sum of the frequencies of preferred terms may exceed the number of subjects with at least 1 cutaneous adverse event.</content></footnote></caption><col width="28%" align="left" valign="top"/><col width="12%" align="center" valign="top"/><col width="12%" align="center" valign="top"/><col width="12%" align="center" valign="top"/><col width="12%" align="center" valign="top"/><col width="12%" align="center" valign="top"/><col width="12%" align="center" valign="top"/><thead><tr><th styleCode="Lrule Rrule"/><th styleCode="Rrule Botrule" colspan="3">FINACEA Gel, 15% N=457 (100%)</th><th styleCode="Rrule Botrule" colspan="3">Vehicle N=331 (100%)</th></tr><tr><th styleCode="Lrule Rrule"/><th styleCode="Rrule">Mild N=99 (22%)</th><th styleCode="Rrule">Moderate N=61 (13%)</th><th styleCode="Rrule">Severe N=27 (6%)</th><th styleCode="Rrule">Mild N=46 (14%)</th><th styleCode="Rrule">Moderate N=30 (9%)</th><th styleCode="Rrule">Severe N=5 (2%)</th></tr></thead><tbody><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Burning/stinging/tingling</td><td styleCode="Rrule">71 (16%)</td><td styleCode="Rrule">42 (9%)</td><td styleCode="Rrule">17 (4%)</td><td styleCode="Rrule">8 (2%)</td><td styleCode="Rrule">6 (2%)</td><td styleCode="Rrule">2 (1%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Pruritus</td><td styleCode="Rrule">29 (6%)</td><td styleCode="Rrule">18 (4%)</td><td styleCode="Rrule">5 (1%)</td><td styleCode="Rrule">9 (3%)</td><td styleCode="Rrule">6 (2%)</td><td styleCode="Rrule">0 (0%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Scaling/dry skin/xerosis</td><td styleCode="Rrule">21 (5%)</td><td styleCode="Rrule">10 (2%)</td><td styleCode="Rrule">5 (1%)</td><td styleCode="Rrule">31 (9%)</td><td styleCode="Rrule">14 (4%)</td><td styleCode="Rrule">1 (<1%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Erythema/irritation</td><td styleCode="Rrule">6 (1%)</td><td styleCode="Rrule">7 (2%)</td><td styleCode="Rrule">2 (<1%)</td><td styleCode="Rrule">8 (2%)</td><td styleCode="Rrule">4 (1%)</td><td styleCode="Rrule">2 (1%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Contact dermatitis</td><td styleCode="Rrule">2 (<1%)</td><td styleCode="Rrule">3 (1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">1 (<1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">0 (0%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Edema</td><td styleCode="Rrule">3 (1%)</td><td styleCode="Rrule">2 (<1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">3 (1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">0 (0%)</td></tr><tr styleCode="Botrule"><td styleCode="Lrule Rrule">Acne</td><td styleCode="Rrule">3 (1%)</td><td styleCode="Rrule">1 (<1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">1 (<1%)</td><td styleCode="Rrule">0 (0%)</td><td styleCode="Rrule">0 (0%)</td></tr></tbody></table>