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warnings and cautions
5 WARNINGS AND PRECAUTIONS Proteinuria, including nephrotic syndrome, and membranous nephropathy, has been reported with tiopronin use. Pediatric patients receiving greater than 50 mg/kg of tiopronin per day may be at increased risk for proteinuria. ( 2.1 , 5.1 , 8.4 ) Hypersensitivity Reactions have been reported during tiopronin treatment. ( 4 , 5.2 ) 5.1 Proteinuria Proteinuria, including nephrotic syndrome, and membranous nephropathy, have been reported with tiopronin use. Pediatric patients receiving greater than 50 mg/kg of tiopronin per day may be at increased risk for proteinuria [see Dosage and Administration ( 2.2 ), Adverse Reactions ( 6.1 , 6.2 ), Use in Specific Populations ( 8.4 )] . Monitor patients for the development of proteinuria and discontinue therapy in patients who develop proteinuria [see Dosage and Administration ( 2.2 )] . 5.2 Hypersensitivity Reactions Hypersensitivity reactions (drug fever, rash, fever, arthralgia and lymphadenopathy) have been reported [see Contraindications ( 4 )] .
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adverse reactions
6 ADVERSE REACTIONS The following adverse reactions are discussed in greater detail in other sections of the labeling: Proteinuria [see Warnings and Precautions ( 5.1 )] Hypersensitivity [see Warnings and Precautions ( 5.2 )] Most common adverse reactions (≥10%) are nausea, diarrhea or soft stools, oral ulcers, rash, fatigue, fever, arthralgia, proteinuria, and emesis. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Teva at 1-888-838-2872 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, the adverse reaction rates observed in the clinical trials of the drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Adverse reactions occurring at an incidence of ≥5% in an uncontrolled trial in 66 patients with cystinuria age 9 to 68 years are shown in the table below. Patients in group 1 had previously been treated with d-penicillamine; those in group 2 had not. Of those patients who had stopped taking d-penicillamine due to toxicity (34 out of 49 patients in group 1), 22 were able to continue treatment with tiopronin. In those without prior history of d-penicillamine treatment, 6% developed reactions of sufficient severity to require tiopronin withdrawal. Table 1 presents adverse reactions ≥5% in either treatment group occurring in this trial. Table 1: Adverse Reactions Occurring in One or More Patients System Organ Class Adverse Reaction Group 1 Previously treated with d-penicillamine (N=49) Group 2 Naïve to d-penicillamine (N=17) Blood and Lymphatic System Disorders anemia 1 (2%) 1 (6%) Gastrointestinal Disorders nausea 12 (25%) 2 (12%) emesis 5 (10%) – diarrhea/soft stools 9 (18%) 1 (6%) abdominal pain – 1 (6%) oral ulcers 6 (12%) 3 (18%) General Disorders and Administration Site Conditions fever 4 (8%) – weakness 2 (4%) 2 (12%) fatigue 7 (14%) – peripheral (edema) 3 (6%) 1 (6%) chest pain – 1 (6%) Metabolism and Nutrition Disorders anorexia 4 (8%) – Musculoskeletal and Connective Tissue Disorders arthralgia – 2 (12%) Renal and Urinary Disorders proteinuria 5 (10%) 1 (6%) impotence – 1 (6%) Respiratory, Thoracic and Mediastinal Disorders cough – 1 (6%) Skin and Subcutaneous Tissue Disorders rash 7 (14%) 2 (12%) ecchymosis 3 (6%) – pruritus 2 (4%) 1 (6%) urticaria 4 (8%) – skin wr...
adverse reactions table
Table 1: Adverse Reactions Occurring in One or More PatientsSystem Organ ClassAdverse ReactionGroup 1Previously treatedwithd-penicillamine(N=49)Group 2Naïve tod-penicillamine(N=17)Blood and Lymphatic System Disordersanemia1 (2%)1 (6%)Gastrointestinal Disordersnausea12 (25%)2 (12%)emesis5 (10%)–diarrhea/soft stools9 (18%)1 (6%)abdominal pain–1 (6%)oral ulcers6 (12%)3 (18%)General Disorders and Administration Site Conditionsfever4 (8%)–weakness2 (4%)2 (12%)fatigue7 (14%)–peripheral (edema)3 (6%)1 (6%)chest pain–1 (6%)Metabolism and Nutrition Disordersanorexia4 (8%)–Musculoskeletal and Connective Tissue Disordersarthralgia–2 (12%)Renal and Urinary Disordersproteinuria5 (10%)1 (6%)impotence–1 (6%)Respiratory, Thoracic and Mediastinal Disorderscough–1 (6%)Skin and Subcutaneous Tissue Disordersrash7 (14%)2 (12%)ecchymosis3 (6%)–pruritus2 (4%)1 (6%)urticaria4 (8%)–skin wrinkling3 (6%)1 (6%)