US Pharm.
32(11):60-62.
FDA Halts Marketing of
Unapproved Hydrocone Products
Companies marketing
unapproved drug products containing the narcotic hydrocone must cease or they
will be subject to enforcement action, the FDA announced. Hydrocone, used to
treat pain and suppress coughs, can cause serious illness or death if not used
correctly. The agency is especially concerned about unapproved drugs
containing hydrocone being marketed for pediatric use.
"This is another example of
the kinds of safety risks that warrant priority enforcement under our
Compliance Policy Guide," said Deborah M. Autor, JD, director of the FDA's
Center for Drug Evaluation and Research Office of Compliance. "These products
need to come off the market until they meet FDA approval standards," Autor
said.
Companies marketing unapproved
products with hydrocone labeled for use in children under 6 years had until
October 31, 2007, to stop manufacturing and distributing the products.
Companies marketing any other unapproved hydrocone-containing products must
stop manufacturing them by December 31, 2007, and must stop interstate
shipment of the products by March 31, 2008.
FDA Proposes Removing CFCs
from Asthma Inhalers
The FDA proposed
removing the "essential-use" designation for chlorofluorocarbons (CFCs) in
epinephrine-containing metered dose inhalers (MDIs) for temporary relief of
mild asthma symptoms. The agency initially concluded that there are no
technical barriers to formulating epinephrine that does not release CFCs.
Currently, MDIs with epinephrine are the only OTC devices for asthma. The
proposed rule would mandate that epinephrine MDIs containing CFCs be removed
from the market by the end of 2010. Following a 60-day public comment period
that starts following publication of the proposed rule in the Federal
Register, an open public meeting on the essential use of epinephrine will be
held.
The Clean Air Act only permits
CFC use in medical products that the FDA deems essential. Since 1978, CFC use
has been banned due to deleterious effects on the earth's ozone layer. The
majority of MDIs available in the U.S. contained CFCs at one time, but most of
these have been reformulated with other propellant substances. Should this
rule become final, epinephrine MDI users will need a prescription for
alternative drug products if a non-CFC epinephrine inhaler is not available.
Meningitis and Cochlear
Implant Connection
Cochlear implant
devices used in profoundly deaf or severely hard-of-hearing patients carry
increased risk of bacterial meningitis caused by Streptococcus pneumoniae
, the FDA warned health care professionals and consumers. Children implanted
with cochlear devices with a positioner component, the FDA added, are at a
greater risk. Two deaths from meningitis occurred within the past year in
children ages 9 and 11 who were implanted with cochlear devices with
positioners. Neither child was fully vaccinated; one of the children died due
to the lack of vaccination.
According to the CDC's
vaccination recommendations, people implanted with this device must be fully
immunized. Since children with cochlear implants are at increased risk for
pneumococcal meningitis, the CDC recommends that they receive pneumococcal
vaccination following the same schedules as other individuals who are at high
risk for the disease.
ED Drug Class Linked to Hearing
Loss
To clearly display
the potential risk of sudden hearing loss and tell consumers what action to
take if they do experience this, the FDA approved labeling changes for
erectile dysfunction (ED) drugs in the class that includes Cialis, Levitra,
and Viagra.
The FDA asked makers of these
drugs to change the product's labeling after a very small number of patients
taking the phosphodiesterase type 5 (PDE5) inhibitors reported sudden hearing
loss, sometimes with ringing in the ears and dizziness. The FDA also plans to
mandate the same changes in labeling for Revatio, a PDE5 inhibitor used to
treat pulmonary arterial hypertension.
Patients taking Cialis,
Levitra, or Viagra who experience sudden hearing loss should immediately stop
taking the drug and seek prompt medical attention, the FDA said. Revatio users
should continue taking the medication but should contact their health care
provider for further evaluation. Since Revatio is used to treat a potentially
life-threatening condition, the FDA does not recommend that patients abruptly
stop taking this medication but says they should consult their physician if
they have sudden hearing problems.
The FDA found a total of 29
postmarketing reports of sudden hearing loss following a search through its
Adverse Events Reporting System. A report in the April issue of Laryngology
& Otology involving sudden hearing loss in a man taking Viagra
prompted the FDA to look into a possible relationship between hearing loss
cases and PDE5 inhibitors. Even though no causal relationship has been
demonstrated, the FDA said, a strong relationship between these ED drugs and
sudden hearing loss in these cases warrants the labeling revisions in this
drug class.
"Because some level of hearing
loss is usually associated with the aging process, patients on these drugs may
not think to talk to their doctor about it," said Janet Woodcock, MD, the
FDA's deputy commissioner for scientific and medical programs, chief medical
officer, and acting director of its Center for Drug Evaluation and Research.
Initiative Gives Boost to
Generics
To increase the
number and variety of generic drugs available to consumers and health care
providers, the FDA introduced an initiative to modernize and streamline the
generic drug approval process. Called the Generic Initiative for Value and
Efficiency (GIVE), the program will identify generic drugs with no blocking
patents or exclusivity protections and expedite review. Under the program, the
FDA will also hire new generic drug reviewers and focus on electronic tools
for processing drug submissions, also designed to deliver generics to
consumers faste.
"The GIVE plan outlines ways
to maximize the use of our resources so that FDA can review and approve even
more high-quality generic drugs during the upcoming fiscal year than it did in
2007," said Gary Buehler, director of the FDA's Office of Generic Drugs. The
FDA approved 682 generic drug products in fiscal year 2007, an increase of
more than 30% over 2006.
Thyroid Drug's Potency
Parameters Tightened
To ensure that the
thyroid drug levothyroxine sodium retains its potency throughout its entire
shelf life, the FDA is requiring that the drug products meet a 95% to 105%
potency specification until their expiration date. These drugs are currently
allowed a 90% to 110% potency specification. Manufacturers and marketers of
levothyroxine sodium have two years to comply with the revised specifications.
The FDA studied data from
approved levothyroxine sodium drug products manufactured between July 2003 and
June 2005. Even though all of the drugs retained at least 90% potency, a trend
toward potency degradation emerged, particularly with blister packs.
Risks Reported with
Psoriasis Drug
The FDA and Roche
Pharmaceuticals notified health care providers that the psoriasis drug
CellCept (mycophenolate mofetil) is associated with increased risk of
first-trimester pregnancy loss and increased risk of congenital malformations,
including cleft lip and palate, and anomalies of the distal limbs,
heart, esophagus, and kidney.
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