Heparin warnings from FDA

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snowyday
snowyday Member Posts: 1,478

Anyone getting your port flushed with heparin, ask your chemo nurse about this FDA warning, Serious. 

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Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) -- February 2009

 
     

The detailed view includes drug products with safety labeling changes to the BOXED WARNING, CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE REACTIONS, or PATIENT PACKAGE INSERT/MEDICATION GUIDE sections. Deletions or editorial revisions made to these sections are not included in this summary. Read about the new physician labeling format

Summary View

 
     

 

Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Fludara (fludarabine phosphate), 50 milligrams, for intravenous injection

Prescribing Information

BOXED WARNING

WARNINGS

  • Pregnancy Category D

PRECAUTIONS

  • Nursing Mothers

BOXED WARNING

  • ....including coma, seizures, agitation and confusion,.....

WARNINGS

  • ....Similar severe central nervous system toxicity, including coma,......
  • Pregnancy Category D
    • on its mechanism of action, fludarabine phosphate can cause fetal harm ...

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Novantrone (mitoxantrone HCl) Injection

Prescribing Information

BOXED WARNING

  • Cardiotoxicity

WARNINGS

  • Cardiac Effects
    • Multiple Sclerosis

PATIENT PACKAGE INSERT

  • What is the most important information I should know about NOVANTRONE?
  • What are the possible side effects of NOVANTRONE?

BOXED WARNING

  • Cardiotoxicity: Congestive heart failure (CHF), potentially fatal, may occur either during therapy with NOVANTRONE or months to years after termination of therapy. Cardiotoxicity risk increases with cumulative NOVANTRONE dose and may occur whether or not cardiac risk factors are present.......

WARNINGS

  • Cardiac Effects
    • Multiple Sclerosis
      • Changes in cardiac function may occur in patients with multiple sclerosis treated with NOVANTRONE. In one controlled study.......MS patients should be assessed for cardiac signs and symptoms by history, physical examination, ECG, and quantitative LVEF evaluation using appropriate methodology....

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Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Furadantin (nitrofurantoin) Oral Suspension

Prescribing Information

CONTRAINDICATIONS

CONTRAINDICATIONS

  • Furadantin is contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin.

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Brand (Generic) Name

Sections Modified

Summary of Changes to Contraindications and Warnings

Heparin Sodium in 5% Dextrose Injection

Heparin Sodium in 0.9% Sodium Chloride Injection

The latest label is not available on this site

WARNINGS

  • Fatal Medication Errors
  • Thrombocytopenia
  • Heparin-induced Thrombocytopenia and Heparin-induced Thrombocytopenia and Thrombosis
  • Delayed Onset of HIT and HITT
  • Use in Neonates

PRECAUTIONS

  • General
    • HIT and HITT

ADVERSE REACTIONS

  • Thrombocytopenia, Heparin-induced Thrombocytopenia (HIT), Heparin-induced Thrombocytopenia and Thrombosis (HITT) and Delayed Onset of HIT and HITT

WARNINGS

  • Fatal Medication Errors
    • Heparin is supplied in a wide range of strengths. Fatal hemorrhages have occurred in infants and pediatric patients ....
  • Thrombocytopenia
    • ...of up to 30%. Platelet counts
      should be obtained at baseline....
  • Heparin-induced Thrombocytopenia and Heparin-induced Thrombocytopenia and Thrombosis
    • new section
  • Delayed Onset of HIT and HITT
    • new section
  • Use in Neonates
    • new section

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Implanon (etonogestrel implant) 68 mg

Prescribing Information

 

WARNINGS

  • Complications of Insertion and Removal

WARNINGS

  • Complications of Insertion and Removal
    • IMPLANON should be inserted subdermally so that it is palpable after insertion....

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Luvox (fluvoxamine maleate) Tablets

Luvox CR (fluvoxamine maleate) Extended-release Capsules

Prescribing Information

WARNINGS

  • Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions

WARNINGS

  • The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including Luvox treatment, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists.....

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Prograf (tacrolimus) Capsules, 0.5 mg, 1 mg, and 5 mg

Prograf (tacrolimus) Injection, 5 mg/ml

Prescribing Information

WARNINGS

  • Nephrotoxicity
  • Neurotoxicity
  • Latent Viral Infections
  • Prograf in Combination with MMF or Sirolimus

WARNINGS

  • Nephrotoxicity
    • can cause nephrotoxicity, particularly when used in high doses...
  • Neurotoxicity
    • can cause neurotoxicity, particularly when used in high doses
    • Patients treated with tacrolimus have been reported to develop posterior reversible encephalopathy syndrome (PRES)...
  • Latent Viral Infections
    • Immunosuppressed patients are at increased risk for opportunistic infections...
  • Prograf in Combination with MMF or Sirolimus
    • In one randomized, open-label, multi-center trial... A safe and effective dosing regimen of MMF in combination with Prograf has not been established in kidney transplantation.
    • The use of full-dose Prograf with sirolimus (2 mg per day) in heart transplant recipients...

PRECAUTIONS

  • Other Drug Interactions
    • a second paragraph added...At a given MMF dose, mycophenolic acid (MPA) exposure is higher with Prograf co-administration than with cyclosporine co-administration...

ADVERSE REACTIONS

  • Urogenital
    • BK nephropathy
  • Post Marketing/Nervous System
    • posterior reversible encephalopathy syndrome (PRES), progressive multifocal
      leukoencephalopathy (PML)
  • Post Marketing/Respiratory
    • interstitial lung disease

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Toprol XL (metoprolol succinate) 25 mg, 50 mg, 100 mg, and 200 mg Extended Release Tablets

Prescribing Information

WARNINGS

  • Pheochromocytoma

WARNINGS

  • Pheochromocytoma
    • If Toprol-XL is used in the setting of pheochromocytoma, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated....

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Tracleer (bosentan) 62.5 and 125 mg Tablets

Prescribing Information

Medication Guide

WARNINGS

  • Decreased Sperm Counts

ADVERSE REACTIONS

  • Post-Marketing Experience

WARNINGS

  • Decreased Sperm Counts
    • An open-label, single arm, multicenter, safety study evaluated the effect on testicular function of TRACLEER.....Based on these findings and preclinical data from endothelin receptor antagonists, it cannot be excluded that endothelin receptor antagonists such as TRACLEER have an adverse effect on spermatogenesis

MEDICATION GUIDE

  • What are the possible side effects of Tracleer
    • Sperm Count Reduction
      • Reduced sperm counts have been observed ....

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Zerit (stavudine) Capsules, 15 mg, 20 mg, 30 mg and 40 mg

Zerit (stavudine) Powder for Oral Solution, 1mg/mL

Prescribing Information

 

WARNINGS

  • Hepatic Impairment and Toxicity
    • deletion... use with Didanosine and Hydroxyurea Based Regimen

WARNINGS

  • Hepatic Impairment and Toxicity
    • ...this combination should be avoided

ADVERSE REACTIONS

  • Use with Didanosine- and Hydroxyurea-Based Regimens
    • ...explaining the potential hepatoxicity, pancreatitis, and peripheral neuropathy with didanosine and hydroxyurea was revised and moved from the Adults subsection to Observed During Clinical Practice

PATIENT PACKAGE INSERT

  • What are the possible side effects of ZERIT?
    • Deletion Zerit, didanosine, and hydroxyurea combination
    • Deletion of "with or without hydroxyurea" in the subsection Pancreatitis

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Brand (Generic) Name Sections Modified

Altace (ramipril) 1.25, 2.5, 5, and 10 Capsules

Altace (ramipril) 1.25, 2.5, 5 and 10 mg Tablets

Prescribing Information

 

PRECAUTIONS

  • Drug Interactions
    • Gold: Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy including ALTACE.

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Amaryl (glimepiride) Tablets

Prescribing Information

 

PRECAUTIONS

  • General
    • Macrovascular Outcomes
      • There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction...
  • Drug Interactions
    • ...Clarithromycin....

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Capozide (captopril/hydrochlorothiazide) 25/15, 50/15, 25/25, 50/25 mg Tablets

The latest label (approved 02/26/2009) is not available on this site

PRECAUTIONS

  • Drug Interactions
    • Gold: Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy including CAPOZIDE.

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Casodex (bicalutamide) Tablets

Prescribing Information

PRECAUTIONS

  • (5.3) Glucose Tolerance
    • new section added

ADVERSE REACTIONS

  • (6.2) Postmarketing Experience
    • reduction in glucose tolerance....

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Comtan (entacapone) Tablets

Prescribing Information

PRECAUTIONS

  • Melanoma
  • Information for Patients
    • ...urge to gamble....

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Monopril (fosinopril sodium) 10, 20, and 40 mg Tablets

Monopril HCT (fosinopril/hydrochlorothiazide) 20/12.5mg and 10/12.5mg Tablets

The latest label (approved 02/09/2009) is not available on this site

 

PRECAUTIONS

  • Drug Interaction
    • Gold: Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and
      hypotension) have been reported rarely in patients on therapy with injectable gold (sodium
      aurothiomalate) and concomitant ACE inhibitor therapy including MONOPRIL/ MONOPRIL HCT.

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Noxafil (posaconazole) Oral Suspension, 40mg/mL

Prescribing Information

 

PRECAUTIONS

  • Information for Patients
    • ...advised to take each dose of NOXAFIL Oral Suspension during or immediately (i.e. within 20 minutes) following a full meal.....
  • Drug Interactions
    • Table 8
      • Esomeprazole and Metoclopramide....monitor closely for breakthrough fungal infections

PATIENT PACKAGE INSERT

  • How do I take Noxafil?
    • Take each dose of NOXAFIL with during or immediately (i.e. within 20 minutes) following a full meal, or with a liquid nutritional supplement if you are unable to eat a full meal. Alternatively, NOXAFIL may be taken with an acidic carbonated beverage (e.g. gingerale)

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Revlimid (lenalidomide) Capsules

Prescribing Information

PRECAUTIONS

  • Renal Impairment
    • Since lenalidomide is primarily excreted unchanged by the kidney, adjustments to the starting dose of REVLIMID (lenalidomide) are recommended to provide appropriate drug exposure in patients with moderate or severe renal impairment and in patients on dialysis. See DOSAGE AND AMINISTRATION.

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Roxicodone (Oxycodone Hydrochloride Tablets USP)

Prescribing Information

PRECAUTIONS

  • Carcinogenicity, Mutagenesis, and Impairment of Fertility

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Stalevo (levodopa/carbidopa/entacapone) Tablets 200/50/200 mg

The latest approved label is not available on this site

PRECAUTIONS

  • Melanoma
  • Information for Patients
    • ...urge to gamble....

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Symmetrel (amantadine hydrochloride) Syrup and Tablets

The latest approved label is not available on this site

 

PRECAUTIONS

  • Melanoma
  • Information for Patients
    • ...urge to gamble....

ADVERSE REACTIONS

  • Miscellaneous section
    • addition of impulse control disorder

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Tasmar (tolcapone) Tablets

Prescribing Information

 

PRECAUTIONS

  • Melanoma
  • Information for Patients
    • ...urge to gamble....

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Xenical (orlistat) Capsules, 120 mg

Prescribing Information

 

PRECAUTIONS
  • Drug Interactions
    • Levothyroxine
      • Hypothyroidism has been reported in patients treated concomitantly with orlistat and levothyroxine.....

ADVERSE REACTIONS

  • Other Clinical Studies or Postmarketing
    Surveillance
    • Hypothyroidism has been reported in patients treated concomitantly with orlistat and
      levothyroxine.

PATIENT PACKAGE INSERT

  • What should I tell my doctor before taking XENICAL?
    • make sure your doctor knows if you are taking thyroid medicine....
  • Can I take XENICAL while taking other medications?
    • ..... XENICAL and levothyroxine should be taken at least 4 hours apart

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Zantac 150/300 (ranitidine hydrochloride) Tablets,

Zantac (ranitidine hydrochloride) Syrup, USP;

Zantac 25/150 (ranitidine hydrochloride) EFFERdose Tablets and 150 (ranitidine hydrochloride effervescent) Granules

Zantac (ranitidine hydrochloride) Injection and Injection Bulk Pharmacy Pack

Zantac (ranitidine hydrochloride) Injection Premixed

The latest label (approved 02/17/2009) is not available on this site

PRECAUTIONS

  • Drug Interactions
    • Inhibition....
    • Competition....
    • Alteration....
  • Midazolam
    • ...in another interaction study in 8 volunteers receiving IV midazolam, a 300 mg oral dose of ranitidine increased midazolam exposure by about 9%. Monitor patients for excessive or prolonged sedation when ranitidine is coadministered with oral midazolam

ADVERSE REACTIONS

  • Other
    • the addition of "acute interstitial nephritis".

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Zithromax (azithromycin) 200 mg Tablets

Zithromax (azithromycin) 500 mg Tablets

Zithromax (azithromycin) IV

The latest label (approved 02/27/2009) is not available on this site

 

PRECAUTIONS

  • General
    • Exacerbations of symptoms of myasthenia gravis and new onset of myasthenia syndrome have been reported in patients receiving azithromycin therapy.
  • Drug Interactions
    • ...study of 22 healthy men, a 5-day course of azithromycin did not affect the prothrombin time from a subsequently administered dose of warfarin, spontaneous post-marketing reports suggest that concomitant administration of azithromycin may potentiate the effects of oral anticoagulants. Prothrombin times should be carefully monitored while patients are receiving azithromycin and oral anticoagulants concomitantly.

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Brand (Generic) Name Sections Modified

Arthrotec (diclofenac sodium and misoprostol) Tablets

Prescribing Information

ADVERSE REACTIONS

  • (addition of risk of elevations in liver enzymes associated with the use of diclofenac)

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Baraclude (entecavir) tablets and oral solution

Prescribing Information

ADVERSE REACTIONS

  • Postmarketing Experience section
    • alopecia

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Cataflam (diclofenac potassium immediate-release tablets)

Prescribing Information

ADVERSE REACTIONS

  • (addition of risk of elevations in liver enzymes associated with the use of diclofenac)

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Cedax (ceftibuten capsules) 400 mg

Cedax (ceftibuten for oral suspension) 18 mg/mL

Prescribing Information

ADVERSE REACTIONS

  • Post-marketing
    • ..... Stevens-Johnson Syndrome

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Emend (aprepitant) capsules 40 mg, 80 mg, and 125 mg

Emend (fosaprepitant dimeglumine) for Injection, 115 mg/mL

Prescribing Information

 

ADVERSE REACTIONS

  • Post-Marketing Experience
    • pruritus, rash, urticaria; hypersensitivity reactions including anaphylactic reactions

PATIENT PACKAGE INSERT

  • What are the possible side effects of EMEND?

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Voltaren-XR (diclofenac sodium extended-release tablets)

Voltaren (diclofenac sodium enteric-coated tablets)

Prescribing Information

ADVERSE REACTIONS

  • (addition of risk of elevations in liver enzymes associated with the use of diclofenac)

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Center for Drug Evaluation and Research/Office of the Center Director/Safety Policy and Communication Staff
Web page last revised by jlw March 23, 2009

 
   
       
 

Comments

  • LibraGirl
    LibraGirl Member Posts: 160
    edited March 2009

    This is really difficult to read.  Can you give us the gist of it?

  • snowyday
    snowyday Member Posts: 1,478
    edited March 2009

    I don't know why it's copying this way, but the FDA is reporting problems with Heparin, go to your FDA site and look it up and just ask at your clinic or hospital if they are aware of the recall from the FDA.  Also Look up TTP Heparin Induced.

  • bluedasher
    bluedasher Member Posts: 1,203
    edited March 2009

    The recall is about the packaging for two strengths of Heparin being too similar so sometimes the wrong one has been used which has caused fatal hemorrhages in pediatric patients and infants - you may remember news stories about this almost killing an actor's twins.

    Its tragic but not something that applies to the Heparin flushes used for our ports.

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