WARNINGS
Pregnancy Category X. See CONTRAINDICATIONS section. Women of
child-bearing potential should be warned of the potential risk and use adequate
birth-control measures when AVAGE® (tazarotene) Cream is used. The possibility that a
woman of child-bearing potential is pregnant at the time of institution of therapy
should be considered. A negative result for pregnancy test having a sensitivity
down to at least 50 mIU/mL for hCG should be obtained within 2 weeks prior to
AVAGE® (tazarotene) Cream therapy, which should begin during a normal menstrual period.
PRECAUTIONS
General: AVAGE® (tazarotene) Cream should be applied only to the affected areas.
For external use only. Avoid contact with eyes and mouth. If contact with eyes
occurs, rinse thoroughly with water.
Retinoids should not be used on eczematous skin, as they may cause severe irritation.
Because of heightened burning susceptibility, exposure to sunlight (including
sunlamps) should be avoided unless deemed medically necessary, and in such cases,
exposure should be minimized during the use of AVAGE® (tazarotene) Cream. Patients must
be warned to use sunscreens (minimum SPF of 15) and protective clothing when
using AVAGE® (tazarotene) Cream. Patients with sunburn should be advised not to use AVAGE® (tazarotene)
Cream until fully recovered.
Patients who may have considerable sun exposure due to their occupation and
those patients with inherent sensitivity to sunlight should exercise particular
caution when using AVAGE® (tazarotene) Cream and ensure that the precautions outlined
in the Information for Patients subsection are observed.
AVAGE® (tazarotene) Cream should be administered with caution if the patient is also
taking drugs known to be photosensitizers (e.g., thiazides, tetracyclines, fluoroquinolones,
phenothiazines, sulfonamides) because of the increased possibility of augmented
photosensitivity. Some individuals may experience excessive pruritus, burning,
skin redness, or peeling. If these effects occur, the medication should either
be discontinued until the integrity of the skin is restored, or the dosing should
be reduced to an interval the patient can tolerate. However, efficacy at reduced
frequency of application has not been established. Weather extremes, such as
wind or cold, may be more irritating to patients using AVAGE® (tazarotene) Cream.
Some facial pigmented lesions are not lentigines, but rather lentigo maligna,
a type of melanoma. Facial pigmented lesions of concern should be carefully
assessed by a qualified physician (e.g. dermatologist) before application of
AVAGE® (TAZAROTENE) Cream. Lentigo maligna should not be treated with AVAGE®
(TAZAROTENE) Cream.
Information for Patients: AVAGE® (TAZAROTENE) Cream 0.1% is to be
used as described below when used for treatment of facial fine wrinkling, mottled
hypo- and hyperpigmentation, and benign facial lentigines, unless otherwise
directed by your physician:
- It is for use on the face.
- Avoid contact with the eyes and mouth. AVAGE® (TAZAROTENE) Cream 0.1%
may cause severe redness, itching, burning, stinging, and peeling.
- Before applying AVAGE® (TAZAROTENE) Cream 0.1% once per day, gently
wash your face with a mild soap. Make sure skin is dry before applying AVAGE®
(TAZAROTENE) Cream 0.1%. Apply only a small pea sized amount (about ¼ inch
or 5 millimeter diameter) of AVAGE® (TAZAROTENE) Cream 0.1% to your face
at one time. This should be enough to lightly cover the entire face.
- For best results, you are advised that if emollients or moisturizers are
used, they can be applied either before or after tazarotene cream, ensuring
that the first cream or lotion has absorbed into the skin and dried completely.
- In the morning, apply a moisturizing sunscreen, SPF 15 or greater.
- AVAGE® (TAZAROTENE) Cream 0.1% is a serious medication. Do not use AVAGE®
(TAZAROTENE) Cream 0.1% if you are pregnant or attempting to become pregnant.
If you become pregnant while using AVAGE® (TAZAROTENE) Cream 0.1%, please
contact your physician immediately.
- Avoid sunlight and other medicines that may increase your sensitivity to
sunlight. For the mitigation of fine wrinkling, mottled hypo- and hyperpigmentation,
and benign facial lentigines, avoidance of excessive sun exposure and the
use of sunscreens with protective measures (hat, visor) are recommended.
- AVAGE® (TAZAROTENE) Cream 0.1% does not remove or prevent wrinkles or
repair sun-damaged skin.
Please refer to the Patient Package Insert
for additional patient information.
Carcinogenesis, Mutagenesis, Impairment of Fertility
A long term study of tazarotene following oral administration of 0.025, 0.050,
and 0.125 mg/kg/day to rats showed no indications of increased carcinogenic
risks. Based on pharmacokinetic data from a shorter term study in rats, the
highest dose of 0.125 mg/kg/day was anticipated to give systemic exposure in
the rat equivalent to 1.4 times the maximum AUC0-24h in patients
treated with 2 mg/cm² of tazarotene cream 0.1% over 15% body surface area for
fine wrinkling and mottled hyperpigmentation.
In evaluation of photo co-carcinogenicity, median time to onset of tumors was
decreased, and the number of tumors increased in hairless mice following chronic topical dosing with intercurrent exposure to ultraviolet radiation at tazarotene
concentrations of 0.001%, 0.005%, and 0.01% in a gel formulation for up to 40
weeks.
A long-term topical application study of up to 0.1% tazarotene in a gel formulation
in mice terminated at 88 weeks showed that dose levels of 0.05, 0.125, 0.25,
and 1.0 mg/kg/day (reduced to 0.5 mg/kg/day for males after 41 weeks due to
severe dermal irritation) revealed no apparent carcinogenic effects when compared
to vehicle control animals; untreated control animals were not completely evaluated.
Systemic exposure (AUC0-12h) at the highest dose was 7.8 times the maximum AUC0-24h
in patients treated with 2 mg/cm² of tazarotene cream 0.1% over 15% body surface
area for fine wrinkling and mottled hyperpigmentation.
Tazarotene was found to be non-mutagenic in the Ames assays using Salmonella
and E. coli and did not produce structural chromosomal aberrations in
a human lymphocyte assay. Tazarotene was also non-mutagenic in the CHO/HGPRT
mammalian cell forward gene mutation assay and was non-clastogenic in the in
vivo mouse micronucleus test.
No impairment of fertility occurred in rats when male animals were treated
for 70 days prior to mating and female animals were treated for 14 days prior
to mating and continuing through gestation and lactation with topical doses
of tazarotene gel of up to 0.125 mg/kg/day. Based on data from another study,
the systemic drug exposure in the rat would be equivalent to 1.2 times the maximum
AUC0-24h in patients treated with 2 mg/cm² of tazarotene cream 0.1%
over 15% body surface area for fine wrinkling and mottled hyperpigmentation.
No impairment of mating performance or fertility was observed in male rats
treated for 70 days prior to mating with oral doses of up to 1.0 mg/kg/day tazarotene.
That dose produced an AUC0-24h that was 3.7 times the maximum AUC0-24h in patients
treated with 2 mg/cm² of tazarotene cream 0.1% over 15% body surface area for
fine wrinkling and mottled hyperpigmentation.
No effect on parameters of mating performance or fertility was observed in
female rats treated for 15 days prior to mating and continuing through day 7
of gestation with oral doses of tazarotene up to 2.0 mg/kg/day. However, there
was a significant decrease in the number of estrous stages and an increase in
developmental effects at that dose (see CONTRAINDICATIONS). That dose
produced an AUC0-24h that was 6.7 times the maximum AUC0-24h in patients treated
with 2 mg/cm² of tazarotene cream 0.1% over 15% body surface area for signs
of fine wrinkling and mottled hyperpigmentation.
Reproductive capabilities of F1 animals, including F2 survival and development,
were not affected by topical administration of tazarotene gel to female F0 parental
rats from gestation day 16 through lactation day 20 at the maximum tolerated
dose of 0.125 mg/kg/day. Based on data from another study, the systemic drug
exposure in the rat would be equivalent to 1.2 times the maximum AUC0-24h in
patients treated with 2 mg/cm² of tazarotene cream 0.1% over 15% body surface
area for fine wrinkling and mottled hyperpigmentation.
Pregnancy: Teratogenic Effects: Pregnancy Category X
See CONTRAINDICATIONS section. Women of
child-bearing potential should use adequate birth-control measures when AVAGE® (tazarotene)
Cream is used. The possibility that a woman of child-bearing potential is pregnant
at the time of institution of therapy should be considered. A negative result
for pregnancy test having a sensitivity down to at least 50 mIU/mL for hCG should
be obtained within 2 weeks prior to AVAGE® (tazarotene) Cream therapy, which should begin
during a normal menstrual period. There are no adequate and well-controlled
studies in pregnant women. As a retinoid, tazarotene is a teratogenic substance,
and it is not known what level of exposure is required for teratogenicity in
humans. However, there may be less systemic exposure in the treatment of the
face alone, due to less surface area for application (see CLINICAL
PHARMACOLOGY: Pharmacokinetics).
Nursing mothers
After single topical doses of 14C-tazarotene gel to the skin of lactating rats,
radioactivity was detected in milk, suggesting that there would be transfer
of drug-related material to the offspring via milk. It is not known whether
this drug is excreted in human milk. Caution should be exercised when tazarotene
is administered to a nursing woman.
Pediatric Use
The safety and efficacy of tazarotene cream have not been established in patients
under the age of 17 years with facial fine wrinkling, facial mottled hypo- and
hyperpigmentation, and benign facial lentigines.
Geriatric Use
In the studies of facial fine wrinkling, facial mottled hypo- and hyperpigmentation,
and benign facial lentigines, 44 male patients and 180 female patients out of
the total population of 1131 patients were older than 65 years of age. No overall
differences in safety or effectiveness were observed between these patients
and younger patients, and other clinical experience has not identified differences
in responses between the elderly and younger patients, but greater sensitivity
of some older individuals cannot be ruled out.