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Each gram of CENTANY® ointment contains 20 mg mupirocin in a soft white ointment base consisting of caprylic/capric/myristic/stearic triglyceride, castor oil, oleyl alcohol, and propylene glycol monostearate. Mupirocin is a naturally occurring antibacterial drug. The chemical name is (E)-(2S,3R,4R,5S)-5-[(2S,3S,4S,5S)-2,3-Epoxy-5-hydroxy-4-metylhexyl] tetrahydro-3,4-dihydroxy-β-methyl- 2H-pyran-2-crotonic acid, ester with 9-hydroxynonanoic acid. The molecular formula of mupirocin is C26H44O9 and the molecular weight is 500.62. The chemical structure is:
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The following adverse reactions are discussed in more detail in other sections of the labeling:
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.
The following local adverse reactions have been reported in connection with the use of CENTANY ointment, in 300 patients in one clinical trial: application site reactions and pruritus, each in 1% of patients; contact dermatitis and furunculosis, each in 0.7% of patients; and exfoliative dermatitis and rash, each in 0.3% of patients.
The following adverse reactions have been identified during post-approval use of CENTANY ointment. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash [see Warnings and Precautions (5.1)].
The effect of the concurrent application of CENTANY ointment and other drug products is unknown.
Included as part of the PRECAUTIONS section.
Systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash have been reported in patients with mupirocin formulations [see Adverse Reactions (6.2)].
CENTANY ointment is not for ophthalmic use or nasal use or on mucosal surfaces. If this product comes in contact with the eyes, rinse thoroughly with water.
If a reaction suggesting sensitivity or chemical irritation should occur with the use of CENTANY ointment, treatment should be discontinued and appropriate alternative therapy for the infection instituted.
Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxinproducing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial drug use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
As with other antibacterial products, prolonged use of CENTANY ointment may result in overgrowth of nonsusceptible microorganisms, including fungi [see Dosage and Administration (2)].
Long-term studies in animals to evaluate carcinogenic potential of mupirocin have not been conducted.
Results of the following studies performed with mupirocin calcium or mupirocin sodium in vitro and in vivo did not indicate a potential for genotoxicity: rat primary hepatocyte unscheduled DNA synthesis, sediment analysis for DNA strand breaks, Salmonella reversion test (Ames), Escherichia coli mutation assay, metaphase analysis of human lymphocytes, mouse lymphoma assay, and bone marrow micronuclei assay in mice.
Reproduction studies were performed with mupirocin administered subcutaneously to male and female rats at doses up to 14 times the human topical dose (approximately 60 mg mupirocin/day) based on body surface area. Neither evidence of impaired fertility nor impaired reproductive performance attributable to mupirocin was observed.
No information provided.
CENTANY® ointment is contraindicated in patients with a history of sensitivity reactions to any of its components.
Mupirocin is an antibacterial drug [see Microbiology (12.4)].
The pharmacodynamics of CENTANY ointment are unknown.
Following the application of CENTANY ointment to a 400cm2 area on the back of 23 healthy volunteers once daily for 7 days, the mean (range) cumulative urinary excretion of monic acid over 24 hrs following the last administration was 1.25% (0.2% to 3.0%) of the administered dose of mupirocin. The monic acid concentration in urine collected at specified intervals for 24 hrs on Day 7 ranged from < 0.050 to 0.637 μg/mL.
In a trial conducted in 7 healthy adult male subjects, the elimination half-life after intravenous administration of mupirocin was 20 to 40 minutes for mupirocin and 30 to 80 minutes for monic acid.
Metabolism
Following intravenous or oral administration, mupirocin is rapidly metabolized. The principal metabolite, monic acid demonstrates no antibacterial activity.
Excretion
Monic acid is predominantly eliminated by renal excretion. The pharmacokinetics of mupirocin has not been studied in individuals with renal insufficiency.
Mupirocin is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens. Mupirocin is active against some gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and against some gram-negative bacteria. Mupirocin is bactericidal at concentrations typically achieved by topical administration. The minimum bactericidal concentration (MBC) against relevant pathogens is generally eight-fold to thirty-fold higher than the minimum inhibitory concentration (MIC). In addition, mupirocin is highly protein bound (>97%), and the effect of wound secretions on the MICs of mupirocin has not been determined.
Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthase. Due to this mode of action, mupirocin does not demonstrate cross-resistance with other classes of antimicrobial agents.
Low-level mupirocin resistance (MIC = 8 – 256 mcg/mL) results from the production of a modified isoleucyl-tRNA synthase. High level resistance (MIC ≥ 512 mcg/mL) results from acquisition, by genetic transfer, of a separate mediate isoleucyl-tRNA synthase.
Mupirocin has been shown to be active against strains of Staphylococcus aureus and Streptococcus pyogenes, both in vitro and in clinical studies [see Indications and Usage (1)].
Advise the patient to administer CENTANY ointment as follows [see Dosage and Administration (2)] and Warnings and Precautions (5.2)]:
Advise breastfeeding women to thoroughly wash the breast and/or nipple being treated with CENTANY ointment to prevent direct infant exposure [see Use in Specific Populations (8.2)].
