Warnings for Differin Gel .3%
Included as part of the "PRECAUTIONS" Section
Precautions for Differin Gel .3%
Allergic/ Hypersensitivity Reactions
Adverse reactions including anaphylaxis angioedema, face edema, eyelid edema, lip swelling, and pruritus that sometimes required medical treatment have been reported during postmarketing use of adapalene. Advise a patient to stop using DIFFERIN Gel and seek medical attention if experiencing allergic or anaphylactoid/anaphylactic reactions during treatment.
Ultraviolet Light And Environmental Exposure
Exposure to sunlight, including sunlamps, should be minimized during use of DIFFERIN Gel. Patients who normally experience high levels of sun exposure, and those with inherent sensitivity to sun, should be warned to exercise caution. Use of sunscreen products and protective clothing over treated areas is recommended when exposure cannot be avoided. Weather extremes, such as wind or cold, also may be irritating to patients under treatment with DIFFERIN Gel.
Local Cutaneous Reactions
Cutaneous signs and symptoms such as erythema, scaling, dryness, and stinging/burning were reported with use of DIFFERIN Gel. These were most likely to occur during the first four weeks of treatment, were mostly mild to moderate in intensity, and usually lessened with continued use of the medication. Depending upon the severity of these side effects, patients should be instructed to either use a moisturizer, reduce the frequency of application of DIFFERIN Gel or discontinue use.
Avoid application to cuts, abrasions, eczematous or sunburned skin. As with other retinoids, use of “waxing” as a depilatory method should be avoided on skin treated with adapalene.
As DIFFERIN Gel has the potential to induce local irritation in some patients, concomitant use of other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect and products with high concentrations of alcohol, astringents, spices, or lime) should be approached with caution.
Patient Counseling Information
Advise the patient to read the FDA-approved patient labeling (PATIENT INFORMATION)
Information For Patients
Patients using DIFFERIN Gel should receive the following information and instructions:
- Apply a thin film of DIFFERIN Gel to the entire face and any other affected areas of the skin once daily in the evening. Apply a thin film of DIFFERIN Gel to the entire face and any other affected areas of the skin once daily in the evening, after washing gently with a non-medicated soap.
- Avoid contact with the eyes, lips, angles of the nose, and mucous membranes
- Moisturizers may be used if necessary; however, products containing alpha hydroxy or glycolic acids should be avoided.
- This medication should not be applied to cuts, abrasions, eczematous, or sunburned skin.
- Wax depilation should not be performed on treated skin due to the potential for skin erosions.
- Minimize exposure to sunlight including sunlamps. Recommend the use of sunscreen products and protective apparel (e.g., hat) when exposure cannot be avoided.
- Contact the doctor if skin rash, pruritus, hives, chest pain, edema, and shortness of breath occurs, as these may be signs of allergy or hypersensitivity.
- This product is for external use only.
- Lactation: Use DIFFERIN Gel on the smallest area of skin and for the shortest duration possible while breastfeeding. Avoid application of DIFFERIN Gel to areas with increased risk for potential ingestion by or ocular exposure to the breastfeeding child. [See Use In Specific Populations, Lactation]
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment Of Fertility
No carcinogenicity, genotoxicity, or impairment of fertility studies were conducted with DIFFERIN Gel.
Carcinogenicity studies with adapalene were conducted in mice at topical doses of 0.4, 1.3, and 4.0 mg/kg/day (1.2, 3.9, and 12 mg/m2/day) and in rats at oral doses of 0.15, 0.5, and 1.5 mg/kg/day (0.9, 3.0, and 9.0 mg/m2/day). The highest dose levels are 3.2 (mice) and 2.4 (rats) times the MRHD based on a mg/m2 comparison. In the rat study, an increased incidence of benign and malignant pheochromocytomas reported in the adrenal medulla of male rats was observed.
Adapalene was not mutagenic or genotoxic in vitro (Ames test, Chinese hamster ovary cell assay, or mouse lymphoma TK assay) or in vivo (mouse micronucleus test).
In rat oral studies, 20 mg/kg/day adapalene (32 times the MRHD based on a mg/m2 comparison) did not affect the reproductive performance and fertility of F0 males and females or the growth, development, or reproductive function of F1 offspring.
Use In Specific Populations
Pregnancy
Risk Summary
Available data from clinical trials with DIFFERIN Gel use in pregnant women are insufficient to establish a drug-associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. In animal reproduction studies, oral administration of adapalene to pregnant rats and rabbits during organogenesis at dose exposures 40 and 81 times, respectively, the human exposure at the maximum recommended human dose (MRHD) of 2 g resulted in fetal skeletal and visceral malformations (see Data).
The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defects, loss, or other adverse outcomes. In the U.S. general population the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies are 2 to 4% and 15 to 20%, respectively.
Data
Animal Data
No malformations were observed in rats treated with oral adapalene doses of 0.15 to 5.0 mg/kg/day, up to 8 times the MRHD based on a mg/m² comparison. However, malformations were observed in rats and rabbits when treated with oral doses of ≥ 25 mg/kg/day adapalene (40 and 81 times the MRHD, respectively, based on a mg/m² comparison). Findings included cleft palate, microphthalmia, encephalocele, and skeletal abnormalities in rats and umbilical hernia, exophthalmos, and kidney and skeletal abnormalities in rabbits.
Dermal adapalene embryofetal development studies in rats and rabbits at doses up to 6.0 mg/kg/day (9.7 and 19.5 times the MRHD, respectively, based on a mg/m2 comparison) exhibited no fetotoxicity and only minimal increases in skeletal variations (supernumerary ribs in both species and delayed ossification in rabbits).
Lactation
Risk Summary
There are no data on the presence of topical adapalene gel or its metabolite in human milk, the effects on the breastfed infant, or the effects on milk production. In animal studies, adapalene is present in rat milk with oral administration of the drug. When a drug is present in animal milk, it is likely that the drug will be present in human milk. It is possible that topical administration of large amounts of adapalene could result in sufficient systemic absorption to produce detectable quantities in human milk (see Clinical Considerations). The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for DIFFERIN Gel and any potential adverse effects on the breastfed child from DIFFERIN Gel, or from the underlying maternal condition.
Clinical Considerations
To minimize potential exposure to the breastfed infant via breastmilk, use DIFFERIN Gel on the smallest area of skin and for the shortest duration possible while breastfeeding. Avoid application of DIFFERIN Gel to areas with increased risk for potential ingestion by or ocular exposure to the breastfeeding child.
Pediatric Use
Safety and effectiveness have not been established in pediatric patients below the age of 12.
Geriatric Use
Clinical studies of DIFFERIN Gel did not include subjects 65 years of age and older to determine whether they respond differently than younger subjects. Safety and effectiveness in geriatric patients age 65 and above have not been established.