WARNINGS
Included as part of the PRECAUTIONS section.
PRECAUTIONS
Embryofetal Toxicity
Systemic exposure to tazarotenic acid is dependent upon
the extent of the body surface area treated. In patients treated topically over
sufficient body surface area, exposure could be in the same order of magnitude
as in orally treated animals. Although there may be less systemic exposure in
the treatment of acne of the face alone due to less surface area for
application, tazarotene is a teratogenic substance, and it is not known what
level of exposure is required for teratogenicity in humans [see CLINICAL
PHARMACOLOGY].
There were thirteen reported pregnancies in subjects who
participated in the clinical trials for topical tazarotene. Nine of the
subjects were found to have been treated with topical tazarotene, and the other
four had been treated with vehicle. One of the subjects who was treated with
tazarotene cream elected to terminate the pregnancy for non-medical reasons
unrelated to treatment. The other eight pregnant women who were inadvertently
exposed to topical tazarotene during clinical trials subsequently delivered
apparently healthy babies. As the exact timing and extent of exposure in
relation to the gestation times are not certain, the significance of these
findings is unknown.
Females of Child-bearing Potential
Females of child-bearing potential should be warned of
the potential risk and use adequate birth-control measures when TAZORAC® Cream
is used. The possibility that a female of child-bearing potential is pregnant
at the time of institution of therapy should be considered.
A negative result for pregnancy test should be obtained
within 2 weeks prior to TAZORAC® Cream therapy. TAZORAC® Cream
therapy should begin during a menstrual period [see Use in Specific
Populations].
Local Irritation
Application of TAZORAC® Cream may cause
excessive irritation in the skin of certain sensitive individuals. 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. Alternatively, patients with psoriasis
who are being treated with the 0.1% concentration can be switched to the lower
concentration. Frequency of application should be closely monitored by careful
observation of the clinical therapeutic response and skin tolerance. Therapy
can be resumed, or the drug concentration or frequency of application can be
increased as the patient becomes able to tolerate treatment.
Concomitant topical medications and cosmetics that have a
strong drying effect should be avoided. It is also advisable to
“rest” a patient's skin until the effects of such preparations
subside before use of TAZORAC® Cream is begun.
TAZORAC® Cream, should not be used on
eczematous skin, as it may cause severe irritation.
Weather extremes, such as wind or cold, may be more
irritating to patients using TAZORAC® Cream.
Photosensitivity And Risk For Sunburn
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
TAZORAC® Cream. Patients must be warned to use sunscreens (minimum
SPF of 15) and protective clothing when using TAZORAC® Cream.
Patients with sunburn should be advised not to use TAZORAC® 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 TAZORAC® Cream.
TAZORAC® 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.
Patient Counseling Information
Advise the patient to read the
FDA-approved patient labeling (PATIENT INFORMATION).
Advise the patient of the following:
- Fetal risk associated with
TAZORAC® Cream for females of childbearing potential. Advise
patients to use an effective method of contraception during treatment to avoid
pregnancy. Advise the patient to stop medication if she becomes pregnant and
call her doctor [see CONTRAINDICATIONS, WARNINGS AND
PRECAUTIONS and Use In Specific Populations].
- For the patient with psoriasis, apply TAZORAC® Cream
only to psoriasis skin lesions, avoiding uninvolved skin.
- If undue irritation (redness, peeling, or discomfort)
occurs, reduce frequency of application or temporarily interrupt treatment.
Treatment may be resumed once irritation subsides [see DOSAGE AND
ADMINSTRATION].
- Moisturizers may be used as frequently as desired.
- Patients with psoriasis may use a cream or lotion to
soften or moisten skin at least 1 hour before applying TAZORAC® Cream.
- Avoid exposure of the treated areas to either natural or
artificial sunlight, including tanning beds and sun lamps. Use sunscreen and
protective clothing if exposure to sunlight is unavoidable when using TAZORAC® Cream.
- Avoid contact with the eyes. If TAZORAC® Cream
gets in or near their eyes, rinse thoroughly with water.
- Not for ophthalmic, oral, or intravaginal use.
- Wash their hands after applying TAZORAC® Cream.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis,
Impairment Of Fertility
Carcinogenesis
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 0.6 times that
seen in a psoriatic patient treated with 0.1% tazarotene cream at 2 mg/kg/cm²over a 35% body surface area in a controlled pharmacokinetic study. This
estimated systemic exposure in rats was 2 times the maximum systemic exposure
in acne patients treated with tazarotene cream, 0.1% cream at 2 mg/cm² over
a 15% body surface area.
A long-term topical application study of up to 0.1% of
tazarotene in a gel formulation in mice terminated at 88 weeks showed that dose
levels of 0.05, 0.125, 0.25, and 1 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. Systemic
exposures at the highest dose was 3.9 times that seen in a psoriatic patient
treated with 0.1% tazarotene cream at 2 mg/cm² over a 35% body
surface area in a controlled pharmacokinetic study, and 13 times the maximum
systemic exposure in acne patients treated with tazarotene cream, 0.1% at 2
mg/cm² over a 15% body surface area.
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.
Mutagenesis
Tazarotene was found to be non-mutagenic in the Ames
assay and did not produce structural chromosomal aberrations in a human
lymphocyte assay. Tazarotene was non-mutagenic in the CHO/HGPRT mammalian cell
forward gene mutation assay and was non-clastogenic in the in vivo mouse
micronucleus test.
Impairment of Fertility
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 up to 0.125 mg/kg/day. Based on
data from another study, the systemic drug exposure in the rat would be
equivalent to 0.6 times that observed in a psoriatic patient treated with 0.1%
tazarotene cream at 2 mg/cm² over a 35% body surface area in a
controlled pharmacokinetic study, and 2 times the maximum systemic exposure in
acne patients treated with tazarotene cream, 0.1% at 2 mg/cm² over a
15% body surface area.
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 mg/kg/day tazarotene. That dose produced a systemic exposure that was 1.9
times that observed in a psoriatic patient treated with 0.1% tazarotene cream
at 2 mg/cm² over a 35% body surface area, and 6.3 times the maximum
systemic exposure in acne patients treated with tazarotene cream, 0.1% at 2
mg/cm² over a 15% body surface area.
No impairment of mating performance or fertility was
observed in female rats treated for 15 days prior to mating and continuing
through gestation day 7 with oral doses up to 2 mg/kg/day of tazarotene.
However, there was a significant decrease in the number of estrous stages and
an increase in developmental effects at that dose [see Use in Specific
Populations]. That dose produced a systemic exposure that was 3.4 times
that observed in a psoriatic patient treated with 0.1% tazarotene cream at 2
mg/cm² over a 35% body surface area and 11 times the maximum
systemic exposure in acne patients treated with tazarotene cream, 0.1% at 2
mg/cm² over a 15% body surface area.
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 0.6 times that observed in a psoriatic patient treated with 0.1%
tazarotene cream at 2 mg/cm² over a 35% body surface area, and 2
times the maximum systemic exposure in acne patients treated with tazarotene
cream, 0.1% at 2 mg/cm² over a 15% body surface area.
Use In Specific Populations
Pregnancy
Pregnancy Category X
[see CONTRAINDICATIONS].
There are no adequate and well-controlled studies with
TAZORAC® Cream in pregnant women. TAZORAC® Cream is
contraindicated in women who are or may become pregnant. Females of
child-bearing potential should be warned of the potential risk and use adequate
birth-control measures when TAZORAC® Cream is used. The possibility
that a female of child-bearing potential is pregnant at the time of institution
of therapy should be considered. A negative result for pregnancy test should be
obtained within 2 weeks prior to TAZORAC® Cream therapy, which
should begin during a menstrual period. Systemic exposure to tazarotenic acid
is dependent upon the extent of the body surface area treated. In subjects
treated topically over sufficient body surface area, exposure could be in the
same order of magnitude as in orally treated animals. Although there may be
less systemic exposure in the treatment of acne of the face alone due to less
surface area for application, tazarotene is a teratogenic substance, and it is
not known what level of exposure is required for teratogenicity in humans [see CLINICAL
PHARMACOLOGY].
In rats, a tazarotene gel, 0.05% formulation, administered
topically during gestation days 6 through 17 at 0.25 mg/kg/day resulted in
reduced fetal body weights and reduced skeletal ossification. Rabbits dosed
topically with 0.25 mg/kg/day tazarotene gel during gestation days 6 through 18
were noted with single incidences of known retinoid malformations, including
spina bifida, hydrocephaly, and heart anomalies.
Systemic exposure to tazarotenic acid at topical doses of
0.25 mg/kg/day tazarotene in a gel formulation in rats and rabbits represented
1.2 and 13 times, respectively, that in a psoriatic patient treated with 0.1%
tazarotene cream at 2 mg/cm² over a 35% body surface area in a
controlled pharmacokinetic study, and 4 and 44 times the maximum systemic
exposure in acne patients treated with tazarotene cream, 0.1% at 2 mg/cm² over
a 15% body surface area.
When tazarotene was given orally to experimental animals,
developmental delays were seen in rats; and teratogenic effects and
post-implantation loss were observed in rats and rabbits at doses producing 1.1
and 26 times, respectively, the systemic exposure seen in a psoriatic patient
treated topically with tazarotene cream, 0.1% at 2 mg/cm² over a 35%
body surface area in a controlled pharmacokinetic study and 3.5 and 85 times
the maximum systemic exposure in acne patients treated with tazarotene cream,
0.1% at 2 mg/cm² over a 15% body surface area.
In female rats orally administered 2 mg/kg/day of
tazarotene from 15 days before mating through gestation day 7, a number of
classic developmental effects of retinoids were observed including decreased
number of implantation sites, decreased litter size, decreased numbers of live
fetuses, and decreased fetal body weights. A low incidence of retinoid-related
malformations at that dose was observed. The dose produced a systemic exposure
3.4 times that observed in a psoriatic patient treated with tazarotene cream,
0.1% at 2 mg/cm² over a 35% body surface area and 11 times the
maximum systemic exposure in acne patients treated with tazarotene cream, 0.1%
at 2 mg/cm² over a 15% body surface area.
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. The safe use
of TAZORAC® Cream during lactation has not been established. A
decision should be made whether to discontinue breast-feeding or to discontinue
TAZORAC® Cream therapy taking into account the benefit of
breast-feeding for the child and the benefit of therapy for the woman.
Pediatric Use
The safety and efficacy of tazarotene have not been
established in patients with psoriasis under the age of 18 years, or in
patients with acne under the age of 12 years.
Geriatric Use
TAZORAC® Cream for the treatment of acne has
not been clinically tested in persons 65 years of age or older.
Of the total number of subjects in clinical trials of
TAZORAC® Cream for plaque psoriasis, 120 were over the age of 65. No
overall differences in safety or effectiveness were observed between these
subjects and younger subjects. Currently there is no other clinical experience
on the differences in responses between the elderly and younger patients, but
greater sensitivity of some older individuals cannot be ruled out.