WARNINGS
Included as part of the PRECAUTIONS section.
PRECAUTIONS
Embryofetal Toxicity
Based on data from animal reproduction studies, retinoid
pharmacology and the potential for systemic absorption, TAZORAC Gel may cause
fetal harm when administered to a pregnant female and is contraindicated during
pregnancy. Tazarotene elicits malformations and developmental effects associated
with retinoids after topical and oral administration to pregnant rats and
rabbits during organogenesis.
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 causes fetal malformations in animals,
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 had 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 the 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 birthcontrol measures when TAZORAC Gel 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 Gel therapy. TAZORAC Gel therapy should begin
during a normal menstrual period [see Use In Specific Populations].
Local Irritation And Hypersensitivity Reactions
Application of TAZORAC Gel may cause excessive irritation
in the skin of certain sensitive individuals. Local reactions (including
blistering and skin desquamation, pruritus, burning, erythema) and
hypersensitivity adverse reactions (including urticaria) have been observed
with topical tazarotene.
If these adverse reactions occur, consider discontinuing
the medication or reducing the dosing frequency, as appropriate, until the
integrity of the skin is restored. 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 treatment with TAZORAC Gel is initiated.
TAZORAC Gel, 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 Gel.
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 Gel. Patients must be warned to use sunscreens and protective clothing when
using TAZORAC Gel. Patients with sunburn should be advised not to use TAZORAC
Gel 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 Gel.
TAZORAC Gel 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).
Embryofetal Toxicity
Inform females of reproductive potential of the potential
risk to a fetus. Advise these patients to use effective contraception during
treatment with TAZORAC Gel. Advise patients to inform their healthcare provider
of a known or suspected pregnancy [see WARNINGS AND PRECAUTIONS and Use
In Specific Populations].
Photosensitivity And Risk of Sunburn
Advise patients to avoid excessive sun exposure and to
use of sunscreens and protective measures (hat, visor). Advise patients to
avoid using TAZORAC Gel if also taking other medicines may increase sensitivity
to sunlight.
Important Administration Instructions
Advise the patient of the following:
- For the patient with psoriasis, apply TAZORAC Gel 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 ADMINISTRATION].
- 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 Gel.
- Avoid contact with the eyes. If TAZORAC Gel gets in or
near eyes, rinse thoroughly with water. Seek medical attention if eye
irritation continues.
- TAZORAC Gel is for topical use only. Do not apply to
eyes, mouth, or other mucous membrane. Not for ophthalmic, oral, or
intravaginal use.
- Wash hands thoroughly after applying TAZORAC Gel.
Nonclinical Toxicology
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 0.3 times that seen in
subjects treated with the MRHD of tazarotene gel, 0.1%.
A long-term study with topical administration 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 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 exposure at the
highest dose was 2 times that seen in subjects treated with the MRHD of
tazarotene gel, 0.1%.
Tazarotene was 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.
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 at the highest dose was
0.3 times that observed in subjects treated with the MRHD of tazarotene gel,
0.1%.
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, which produced systemic exposure that was
approximately equivalent to that observed in subjects treated with the MRHD of
tazarotene gel, 0.1%.
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 of tazarotene up to 2 mg/kg/day. However,
there was a significant decrease in the number of estrous stages and an
increase in developmental effects at that dose, which produced systemic
exposure 2 times that observed in subjects treated with the MRHD of tazarotene
gel, 0.1% [see Use In Specific Populations].
Use In Specific Populations
Pregnancy
Risk Summary
Based on data from animal reproduction studies, retinoid
pharmacology, and the potential for systemic absorption, TAZORAC Gel may cause
fetal harm when administered to a pregnant female and is contraindicated during
pregnancy. Safety in pregnant females has not been established. The potential
risk to the fetus outweighs the potential benefit to the mother from TAZORAC
Gel during pregnancy; therefore, TAZORAC Gel should be discontinued as soon as
pregnancy is recognized [see CONTRAINDICATIONS, WARNINGS AND
PRECAUTIONS, CLINICAL PHARMACOLOGY]. Limited case reports of
pregnancy in females enrolled in clinical trials for TAZORAC Gel have not
established a clear association with tazarotene and major birth defects or
miscarriage risk. Because the exact timing and extent of exposure in relation
to the gestational age are not certain, the significance of these findings is
unknown.
In animal reproduction studies with pregnant rats,
tazarotene dosed topically during organogenesis at 0.5 times the maximum
systemic exposure in subjects treated with the maximum recommended human dose
(MRHD) of tazarotene gel, 0.1% resulted in reduced fetal body weights and
reduced skeletal ossification. In animal reproduction studies with pregnant
rabbits dosed topically with tazarotene gel at 7 times the maximum systemic
exposure in subjects treated with the MRHD of tazarotene gel, 0.1%, there were
single incidences of known retinoid malformations, including spina bifida,
hydrocephaly, and heart anomalies.
In animal reproduction studies with pregnant rats and
rabbits, tazarotene dosed orally during organogenesis at 0.5 and 13 times,
respectively, the maximum systemic exposure in subjects treated with the MRHD
of tazarotene gel, 0.1% resulted in malformations, fetal toxicity, developmental
delays, and/or behavioral delays. In pregnant rats, tazarotene dosed orally
prior to mating through early gestation resulted in decreased litter size,
decreased numbers of live fetuses, decreased fetal body weights, and increased
malformations at doses approximately 2 times higher than the maximum systemic
exposure in subjects treated with the MRHD of tazarotene gel, 0.1% [see Data].
The background risk of major birth defects and
miscarriage for the indicated population is unknown. Adverse outcomes in pregnancy
occur regardless of the health of the mother or the use of medications. In the
U.S. general population, the estimated background risk of major birth defects
and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%,
respectively.
Data
Animal Data
In rats, a tazarotene gel, 0.05% formulation dosed
topically during gestation days 6 through 17 at 0.25 mg/kg/day, which
represented 0.5 times the maximum systemic exposure in subjects treated with
the MRHD of tazarotene gel, 0.1% (i.e., 2 mg/cm² over a 20% body surface area),
resulted in reduced fetal body weights and reduced skeletal ossification.
Rabbits dosed topically with 0.25 mg/kg/day tazarotene gel, which represented 7
times the maximum systemic exposure in subjects treated with the MRHD of
tazarotene gel, 0.1%, during gestation days 6 through 18 were noted with single
incidences of known retinoid malformations, including spina bifida,
hydrocephaly, and heart anomalies.
When tazarotene was given orally to animals, developmental
delays were seen in rats, and malformations and post-implantation loss were
observed in rats and rabbits at doses producing 0.5 and 13 times, respectively,
the maximum systemic exposure in subjects treated with the MRHD of tazarotene
gel, 0.1%.
In female rats orally administered 2 mg/kg/day of
tazarotene from 15 days before mating through gestation day 7, which
represented 2 times the maximum systemic exposure in subjects treated with the
MRHD of tazarotene gel, 0.1%, 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 was observed at that dose.
In a pre- and postnatal development toxicity study,
topical administration of tazarotene gel (0.125 mg/kg/day) to pregnant female
rats from gestation day 16 through lactation day 20 reduced pup survival, but
did not affect the reproductive capacity of the offspring. Based on data from
another study, the maximum systemic exposure in the rat would be 0.3 times the
maximum systemic exposure in subjects treated with the MRHD of tazarotene gel,
0.1%.
Lactation
Risk Summary
There is no information regarding the presence of
tazarotene in human milk, the effects on the breastfed infant, or the effects
on milk production. After single topical doses of 14C-tazarotene gel to the
skin of lactating rats, radioactivity was detected in rat milk. The lack of
clinical data during lactation precludes a clear determination of the risk of
TAZORAC Gel to an infant during lactation; therefore, the developmental and
health benefits of breastfeeding should be considered along with the mother's
clinical need for TAZORAC Gel and any potential adverse effects on the
breastfed child from TAZORAC Gel or from the underlying maternal condition.
Females And Males Of Reproductive Potential
Pregnancy Testing
Pregnancy testing is recommended for females of
reproductive potential within 2 weeks prior to initiating TAZORAC Gel therapy
which should begin during a menstrual period.
Contraception
Females
Based on animal studies, TAZORAC Gel may cause fetal harm
when administered to a pregnant woman [see Use In Specific Populations].
Advise females of reproductive potential to use effective contraception during
treatment with TAZORAC Gel.
Pediatric Use
The safety and efficacy of TAZORAC Gel have not been established
in pediatric patients with psoriasis or acne under the age of 12 years.
Geriatric Use
Of the total number of subjects in clinical trials of
TAZORAC Gel for plaque psoriasis, 163 were over the age of 65. Subjects over 65
years of age experienced more adverse events and lower treatment success rates
after 12 weeks of use of TAZORAC Gel compared with those 65 years of age and younger.
Currently there is no other clinical experience on the differences in responses
between the elderly and younger subjects, but greater sensitivity of some older
individuals cannot be ruled out. Tazarotene gel for the treatment of acne has
not been clinically evaluated in persons over the age of 65.