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These highlights do not include all the information needed to use ADAPALENE AND BENZOYL PEROXIDE GEL  safely and effectively.  See full prescribing information for ADAPALENE AND BENZOYL PEROXIDE GEL.  ADAPALENE AND BENZOYL PEROXIDE  gel, for  topical | Adapalene and Benzoyl Peroxide [Sandoz Inc.] | BioPortfolio

12:38 EST 27th January 2019 | BioPortfolio

Note: While we endeavour to keep our records up-to-date one should not rely on these details being accurate without first consulting a professional. Click here to read our full medical disclaimer.

Adapalene and benzoyl peroxide gel 0.1% / 2.5% is indicated for the topical treatment of acne vulgaris in patients 9 years of age and older.

For topical use only; adapalene and benzoyl peroxide gel 0.1% / 2.5% is not for oral, ophthalmic, or intravaginal use.

Apply a thin film of adapalene and benzoyl peroxide gel 0.1% / 2.5% to affected areas of the face and/or trunk once daily after washing. Use a pea-sized amount for each area of the face (e.g., forehead, chin, each cheek). Avoid the eyes, lips and mucous membranes.

Each gram of adapalene and benzoyl peroxide gel 0.1% / 2.5% contains 1 mg (0.1%) adapalene and 25 mg (2.5%) benzoyl peroxide in a white to very pale yellow, opaque, aqueous based gel.

None

Exposure to sunlight, including sunlamps, should be minimized during the use of adapalene and benzoyl peroxide gel 0.1% / 2.5%. Patients with high levels of sun exposure and those with inherent sensitivity to sun should exercise particular caution. Use of sunscreen products and protective apparel, (e.g., hat) are recommended when exposure cannot be avoided. Weather extremes, such as wind or cold, may be irritating to patients under treatment with adapalene and benzoyl peroxide gel 0.1% / 2.5%.

Erythema, scaling, dryness, and stinging/burning may be experienced with use of adapalene and benzoyl peroxide gel 0.1% / 2.5%. These are most likely to occur during the first four weeks of treatment, are mostly mild to moderate in intensity, and usually lessen with continued use of the medication. Irritant and allergic contact dermatitis may occur. Depending upon the severity of these adverse reactions, patients should be instructed to use a moisturizer, reduce the frequency of the application of adapalene and benzoyl peroxide gel 0.1% / 2.5%, or discontinue use. The product should not be applied 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 and benzoyl peroxide gel 0.1% / 2.5%.

Avoid concomitant use of other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have strong skin-drying effect and products with high concentrations of alcohol, astringents, spices, or limes).

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.                       

During clinical trials, 1401 subjects were exposed to adapalene and benzoyl peroxide gel 0.1% / 2.5%. A total of 1036 subjects with acne vulgaris, 12 years and older, were treated once daily for 12 weeks to 12 months. Related adverse events reported within 12 weeks of treatment and in at least 1% of subjects treated with adapalene and benzoyl peroxide gel 0.1% / 2.5% and those reported in subjects treated with the vehicle gel are presented in Table 1:

Table 1. Drug Related Adverse Events Reported in Clinical Trials by At Least 1% of Patients Treated For 12 Weeks

Local tolerability evaluations, presented in Table 2, were conducted at each study visit in clinical trials by assessment of erythema, scaling, dryness, burning, and stinging.

Table 2. Incidence of Local Cutaneous Irritation in Controlled Clinical Trials (N=553) Treatment Emergent Signs and Symptoms

Analysis over the 12 week period showed that local tolerability scores for erythema, scaling, dryness, and stinging/burning peaked at Week 1 of therapy and decreased thereafter.

During a pediatric clinical trial, 285 children with acne vulgaris, 9 to 11 years of age were treated with adapalene and benzoyl peroxide gel 0.1% / 2.5% or with the vehicle gel once daily for 12 weeks. Overall, the safety profile of adapalene and benzoyl peroxide gel 0.1% / 2.5% in these subjects is comparable to the safety profile observed in older subjects 12 years of age and above, both in the nature and frequency of the observed adverse events.

Analysis of local tolerability evaluations shows similar incidence of treatment emergent signs and symptoms as in subjects 12 years of age and above, with local tolerability signs and symptoms peaking during the first week and decreasing over time.

System Organ Class/ Preferred Term
  Adapalene and Benzoyl Peroxide Gel 0.1% / 2.5% N=564   Vehicle gel N=489
 Subjects with AE (s)  14%  4%
 Dry Skin  7%  2%
 Contact dermatitis  3%  <1%
 Application site burning  2%  <1%
 Application site irritation  1%  <1%
 Skin irritation  1%  0%
Maximum Severity During Treatment End of Treatment Severity (12 Weeks)
Mild Moderate Severe Mild Moderate Severe
Erythema 27% 13% 1% 8% 2% 1%
Scaling 35% 11% 1% 9% 1% <1%
Dryness 41% 13% 1% 10% 2% <1%
Stinging/burning 41% 15% 3% 7% 2% 1%

The following adverse reactions have been identified during post-approval use of adapalene and benzoyl peroxide gel 0.1% / 2.5%: eyelid edema, sunburn, blister, pain of skin, pruritus, swelling face, conjunctivitis, skin discoloration, rash, eczema, throat tightness and allergic contact dermatitis. 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.

Concomitant topical acne therapy should be used with caution because a possible cumulative irritancy effect may occur, especially with the use of peeling, desquamating, or abrasive agents.

No formal drug-drug interaction studies were conducted with adapalene and benzoyl peroxide gel 0.1% / 2.5%.

Pregnancy Category C. There are no well-controlled trials in pregnant women treated with adapalene and benzoyl peroxide gel 0.1% / 2.5%. Animal reproduction studies have not been conducted with the combination gel or benzoyl peroxide. Furthermore, such studies are not always predictive of human response; therefore, adapalene and benzoyl peroxide gel 0.1% / 2.5% should be used during pregnancy only if the potential benefit justifies the risk to the fetus.

No teratogenic effects were observed in rats treated with oral doses of 0.15 to 5.0 mg adapalene/kg/day, up to 25 times (mg/m/day) the maximum recommended human dose (MRHD) of 2 grams of adapalene and benzoyl peroxide gel 0.1% / 2.5%. However, teratogenic changes were observed in rats and rabbits when treated with oral doses of ≥ 25 mg adapalene/kg/day representing 123 and 246 times MRHD, respectively. Findings included cleft palate, microphthalmia, encephalocele and skeletal abnormalities in rats; and umbilical hernia, exophthalmos and kidney and skeletal abnormalities in rabbits.

Dermal teratology studies conducted in rats and rabbits at doses of 0.6 to 6.0 mg adapalene/kg/day [25 to 59 times (mg/m) the MRHD] exhibited no fetotoxicity and only minimal increases in supernumerary ribs in both species and delayed ossification in rabbits.

It is not known whether adapalene or benzoyl peroxide is excreted in human milk following use of adapalene and benzoyl peroxide gel 0.1% / 2.5%. Because many drugs are excreted in human milk, caution should be exercised when adapalene and benzoyl peroxide gel 0.1% / 2.5% is administered to a nursing woman.

Safety and effectiveness of adapalene and benzoyl peroxide gel 0.1% / 2.5% in pediatric patients under the age of 9 have not been established.

Clinical studies of adapalene and benzoyl peroxide gel 0.1% / 2.5% did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Adapalene and benzoyl peroxide gel 0.1% / 2.5% is a white to very pale yellow, opaque gel for topical use containing adapalene 0.1% and benzoyl peroxide 2.5%.

Adapalene, a synthetic retinoid, is a naphthoic acid derivative with retinoid-like properties. The chemical name for adapalene is (6-[3-(1-adamantyl)-4-methoxyphenyl]-2-naphthoic acid). It has the following structural formula:

Adapalene:

Molecular formula: CHO      Molecular weight: 412.5      

Benzoyl Peroxide is a highly lipophilic oxidizing agent that localizes in both bacterial and keratinocyte cell membranes. The chemical name for benzoyl peroxide is dibenzoyl peroxide. It has the following structural formula: 

Benzoyl Peroxide:

Molecular formula: CHO      Molecular weight: 242.23

Adapalene and benzoyl peroxide gel 0.1% / 2.5% contains the following inactive ingredients: carbopol 980, d-limonene, docusate sodium solution, edetate disodium, glycerin, poloxamer 182, polysorbate 80, propylene glycol, purified water, sodium hydroxide and sorbitan monooleate. 

Adapalene

Adapalene binds to specific retinoic acid nuclear receptors but does not bind to cytosolic receptor protein. Biochemical and pharmacological profile studies have demonstrated that adapalene is a modulator of cellular differentiation, keratinization and inflammatory processes. However, the significance of these findings with regard to the mechanism of action of adapalene for the treatment of acne is unknown.

Benzoyl peroxide

Benzoyl peroxide is an oxidizing agent with bactericidal and keratolytic effects.

Pharmacodynamics of adapalene and benzoyl peroxide gel 0.1% / 2.5% is unknown.

A pharmacokinetic study was conducted in 10 adult subjects with acne vulgaris who were treated once daily for 30 days with 2 grams/day of adapalene and benzoyl peroxide gel 0.1% / 2.5% applied to 1000 cm of acne involved skin, (face, chest, and upper back). Two subjects (20%) had quantifiable adapalene plasma concentrations above the limit of quantification (LOQ=0.1ng/mL). The highest adapalene C and AUC was 0.21 ng/mL and 1.99 ng•h/mL, respectively. Excretion of adapalene appears to be primarily by the biliary route. Pharmacokinetics of adapalene and benzoyl peroxide gel 0.1% / 2.5% in pediatric subjects have not been evaluated.

Benzoyl peroxide is absorbed by the skin where it is converted to benzoic acid and eliminated in the urine.

No carcinogenicity, photocarcinogenicity, genotoxicity, or fertility studies were conducted with adapalene and benzoyl peroxide gel 0.1% / 2.5%.

Carcinogenicity studies with adapalene have been conducted in mice at topical doses of 0.4, 1.3, and 4.0 mg/kg/day (1.2, 3.9, and 12 mg/m/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/m/day). In terms of body surface area, the highest dose levels are 9.8 (mice) and 7.4 times (rats) the MRHD of 2 grams of adapalene and benzoyl peroxide gel 0.1% / 2.5%. In the rat study, an increased incidence of benign and malignant pheochromocytomas in the adrenal medulla of male rats was observed.

No significant increase in tumor formation was observed in rodents topically treated with 15 to 25% benzoyl peroxide carbopol gel (6 to 10 times the concentration of benzoyl peroxide in adapalene and benzoyl peroxide gel 0.1% / 2.5%) for two years. Rats received maximum daily applications of 138 (males) and 205 (females) mg benzoyl peroxide/kg. In terms of body surface area, these levels are 27 to 40 times the MRHD. Similar results were obtained in mice topically treated with 25% benzoyl peroxide carbopol gel for 56 weeks followed by intermittent treatment with 15% benzoyl peroxide carbopol gel for the rest of the 2 year study period, and in mice topically treated with 5% benzoyl peroxide carbopol gel for two years.

The role of benzoyl peroxide as a tumor promoter has been well established in several animal species. However, the significance of this finding in humans is unknown.

In a photocarcinogenicity study conducted with 5% benzoyl peroxide carbopol gel, no increase in UV-induced tumor formation was observed in hairless mice topically treated for 40 weeks.

No photocarcinogenicity studies were conducted with adapalene. However, animal studies have shown an increased tumorigenic risk with the use of pharmacologically similar drugs (e.g., retinoids) when exposed to UV irradiation in the laboratory or sunlight. Although the significance of these findings to humans is not clear, patients should be advised to avoid or minimize exposure to either sunlight or artificial irradiation sources.

Adapalene did not exhibit mutagenic or genotoxic effects in vitro (Ames test, Chinese hamster ovary cell assay, mouse lymphoma TK assay) or in vivo (mouse micronucleus test).

Bacterial mutagenicity assays (Ames test) with benzoyl peroxide has provided mixed results, mutagenic potential was observed in a few but not in a majority of investigations. Benzoyl peroxide has been shown to produce single-strand DNA breaks in human bronchial epithelial and mouse epidermal cells, it has caused DNA-protein cross-links in the human cells, and has also induced a dose-dependent increase in sister chromatid exchanges in Chinese hamster ovary cells.

In rat oral studies, 20 mg adapalene/kg/day (120 mg/m/day; 98 times the MRHD based on mg/m/day comparison) did not affect the reproductive performance and fertility of Fmales and females, or growth, development and reproductive function of F offspring.

No fertility studies were conducted with benzoyl peroxide.

The safety and efficacy of adapalene and benzoyl peroxide gel 0.1% / 2.5% applied once daily for the treatment of acne vulgaris were assessed in two 12 week, multicenter, controlled clinical studies of similar design, comparing adapalene and benzoyl peroxide gel 0.1% / 2.5% to the gel vehicle in acne subjects. Treatment response was defined as the percent of subjects who had a two grade improvement and rated ‘Clear’ and ‘Almost Clear’ at Week 12 based on the Investigator’s Global Assessment (IGA) and mean absolute change from baseline at Week 12 in both inflammatory and non-inflammatory lesion counts. An IGA score of ‘Clear’ corresponded to residual hyperpigmentation and erythema may be present. An IGA score of ‘Almost Clear’ corresponded to a few scattered comedones and a few small papules.

In Study 1, 517 subjects were randomized to adapalene and benzoyl peroxide gel 0.1% / 2.5%, adapalene 0.1% in vehicle gel, benzoyl peroxide 2.5% in vehicle gel, or vehicle gel. The median age of these 517 subjects was 15 years old and 60% were males.

At baseline, subjects had between 20 to 50 inflammatory lesions and 30 to 100 non-inflammatory lesions. The majority of subjects had a baseline IGA score of ‘Moderate’ which corresponded to more than half of the face is involved, many comedones, papules and pustules. The efficacy results at week 12 are presented in Table 3.

In Study 2, 1668 subjects were randomized to adapalene and benzoyl peroxide gel 0.1% / 2.5%, adapalene 0.1% in vehicle gel, benzoyl peroxide 2.5% in vehicle gel, or vehicle gel. The median age of subjects was 16 years old and 49% were males. At baseline, subjects had between 20 to 50 inflammatory lesions and 30 to 100 non-inflammatory lesions as well as an Investigator Global

Assessment score of ‘Moderate’. The efficacy results at week 12 are presented in Table 3.

In Study 3, 285 pediatric subjects 9 to 11 years of age were randomized to adapalene and benzoyl peroxide gel 0.1% / 2.5% or vehicle gel. The median age of subjects was 11 years and 24% were males. At baseline, subjects had a minimum of 20 but not more than 100 total lesions (inflammatory and/or non-inflammatory) with an Investigator Global Assessment score of ‘Moderate’. The efficacy results at week 12 are presented in Table 3.

Table 3: Clinical Efficacy of Adapalene and Benzoyl Peroxide Gel 0.1% / 2.5% at Week 12

In both Studies 1 and 2 the treatment effect was smaller in subjects with a small number of baseline lesions than in subjects with a large number of baseline lesions.

That is, a mean percent increase of 13.2%

Study 1
Adapalene and Benzoyl Peroxide Gel 0.1% / 2.5% (N=149) Adapalene 0.1% in Vehicle gel (N=148) Benzoyl Peroxide 2.5% in Vehicle gel (N=149) Vehicle gel (N=71)
IGA: Two Grade Improvement and Clear or Almost Clear 32 (21.5%) 18 (12.2%) 18 (12.1%) 4 (5.6%)
Inflammatory Lesions: Mean Absolute (Percent) Change 16.0 (52.4%) 11.4 (39.9%) 10.5 (35.8%) 9.5 (31.8%)
Non-inflammatory Lesions: Mean Absolute (Percent) Change 23.4 (45.9%) 15.2 (29.6%) 13.7 (32.2%) 13.2 (27.8%)
Study 2
Adapalene and Benzoyl Peroxide Gel 0.1% / 2.5% (N=415) Adapalene 0.1% in Vehicle gel (N=420) Benzoyl Peroxide 2.5% in Vehicle gel (N=415) Vehicle gel (N=418)
IGA: Two Grade Improvement and Clear or Almost Clear 125 (30.1%) 83 (19.8%) 92 (22.2%) 47 (11.3%)
Inflammatory Lesions: Mean Absolute (Percent) Change 15.4 (53.4%) 12.3 (41.7%) 13.7 (47.6%) 8.7 (30.2%)
Non-inflammatory Lesions: Mean Absolute (Percent) Change 24.6 (48.1%) 21.0 (40.8%) 19.2 (37.2%) 11.3 (23.2%)
Study 3
Adapalene and Benzoyl Peroxide Gel 0.1% / 2.5% N=142 Vehicle Gel N=143
IGA: Two Grade Improvement and Clear or Almost Clear 67 (47.2%) 22 (15.4%)
Inflammatory Lesions: Mean Absolute (Percent) Change 7.4 (36.0%) 0.7 (-13.2%)*
Non-inflammatory Lesions: Mean Absolute (Percent) Change 20.2 (54.7%) 2.9 (2.3%)

Adapalene and benzoyl peroxide gel 0.1% / 2.5% is white to very pale yellow in color and opaque in appearance, and is supplied as follows:

     45 gram tube                             NDC 0781-7182-19     45 gram pump                           NDC 0781-7182-70

Storage and handling

Advise the patient to read the FDA-approved patient labeling (Patient Information)

Information for Patients

Manufactured by:TOLMAR Inc.Fort Collins, CO 80526 forSandoz Inc.Princeton NJ 08540

04005028 Rev. 0 03/18

Adapalene (a dap' a leen) and Benzoyl (ben' zoe il) Peroxide Gel 0.1% / 2.5%

Important: For use on the skin only (topical). Do not use adapalene and benzoyl peroxide gel 0.1% / 2.5% in or on your mouth, eyes, or vagina.

Read this Patient Information leaflet about adapalene and benzoyl peroxide gel 0.1% / 2.5% before you start using it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your treatment or your medical condition. If you have any questions about adapalene and benzoyl peroxide gel 0.1% / 2.5%, talk with your doctor or pharmacist.

What is adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Adapalene and benzoyl peroxide gel 0.1% / 2.5% is a prescription medicine for skin use only (topical) used to treat acne vulgaris in people 9 years of age and older.

Acne vulgaris is a condition in which the skin has blackheads, whiteheads and pimples.

It is not known if adapalene and benzoyl peroxide gel 0.1% / 2.5% is safe and effective in children younger than 9 years old.

What should I tell my doctor before using adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Before you use adapalene and benzoyl peroxide gel 0.1% / 2.5%, tell your doctor if you:

Tell your doctor about all the medicines you take, including prescription and non­prescription medicines, vitamins and herbal supplements.

Especially tell your doctor if you use any other medicine for acne. Using adapalene and benzoyl peroxide gel 0.1% / 2.5% with topical medicines that contain sulfur, resorcinol or salicylic acid may cause skin irritation.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How should I use adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Applying adapalene and benzoyl peroxide gel 0.1% / 2.5% :

What should I avoid while using adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

What are the possible side effects of adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Adapalene and benzoyl peroxide gel 0.1% / 2.5% may cause serious side effects including:

Tell your doctor right away if these side effects continue for longer than 4 weeks or get worse, you may have to stop using adapalene and benzoyl peroxide gel 0.1% / 2.5%.

Tell your doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of adapalene and benzoyl peroxide gel 0.1% / 2.5%. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

You may also report side effects to Sandoz Inc. at 1-800-525-8747.

How should I store adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Keep adapalene and benzoyl peroxide gel 0.1% / 2.5% and all medicines out of the reach of children.

General information about adapalene and benzoyl peroxide gel 0.1% / 2.5%

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information Leaflet. Do not use adapalene and benzoyl peroxide gel 0.1% / 2.5% for a condition for which it was not prescribed. Do not give adapalene and benzoyl peroxide gel 0.1% / 2.5% to other people, even if they have the same symptoms you have. It may harm them.

This Patient Information leaflet summarizes the most important information about adapalene and benzoyl peroxide gel 0.1% / 2.5%. If you would like more information, talk with your doctor. You can also ask your doctor or pharmacist for information about adapalene and benzoyl peroxide gel 0.1% / 2.5% that is written for health professionals.

What are the ingredients in adapalene and benzoyl peroxide gel 0.1% / 2.5% ?

Active ingredient: adapalene and benzoyl peroxide

Inactive ingredients: carbopol 980, d-limonene, docusate sodium solution, edetate disodium, glycerin, poloxamer 182, polysorbate 80, propylene glycol, purified water, sodium hydroxide and sorbitan monooleate.

Manufactured by:TOLMAR Inc., Fort Collins, CO 80526 forSandoz Inc., Princeton NJ 08540

04005028 Rev. 0 03/18

Manufacturer

Sandoz Inc.

Active Ingredients

Source

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