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EXTINA (ketoconazole) Foam, 2% is indicated for the topical treatment of seborrheic dermatitis in immunocompetent patients 12 years of age and older. Safety and efficacy of EXTINA Foam for treatment of fungal infections have not been established.
EXTINA Foam should be applied to the affected area(s) twice daily for four weeks.
Hold the container upright, and dispense EXTINA Foam into the cap of the can or other cool surface in an amount sufficient to cover the affected area(s). Dispensing directly onto hands is not recommended, as the foam will begin to melt immediately upon contact with warm skin. Pick up small amounts of EXTINA Foam with the fingertips, and gently massage into the affected area(s) until the foam disappears. For hair-bearing areas, part the hair, so that EXTINA Foam may be applied directly to the skin (rather than on the hair).
Avoid contact with the eyes and other mucous membranes. EXTINA Foam is not for ophthalmic, oral or intravaginal use.
EXTINA Foam contains 2% ketoconazole in a thermolabile hydroethanolic foam, and is provided in 50 g and 100 g aluminum containers.
EXTINA Foam may result in contact sensitization, including photoallergenicity. [See Adverse Reactions (6.2)]
The contents of EXTINA Foam include alcohol and propane/butane, which are flammable. Avoid fire, flame and/or smoking during and immediately following application. Do not puncture and/or incinerate the containers. Do not expose containers to heat and/or store at temperatures above 120°F (49°C).
Hepatitis has been seen with orally administered ketoconazole (1:10,000 reported incidence). Lowered testosterone and ACTH–induced corticosteroid serum levels have been seen with high doses of orally administered ketoconazole. These effects have not been seen with topical ketoconazole.
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 adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse reactions that appear to be related to drug use and for approximating rates.
The safety data presented in Table 1 (below) reflect exposure to EXTINA Foam in 672 subjects, 12 years and older with seborrheic dermatitis. Subjects applied EXTINA Foam or vehicle foam twice daily for 4 weeks to affected areas on the face, scalp, and/or chest. Adverse reactions occurring in > 1% of subjects are presented in
Application site reactions that were reported in < 1% of subjects were dryness, erythema, irritation, paresthesia, pruritus, rash and warmth.
N = 672
N = 497
In a photoallergenicity study, 9 of 53 subjects (17%) had reactions during the challenge period at both the irradiated and non-irradiated sites treated with EXTINA Foam. EXTINA Foam may cause contact sensitization.
Teratogenic Effects, Pregnancy Category C
Ketoconazole has been shown to be teratogenic (syndactylia and oligodactylia) in the rat when given orally in the diet at 80 mg/kg/day (4.8 times the maximum expected human topical dose based on a mg/m comparison, assuming 100% absorption from 8 g of foam). However, these effects may be partly related to maternal toxicity, which was also observed at this dose level. [See Pharmacokinetics (12.3)]
No reproductive studies in animals have been performed with EXTINA Foam. There are no adequate and well-controlled studies of EXTINA Foam in pregnant women.
EXTINA Foam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
It is not known whether EXTINA Foam administered topically could result in sufficient systemic absorption to produce detectable quantities in breast milk. Because many drugs are excreted in human milk, caution should be exercised when EXTINA Foam is administered to women who are breastfeeding.
The safety and effectiveness of EXTINA Foam in pediatric patients less than 12 years of age have not been established.
Of the 672 subjects treated with EXTINA Foam in the clinical trials, 44 (7%) were from 12 to 17 years of age. [See Clinical Studies (14)]
Of the 672 subjects treated with EXTINA Foam in the clinical trials, 107 (16%) were 65 years and over.
EXTINA Foam contains 2% ketoconazole USP, an antifungal agent, in a thermolabile hydroethanolic foam for topical application.
The chemical name for ketoconazole is piperazine, 1-acetyl-4-[4-[[2-(2,4-dichlorophenyl) -2-(1H-imidazol-l-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl]-, cis- with the molecular formula CHClNO and a molecular weight of 531.43. The following is the chemical structure:
EXTINA Foam contains 20 mg ketoconazole per gram in a thermolabile hydroethanolic foam vehicle consisting of cetyl alcohol, citric acid, ethanol (denatured with tert-butyl alcohol and brucine sulfate) 58%, polysorbate 60, potassium citrate, propylene glycol, purified water, and stearyl alcohol pressurized with a hydrocarbon (propane/butane) propellant.
The mechanism of action of ketoconazole in the treatment of seborrheic dermatitis is not known.
The pharmacodynamics of EXTINA Foam has not been established.
In a bioavailability study, 12 subjects with moderate to severe seborrheic dermatitis applied 3 g of EXTINA Foam twice daily for 4 weeks. Circulating plasma levels of ketoconazole were < 6 ng/mL for a majority of subjects (75%), with a maximum level of 11 ng/mL observed in one subject.
Ketoconazole is an antifungal agent which inhibits the in vitro synthesis of ergosterol, a key sterol in the cell membrane of Malasseziafurfur. The clinical significance of antifungal activity in the treatment of seborrheic dermatitis is not known.
Long-term animal studies have not been performed to evaluate the carcinogenic or photo-carcinogenic potential of EXTINA Foam.
In oral carcinogenicity studies in mice (18-months) and rats (24-months) at dose levels of 5, 20 and 80 mg/kg/day ketoconazole was not carcinogenic. The high dose in these studies was approximately 2.4 to 4.8 times the expected topical dose in humans based on a mg/m comparison. In a bacterial reverse mutation assay, ketoconazole did not express any mutagenic potential. In three in vivo assays (sister chromatid exchange in humans, dominant lethal and micronucleus tests in mice), ketoconazole did not exhibit any genotoxic potential.
At oral dose levels of 75 mg/kg/day (4.5 times the expected topical human dose in mg/m), ketoconazole impaired reproductive performance and fertility when administered to male rats (increased abnormal sperm, decreased sperm mobility and decreased pregnancy in mated females).
The safety and efficacy of EXTINA Foam were evaluated in a randomized, double-blind, vehicle-controlled study in subjects 12 years and older with mild to severe seborrheic dermatitis. In the study, 427 subjects received EXTINA Foam and 420 subjects received vehicle foam. Subjects applied EXTINA Foam or vehicle foam twice daily for 4 weeks to affected areas on the face, scalp, and/or chest. The overall disease severity in terms of erythema, scaling, and induration was assessed at Baseline and week 4 on a 5-point Investigator’s Static Global Assessment (ISGA) scale.
Treatment success was defined as achieving a Week 4 (end of treatment) ISGA score of 0 (clear) or 1 (majority of lesions have individual scores for scaling, erythema, and induration that averages 1 [minimal or faint]) and at least two grades of improvement from baseline. The results are presented in Table 2. The database was not large enough to assess whether there were differences in effects in age, gender, or race subgroups.
N = 427
N = 420
EXTINA Foam, 2% is supplied in 50 g (NDC 40076-051-50) and 100 g (NDC 40076-051-00) aluminum containers.
Store at controlled room temperature 68° to 77°F (20° to 25°C). Do not store under refrigerated conditions. Do not expose containers to heat, and/or store at temperatures above 120°F (49°C). Do not store in direct sunlight.
Contents are flammable.
Contents under pressure. Do not puncture and/or incinerate container.
Keep out of reach of children.
See FDA-approved patient labeling. (17.3)
PATIENT INFORMATION EXTINA (ex-TEEN-ah) Foam (ketoconazole, 2%)
IMPORTANT: For skin use only. Do not use in the eyes, mouth or vagina. Read the Patient Information that comes with EXTINA Foam 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 condition or treatment.
What is EXTINA Foam?
EXTINA Foam is used on the skin (topical) to treat a skin condition called seborrheic dermatitis in patients 12 years and older. Seborrheic dermatitis can cause areas of flaky skin (scales) on the scalp, face, ears, chest or upper back.
EXTINA Foam has not been studied in children less than 12 years old.
What should I tell my doctor before using EXTINA Foam?
For female patients, tell your doctor if you:
How should I use EXTINA Foam?
Instructions for applying EXTINA Foam
What are the possible side effects of EXTINA Foam?
The most common side effects of EXTINA Foam are reaction or burning on treated skin areas. Tell your doctor if you have any reaction on your treated skin such as redness, itching, or a rash. These are not all the side effects of EXTINA Foam. Ask your doctor or pharmacist for more information.
How should I store EXTINA Foam?
General information about EXTINA Foam
Medicines are sometimes prescribed for conditions that are not mentioned in Patient Information leaflets. Do not use EXTINA Foam for any other condition for which it was not prescribed. Do not give EXTINA Foam to other people, even if they have the same condition that you have. It may harm them.
This leaflet summarizes the most important information about EXTINA Foam. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about EXTINA Foam that is written for health professionals.
If you have questions about EXTINA Foam you can also call: 1-866-897-5002 (Prestium). (this is a toll-free number)
What are the ingredients in EXTINA Foam?
Active ingredients: ketoconazole Inactive Ingredients: cetyl alcohol, citric acid, ethanol (denatured with tert-butyl alcohol and brucine sulfate) 58%, polysorbate 60, potassium citrate, propylene glycol, purified water, and stearyl alcohol pressurized with a hydrocarbon (propane/butane) propellant.
This Patient Information leaflet has been approved by the U.S. Food and Drug Administration.
The Patient Information leaflet was last revised: June 2013
Manufactured forPrestium Pharma, Inc.Newtown, PA 18940By DPT Laboratories, Ltd San Antonio, TX 78215
EXTINA is a registered trademark of Stiefel Laboratories, Inc.
© 2013 Delcor Asset Corporation, an affiliate of Prestium Pharma, Inc. 140112-0613
PRINCIPAL DISPLAY PANEL NDC 40076-051-00 100 g R only FOR TOPICAL USE ONLY extina (ketoconazole) Foam, 2%
Prestium Pharma, Inc.
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