Onexton

Clindamycin Phosphate And Benzoyl Peroxide


Bausch Health Us, Llc
Human Prescription Drug
NDC 0187-3050
Onexton also known as Clindamycin Phosphate And Benzoyl Peroxide is a human prescription drug labeled by 'Bausch Health Us, Llc'. National Drug Code (NDC) number for Onexton is 0187-3050. This drug is available in dosage form of Gel. The names of the active, medicinal ingredients in Onexton drug includes Benzoyl Peroxide - 37.5 mg/g Clindamycin Phosphate - 10 mg/g . The currest status of Onexton drug is Active.

Drug Information:

Drug NDC: 0187-3050
The labeler code and product code segments of the National Drug Code number, separated by a hyphen. Asterisks are no longer used or included within the product code segment to indicate certain configurations of the NDC.
Proprietary Name: Onexton
Also known as the trade name. It is the name of the product chosen by the labeler.
Product Type: Human Prescription Drug
Indicates the type of product, such as Human Prescription Drug or Human OTC Drug. This data element corresponds to the “Document Type” of the SPL submission for the listing.
Non Proprietary Name: Clindamycin Phosphate And Benzoyl Peroxide
Also known as the generic name, this is usually the active ingredient(s) of the product.
Labeler Name: Bausch Health Us, Llc
Name of Company corresponding to the labeler code segment of the ProductNDC.
Dosage Form: Gel
The translation of the DosageForm Code submitted by the firm. There is no standard, but values may include terms like `tablet` or `solution for injection`.The complete list of codes and translations can be found www.fda.gov/edrls under Structured Product Labeling Resources.
Status: Active
FDA does not review and approve unfinished products. Therefore, all products in this file are considered unapproved.
Substance Name:BENZOYL PEROXIDE - 37.5 mg/g
CLINDAMYCIN PHOSPHATE - 10 mg/g
This is the active ingredient list. Each ingredient name is the preferred term of the UNII code submitted.
Route Details:TOPICAL
The translation of the Route Code submitted by the firm, indicating route of administration. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.

Marketing Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Marketing Category: NDA
Product types are broken down into several potential Marketing Categories, such as New Drug Application (NDA), Abbreviated New Drug Application (ANDA), BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.
Marketing Start Date: 24 Nov, 2014
This is the date that the labeler indicates was the start of its marketing of the drug product.
Marketing End Date: 22 Dec, 2025
This is the date the product will no longer be available on the market. If a product is no longer being manufactured, in most cases, the FDA recommends firms use the expiration date of the last lot produced as the EndMarketingDate, to reflect the potential for drug product to remain available after manufacturing has ceased. Products that are the subject of ongoing manufacturing will not ordinarily have any EndMarketingDate. Products with a value in the EndMarketingDate will be removed from the NDC Directory when the EndMarketingDate is reached.
Application Number: NDA050819
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.
Listing Expiration Date: 31 Dec, 2023
This is the date when the listing record will expire if not updated or certified by the firm.

OpenFDA Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Manufacturer Name:Bausch Health US, LLC
Name of manufacturer or company that makes this drug product, corresponding to the labeler code segment of the NDC.
Original Packager:Yes
Whether or not the drug has been repackaged for distribution.
UNII:W9WZN9A0GM
EH6D7113I8
Unique Ingredient Identifier, which is a non-proprietary, free, unique, unambiguous, non-semantic, alphanumeric identifier based on a substance’s molecular structure and/or descriptive information.
Pharmacologic Class:Decreased Sebaceous Gland Activity [PE]
Lincosamide Antibacterial [EPC]
Lincosamides [CS]
These are the reported pharmacological class categories corresponding to the SubstanceNames listed above.

Packaging Information:

Package NDCDescriptionMarketing Start DateMarketing End DateSample Available
0187-3050-353.5 g in 1 TUBE (0187-3050-35)24 Nov, 2014N/ANo
0187-3050-501 BOTTLE, PUMP in 1 CARTON (0187-3050-50) / 50 g in 1 BOTTLE, PUMP24 Nov, 2014N/ANo
Package NDC number, known as the NDC, identifies the labeler, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. Description tells the size and type of packaging in sentence form. Multilevel packages will have the descriptions concatenated together.

Product Elements:

Onexton clindamycin phosphate and benzoyl peroxide clindamycin phosphate clindamycin benzoyl peroxide benzoyl peroxide water carbomer homopolymer type c (allyl pentaerythritol crosslinked) propylene glycol potassium hydroxide

Drug Interactions:

7 drug interactions • avoid using onexton gel in combination with topical or oral erythromycin-containing products because of its clindamycin component. ( 7.1 ) 7.1 erythromycin avoid using onexton gel in combination with topical or oral erythromycin-containing products due to its clindamycin component. in vitro studies have shown antagonism between erythromycin and clindamycin. the clinical significance of this in vitro antagonism is not known. 7.2 neuromuscular blocking agents clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. onexton gel should be used with caution in patients receiving such agents.

Indications and Usage:

1 indications and usage onexton ® (clindamycin phosphate and benzoyl peroxide) gel, 1.2%/3.75% is indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. onexton gel is a combination of clindamycin phosphate (a lincosamide antibacterial) and benzoyl peroxide indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. ( 1 )

Warnings and Cautions:

5 warnings and precautions • colitis : clindamycin can cause severe colitis, which may result in death. diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of clindamycin. onexton gel should be discontinued if significant diarrhea occurs. ( 5.1 ) • ultraviolet light and environmental exposure : minimize sun exposure following drug application. ( 5.2 ) 5.1 colitis systemic absorption of clindamycin has been demonstrated following topical use of clindamycin. diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. if significant diarrhea occurs, onexton gel should be discontinued. severe colitis has occurred following oral and parenteral administration of clindamycin with an onset of up to several weeks following cessation of therapy. antiperistaltic agents such as opiates and diphenoxylate with atropine may prolong and/or worsen severe
colitis. severe colitis may result in death. studies indicate toxin(s) produced by clostridia is one primary cause of antibiotic-associated colitis. the colitis is usually characterized by severe persistent diarrhea and severe abdominal cramps and may be associated with the passage of blood and mucus. stool cultures for clostridium difficile and stool assay for c. difficile toxin may be helpful diagnostically. 5.2 ultraviolet light and environmental exposure minimize sun exposure (including use of tanning beds or sun lamps) following drug application. 5.3 concomitant topical medications concomitant topical acne therapy should be used with caution since a possible cumulative irritancy effect may occur, especially with the use of peeling, desquamating, or abrasive agents. if irritancy or dermatitis occurs, reduce frequency of application or temporarily interrupt treatment and resume once the irritation subsides. treatment should be discontinued if the irritation persists.

Dosage and Administration:

2 dosage and administration before applying onexton gel, wash the face gently with a mild soap, rinse with warm water, and pat the skin dry. apply a pea-sized amount of onexton gel to the face once daily. avoid the eyes, mouth, mucous membranes, or areas of broken skin. use of onexton gel beyond 12 weeks has not been evaluated. onexton gel is not for oral, ophthalmic, or intravaginal use. • apply a pea-sized amount of onexton gel to the face once daily. ( 2 ) • not for oral, ophthalmic, or intravaginal use. ( 2 )

Dosage Forms and Strength:

3 dosage forms and strengths gel, 1.2%/3.75% each gram of onexton gel contains 12 mg (1.2%) clindamycin phosphate, equivalent to 10 mg (1%) clindamycin, and 37.5 mg (3.75%) benzoyl peroxide in a white to off-white, opaque, smooth gel. gel, 1.2% clindamycin phosphate/3.75% benzoyl peroxide

Contraindications:

4 contraindications onexton gel is contraindicated in: • patients who have demonstrated hypersensitivity (e.g., anaphylaxis) to clindamycin, benzoyl peroxide, any components of the formulation, or lincomycin. ( 4.1 ) • patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis. ( 4.2 ) 4.1 hypersensitivity onexton gel is contraindicated in those individuals who have shown hypersensitivity to clindamycin, benzoyl peroxide, any components of the formulation, or lincomycin. anaphylaxis, as well as allergic reactions leading to hospitalization, has been reported in postmarketing use with onexton gel [ see postmarketing experience (6.2) ]. 4.2 colitis/enteritis onexton gel is contraindicated in patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis [ see warnings and precautions (5.1) ].

Adverse Reactions:

6 adverse reactions the following adverse reaction is described in more detail in the warnings and precautions section of the label: • colitis [see warnings and precautions (5.1) ] . • the most common adverse reactions are: burning sensation (0.4%); contact dermatitis (0.4%); pruritus (0.4%); and rash (0.4%). (6.1) to report suspected adverse reactions, contact bausch health us, llc at 1-800-321-4576 or fda at 1-800-fda-1088 or www.fda.gov/medwatch. 6.1 clinical trials experience because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates observed in clinical trials of another drug and may not reflect the rates observed in clinical practice. these adverse reactions occurred in less than 0.5% of subjects treated with onexton gel: burning sensation (0.4%); contact dermatitis (0.4%); pruritus (0.4%); and rash (0.4%). during the clinical trial, subjects were assessed for l
ocal cutaneous signs and symptoms of erythema, scaling, itching, burning and stinging. most local skin reactions either were the same as baseline or increased and peaked around week 4 and were near or improved from baseline levels by week 12. the percentage of subjects that had symptoms present before treatment (at baseline), during treatment, and the percent with symptoms present at week 12 are shown in table 1. table 1: percent of subjects with local skin reactions. results from the phase 3 trial (n = 243) before treatment (baseline) during treatment end of treatment (week 12) mild mod. mod. = moderate severe mild mod. severe mild mod. severe erythema 20 6 0 28 5 <1 15 2 0 scaling 10 1 0 19 3 0 10 ˂1 0 itching 14 3 ˂1 15 3 0 7 2 0 burning 5 <1 ˂1 7 1 ˂1 3 <1 0 stinging 5 <1 0 7 0 ˂1 3 0 ˂1 6.2 postmarketing experience because postmarketing adverse 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. anaphylaxis, as well as allergic reactions leading to hospitalizations, has been reported in postmarketing use of products containing clindamycin phosphate/benzoyl peroxide.

Adverse Reactions Table:

Table 1: Percent of Subjects with Local Skin Reactions. Results from the Phase 3 Trial (N = 243)
Before Treatment (Baseline) During Treatment End of Treatment (Week 12)
Mild Mod. Mod. = Moderate Severe Mild Mod. Severe Mild Mod. Severe
Erythema 20 6 0 28 5 <1 15 2 0
Scaling 10 1 0 19 3 0 10 ˂1 0
Itching 14 3 ˂1 15 3 0 7 2 0
Burning 5 <1 ˂1 7 1 ˂1 3 <1 0
Stinging 5 <1 0 7 0 ˂1 3 0 ˂1

Drug Interactions:

7 drug interactions • avoid using onexton gel in combination with topical or oral erythromycin-containing products because of its clindamycin component. ( 7.1 ) 7.1 erythromycin avoid using onexton gel in combination with topical or oral erythromycin-containing products due to its clindamycin component. in vitro studies have shown antagonism between erythromycin and clindamycin. the clinical significance of this in vitro antagonism is not known. 7.2 neuromuscular blocking agents clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. onexton gel should be used with caution in patients receiving such agents.

Use in Specific Population:

8 use in specific populations 8.1 pregnancy risk summary there are no available data on onexton gel use in pregnant women to evaluate a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. the limited published data on use of clindamycin in pregnant women with exposure during the first trimester are insufficient to inform a drug-associated risk of pregnancy-related adverse outcomes (see data). in limited published clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters has not been associated with an increased frequency of major birth defects. in animal reproduction studies, clindamycin did not cause malformations or embryo-fetal development toxicity in pregnant rats and mice when administered during the period of organogenesis at systemic doses up to 240 times the maximum recommended human dose (mrhd) of 2.5 g onexton gel, based on body surface area (bsa) comparisons (see data) .
the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of major birth defects, loss, and other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data human data in limited published trials in pregnant women administered clindamycin during the first trimester of pregnancy, there was no difference in the rate of major birth defects reported among in utero exposed infants compared to unexposed infants. these data cannot definitely establish or exclude any clindamycin-associated risk during pregnancy. animal data animal reproductive/developmental toxicity studies have not been conducted with onexton gel or benzoyl peroxide. developmental toxicity studies of clindamycin performed in pregnant rats and mice administered during the period of organogenesis at oral doses of up to 600 mg/kg/day (240 and 120 times the mrhd for clindamycin, respectively, based on bsa comparisons) or subcutaneous doses of up to 200 mg/kg/day (80 and 40 times the mrhd for clindamycin, respectively, based on bsa comparisons) revealed no malformations or embryo-fetal development toxicity. 8.2 lactation risk summary there are no data on the presence of clindamycin or benzoyl peroxide in human milk, the effects on the breastfed child, or the effects on milk production following topical administration. however, clindamycin has been reported to be present in breast milk in small amounts following oral and parenteral administration. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for onexton gel and any potential adverse effects on the breastfed child from onexton gel or from the underlying maternal condition. clinical considerations if used during lactation and onexton gel is applied to the chest, care should be taken to avoid accidental ingestion by the infant. 8.4 pediatric use safety and effectiveness of onexton gel in pediatric patients under the age of 12 years have not been evaluated. 8.5 geriatric use clinical trials of onexton gel did not include sufficient numbers of subjects age 65 years and older to determine whether they respond differently from younger subjects.

Use in Pregnancy:

8.1 pregnancy risk summary there are no available data on onexton gel use in pregnant women to evaluate a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. the limited published data on use of clindamycin in pregnant women with exposure during the first trimester are insufficient to inform a drug-associated risk of pregnancy-related adverse outcomes (see data). in limited published clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters has not been associated with an increased frequency of major birth defects. in animal reproduction studies, clindamycin did not cause malformations or embryo-fetal development toxicity in pregnant rats and mice when administered during the period of organogenesis at systemic doses up to 240 times the maximum recommended human dose (mrhd) of 2.5 g onexton gel, based on body surface area (bsa) comparisons (see data) . the estimated background risk
of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of major birth defects, loss, and other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. data human data in limited published trials in pregnant women administered clindamycin during the first trimester of pregnancy, there was no difference in the rate of major birth defects reported among in utero exposed infants compared to unexposed infants. these data cannot definitely establish or exclude any clindamycin-associated risk during pregnancy. animal data animal reproductive/developmental toxicity studies have not been conducted with onexton gel or benzoyl peroxide. developmental toxicity studies of clindamycin performed in pregnant rats and mice administered during the period of organogenesis at oral doses of up to 600 mg/kg/day (240 and 120 times the mrhd for clindamycin, respectively, based on bsa comparisons) or subcutaneous doses of up to 200 mg/kg/day (80 and 40 times the mrhd for clindamycin, respectively, based on bsa comparisons) revealed no malformations or embryo-fetal development toxicity.

Pediatric Use:

8.4 pediatric use safety and effectiveness of onexton gel in pediatric patients under the age of 12 years have not been evaluated.

Geriatric Use:

8.5 geriatric use clinical trials of onexton gel did not include sufficient numbers of subjects age 65 years and older to determine whether they respond differently from younger subjects.

Description:

11 description onexton gel is a combination product with two active ingredients in a white to off-white, opaque, smooth, aqueous gel formulation intended for topical use. clindamycin phosphate is a water-soluble ester of the semisynthetic antibiotic produced by a 7(s)-chloro-substitution of the 7(r)‑hydroxyl group of the parent antibiotic lincomycin. the chemical name for clindamycin phosphate is methyl 7-chloro-6,7,8-trideoxy-6-(1-methyl-trans-4-propyl-l-2-pyrrolidinecarboxamido)-1-thio-l-threo-α-d-galacto-octopyranoside 2 -(dihydrogen phosphate). the structural formula for clindamycin phosphate is represented below: clindamycin phosphate: molecular formula: c 18 h 34 cln 2 o 8 ps molecular weight: 504.97 benzoyl peroxide is an antibacterial and keratolytic agent. the structural formula for benzoyl peroxide is represented below: benzoyl peroxide: molecular formula: c 14 h 10 o 4 molecular weight: 242.23 onexton gel contains the following inactive ingredients: carbomer 980, potassium hydroxide, propylene glycol, and purified water. each gram of onexton gel contains 12 mg (1.2%) clindamycin phosphate, equivalent to 10 mg (1%) clindamycin, and 37.5 mg (3.75%) benzoyl peroxide. onexton chemical structure onexton_benzoyl peroxide chemical structure

Clinical Pharmacology:

12 clinical pharmacology 12.1 mechanism of action clindamycin: clindamycin is a lincosamide antibacterial [ see microbiology (12.4) ]. benzoyl peroxide: benzoyl peroxide is an oxidizing agent with bactericidal and keratolytic effects but the precise mechanism of action is unknown. 12.3 pharmacokinetics the systemic absorption of onexton gel has not been evaluated. the systemic absorption of clindamycin was investigated in an open-label, multiple-dose trial in 16 adult subjects with moderate to severe acne vulgaris treated with 1 gram of a marketed gel containing clindamycin 1%/benzoyl peroxide 2.5% applied to the face once daily for 30 days. this product has the same formulation as onexton gel but with a lower concentration of benzoyl peroxide. twelve subjects (75%) had at least one quantifiable clindamycin plasma concentration above the lower limit of quantification (loq = 0.5 ng/ml) on day 1 or day 30. on day 1, the mean (± standard deviation) peak plasma concentrations (c max ) w
as 0.78 ± 0.22 ng/ml (n=9 with measurable concentrations), and the mean auc 0-t was 5.29 ± 0.81 h.ng/ml (n=4). on day 30, the mean c max was 1.22 ± 0.88 ng/ml (n=10), and the mean auc 0-t was 8.42 ± 6.01 h.ng/ml (n=6). clindamycin plasma concentrations were below loq in all subjects at 24 hours post-dose on the three tested days (day 1, 15, and 30). benzoyl peroxide has been shown to be absorbed by the skin where it is converted to benzoic acid. 12.4 microbiology clindamycin binds to the 50s ribosomal subunits of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing bacterial protein synthesis. clindamycin and benzoyl peroxide individually have been shown to have in vitro activity against propionibacterium acnes , an organism which has been associated with acne vulgaris. in an in vitro study, the minimum inhibitory concentration (mic) for benzoyl peroxide against propionibacterium acnes is 128 mg/l. the clinical significance of this activity against p. acnes is not known. p. acnes resistance to clindamycin has been documented. resistance to clindamycin is often associated with resistance to erythromycin.

Mechanism of Action:

12.1 mechanism of action clindamycin: clindamycin is a lincosamide antibacterial [ see microbiology (12.4) ]. benzoyl peroxide: benzoyl peroxide is an oxidizing agent with bactericidal and keratolytic effects but the precise mechanism of action is unknown.

Pharmacokinetics:

12.3 pharmacokinetics the systemic absorption of onexton gel has not been evaluated. the systemic absorption of clindamycin was investigated in an open-label, multiple-dose trial in 16 adult subjects with moderate to severe acne vulgaris treated with 1 gram of a marketed gel containing clindamycin 1%/benzoyl peroxide 2.5% applied to the face once daily for 30 days. this product has the same formulation as onexton gel but with a lower concentration of benzoyl peroxide. twelve subjects (75%) had at least one quantifiable clindamycin plasma concentration above the lower limit of quantification (loq = 0.5 ng/ml) on day 1 or day 30. on day 1, the mean (± standard deviation) peak plasma concentrations (c max ) was 0.78 ± 0.22 ng/ml (n=9 with measurable concentrations), and the mean auc 0-t was 5.29 ± 0.81 h.ng/ml (n=4). on day 30, the mean c max was 1.22 ± 0.88 ng/ml (n=10), and the mean auc 0-t was 8.42 ± 6.01 h.ng/ml (n=6). clindamycin plasma concentrations were below loq in
all subjects at 24 hours post-dose on the three tested days (day 1, 15, and 30). benzoyl peroxide has been shown to be absorbed by the skin where it is converted to benzoic acid.

Nonclinical Toxicology:

13 nonclinical toxicology 13.1 carcinogenesis, mutagenesis, impairment of fertility carcinogenicity, mutagenicity, and impairment of fertility testing of onexton gel have not been performed. benzoyl peroxide has been shown to be a tumor promoter and progression agent in a number of animal studies. benzoyl peroxide in acetone at doses of 5 and 10 mg administered topically twice per week for 20 weeks induced skin tumors in transgenic tg.ac mice. the clinical significance of this is unknown. carcinogenicity studies have been conducted with a gel formulation containing 1% clindamycin and 5% benzoyl peroxide. in a 2-year dermal carcinogenicity study in mice, treatment with the gel formulation at doses of 900, 2700, and 15000 mg/kg/day (1.8, 5.4, and 30 times the mrhd for clindamycin and 2.4, 7.2, and 40 times the mrhd for benzoyl peroxide, respectively, based on bsa comparisons) did not cause any increase in tumors. however, topical treatment with a different gel formulation containing 1% c
lindamycin and 5% benzoyl peroxide at doses of 100, 500, and 2000 mg/kg/day caused a dose-dependent increase in the incidence of keratoacanthoma at the treated skin site of male rats in a 2-year dermal carcinogenicity study in rats. in an oral (gavage) carcinogenicity study in rats, treatment with the gel formulation at doses of 300, 900, and 3000 mg/kg/day (1.2, 3.6, and 12 times the mrhd for clindamycin and 1.6, 4.8, and 16 times the mrhd for benzoyl peroxide, respectively, based on bsa comparisons) for up to 97 weeks did not cause any increase in tumors. clindamycin phosphate was not genotoxic in the human lymphocyte chromosome aberration assay. benzoyl peroxide has been found to cause dna strand breaks in a variety of mammalian cell types, to be mutagenic in s. typhimurium tests by some but not all investigators, and to cause sister chromatid exchanges in chinese hamster ovary cells. fertility studies have not been performed with onexton gel or benzoyl peroxide, but fertility and mating ability have been studied with clindamycin. fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (approximately 120 times the mrhd for clindamycin based on bsa comparisons) revealed no effects on fertility or mating ability.

Carcinogenesis and Mutagenesis and Impairment of Fertility:

13.1 carcinogenesis, mutagenesis, impairment of fertility carcinogenicity, mutagenicity, and impairment of fertility testing of onexton gel have not been performed. benzoyl peroxide has been shown to be a tumor promoter and progression agent in a number of animal studies. benzoyl peroxide in acetone at doses of 5 and 10 mg administered topically twice per week for 20 weeks induced skin tumors in transgenic tg.ac mice. the clinical significance of this is unknown. carcinogenicity studies have been conducted with a gel formulation containing 1% clindamycin and 5% benzoyl peroxide. in a 2-year dermal carcinogenicity study in mice, treatment with the gel formulation at doses of 900, 2700, and 15000 mg/kg/day (1.8, 5.4, and 30 times the mrhd for clindamycin and 2.4, 7.2, and 40 times the mrhd for benzoyl peroxide, respectively, based on bsa comparisons) did not cause any increase in tumors. however, topical treatment with a different gel formulation containing 1% clindamycin and 5% benzoyl
peroxide at doses of 100, 500, and 2000 mg/kg/day caused a dose-dependent increase in the incidence of keratoacanthoma at the treated skin site of male rats in a 2-year dermal carcinogenicity study in rats. in an oral (gavage) carcinogenicity study in rats, treatment with the gel formulation at doses of 300, 900, and 3000 mg/kg/day (1.2, 3.6, and 12 times the mrhd for clindamycin and 1.6, 4.8, and 16 times the mrhd for benzoyl peroxide, respectively, based on bsa comparisons) for up to 97 weeks did not cause any increase in tumors. clindamycin phosphate was not genotoxic in the human lymphocyte chromosome aberration assay. benzoyl peroxide has been found to cause dna strand breaks in a variety of mammalian cell types, to be mutagenic in s. typhimurium tests by some but not all investigators, and to cause sister chromatid exchanges in chinese hamster ovary cells. fertility studies have not been performed with onexton gel or benzoyl peroxide, but fertility and mating ability have been studied with clindamycin. fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (approximately 120 times the mrhd for clindamycin based on bsa comparisons) revealed no effects on fertility or mating ability.

Clinical Studies:

14 clinical studies the safety and efficacy of once-daily use of onexton gel was assessed in a 12-week multi-center, randomized, blinded trial in subjects 12 years and older with moderate to severe acne vulgaris. this trial evaluated onexton gel compared to vehicle gel. the co-primary efficacy variables for this trial were: (1) mean absolute change from baseline at week 12 in: • inflammatory lesion counts • non-inflammatory lesion counts (2) percent of subjects who had a 2-grade reduction from baseline on an evaluator's global severity (egs) score. the egs scoring scale used in the clinical trial for onexton gel is as follows: table 2: egs scoring scale grade description clear normal, clear skin with no evidence of acne almost clear rare non-inflammatory lesions present, with rare non-inflamed papules (papules must be resolving and may be hyperpigmented, though not pink-red) mild some non-inflammatory lesions are present, with few inflammatory lesions (papules/pustules only;
no nodulocystic lesions) moderate non-inflammatory lesions predominate, with multiple inflammatory lesions evident: several to many comedones and papules/pustules, and there may or may not be one small nodulocystic lesion severe inflammatory lesions are more apparent, many comedones and papules/pustules, there may or may not be up to 2 nodulocystic lesions very severe highly inflammatory lesions predominate, variable number of comedones, many papules/pustules and more than 2 nodulocystic lesions the results of the trial at week 12 are presented in table 3: table 3: results of phase 3 trial at week 12 onexton gel n = 253 vehicle gel n = 245 egss: clear or almost clear 29% 15% 2-grade reduction from baseline 35% 17% inflammatory lesions: mean absolute reduction 16.3 8.2 mean percent (%) reduction 60.4% 31.3% non-inflammatory lesions: mean absolute reduction 19.2 9.6 mean percent (%) reduction 51.8% 27.6%

How Supplied:

16 how supplied/storage and handling 16.1 how supplied onexton gel, 1.2%/3.75% is a white to off-white smooth gel supplied as: ndc 0187-3050-50 50 g pump 16.2 dispensing instructions for the pharmacist • dispense onexton gel with a 10-week expiration date. • specify “store at room temperature up to 25°c (77°f). do not freeze.” 16.3 storage and handling • pharmacist: prior to dispensing: store in a refrigerator, 2° to 8°c (36° to 46°f). • patient: store at room temperature at or below 25°c (77°f). • protect from freezing. • store pump upright. • keep out of the reach of children • keep container tightly closed.

Information for Patients:

17patient counseling information advise the patient to read the fda-approved patient labeling (patient information). • patients who develop allergic reactions, such as severe swelling or shortness of breath, should discontinue use and contact their physician immediately. • onexton gel may cause irritation, such as erythema, scaling, itching, or burning, especially when used in combination with other topical acne therapies. • patients should limit excessive or prolonged exposure to sunlight. to minimize exposure to sunlight, a hat or other clothing should be worn. sunscreen may also be used. • onexton gel may bleach hair or colored fabric. distributed by: bausch health us, llc, bridgewater, nj 08807 usa manufactured by: bausch health companies inc. laval, quebec h7l 4a8, canada u.s. patent numbers: 8,288,434; 9,504,704; 9,561,208; 10,137,142 and 10,220,049 onexton is a trademark of bausch health companies inc. or its affiliates. © 2020 bausch health companies inc.
or its affiliates 9432704

Package Label Principal Display Panel:

Principal display panel - 50 gram carton ndc 0187-3050-50 rx only onexton ® (clindamycin phosphate and benzoyl peroxide) gel, 1.2%/3.75% for topical use only not for ophthalmic, oral or intravaginal use keep out of reach of children one premixed 50-gram pump dispenser ortho dermatologics carton.jpg


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