Ketaconazole


Mylan Pharmaceuticals Inc.
Human Prescription Drug
NDC 0378-7007
Ketaconazole is a human prescription drug labeled by 'Mylan Pharmaceuticals Inc.'. National Drug Code (NDC) number for Ketaconazole is 0378-7007. This drug is available in dosage form of Aerosol, Foam. The names of the active, medicinal ingredients in Ketaconazole drug includes Ketoconazole - 20 mg/g . The currest status of Ketaconazole drug is Active.

Drug Information:

Drug NDC: 0378-7007
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: Ketaconazole
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: Ketaconazole
Also known as the generic name, this is usually the active ingredient(s) of the product.
Labeler Name: Mylan Pharmaceuticals Inc.
Name of Company corresponding to the labeler code segment of the ProductNDC.
Dosage Form: Aerosol, Foam
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:KETOCONAZOLE - 20 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 AUTHORIZED GENERIC
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: 20 Dec, 2018
This is the date that the labeler indicates was the start of its marketing of the drug product.
Marketing End Date: 15 Jun, 2026
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: NDA021738
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:Mylan Pharmaceuticals Inc.
Name of manufacturer or company that makes this drug product, corresponding to the labeler code segment of the NDC.
RxCUI:728550
The RxNorm Concept Unique Identifier. RxCUI is a unique number that describes a semantic concept about the drug product, including its ingredients, strength, and dose forms.
Original Packager:Yes
Whether or not the drug has been repackaged for distribution.
NUI:N0000175487
M0002083
N0000182141
N0000190115
N0000185503
Unique identifier applied to a drug concept within the National Drug File Reference Terminology (NDF-RT).
UNII:R9400W927I
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 MOA:Cytochrome P450 3A4 Inhibitors [MoA]
Cytochrome P450 3A5 Inhibitors [MoA]
P-Glycoprotein Inhibitors [MoA]
Mechanism of action of the drug—molecular, subcellular, or cellular functional activity—of the drug’s established pharmacologic class. Takes the form of the mechanism of action, followed by `[MoA]` (such as `Calcium Channel Antagonists [MoA]` or `Tumor Necrosis Factor Receptor Blocking Activity [MoA]`.
Pharmacologic Class EPC:Azole Antifungal [EPC]
Established pharmacologic class associated with an approved indication of an active moiety (generic drug) that the FDA has determined to be scientifically valid and clinically meaningful. Takes the form of the pharmacologic class, followed by `[EPC]` (such as `Thiazide Diuretic [EPC]` or `Tumor Necrosis Factor Blocker [EPC]`.
Pharmacologic Class CS:Azoles [CS]
Chemical structure classification of the drug product’s pharmacologic class. Takes the form of the classification, followed by `[Chemical/Ingredient]` (such as `Thiazides [Chemical/Ingredient]` or `Antibodies, Monoclonal [Chemical/Ingredient].
Pharmacologic Class:Azole Antifungal [EPC]
Azoles [CS]
Cytochrome P450 3A4 Inhibitors [MoA]
Cytochrome P450 3A5 Inhibitors [MoA]
P-Glycoprotein Inhibitors [MoA]
These are the reported pharmacological class categories corresponding to the SubstanceNames listed above.

Packaging Information:

Package NDCDescriptionMarketing Start DateMarketing End DateSample Available
0378-7007-011 CAN in 1 CARTON (0378-7007-01) / 100 g in 1 CAN20 Dec, 2018N/ANo
0378-7007-501 CAN in 1 CARTON (0378-7007-50) / 50 g in 1 CAN20 Dec, 2018N/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:

Ketaconazole ketaconazole ketoconazole ketoconazole cetyl alcohol citric acid monohydrate alcohol polysorbate 60 potassium citrate propylene glycol water stearyl alcohol

Indications and Usage:

1 indications and usage ketoconazole foam, 2% is indicated for the topical treatment of seborrheic dermatitis in immunocompetent patients 12 years of age and older. limitations of use safety and efficacy of ketoconazole foam for treatment of fungal infections have not been established. ketoconazole foam is indicated for topical treatment of seborrheic dermatitis in immunocompetent patients 12 years of age and older ( 1 ). limitations of use safety and efficacy of ketoconazole foam for treatment of fungal infections have not been established.

Warnings and Cautions:

5 warnings and precautions • ketoconazole foam may result in contact sensitization, including photoallergenicity ( 5.1 , 6.2 ). • the contents of ketoconazole foam are flammable. avoid fire, flame, or smoking during and immediately following application ( 5.2 ). 5.1 contact sensitization ketoconazole foam may result in contact sensitization, including photoallergenicity [see adverse reactions (6.2) ]. 5.2 flammable contents the contents of ketoconazole 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). 5.3 systemic effects 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. t
hese effects have not been seen with topical ketoconazole.

Dosage and Administration:

2 dosage and administration ketoconazole foam should be applied to the affected area(s) twice daily for four weeks. hold the container upright, and dispense ketoconazole 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 ketoconazole 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 ketoconazole foam may be applied directly to the skin (rather than on the hair). avoid contact with the eyes and other mucous membranes. ketoconazole foam is not for ophthalmic, oral or intravaginal use. • ketoconazole foam should be applied to the affected area(s) twice daily for four weeks ( 2 ). • ketoconazole foam is not for ophthalmic, oral, or intravaginal use ( 2 ).

Dosage Forms and Strength:

3 dosage forms and strengths ketoconazole foam, 2% contains 20 mg of ketoconazole, usp per gram, supplied in 50 g and 100 g containers. foam: 2% ketoconazole in 50 g and 100 g containers ( 3 ).

Contraindications:

4 contraindications none. none .

Adverse Reactions:

6 adverse reactions the most common adverse reactions observed in clinical studies (incidence > 1%) were application site burning and application site reaction ( 6.1 ). to report suspected adverse reactions, contact mylan at 1-877-446-3679 (1-877-4-info-rx) 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 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 reflect exposure to ketoconazole foam in 672 subjects, 12 years and older with seborrheic dermatitis. subjects applied ketoconazole 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 table 1. table 1: adverse reactions reported by > 1% subjects in clinical trials adverse reactions ketoconazole foam n = 672 n (%) vehicle foam n = 497 n (%) subjects with an adverse reaction 188 (28%) 122 (25%) application site burning 67 (10%) 49 (10%) application site reaction 41 (6%) 24 (5%) application site reactions that were reported in < 1% of subjects were dryness, erythema, irritation, paresthesia, pruritus, rash and warmth. 6.2 dermal safety studies 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 ketoconazole foam. ketoconazole foam may cause contact sensitization. 6.3 postmarketing experience the following adverse events have been identified during postmarketing use of ketoconazole foam: gastrointestinal disorders: cheilitis general disorders and administration site conditions: application site pain and application site burn skin and subcutaneous tissue disorders: skin burning sensation and erythema because these events 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.

Adverse Reactions Table:

Table 1: Adverse Reactions Reported by > 1% Subjects in Clinical Trials
Adverse Reactions Ketoconazole Foam N = 672 n (%) Vehicle Foam N = 497 n (%)
Subjects with an Adverse Reaction 188 (28%) 122 (25%)
Application site burning 67 (10%) 49 (10%)
Application site reaction 41 (6%) 24 (5%)

Use in Specific Population:

8 use in specific populations 8.1 pregnancy risk summary there are no available data on ketoconazole foam use in pregnant women to identify a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. no reproductive studies in animals have been performed with ketoconazole foam. in animal reproduction studies with pregnant mice, rats and rabbits both embryotoxic and developmental effects (structural abnormalities) were observed following oral dosing of ketoconazole during organogenesis. assuming equivalent systemic absorption of topical and oral ketoconazole doses and an ketoconazole foam maximum recommended human dose (mrhd) of 8 grams (equivalent to 160 mg ketoconazole), embryotoxic effects were observed at 0.8 to 2.4 times the mrhd and developmental effects were observed at 4.8 times the mrhd [see data ] . the background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of
birth defect, loss, or 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 animal data the animal multiples of human exposure calculations are based on body surface area (bsa) comparisons of oral doses administered to animals and an ketoconazole foam maximum recommended human dose (mrhd) of 8 grams (equivalent to 2.67 mg ketoconazole/kg/day for a 60 kg individual or 98.8 mg ketoconazole/m 2 /day). embryofetal development studies have been conducted in mice, rats and rabbits with orally administered ketoconazole. when orally administered to mice on gestational days 6 through 18 (covering the period of organogenesis), ketoconazole was embryotoxic (25 mg/kg and higher; 0.8 times the mrhd based on bsa comparisons) with a high incidence of resorptions, increased number of stillbirths and delayed parturition. delays in maturation were also observed. there was no evidence of maternal toxicity or malformations at up to 50 mg/kg (1.5 times the mrhd based on bsa comparisons). no treatment related developmental effects were observed at 10 mg/kg (0.3 times the mrhd based on bsa comparisons). in the presence of maternal toxicity in rats, orally administered ketoconazole was both embryotoxic (40 mg/kg and higher; 2.4 times the mrhd based on bsa comparisons), including increased resorbed fetuses and stillbirths, and teratogenic (80 mg/kg and higher; 4.8 times the mrhd based on bsa comparisons), including syndactylia, oligodactylia, waved ribs and cleft palate. additionally, 100 mg/kg (6 times the mrhd based on bsa comparisons) ketoconazole orally administered on a single day during gestation (gestational days 9 through 12) was embryotoxic (increased resorptions). this same oral dose given on gestation day 12, 13, 14 or 15 induced external malformations including cleft palate, micromelia and digital anomalies (brachydactyly, ectrodactyly, syndactyly). in pregnant rabbits orally administered ketoconazole, evidence of embryotoxicity (increased resorptions) was observed at 10 mg/kg (1.2 times the mrhd based on bsa comparisons) and higher and an increased incidence of skeletal abnormalities was observed at 40 mg/kg (4.8 times the mrhd based on bsa comparisons). 8.2 lactation risk summary there is no information available on the presence of ketoconazole in human milk, or the effects on the breastfed child, or the effects on milk production after topical application of ketoconazole foam to women who are breastfeeding. in animal studies ketoconazole was found in milk following oral administration. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ketoconazole foam and any potential adverse effects on the breastfed infant from ketoconazole foam or from the underlying maternal condition. 8.3 females and males of reproductive potential infertility in animal fertility studies in rats and dogs, administration of oral doses of ketoconazole between 3-day and 3-month periods resulted in infertility that was reversible [see nonclinical toxicology (13.1) ]. 8.4 pediatric use the safety and effectiveness of ketoconazole foam in pediatric patients less than 12 years of age have not been established. of the 672 subjects treated with ketoconazole foam in the clinical trials, 44 (7%) were from 12 to 17 years of age. [see clinical studies (14) ]. 8.5 geriatric use of the 672 subjects treated with ketoconazole foam in the clinical trials, 107 (16%) were 65 years and over. clinical trials of ketoconazole foam did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects.

Use in Pregnancy:

8.1 pregnancy risk summary there are no available data on ketoconazole foam use in pregnant women to identify a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. no reproductive studies in animals have been performed with ketoconazole foam. in animal reproduction studies with pregnant mice, rats and rabbits both embryotoxic and developmental effects (structural abnormalities) were observed following oral dosing of ketoconazole during organogenesis. assuming equivalent systemic absorption of topical and oral ketoconazole doses and an ketoconazole foam maximum recommended human dose (mrhd) of 8 grams (equivalent to 160 mg ketoconazole), embryotoxic effects were observed at 0.8 to 2.4 times the mrhd and developmental effects were observed at 4.8 times the mrhd [see data ] . the background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of birth defect, loss, or other a
dverse 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 animal data the animal multiples of human exposure calculations are based on body surface area (bsa) comparisons of oral doses administered to animals and an ketoconazole foam maximum recommended human dose (mrhd) of 8 grams (equivalent to 2.67 mg ketoconazole/kg/day for a 60 kg individual or 98.8 mg ketoconazole/m 2 /day). embryofetal development studies have been conducted in mice, rats and rabbits with orally administered ketoconazole. when orally administered to mice on gestational days 6 through 18 (covering the period of organogenesis), ketoconazole was embryotoxic (25 mg/kg and higher; 0.8 times the mrhd based on bsa comparisons) with a high incidence of resorptions, increased number of stillbirths and delayed parturition. delays in maturation were also observed. there was no evidence of maternal toxicity or malformations at up to 50 mg/kg (1.5 times the mrhd based on bsa comparisons). no treatment related developmental effects were observed at 10 mg/kg (0.3 times the mrhd based on bsa comparisons). in the presence of maternal toxicity in rats, orally administered ketoconazole was both embryotoxic (40 mg/kg and higher; 2.4 times the mrhd based on bsa comparisons), including increased resorbed fetuses and stillbirths, and teratogenic (80 mg/kg and higher; 4.8 times the mrhd based on bsa comparisons), including syndactylia, oligodactylia, waved ribs and cleft palate. additionally, 100 mg/kg (6 times the mrhd based on bsa comparisons) ketoconazole orally administered on a single day during gestation (gestational days 9 through 12) was embryotoxic (increased resorptions). this same oral dose given on gestation day 12, 13, 14 or 15 induced external malformations including cleft palate, micromelia and digital anomalies (brachydactyly, ectrodactyly, syndactyly). in pregnant rabbits orally administered ketoconazole, evidence of embryotoxicity (increased resorptions) was observed at 10 mg/kg (1.2 times the mrhd based on bsa comparisons) and higher and an increased incidence of skeletal abnormalities was observed at 40 mg/kg (4.8 times the mrhd based on bsa comparisons).

Pediatric Use:

8.4 pediatric use the safety and effectiveness of ketoconazole foam in pediatric patients less than 12 years of age have not been established. of the 672 subjects treated with ketoconazole foam in the clinical trials, 44 (7%) were from 12 to 17 years of age. [see clinical studies (14) ].

Geriatric Use:

8.5 geriatric use of the 672 subjects treated with ketoconazole foam in the clinical trials, 107 (16%) were 65 years and over. clinical trials of ketoconazole foam did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects.

Description:

11 description ketoconazole 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-(1 h -imidazol-l-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl]-, cis - with the molecular formula c 26 h 28 cl 2 n 4 o 4 and a molecular weight of 531.43. the following is the chemical structure: ketoconazole foam contains 20 mg of 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. ketoconazole structural formula

Clinical Pharmacology:

12 clinical pharmacology 12.1 mechanism of action the mechanism of action of ketoconazole in the treatment of seborrheic dermatitis is not known. 12.2 pharmacodynamics the pharmacodynamics of ketoconazole foam has not been established. 12.3 pharmacokinetics in a bioavailability study, 12 subjects with moderate to severe seborrheic dermatitis applied 3 g of ketoconazole 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. 12.4 microbiology ketoconazole is an antifungal agent which inhibits the in vitro synthesis of ergosterol, a key sterol in the cell membrane of malassezia furfur . the clinical significance of antifungal activity in the treatment of seborrheic dermatitis is not known.

Mechanism of Action:

12.1 mechanism of action the mechanism of action of ketoconazole in the treatment of seborrheic dermatitis is not known.

Pharmacodynamics:

12.2 pharmacodynamics the pharmacodynamics of ketoconazole foam has not been established.

Pharmacokinetics:

12.3 pharmacokinetics in a bioavailability study, 12 subjects with moderate to severe seborrheic dermatitis applied 3 g of ketoconazole 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.

Nonclinical Toxicology:

13 nonclinical toxicology 13.1 carcinogenesis, mutagenesis, impairment of fertility long-term animal studies have not been performed to evaluate the carcinogenic or photo-carcinogenic potential of ketoconazole 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 mrhd based on bsa comparisons. 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. in animal fertility studies, oral ketoconazole impaired both male and female fertility in rats in a dose and duration dependent manner. in females, oral doses up to 40 mg/kg (2.4 times the mrhd based on bsa comparisons) had no effect on fertility, while doses of 75 mg/kg (4.5
times the mrhd based on bsa comparisons) and higher decreased the pregnancy rate and number of implantation sites. in male rats, oral dosing at 200 mg/kg/day (12 times the mrhd based on bsa comparisons) for three days decreased fertility and 400 mg/kg/day (24 times the mrhd based on bsa comparisons) for three days resulted in a complete loss of fertility. when administered for longer durations (up to 3 months), decreased fertility in male rats was observed at doses as low as 24 mg/kg/day (1.4 times the mrhd based on bsa comparisons). in male beagle dogs, an oral dose of 25 mg/kg/day ketoconazole for up to 4 weeks (5.2 times the mrhd based on bsa comparisons) resulted in decreased sperm motility, decreased sperm count, increased abnormal sperm and atrophy of the testes. these effects were reversed subsequent to withdrawal of treatment.

Carcinogenesis and Mutagenesis and Impairment of Fertility:

13.1 carcinogenesis, mutagenesis, impairment of fertility long-term animal studies have not been performed to evaluate the carcinogenic or photo-carcinogenic potential of ketoconazole 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 mrhd based on bsa comparisons. 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. in animal fertility studies, oral ketoconazole impaired both male and female fertility in rats in a dose and duration dependent manner. in females, oral doses up to 40 mg/kg (2.4 times the mrhd based on bsa comparisons) had no effect on fertility, while doses of 75 mg/kg (4.5 times the mrhd based on b
sa comparisons) and higher decreased the pregnancy rate and number of implantation sites. in male rats, oral dosing at 200 mg/kg/day (12 times the mrhd based on bsa comparisons) for three days decreased fertility and 400 mg/kg/day (24 times the mrhd based on bsa comparisons) for three days resulted in a complete loss of fertility. when administered for longer durations (up to 3 months), decreased fertility in male rats was observed at doses as low as 24 mg/kg/day (1.4 times the mrhd based on bsa comparisons). in male beagle dogs, an oral dose of 25 mg/kg/day ketoconazole for up to 4 weeks (5.2 times the mrhd based on bsa comparisons) resulted in decreased sperm motility, decreased sperm count, increased abnormal sperm and atrophy of the testes. these effects were reversed subsequent to withdrawal of treatment.

Clinical Studies:

14 clinical studies the safety and efficacy of ketoconazole foam were evaluated in a randomized, double-blind, vehicle-controlled trial in subjects 12 years and older with mild to severe seborrheic dermatitis. in the trial, 427 subjects received ketoconazole foam and 420 subjects received vehicle foam. subjects applied ketoconazole 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 i
n effects in age, gender, or race subgroups. table 2: efficacy results number of subjects ketoconazole foam n = 427 n (%) vehicle foam n = 420 n (%) subjects achieving treatment success 239 (56%) 176 (42%)

How Supplied:

16 how supplied/storage and handling ketoconazole foam, 2% contains 20 mg of ketoconazole, usp per gram. the thermolabile hydroethanolic foam is available as follows: ndc 0378-7007-50 50 g aluminum can ndc 0378-7007-01 100 g aluminum can store at 20° to 25°c (68° to 77°f). [see usp controlled room temperature.] do not store under refrigerated conditions. contents are flammable. do not expose containers to heat and/or store at temperatures above 49°c (120°f). do not store in direct sunlight. contents under pressure. do not puncture and/or incinerate container. keep out of reach of children.

Information for Patients:

17 patient counseling information see fda-approved patient labeling ( patient package insert ). instruct patients on a proper use of ketoconazole foam • avoid fire, flame and/or smoking during and immediately following application. • do not apply ketoconazole foam directly to hands. dispense onto a cool surface, and apply to the affected areas using the fingertips. • wash their hands after application • ketoconazole foam may cause skin irritation (application site burning and/or reactions) • instruct a patient to contact a health care provider if the area of application shows signs of increased irritation and report any signs of adverse reactions.

Spl Patient Package Insert:

Patient information ketoconazole foam (kee″ toe kon′ a zole) important information: ketoconazole foam is for use on the skin only. do not use ketoconazole foam in your eyes, mouth or vagina. what is ketoconazole foam? ketoconazole foam is a prescription medicine used on the skin (topical) to treat seborrheic dermatitis in people 12 years of age and older with a normal immune system. it is not known if ketoconazole foam is safe and effective when used to treat fungal infections. it is not known if ketoconazole foam is safe and effective in children less than 12 years of age. before using ketoconazole foam, tell your healthcare provider about all of your medical conditions, including if you: • are pregnant or plan to become pregnant. it is not known if ketoconazole foam will harm your unborn baby. • are breastfeeding or plan to breastfeed. it is not known if ketoconazole passes into your breast milk. talk to your healthcare provider about the best way to feed your bab
y during treatment with ketoconazole foam. tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. how should i use ketoconazole foam? • use ketoconazole foam exactly as your healthcare provider tells you to use it. see the detailed “instructions for use” at the end of this leaflet for directions about how to apply ketoconazole foam the right way. • apply ketoconazole foam to the affected skin area(s) 2 times each day for 4 weeks. you should apply enough ketoconazole foam to cover the entire affected area(s). • talk to your healthcare provider if your skin does not improve after 4 weeks of treatment with ketoconazole foam. • dispense ketoconazole foam directly into the cap. do not dispense ketoconazole foam directly onto your hands, because the foam will begin to melt on contact with warm skin. • wash your hands after applying ketoconazole foam. what should i avoid while using ketoconazole foam? • ketoconazole foam is flammable. avoid fire, flames, or smoking during and right after you apply ketoconazole foam to your skin. • avoid getting ketoconazole foam in or near your eyes, mouth, lips or vagina. if you get ketoconazole foam on your lips or in your eyes, mouth or vagina, rinse well with water. what are the possible side effects of ketoconazole foam? ketoconazole foam may cause serious side effects, including: • skin irritation at the application area(s), including skin reactions caused by exposure to light. tell your healthcare provider if you develop skin irritation during treatment with ketoconazole foam. the most common side effects of ketoconazole foam include, burning, dryness, redness, irritation, numbness, itching, rash and warmth at the application site. these are not all of the possible side effects of ketoconazole foam. call your doctor for medical advice about side effects. you may report side effects to fda at 1-800-fda-1088. how should i store ketoconazole foam? • store ketoconazole foam at room temperature between 68°f to 77°f (20°c to 25°c). • do not store the ketoconazole foam can in the refrigerator or freezer. • keep ketoconazole foam away from heat. never throw the ketoconazole foam can into a fire, even if the can is empty. • do not store ketoconazole foam at temperatures above 120°f (49°c). • do not break through (puncture) the ketoconazole foam can. keep ketoconazole foam and all medicines out of the reach of children. general information about the safe and effective use of ketoconazole foam. medicines are sometimes prescribed for purposes other than those listed in a patient information leaflet. do not use ketoconazole foam for a condition for which it was not prescribed. do not give ketoconazole foam to other people, even if they have the same symptoms that you have. it may harm them. you can ask your pharmacist or healthcare provider for information about ketoconazole foam that is written for health professionals. what are the ingredients in ketoconazole foam? active ingredient: 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 manufactured for: mylan pharmaceuticals inc., morgantown, wv 26505 u.s.a. for more information, call mylan at 1-877-446-3679 (1-877-4-info-rx). this patient information leaflet has been approved by the u.s. food and drug administration. instructions for use ketoconazole foam (kee″ toe kon′ a zole) important information: ketoconazole foam is for use on the skin only. do not use ketoconazole foam in your eyes, mouth or vagina. step 1: remove the clear cap from the ketoconazole foam can. step 2: hold the can upright and firmly press the nozzle to dispense ketoconazole foam into the clear cap. • dispense enough ketoconazole foam to cover the entire affected area(s). • if the can seems warm or the foam seems runny, run the can under cold water. step 3: pick up small amounts of ketoconazole foam with your fingertips and gently rub the foam into the affected area(s) until the foam disappears. • if you are treating areas such as your scalp, part the hair so that ketoconazole foam may be applied directly to the skin. step 4: wash your hands after applying ketoconazole foam. • throw away any of the unused medicine that is left in the cap. how should i store ketoconazole foam? • store ketoconazole foam at room temperature between 68°f to 77°f (20°c to 25°c). • do not store the ketoconazole foam can in the refrigerator or freezer. • keep ketoconazole foam away from heat. never throw the can into a fire, even if the can is empty. • do not store ketoconazole foam at temperatures above 120°f (49°c). • do not break through (puncture) the ketoconazole foam can. keep ketoconazole foam and all medicines out of the reach of children. this instructions for use has been approved by the u.s. food and drug administration. manufactured for: mylan pharmaceuticals inc. morgantown, wv 26505 u.s.a. manufactured by: dpt laboratories, ltd. san antonio, tx 78215 u.s.a. 141031-0918 revised: 9/2018 dpt:ktczfog:r1 instructions for use figure 01 instructions for use figure 02 instructions for use figure 03 instructions for use figure 04 instructions for use figure 05 instructions for use figure 06 instructions for use figure 07

Package Label Principal Display Panel:

Principal display panel – 2% ndc 0378-7007-50 ketoconazole foam 2% for topical use only rx only 50 g not for ophthalmic, oral, or intravaginal use. hold the can at an upright angle and then press firmly to dispense. description: ketoconazole foam, 2% contains 20 mg of ketoconazole, usp 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, stearyl alcohol pressurized with a hydrocarbon (propane/butane) propellant. usual dosage: use only as prescribed by your physician. see accompanying prescribing information. warning: flammable. avoid fire, flame, or smoking during and immediately following application. contents under pressure. do not puncture and/or incinerate container. do not expose containers to heat and/or store at temperatures above 120ºf (49ºc). do not store in direct sunlight. avoid contact with eyes. keep this and all medication out of the reach of children. do not store in the refrigerator. store at 20º to 25ºc (68º to 77ºf). [see usp controlled room temperature.] cfc free manufactured for: mylan pharmaceuticals inc. morgantown, wv 26505 u.s.a. manufactured by: dpt laboratories, ltd. san antonio, tx 78215 u.s.a. for more information, call mylan at 1-877-446-3679 (1-877-4-info-rx) 117545-0918 dpt:7007:50:1c:r1 mylan.com ketoconazole 2% carton image ketoconazole foam 2% carton label


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