Fluocinonide


Amneal Pharmaceuticals Ny Llc
Human Prescription Drug
NDC 69238-1271
Fluocinonide is a human prescription drug labeled by 'Amneal Pharmaceuticals Ny Llc'. National Drug Code (NDC) number for Fluocinonide is 69238-1271. This drug is available in dosage form of Cream. The names of the active, medicinal ingredients in Fluocinonide drug includes Fluocinonide - 1 mg/g . The currest status of Fluocinonide drug is Active.

Drug Information:

Drug NDC: 69238-1271
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: Fluocinonide
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: Fluocinonide
Also known as the generic name, this is usually the active ingredient(s) of the product.
Labeler Name: Amneal Pharmaceuticals Ny Llc
Name of Company corresponding to the labeler code segment of the ProductNDC.
Dosage Form: Cream
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:FLUOCINONIDE - 1 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: ANDA
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: 31 Jul, 2018
This is the date that the labeler indicates was the start of its marketing of the drug product.
Marketing End Date: 20 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: ANDA211111
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:Amneal Pharmaceuticals NY LLC
Name of manufacturer or company that makes this drug product, corresponding to the labeler code segment of the NDC.
RxCUI:485647
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.
UPC:0369238127133
UPC stands for Universal Product Code.
NUI:N0000175576
N0000175450
Unique identifier applied to a drug concept within the National Drug File Reference Terminology (NDF-RT).
UNII:2W4A77YPAN
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:Corticosteroid Hormone Receptor Agonists [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:Corticosteroid [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:Corticosteroid Hormone Receptor Agonists [MoA]
Corticosteroid [EPC]
These are the reported pharmacological class categories corresponding to the SubstanceNames listed above.

Packaging Information:

Package NDCDescriptionMarketing Start DateMarketing End DateSample Available
69238-1271-21 TUBE in 1 CARTON (69238-1271-2) / 120 g in 1 TUBE31 Jul, 2018N/ANo
69238-1271-31 TUBE in 1 CARTON (69238-1271-3) / 30 g in 1 TUBE31 Jul, 2018N/ANo
69238-1271-61 TUBE in 1 CARTON (69238-1271-6) / 60 g in 1 TUBE31 Jul, 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:

Fluocinonide fluocinonide fluocinonide fluocinonide propylene glycol diethylene glycol monoethyl ether glyceryl monostearate polyoxyl 100 stearate water carbomer homopolymer type c diisopropanolamine anhydrous citric acid white to off-white

Indications and Usage:

1 indications and usage fluocinonide cream, 0.1% is a corticosteroid indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses in patients 12 years of age or older. (1) limitation of use: treatment beyond 2 consecutive weeks is not recommended and the total dosage should not exceed 60 g per week because of the potential for the drug to suppress the hypothalamic-pituitary-adrenal (hpa) axis. (1) avoid use on the face, groin, or axillae. (1.2) avoid use in perioral dermatitis or rosacea. 1.1 indication fluocinonide cream, 0.1%, is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses in patients 12 years of age or older [see use in specific populations (8.4) ] . 1.2 limitation of use treatment beyond 2 consecutive weeks is not recommended and the total dosage should not exceed 60 g per week because the safety of fluocinonide cream, 0.1% for longer than 2 weeks has not been es
tablished and because of the potential for the drug to suppress the hypothalamic-pituitary-adrenal (hpa) axis. therapy should be discontinued when control of the disease is achieved. if no improvement is seen within 2 weeks, reassessment of the diagnosis may be necessary. do not use more than half of the 120 g tube per week. fluocinonide cream, 0.1% should not be used in the treatment of rosacea or perioral dermatitis, and should not be used on the face, groin, or axillae.

Warnings and Cautions:

5 warnings and precautions fluocinonide cream has been shown to suppress the hpa axis. systemic absorption of fluocinonide cream may produce reversible hypothalamic-pituitary-adrenal (hpa) axis suppression, cushing’s syndrome, hyperglycemia and unmask latent diabetes (5.1) systemic absorption may require evaluation for hpa axis suppression (5.1) modify use should hpa axis suppression develop (5.1) potent corticosteroids, use on large areas, prolonged use or occlusive use may increase systemic absorption (5.3) local adverse reactions with topical steroids may include atrophy, striae, irritation, acneiform eruptions, hypopigmentation and allergic contact dermatitis and may be more likely to occur with occlusive use or more potent corticosteroids (5.3) children may be more susceptible to systemic toxicity when treated with topical corticosteroids (5.1 , 8.4) 5.1 effect on endocrine system systemic absorption of topical corticosteroids, including fluocinonide cream, can produce revers
ible hypothalamic-pituitary-adrenal (hpa) axis suppression with the potential for clinical glucocorticosteroid insufficiency. this may occur during treatment or upon withdrawal of the topical corticosteroid. in addition, the use of fluocinonide cream for longer than 2 weeks may suppress the immune system [see nonclinical toxicology (13.1) ] . hpa axis suppression has been observed with fluocinonide cream, 0.1% applied once or twice daily in 2 out of 18 adult patients with plaque-type psoriasis, 1 out of 31 adult patients with atopic dermatitis and 4 out of 123 pediatric patients with atopic dermatitis [see use in specific populations (8.4) and clinical pharmacology (12.2) ] . because of the potential for systemic absorption, use of topical corticosteroids, including fluocinonide cream, may require that patients be periodically evaluated for hpa axis suppression. factors that predispose a patient using a topical corticosteroid to hpa axis suppression include the use of more potent steroids, use over large surface areas, use over prolonged periods, use under occlusion, use on an altered skin barrier, and use in patients with liver failure. an acth stimulation test may be helpful in evaluating patients for hpa axis suppression. if hpa axis suppression is documented, an attempt should be made to gradually withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. manifestations of adrenal insufficiency may require supplemental systemic corticosteroids. recovery of hpa axis function is generally prompt and complete upon discontinuation of topical corticosteroids. cushing’s syndrome, hyperglycemia, and unmasking of latent diabetes mellitus can also result from systemic absorption of topical corticosteroids. use of more than one corticosteroid-containing product at the same time may increase the total systemic absorption of topical corticosteroids. studies conducted in pediatric patients demonstrated reversible hpa axis suppression after use of fluocinonide cream. pediatric patients may be more susceptible than adults to systemic toxicity from equivalent doses of fluocinonide cream due to their larger skin surface-to-body-mass ratios [see use in specific populations (8.4) ] . 5.2 local adverse reactions with topical corticosteroids local adverse reactions may be more likely to occur with occlusive use, prolonged use or use of higher potency corticosteroids. reactions may include atrophy, striae, telangiectasis, burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, and miliaria. some local adverse reactions may be irreversible. 5.3 concomitant skin infections if concomitant skin infections are present or develop, an appropriate antifungal or antibacterial agent should be used. if a favorable response does not occur promptly, use of fluocinonide cream should be discontinued until the infection has been adequately controlled. 5.4 allergic contact dermatitis if irritation develops, fluocinonide cream should be discontinued and appropriate therapy instituted. allergic contact dermatitis with corticosteroids is usually diagnosed by observing failure to heal rather than noting a clinical exacerbation as with most topical products not containing corticosteroids. such an observation should be corroborated with appropriate diagnostic patch testing.

Dosage and Administration:

2 dosage and administration for topical use only. fluocinonide cream, 0.1% is not for ophthalmic, oral, or intravaginal use. for psoriasis, apply a thin layer of fluocinonide cream, 0.1% once or twice daily to the affected skin areas as directed by a physician. twice daily application for the treatment of psoriasis has been shown to be more effective in achieving treatment success during 2 weeks of treatment. for atopic dermatitis, apply a thin layer of fluocinonide cream, 0.1% once daily to the affected skin areas as directed by a physician. once daily application for the treatment of atopic dermatitis has been shown to be as effective as twice daily treatment in achieving treatment success during 2 weeks of treatment [see clinical studies (14) ] . for corticosteroid responsive dermatoses, other than psoriasis or atopic dermatitis, apply a thin layer of fluocinonide cream, 0.1% once or twice daily to the affected areas as directed by a physician. for topical use only. fluocinonide cre
am, 0.1% is not for ophthalmic, oral, or intravaginal use. (2) psoriasis: apply a thin layer once or twice daily to the affected skin areas. (2) atopic dermatitis: apply a thin layer once daily to the affected skin areas. (2) corticosteroid responsive dermatoses, other than psoriasis or atopic dermatitis: apply a thin layer once or twice daily to the affected areas. (2)

Dosage Forms and Strength:

3 dosage forms and strengths cream, 0.1%. each gram of fluocinonide cream, usp 0.1% contains 1 mg of fluocinonide, usp in a white to off-white cream base free from any foreign particles. cream, 0.1% (3)

Contraindications:

4 contraindications none. none (4)

Adverse Reactions:

6 adverse reactions the most commonly reported adverse reactions (≥1%) were headache, application site burning, nasopharyngitis, and nasal congestion. (6) to report suspected adverse reactions, contact amneal pharmaceuticals at 1-877-835-5472 or fda at 1-800-fda-1088 or www.fda.gov/medwatch . 6.1 clinical trials experience because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. in clinical trials, a total of 443 adult subjects with atopic dermatitis or plaque-type psoriasis were treated once daily or twice daily with fluocinonide cream for 2 weeks. the most commonly observed adverse reactions in these clinical trials were as follows: table 1: most commonly observed adverse reactions ( ≥1%) in adult clinical trials adverse reaction fluocinonide cream, once daily (n=216)
fluocinonide cream, twice daily (n=227) vehicle cream, once or twice daily (n=211) headache 8 (3.7%) 9 (4.0%) 6 (2.8%) application site burning 5 (2.3%) 4 (1.8%) 14 (6.6%) nasopharyngitis 2 (0.9%) 3 (1.3%) 3 (1.4%) nasal congestion 3 (1.4%) 1 (0.4%) 0 safety in patients 12 to 17 years of age was similar to that observed in adults. 6.2 postmarketing experience the following adverse reactions have been identified during post approval use of fluocinonide cream: administration site conditions: discoloration, erythema, irritation, pruritus, swelling, pain and condition aggravated. immune system disorders: hypersensitivity. nervous system disorders: headache and dizziness. skin and subcutaneous tissue disorders: acne, dry skin, rash, skin exfoliation and skin tightness. 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.

Adverse Reactions Table:

Table 1: Most Commonly Observed Adverse Reactions (≥1%) in Adult Clinical Trials
Adverse ReactionFluocinonide Cream, once daily (n=216)Fluocinonide Cream, twice daily (n=227)Vehicle Cream, once or twice daily (n=211)
Headache 8 (3.7%)9 (4.0%)6 (2.8%)
Application Site Burning 5 (2.3%)4 (1.8%)14 (6.6%)
Nasopharyngitis 2 (0.9%)3 (1.3%)3 (1.4%)
Nasal Congestion 3 (1.4%)1 (0.4%)0

Use in Specific Population:

8 use in specific populations 8.1 pregnancy teratogenic effects: pregnancy category c there are no adequate and well-controlled studies in pregnant women. therefore, fluocinonide cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. some corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. 8.3 nursing mothers systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. it is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. nevertheless, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into ac
count the importance of the drug to the mother. 8.4 pediatric use safety and efficacy of fluocinonide cream in pediatric patients younger than 12 years of age have not been established; therefore use in pediatric patients younger than 12 years of age is not recommended. hpa axis suppression was studied in 4 sequential cohorts of pediatric patients with atopic dermatitis covering at least 20% of the body surface area, treated once daily or twice daily with fluocinonide cream. the first cohort of 31 patients (mean 36.3% bsa) 12 to < 18 years old; the second cohort included 31 patients (mean 39.0% bsa) 6 to < 12 years old; the third cohort included 30 patients (mean 34.6% bsa) 2 to < 6 years old; the fourth cohort included 31 patients (mean 40.0% bsa) 3 months to < 2 years old. fluocinonide cream caused hpa-axis suppression in 1 patient in the twice daily group in cohort 1, 2 patients in the twice daily group in cohort 2, and 1 patient in the twice daily group in cohort 3. follow-up testing 14 days after treatment discontinuation, available for all 4 suppressed patients, demonstrated a normally responsive hpa axis. signs of skin atrophy were present at baseline and severity was not determined making it difficult to assess local skin safety. therefore, the safety of fluocinonide cream in patients younger than 12 years of age has not been demonstrated [see warnings and precautions (5.2) ] . hpa axis suppression has not been evaluated in patients with psoriasis who are less than 18 years of age. because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of hpa-axis suppression and cushing’s syndrome when they are treated with topical corticosteroids. they are therefore also at greater risk of adrenal insufficiency during or after withdrawal of treatment. adverse effects including striae have been reported with inappropriate use of topical corticosteroids in infants and children. hpa-axis suppression, cushing’s syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension have been reported in children receiving topical corticosteroids. manifestations of adrenal suppression in children include low plasma cortisol levels and absence of response to cosyntropin (acth 1-24 ) stimulation. manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema. 8.5 geriatric use clinical studies of fluocinonide cream did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Use in Pregnancy:

8.1 pregnancy teratogenic effects: pregnancy category c there are no adequate and well-controlled studies in pregnant women. therefore, fluocinonide cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. some corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.

Pediatric Use:

8.4 pediatric use safety and efficacy of fluocinonide cream in pediatric patients younger than 12 years of age have not been established; therefore use in pediatric patients younger than 12 years of age is not recommended. hpa axis suppression was studied in 4 sequential cohorts of pediatric patients with atopic dermatitis covering at least 20% of the body surface area, treated once daily or twice daily with fluocinonide cream. the first cohort of 31 patients (mean 36.3% bsa) 12 to < 18 years old; the second cohort included 31 patients (mean 39.0% bsa) 6 to < 12 years old; the third cohort included 30 patients (mean 34.6% bsa) 2 to < 6 years old; the fourth cohort included 31 patients (mean 40.0% bsa) 3 months to < 2 years old. fluocinonide cream caused hpa-axis suppression in 1 patient in the twice daily group in cohort 1, 2 patients in the twice daily group in cohort 2, and 1 patient in the twice daily group in cohort 3. follow-up testing 14 days after treatment discontinuation, avai
lable for all 4 suppressed patients, demonstrated a normally responsive hpa axis. signs of skin atrophy were present at baseline and severity was not determined making it difficult to assess local skin safety. therefore, the safety of fluocinonide cream in patients younger than 12 years of age has not been demonstrated [see warnings and precautions (5.2) ] . hpa axis suppression has not been evaluated in patients with psoriasis who are less than 18 years of age. because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of hpa-axis suppression and cushing’s syndrome when they are treated with topical corticosteroids. they are therefore also at greater risk of adrenal insufficiency during or after withdrawal of treatment. adverse effects including striae have been reported with inappropriate use of topical corticosteroids in infants and children. hpa-axis suppression, cushing’s syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension have been reported in children receiving topical corticosteroids. manifestations of adrenal suppression in children include low plasma cortisol levels and absence of response to cosyntropin (acth 1-24 ) stimulation. manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.

Geriatric Use:

8.5 geriatric use clinical studies of fluocinonide cream did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Overdosage:

10 overdosage topically applied fluocinonide cream can be absorbed in sufficient amounts to produce systemic effects [see warnings and precautions (5.1) ] .

Description:

11 description fluocinonide cream, usp, 0.1% contains fluocinonide, usp, a synthetic corticosteroid for topical dermatologic use. the corticosteroids constitute a class of primarily synthetic steroids used topically as anti-inflammatory and antipruritic agents. fluocinonide, usp has the chemical name 6α, 9-­difluoro-11ß, 16α, 17,21-tetrahydroxypregna-1, 4-diene-3,20-dione, cyclic 16,17-acetal with acetone, 21-acetate. its chemical formula is c 26 h 32 f 2 o 7 and it has a molecular weight of 494.52. it has the following chemical structure: fluocinonide, usp is an almost odorless white to creamy white crystalline powder. it is practically insoluble in water and slightly soluble in ethanol. each gram of fluocinonide cream, usp 0.1% contains 1 mg micronized fluocinonide, usp in a cream base of propylene glycol usp, diethylene glycol monoethyl ether nf, glyceryl stearate (and) peg-100 stearate, glyceryl monostearate nf, purified water usp, carbomer homopolymer type c nf (carbopol 980), diisopropanolamine, and anhydrous citric acid usp. structural formula

Clinical Pharmacology:

12 clinical pharmacology 12.1 mechanism of action corticosteroids play a role in cellular signaling, immune function, inflammation, and protein regulation; however, the precise mechanism of action of fluocinonide cream in corticosteroid responsive dermatoses is unknown. 12.2 pharmacodynamics vasoconstrictor studies performed with fluocinonide cream in healthy subjects indicate that it is in the super-high range of potency as compared with other topical corticosteroids; however, similar blanching scores do not necessarily imply therapeutic equivalence. application of fluocinonide cream twice daily for 14 days in 18 adult subjects with plaque-type psoriasis (10% to 50% bsa, mean 19.6% bsa) and 31 adult subjects (17 treated once daily; 14 treated twice daily) with atopic dermatitis (2% to 10% bsa, mean 5% bsa) showed demonstrable hpa-axis suppression in 2 subjects with psoriasis (with 12% and 25% bsa) and 1 subject with atopic dermatitis (treated once daily, 4% bsa) where the criterion fo
r hpa-axis suppression is a serum cortisol level of less than or equal to 18 micrograms per deciliter 30 minutes after stimulation with cosyntropin (acth 1-24 ) [see warnings and precautions (5.1) ] . hpa-axis suppression following application of fluocinonide cream, 0.1% (once or twice daily) was also evaluated in 123 pediatric patients from 3 months to < 18 years of age with atopic dermatitis (mean bsa range 34.6 % to 40.0 %). hpa-axis suppression was observed in 4 patients in the twice daily groups. follow-up testing 14 days after treatment discontinuation demonstrated a normally responsive hpa axis in all 4 suppressed patients [see warnings and precautions (5.1) and use in specific populations (8.4) ] . 12.3 pharmacokinetics the extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle and the integrity of the epidermal barrier. topical corticosteroids can be absorbed from normal intact skin. inflammation and/or other disease processes in the skin may increase percutaneous absorption.

Mechanism of Action:

12.1 mechanism of action corticosteroids play a role in cellular signaling, immune function, inflammation, and protein regulation; however, the precise mechanism of action of fluocinonide cream in corticosteroid responsive dermatoses is unknown.

Pharmacodynamics:

12.2 pharmacodynamics vasoconstrictor studies performed with fluocinonide cream in healthy subjects indicate that it is in the super-high range of potency as compared with other topical corticosteroids; however, similar blanching scores do not necessarily imply therapeutic equivalence. application of fluocinonide cream twice daily for 14 days in 18 adult subjects with plaque-type psoriasis (10% to 50% bsa, mean 19.6% bsa) and 31 adult subjects (17 treated once daily; 14 treated twice daily) with atopic dermatitis (2% to 10% bsa, mean 5% bsa) showed demonstrable hpa-axis suppression in 2 subjects with psoriasis (with 12% and 25% bsa) and 1 subject with atopic dermatitis (treated once daily, 4% bsa) where the criterion for hpa-axis suppression is a serum cortisol level of less than or equal to 18 micrograms per deciliter 30 minutes after stimulation with cosyntropin (acth 1-24 ) [see warnings and precautions (5.1) ] . hpa-axis suppression following application of fluocinonide cream, 0.1% (once or twice daily) was also evaluated in 123 pediatric patients from 3 months to < 18 years of age with atopic dermatitis (mean bsa range 34.6 % to 40.0 %). hpa-axis suppression was observed in 4 patients in the twice daily groups. follow-up testing 14 days after treatment discontinuation demonstrated a normally responsive hpa axis in all 4 suppressed patients [see warnings and precautions (5.1) and use in specific populations (8.4) ] .

Pharmacokinetics:

12.3 pharmacokinetics the extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle and the integrity of the epidermal barrier. topical corticosteroids can be absorbed from normal intact skin. inflammation and/or other disease processes in the skin may increase percutaneous absorption.

Nonclinical Toxicology:

13 nonclinical toxicology 13.1 carcinogenesis, mutagenesis, impairment of fertility long-term animal studies have not been performed to evaluate the carcinogenic potential of fluocinonide cream because of severe immunosuppression induced in a 13-week dermal rat study. the effects of fluocinonide on fertility have not been evaluated. fluocinonide revealed no evidence of mutagenic or clastogenic potential based on the results of two in vitro genotoxicity tests (ames test and chromosomal aberration assay using human lymphocytes). however, fluocinonide was positive for clastogenic potential when tested in the in vivo mouse micronucleus assay. topical (dermal) application of 0.0003% to 0.03% fluocinonide cream to rats once daily for 13 weeks resulted in a toxicity profile generally associated with long term exposure to corticosteroids including decreased skin thickness, adrenal atrophy, and severe immunosuppression. a noael could not be determined in this study. in addition, topical (dermal
) application of 0.1% fluocinonide cream plus uvr exposure to hairless mice for 13 weeks and 150 to 900 mg/kg/day of 0.1% fluocinonide cream to minipigs (a model which more closely approximates human skin) for 13 weeks produced glucocorticoid-related suppression of the hpa axis, with some signs of immunosuppression noted in the dermal minipig study. although the clinical relevance of the findings in animals to humans is not clear, sustained glucocorticoid-related immune suppression may increase the risk of infection and possibly the risk for carcinogenesis. topical doses of 0% (fluocinonide cream vehicle), 0.0001%, 0.005% and 0.001% fluocinonide cream were evaluated in a 52 week dermal photo-carcinogenicity study (40 weeks of treatment followed by 12 weeks of observation) conducted in hairless albino mice with concurrent exposure to low level ultraviolet radiation. topical treatment with increasing concentrations of fluocinonide cream did not have an adverse effect in this study. the results of this study suggest that topical treatment with fluocinonide cream would not enhance photo-carcinogenesis.

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 potential of fluocinonide cream because of severe immunosuppression induced in a 13-week dermal rat study. the effects of fluocinonide on fertility have not been evaluated. fluocinonide revealed no evidence of mutagenic or clastogenic potential based on the results of two in vitro genotoxicity tests (ames test and chromosomal aberration assay using human lymphocytes). however, fluocinonide was positive for clastogenic potential when tested in the in vivo mouse micronucleus assay. topical (dermal) application of 0.0003% to 0.03% fluocinonide cream to rats once daily for 13 weeks resulted in a toxicity profile generally associated with long term exposure to corticosteroids including decreased skin thickness, adrenal atrophy, and severe immunosuppression. a noael could not be determined in this study. in addition, topical (dermal) application of 0.1% fluo
cinonide cream plus uvr exposure to hairless mice for 13 weeks and 150 to 900 mg/kg/day of 0.1% fluocinonide cream to minipigs (a model which more closely approximates human skin) for 13 weeks produced glucocorticoid-related suppression of the hpa axis, with some signs of immunosuppression noted in the dermal minipig study. although the clinical relevance of the findings in animals to humans is not clear, sustained glucocorticoid-related immune suppression may increase the risk of infection and possibly the risk for carcinogenesis. topical doses of 0% (fluocinonide cream vehicle), 0.0001%, 0.005% and 0.001% fluocinonide cream were evaluated in a 52 week dermal photo-carcinogenicity study (40 weeks of treatment followed by 12 weeks of observation) conducted in hairless albino mice with concurrent exposure to low level ultraviolet radiation. topical treatment with increasing concentrations of fluocinonide cream did not have an adverse effect in this study. the results of this study suggest that topical treatment with fluocinonide cream would not enhance photo-carcinogenesis.

Clinical Studies:

14 clinical studies two adequate and well-controlled efficacy and safety studies of fluocinonide cream have been completed, one in adult subjects with plaque-type psoriasis (table 2), and one in adult subjects with atopic dermatitis (table 3). in each of these studies, subjects with between 2% and 10% body surface area involvement at baseline treated all affected areas either once daily or twice daily with fluocinonide cream for 14 consecutive days. the primary measure of efficacy was the proportion of subjects whose condition was cleared or almost cleared at the end of treatment. the results of these studies are presented in the tables below as percent and number of patients achieving treatment success at week 2. table 2: plaque-type psoriasis in adults fluocinonide cream, once daily (n=107) vehicle, once daily (n=54) fluocinonide cream, twice daily (n=107) vehicle, twice daily (n=55) subjects cleared 0 (0) 0 (0) 6 (6%) 0 (0) subjects achieving treatment success* 19 (18%) 4 (7%) 33 (3
1%) 3 (5%) *cleared or almost cleared table 3: atopic dermatitis in adults fluocinonide cream, once daily (n=109) vehicle, once daily (n=50) fluocinonide cream, twice daily (n=102) vehicle, twice daily (n=52) subjects cleared 11 (10%) 0 (0) 17 (17%) 0 (0) subjects achieving treatment success* 64 (59%) 6 (12%) 58 (57%) 10 (19%) *cleared or almost cleared no efficacy studies have been conducted to compare fluocinonide cream, 0.1% with any other topical corticosteroid product, including fluocinonide cream 0.05%.

How Supplied:

16 how supplied fluocinonide cream, usp 0.1% is white to off-white in color and is supplied in tubes as follows: 30 g (ndc 69238-1271-3) 60 g (ndc 69238-1271-6) 120 g (ndc 69238-1271-2) store at 20° to 25°c (68° to 77°f); excursions permitted between 15° to 30°c (59° to 86°f) [see usp controlled room temperature]. keep the tube tightly closed.

Information for Patients:

17 patient counseling information [see fda-approved patient labeling (patient information) ] patients using fluocinonide cream should receive the following information and instructions. this information is intended to aid in the safe and effective use of this medication. it is not a disclosure of all possible adverse or unintended effects: fluocinonide cream is to be used as directed by the physician. it is for external use only. avoid contact with the eyes. it should not be used on the face, groin, and underarms. fluocinonide cream should not be used for any disorder other than that for which it was prescribed. the treated skin area should not be bandaged or otherwise covered or wrapped, so as to be occlusive unless directed by the physician. patients should report to their physician any signs of local adverse reactions. other corticosteroid-containing products should not be used with fluocinonide cream without first talking to the physician. as with other corticosteroids, therapy sho
uld be discontinued when control is achieved. if no improvement is seen in 2 weeks, the patient should be instructed to contact a physician. the safety of the use of fluocinonide cream for longer than 2 weeks has not been established. patients should be informed to not use more than 60 g per week of fluocinonide cream. do not use more than half of the 120 g tube per week. patients should inform their physicians that they are using fluocinonide cream if surgery is contemplated. patients should wash their hands after applying medication. distributed by: amneal pharmaceuticals llc bridgewater, nj 08807 rev. 12-2017-00

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* Data of this site is collected from www.fda.gov. This page is for informational purposes only. Always consult your physician with any questions you may have regarding a medical condition.