FAMCICLOVIR: Package Insert and Label Information

FAMCICLOVIR- famciclovir tablet
Proficient Rx LP

1 INDICATIONS AND USAGE

1.1 Immunocompetent Adult Patients

Herpes labialis (cold sores): Famciclovir tablets are indicated for the treatment of recurrent herpes labialis.

Genital herpes:

Recurrent episodes: Famciclovir tablets are indicated for the treatment of recurrent episodes of genital herpes. The efficacy of famciclovir tablets when initiated more than 6 hours after onset of symptoms or lesions has not been established.

Suppressive therapy: Famciclovir tablets are indicated for chronic suppressive therapy of recurrent episodes of genital herpes. The efficacy and safety of famciclovir tablets for the suppression of recurrent genital herpes beyond 1 year have not been established.

Herpes zoster (shingles): Famciclovir tablets are indicated for the treatment of herpes zoster. The efficacy of famciclovir tablets when initiated more than 72 hours after onset of rash has not been established.

1.2 HIV-Infected Adult Patients

Recurrent orolabial or genital herpes: Famciclovir tablets are indicated for the treatment of recurrent episodes of orolabial or genital herpes in HIV-infected adults. The efficacy of famciclovir tablets when initiated more than 48 hours after onset of symptoms or lesions has not been established.

1.3 Limitation of Use

The efficacy and safety of famciclovir tablets have not been established for:

• Patients <18 years of age

• Patients with first episode of genital herpes

Patients with ophthalmic zoster

• Immunocompromised patients other than for the treatment of recurrent orolabial or genital herpes in HIV-infected patients

• Black and African American patients with recurrent genital herpes

2 DOSAGE AND ADMINISTRATION

Famciclovir tablets may be taken with or without food.

2.1 Dosing Recommendation in Immunocompetent Adult Patients

Herpes labialis (cold sores): The recommended dosage of famciclovir tablets for the treatment of recurrent herpes labialis is 1500 mg as a single dose. Therapy should be initiated at the first sign or symptom of herpes labialis (e.g., tingling, itching, burning, pain, or lesion).

Genital herpes:

Recurrent episodes: The recommended dosage of famciclovir tablets for the treatment of recurrent episodes of genital herpes is 1000 mg twice daily for 1 day. Therapy should be initiated at the first sign or symptom of a recurrent episode (e.g., tingling, itching, burning, pain, or lesion).

Suppressive therapy: The recommended dosage of famciclovir tablets for chronic suppressive therapy of recurrent episodes of genital herpes is 250 mg twice daily.

Herpes zoster (shingles): The recommended dosage of famciclovir tablets for the treatment of herpes zoster is 500 mg every 8 hours for 7 days. Therapy should be initiated as soon as herpes zoster is diagnosed.

2.2 Dosing Recommendation in HIV-Infected Adult Patients

Recurrent orolabial or genital herpes: The recommended dosage of famciclovir tablets for the treatment of recurrent orolabial or genital herpes in HIV-infected patients is 500 mg twice daily for 7 days. Therapy should be initiated at the first sign or symptom of a recurrent episode (e.g., tingling, itching, burning, pain, or lesion).

2.3 Dosing Recommendation in Patients with Renal Impairment

Dosage recommendations for adult patients with renal impairment are provided in Table 1 [see Use in Specific Populations (8.6), Clinical Pharmacology (12.3)].

Table 1 Dosage Recommendations for Adult Patients with Renal Impairment
* Hemodialysis.

Indication and Normal Dosage Regimen

Creatinine Clearance (mL/min)

Adjusted Dosage Regimen Dose (mg)

Dosing Interval

Single-Day Dosing Regimens

Recurrent Genital Herpes1000 mg every 12 hours for 1 day

≥60

1000

every 12 hours for 1 day

40-59

500

every 12 hours for 1 day

20-39

500

single dose

<20

250

single dose

HD*

250

single dose following dialysis

Recurrent Herpes Labialis1500 mg single dose

≥60

1500

single dose

40-59

750

single dose

20-39

500

single dose

<20

250

single dose

HD*

250

single dose following dialysis

Multiple-Day Dosing Regimens

Herpes zoster500 mg every 8 hours

≥60

500

every 8 hours

40-59

500

every 12 hours

20-39

500

every 24 hours

<20

250

every 24 hours

HD*

250

following each dialysis

Suppression of Recurrent Genital Herpes 250 mg every 12 hours

≥40

250

every 12 hours

20-39

125

every 12 hours

<20

125

every 24 hours

HD*

125

following each dialysis

Recurrent Orolabial or Genital Herpes in HIV-Infected Patients 500 mg every 12 hours

≥40

500

every 12 hours

20-39

500

every 24 hours

<20

250

every 24 hours

HD*

250

following each dialysis

3 DOSAGE FORMS AND STRENGTHS

Famciclovir tablets are available in 3 strengths:

• 125 mg: White coloured, circular, film-coated, biconvex tablet debossed with ‘C’ and’269′ on one side and plain on other side.

• 250 mg: White coloured, circular, film-coated, biconvex tablet debossed with ‘C’ and ‘271’ on one side and plain on other side.

• 500 mg: White coloured, capsule shaped, film-coated, biconvex tablets debossed with ‘C272’ on one side and plain on other side.

4 CONTRAINDICATIONS

Famciclovir tablets are contraindicated in patients with known hypersensitivity to the product, its components, or penciclovir cream.

5 WARNINGS AND PRECAUTIONS

Acute renal failure: Cases of acute renal failure have been reported in patients with underlying renal disease who have received inappropriately high doses of famciclovir for their level of renal function. Dosage reduction is recommended when administering famciclovir to patients with renal impairment [see Dosage and Administration (2.3), Use in Specific Populations (8.6)].

6 ADVERSE REACTIONS

Acute renal failure is discussed in greater detail in other sections of the label [see Warnings and Precautions (5)].

The most common adverse events reported in at least 1 indication by >10% of adult patients treated with famciclovir are headache and nausea.

6.1 Clinical Trials Experience in Adult Patients

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Immunocompetent patients: The safety of famciclovir has been evaluated in active-and placebo-controlled clinical studies involving 816 famciclovir-treated patients with herpes zoster (famciclovir, 250 mg three times daily to 750 mg three times daily); 163 famciclovir -treated patients with recurrent genital herpes (famciclovir, 1000 mg twice daily); 1,197 patients with recurrent genital herpes treated with famciclovir as suppressive therapy (125 mg once daily to 250 mg three times daily) of which 570 patients received famciclovir (open-labeled and/or double-blind) for at least 10 months; and 447 famciclovir -treated patients with herpes labialis (famciclovir, 1500 mg once daily or 750 mg twice daily). Table 2 lists selected adverse events.

Table 2 Selected Adverse Events (all grades and without regard to causality) Reported by ≥2% of Patients in Placebo-Controlled Famciclovir Tablets Trials*
* Patients may have entered into more than one clinical trial.
7 days of treatment
1 day of treatment
§ daily treatment

Incidence

Events

Herpes Zoster †

Recurrent Genital Herpes

Genital Herpes- Suppression§

Herpes Labialis

Famciclovir (n=273) %

Placebo (n=146) %

Famciclovir (n=163) %

Placebo (n=166) %

Famciclovir (n=458) %

Placebo (n=63) %

Famciclovir (n=447) %

Placebo (n=254) %

Nervous System

Headache

22.7

17.8

13.5

5.4

39.3

42.9

8.5

6.7

Paresthesia

2.6

0.0

0.0

0.0

0.9

0.0

0.0

0.0

Migraine

0.7

0.7

0.6

0.6

3.1

0.0

0.2

0.0

Gastrointestinal

Nausea

12.5

11.6

2.5

3.6

7.2

9.5

2.2

3.9

Diarrhea

7.7

4.8

4.9

1.2

9.0

9.5

1.6

0.8

Vomiting

4.8

3.4

1.2

0.6

3.1

1.6

0.7

0.0

Flatulence

1.5

0.7

0.6

0.0

4.8

1.6

0.2

0.0

Abdominal Pain

1.1

3.4

0.0

1.2

7.9

7.9

0.2

0.4

Body as a Whole

Fatigue

4.4

3.4

0.6

0.0

4.8

3.2

1.6

0.4

Skin and Appendages

Pruritus

3.7

2.7

0.0

0.6

2.2

0.0

0.0

0.0

Rash

0.4

0.7

0.0

0.0

3.3

1.6

0.0

0.0

Reproductive (Female)

Dysmenorrhea

0.0

0.7

1.8

0.6

7.6

6.3

0.4

0.0

Table 3 lists selected laboratory abnormalities in genital herpes suppression trials.

Table 3 Selected Laboratory Abnormalities in Genital Herpes Suppression Studies*
*Percentage of patients with laboratory abnormalities that were increased or decreased from baseline and were outside of specified ranges.
†n values represent the minimum number of patients assessed for each laboratory parameter.
NRH=Normal Range High.
NRL=Normal Range Low.

Parameter

Famciclovir (n=660) %

Placebo (n=210) %

Anemia (<0.8 x NRL)

0.1

0.0

Leukopenia (<0.75 x NRL)

1.3

0.9

Neutropenia (<0.8 x NRL)

3.2

1.5

AST (SGOT) (>2 x NRH)

2.3

1.2

ALT (SGPT) (>2 x NRH)

3.2

1.5

Total Bilirubin (>1.5 x NRH)

1.9

1.2

Serum Creatinine (>1.5 x NRH)

0.2

0.3

Amylase (>1.5 x NRH)

1.5

1.9

Lipase (>1.5 x NRH)

4.9

4.7

HIV-infected patients: In HIV-infected patients, the most frequently reported adverse events for famciclovir (500 mg twice daily; n=150) and acyclovir (400 mg, 5x/day; n=143), respectively, were headache (17% vs. 15%), nausea (11% vs. 13%), diarrhea (7% vs. 11%), vomiting (5% vs. 4%), fatigue (4% vs. 2%), and abdominal pain (3% vs. 6%).

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