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HIGHLIGHTSOF PRESCRIBING INFORMATION These Highlights Do HIGHLIGHTSOF PRESCRIBING INFORMATION • These highlights do not include all the information needed to use CAMBIA Hypertension: Patients taking some antihypertensive medications may safely and effectively. See full prescribing information for CAMBIA. have impaired response to these therapies when taking NSAIDs. Monitor blood pressure (5.4, 7) CAMBIA® (diclofenac potassium), for oral solution • Heart Failure and Edema: Avoid use of CAMBIA in patients with Initial U.S. Approval: 1988 severe heart failure unless benefits are expected to outweigh risk of worsening heart failure (5.5) WARNING: RISK OF SERIOUS CARDIOVASCULAR • Renal Toxicity: Monitor renal function in patients with renal or AND GASTROINTESTINAL EVENTS hepatic impairment, heart failure, dehydration, or hypovolemia. Avoid See full prescribing information for complete boxed warning use of CAMBIA in patients with advanced renal disease unless benefits are expected to outweigh risk of worsening renal function (5.6) Non-steroidal anti-inflammatory drugs (NSAIDs) cause an increased risk • Anaphylactic Reactions: Seek emergency help if an anaphylactic of serious cardiovascular thrombotic events, including myocardial reaction occurs (5.7) infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use (5.1) • Exacerbation of Asthma Related to Aspirin Sensitivity: CAMBIA is contraindicated in patients with aspirin-sensitive asthma. Monitor patients CAMBIA is contraindicated in the setting of coronary artery bypass with preexisting asthma (without aspirin sensitivity) (5.8) graft (CABG) surgery (4, 5.1) • Serious Skin Reactions: Discontinue CAMBIA at first appearance of skin rash or other signs of hypersensitivity (5.9). NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): events including bleeding, ulceration, and perforation of the stomach or Discontinue and evaluate clinically (5.10) intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a • Medication Overuse Headache: Detoxification may be necessary. (5.11) prior history of peptic ulcer disease and/or GI bleeding are at greater risk • Fetal Toxicity: Limit use of NSAIDs, including Cambia, between about for serious GI events (5.2) 20 to 30 weeks in pregnancy due to the risk of oligohydramnios/fetal renal dysfunction. Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy due to the risks of oligohydramnios/fetal dysfunction and premature closure of the fetal –––––––––––––––––– RECENT MAJOR CHANGES ––––––––––––––––––– ductus arteriosus (5.12, 8.1) Warnings and Precautions (5.10, 5.12) 4/2021 • Hematologic Toxicity: Monitor hemoglobin or hematocrit in patients with any signs or symptoms of anemia (5.13, 7) –––––––––––––––––– INDICATIONS AND USAGE ––––––––––––––––––– CAMBIA is a non-steroidal anti-inflammatory drug (NSAID) indicated for ––––––––––––––––––––– ADVERSE REACTIONS –––––––––––––––––––– the acute treatment of migraine attacks with or without aura in adults 18 Most common adverse reactions (≥1% and >placebo) were nausea and years of age or older (1) dizziness (6.1) Limitations of Use (1): To report SUSPECTED ADVERSE REACTIONS, contact Assertio Therapeutics, Inc. at 866-458-6389 or FDA at 1-800-FDA-1088 or • CAMBIA is not indicated for the prophylactic therapy of migraine www.fda.gov/medwatch. • Safety and effectiveness of CAMBIA not established for cluster headache, which is present in an older, predominantly male population ––––––––––––––––––––– DRUG INTERACTIONS –––––––––––––––––––– –––––––––––––– DOSAGE AND ADMINISTRATION –––––––––––––––– • Drugs that Interfere with Hemostasis (e.g. warfarin, aspirin, Single 50 mg dose; mix single packet contents with 1 to 2 ounces or 2 to 4 SSRIs/SNRIs): Monitor patients for bleeding who are concomitantly tablespoons (30 to 60 mL) of water prior to administration taking CAMBIA with drugs that interfere with hemostasis. Concomitant use of CAMBIA and analgesic doses of aspirin is not generally • Use the lowest effective dose for shortest duration consistent with recommended (7) individual patient treatment goals (2.1) • ACE Inhibitors and ARBs: Concomitant use with CAMBIA in elderly, ––––––––––––– DOSAGE FORMS AND STRENGTHS ––––––––––––––– volume depleted, or those with renal impairment may result in Packets: Each containing buffered diclofenac potassium 50 mg in a soluble deterioration of renal function. In such high risk patients, monitor for powder (3) signs of worsening renal function (7) • Diuretics: NSAIDs can reduce natriuretic effect of loop and thiazide –––––––––––––––––– CONTRAINDICATIONS ––––––––––––––––––––––– diuretics. Monitor patients to assure diuretic efficacy including • Known hypersensitivity to diclofenac or NSAIDs or any components antihypertensive effects (7) of the drug product (4) • Digoxin: Concomitant use with CAMBIA can increase serum • History of asthma, urticaria, or other allergic-type reactions after concentration and prolong half-life of digoxin. Monitor serum digoxin taking aspirin or other NSAIDs (4) levels (7) • In the setting of (CABG) surgery (4) ––––––––––––––– USE IN SPECIFIC POPULATIONS –––––––––––––––– • Infertility: NSAIDs are associated with reversible infertility. Consider ––––––––––––– WARNINGS AND PRECAUTIONS ––––––––––––––– withdrawal of CAMBIA in women who have difficulties conceiving (8.3) • Hepatotoxicity: Inform patients of warning signs and symptoms of hepatotoxicity. Discontinue if abnormal liver tests persist or worsen See 17 for PATIENT COUNSELING INFORMATION and Medication or if clinical signs and symptoms of liver disease develop (5.3, 8.6, Guide 12.3) Revised: 4/2021 Reference ID: 4785347 FULL PRESCRIBING INFORMATION: CONTENTS* 6 ADVERSE REACTIONS WARNING: RISK OF SERIOUS CARDIOVASCULAR AND 6.1 Clinical Trial Experience GASTROINTESTINAL EVENTS 6.2 Postmarketing Experience 1 INDICATIONS AND USAGE 7 DRUG INTERACTIONS 2 DOSAGE AND ADMINISTRATION 8 USE IN SPECIFIC POPULATIONS 2.1 Acute Treatment of Migraine 8.1 Pregnancy 2.2 Non-Interchangeability with Other Formulations of Diclofenac 8.2 Lactation 3 DOSAGE FORMS AND STRENGTHS 8.3 Females and Males of Reproductive Potential 4 CONTRAINDICATIONS 8.4 Pediatric Use 5 WARNINGS AND PRECAUTIONS 8.5 Geriatric Use 5.1 Cardiovascular Thrombotic Events 8.6 Hepatic Impairment 5.2 Gastrointestinal Bleeding, Ulceration, and Perforation 8.7 Renal Impairment 5.3 Hepatotoxicity 10 OVERDOSAGE 5.4 Hypertension 11 DESCRIPTION 5.5 Heart Failure and Edema 12 CLINICALPHARMACOLOGY 5.6 Renal Toxicity and Hyperkalemia 12.1 Mechanism of Action 5.7 Anaphylactic Reactions 12.3 Pharmacokinetics 5.8 Exacerbation of Asthma Related to Aspirin Sensitivity 13 NON-CLINICAL TOXICOLOGY 5.9 Serious Skin Reactions 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.10 Drug Rash with Eosinophilia and Systemic Symptoms 14 CLINICAL STUDIES (DRESS) 16 HOW SUPPLIED/STORAGE AND HANDLING 5.11 Medication Overuse Headache 17 PATIENT COUNSELING INFORMATION 5.12 Fetal Toxicity 5.13 Hematologic Toxicity *Sections or subsections omitted from the full prescribing information 5.14 Masking of Inflammation and Fever are not listed. 5.15 Laboratory Monitoring Reference ID: 4785347 FULL PRESCRIBING INFORMATION WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS Cardiovascular Thrombotic Events • Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use [see Warnings and Precautions (5.1)]. • CAMBIA is contraindicated in the setting of coronary artery bypass graft (CABG) surgery [see Contraindications (4) and Warnings and Precautions (5.1)]. Gastrointestinal Bleeding, Ulceration, and Perforation • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events [see Warnings and Precautions (5.2)]. 1 INDICATIONS AND USAGE CAMBIA is indicated for the acute treatment of migraine attacks with or without aura in adults (18 years of age or older). Limitations of Use • CAMBIA is not indicated for the prophylactic therapy of migraine. • The safety and effectiveness of CAMBIA have not been established for cluster headache, which is present in an older, predominantly male population. 2 DOSAGE AND ADMINISTRATION 2.1 Acute Treatment of Migraine Administer one packet (50 mg) of CAMBIA for the acute treatment of migraine. Empty the contents of one packet into a cup containing 1 to 2 ounces or 2 to 4 tablespoons (30 to 60 mL) of water, mix well and drink immediately. Do not use liquids other than water. Taking CAMBIA with food may cause a reduction in effectiveness compared to taking CAMBIA on an empty stomach [see Clinical Pharmacology (12.3)]. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. The safety and effectiveness of a second dose have not been established. 2.2 Non-Interchangeability with Other Formulations of Diclofenac Different formulations of oral diclofenac (e.g., CAMBIA, diclofenac sodium
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