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PEGASYS Prescribing Information HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use Additional contraindications for use with other HCV antiviral drugs: PEGASYS safely and effectively. See full prescribing information for When used in combination with other HCV antiviral drugs, all PEGASYS. contraindications also apply to PEGASYS combination therapy (4) Ribavirin is contraindicated in pregnant women and men whose female PEGASYS (peginterferon alfa-2a) injection, for subcutaneous use partners are pregnant (4, 8.1) Initial U.S. Approval: 2002 ----------------------- WARNINGS AND PRECAUTIONS ----------------------- WARNING: RISK OF SERIOUS DISORDERS Use with Ribavirin See full prescribing information for complete boxed warning. Birth defects and fetal death: patients must have a negative pregnancy test prior to therapy, use 2 forms of effective contraception, and have monthly Risk of Serious Disorders pregnancy tests (5.1) May cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor closely and PEGASYS Clinically Significant Adverse Reactions or Risks withdraw therapy with persistently severe or worsening signs or Patients exhibiting the following events should be closely monitored and may symptoms of the above disorders (5) require dose reduction or discontinuation of therapy: Neuropsychiatric reactions (5.2) Cardiovascular disorders (5.3) ---------------------------RECENT MAJOR CHANGES --------------------------- Bone marrow suppression (5.4) Dosage and Administration, Preparation and Administration (2.7) 03/2021 Autoimmune and endocrine disorders (including thyroid disorders; hyperglycemia) (5.5, 5.6) --------------------------- INDICATIONS AND USAGE---------------------------- Ophthalmologic disorders (5.7) PEGASYS is an inducer of the innate immune response indicated for the Cerebrovascular disorders (5.8) treatment of Hepatic decompensation in cirrhotic patients. Exacerbation of hepatitis Chronic Hepatitis C (CHC) (1.1) during hepatitis B treatment (5.9) Adult Patients: In combination therapy with other hepatitis C virus drugs Pulmonary disorders (5.10) for adults with compensated liver disease. PEGASYS monotherapy is Infections (bacterial, viral, fungal) (5.11) indicated only if patient has contraindication or significant intolerance to Colitis and pancreatitis (5.12, 5.13) other HCV drugs. Hypersensitivity and serious skin reactions including Stevens-Johnson Pediatric Patients: In combination with ribavirin for pediatric patients 5 syndrome (5.14) years of age and older with compensated liver disease Growth impairment with combination therapy in pediatric patients (5.15) Chronic Hepatitis B (CHB) (1.2) Peripheral neuropathy when used in combination with telbivudine (5.16) Adult Patients: Treatment of adults with HBeAg-positive and HBeAg- negative chronic hepatitis B (CHB) infection who have compensated ------------------------------ ADVERSE REACTIONS ------------------------------ liver disease and evidence of viral replication and liver inflammation Adult subjects: The most common adverse reactions (incidence greater than Pediatric Patients: Treatment of non-cirrhotic pediatric patients 3 years 40%) are fatigue/asthenia, pyrexia, myalgia, and headache (6.1) of age and older with HBeAg-positive CHB and evidence of viral Pediatric subjects: The most common adverse reactions are similar to those replication and elevations in serum alanine aminotransferase (ALT) seen in adults (6.1) -----------------------DOSAGE AND ADMINISTRATION----------------------- To report SUSPECTED ADVERSE REACTIONS, contact Genentech at PEGASYS is administered by subcutaneous injection (2) 1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In adult patients with CHC, PEGASYS is dosed as 180 mcg per week and the duration of treatment depends on indication, genotype, and whether it is ------------------------------ DRUG INTERACTIONS------------------------------- administered with other HCV antiviral drugs (2.2). Drugs metabolized by CYP1A2: monitor for increased serum levels of In adult patients with CHB, PEGASYS is dosed as 180 mcg per week for theophylline and adjust dose accordingly (7.2) 48 weeks (2.4). 2 Methadone: monitor for signs and symptoms of methadone toxicity (7.3) In pediatric patients with CHC, PEGASYS is dosed as 180 mcg/1.73 m x Nucleoside analogues: closely monitor for toxicities. Reduce or discontinue BSA per week, in combination with ribavirin, and the duration of treatment the dose of PEGASYS or ribavirin or both should the events worsen (7.4) depends on genotype (2.3) 2 Zidovudine: monitor for worsening neutropenia and/or anemia with In pediatric patients with CHB, PEGASYS is dosed as 180 mcg/1.73 m x PEGASYS and/or ribavirin (7.4) BSA per week for 48 weeks (2.5): Dosage modification is recommended in patients experiencing certain ----------------------- USE IN SPECIFIC POPULATIONS ----------------------- laboratory abnormalities, adverse reactions or renal impairment (2.6, 12.3) Pediatric patients: Safety and efficacy in CHC pediatric patients less than 5 years old and CHB pediatric patients less than 3 years old have not been --------------------- DOSAGE FORMS AND STRENGTHS---------------------- established (8.4) Injection (all presentations below are single-dose): Geriatric patients: Neuropsychiatric, cardiac, and systemic (flu-like) 180 mcg/mL in a Vial (3) adverse reactions may be more severe (8.5) 180 mcg/0.5 mL in a Prefilled Syringe (3) Patients with hepatic impairment: Clinical status and hepatic function should be closely monitored and treatment should be immediately ------------------------------ CONTRAINDICATIONS ------------------------------ discontinued if decompensation occurs (8.6) Autoimmune hepatitis (4) Patients with renal impairment: PEGASYS dose should be reduced in Hepatic decompensation in patients with cirrhosis (4) patients with creatinine clearance less than 30 mL/min (2.6, 8.7) Use in neonates/infants (4) CHB: Safety and efficacy have not been established in hepatitis B patients Known hypersensitivity reactions such as urticaria, angioedema, coinfected with HCV or HIV (8.9) bronchoconstriction and anaphylaxis to alpha interferons or any component of the product (4) See 17 for PATIENT COUNSELING INFORMATION and FDA- approved Medication Guide. Revised: 03/2021 _____________________________________________________________________________________________________________________________________ 1 FULL PRESCRIBING INFORMATION: CONTENTS* 7 DRUG INTERACTIONS WARNING: RISK OF SERIOUS DISORDERS 7.1 Drugs Metabolized by Cytochrome P450 1 INDICATIONS AND USAGE 7.2 Theophylline 1.1 Chronic Hepatitis C (CHC) 7.3 Methadone 1.2 Chronic Hepatitis B (CHB) 7.4 Nucleoside Analogues 2 DOSAGE AND ADMINISTRATION 8 USE IN SPECIFIC POPULATIONS 2.1 Dosage Overview 8.1 Pregnancy 2.2 Recommended Dosage for Adults with CHC 8.2 Lactation 2.3 Recommended Dosage for Pediatric Patients with CHC 8.3 Females and Males of Reproductive Potential 2.4 Recommended Dosage for Adults with CHB 8.4 Pediatric Use 2.5 Recommended Dosage for Pediatric Patients with CHB 8.5 Geriatric Use 2.6 Dosage Modifications 8.6 Hepatic Impairment 2.7 Preparation and Administration 8.7 Renal Impairment 3 DOSAGE FORMS AND STRENGTHS 8.8 Organ Transplant Recipients 4 CONTRAINDICATIONS 8.9 Chronic Hepatitis B 5 WARNINGS AND PRECAUTIONS 10 OVERDOSAGE 5.1 Pregnancy: Use with Ribavirin 11 DESCRIPTION 5.2 Neuropsychiatric Reactions 12 CLINICAL PHARMACOLOGY 5.3 Cardiovascular Disorders 12.1 Mechanism of Action 5.4 Bone Marrow Suppression 12.2 Pharmacodynamics 5.5 Autoimmune Disorders 12.3 Pharmacokinetics 5.6 Endocrine Disorders 12.4 Microbiology 5.7 Ophthalmologic Disorders 13 NONCLINICAL TOXICOLOGY 5.8 Cerebrovascular Disorders 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.9 Hepatic Failure and Hepatitis Exacerbations 14 CLINICAL STUDIES 5.10 Pulmonary Disorders 14.1 Chronic Hepatitis C Studies 1, 2, and 3: PEGASYS/COPEGUS 5.11 Infections Combination Therapy 5.12 Colitis 14.2 Chronic Hepatitis C and Coinfection with HIV (CHC/HIV) 5.13 Pancreatitis Study 4: PEGASYS Monotherapy and PEGASYS/COPEGUS 5.14 Hypersensitivity Combination Therapy 5.15 Impact on Growth in Pediatric Patients 14.3 Chronic Hepatitis C Studies 5, 6 and 7: PEGASYS Monotherapy 5.16 Peripheral Neuropathy 14.4 Chronic Hepatitis B Studies 8, 9 and 10: PEGASYS Monotherapy 5.17 Laboratory Tests 16 HOW SUPPLIED/STORAGE AND HANDLING 6 ADVERSE REACTIONS 17 PATIENT COUNSELING INFORMATION 6.1 Clinical Trials Experience 6.2 Immunogenicity *Sections or subsections omitted from the full prescribing information are not 6.3 Postmarketing Experience listed _____________________________________________________________________________________________________________________________________ 2 FULL PRESCRIBING INFORMATION WARNING: RISK OF SERIOUS DISORDERS Risk of Serious Disorders Alpha interferons, including PEGASYS (peginterferon alfa-2a), may cause or aggravate fatal or life- threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Patients should be monitored closely with periodic clinical and laboratory evaluations. Therapy should be withdrawn in patients with persistently severe or worsening signs or symptoms of these conditions. In many, but not all cases, these disorders resolve after stopping PEGASYS therapy [see Warnings and Precautions (5.2, 5.5, 5.8, 5.11, 5.14, 5.16), Adverse Reactions (6.1) and Nonclinical Toxicology (13.1)].
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