HIGHLIGHTS OF PRESCRIBING INFORMATION • Dose patients weighing more than 60 kg according to adult recommendations These highlights do not include all the information needed to use SABRIL (2.2) safely and effectively. See full prescribing information for SABRIL. Infantile Spasms • Initiate at a daily dose of 50 mg/kg (25 mg/kg twice daily); increase total SABRIL® (vigabatrin) tablets, for oral use daily dose every 3 days, in increments of 25 mg/kg/day to 50 mg/kg/day, up SABRIL® (vigabatrin) powder for oral solution to a maximum daily dose of 150 mg/kg (75 mg/kg twice daily) (2.3) Initial U.S. Approval: 2009 Renal Impairment: Dose adjustment recommended (2.4, 8.5, 8.6) WARNING: PERMANENT VISION LOSS -------------------DOSAGE FORMS AND STRENGTHS------------------- See full prescribing information for complete boxed warning. • Tablet: 500 mg (3) • SABRIL can cause permanent bilateral concentric visual field • Powder for Oral Solution: 500 mg (3) constriction, including tunnel vision that can result in disability. In some ----------------------------CONTRAINDICATIONS---------------------------- cases, SABRIL may also decrease visual acuity (5.1). None (4) • Risk increases with increasing dose and cumulative exposure, but there is no dose or exposure to SABRIL known to be free of risk of vision loss ----------------------WARNINGS AND PRECAUTIONS--------------------- (5.1). • Abnormal MRI signal changes and intramyelinic edema have been reported • Risk of new and worsening vision loss continues as long as SABRIL is in some infants with Infantile Spasms receiving SABRIL (5.3, 5.4) used, and possibly after discontinuing SABRIL (5.1). • Suicidal behavior and ideation: Antiepileptic drugs, including SABRIL, • Baseline and periodic vision assessment is recommended for patients on increase the risk of suicidal thoughts and behavior (5.5) SABRIL. However, this assessment cannot always prevent vision • Withdrawal of AEDs: Taper dose to avoid withdrawal seizures (5.6) damage (5.1). • Anemia: Monitor for symptoms of anemia (5.7) • SABRIL is available only through a restricted program called the • Somnolence and fatigue: Advise patients not to drive or operate machinery Vigabatrin REMS Program (5.2). until they have gained sufficient experience on SABRIL (5.8) --------------------------RECENT MAJOR CHANGES-------------------------- -----------------------------ADVERSE REACTIONS----------------------------- Indications and Usage (1.1) 1/2020 Refractory Complex Partial Seizures Dosage and Administration (2.1, 2.2, 2.4, 2.5) 1/2020 Most common adverse reactions in controlled studies include (incidence ≥5% Warnings and Precautions (5.3) 1/2020 over placebo): Warnings and Precautions (5.4) 7/2019 • Adults: blurred vision, somnolence, dizziness, abnormal coordination, tremor, and fatigue (6.1) ---------------------------INDICATIONS AND USAGE--------------------------- • Pediatric patients (3 to 16 years of age): weight gain (6.1) SABRIL is indicated for the treatment of: Infantile Spasms (incidence >5% and greater than on placebo) • Refractory Complex Partial Seizures as adjunctive therapy in patients 2 years • Somnolence, bronchitis, ear infection, and acute otitis media (6.1) of age and older who have responded inadequately to several alternative treatments; SABRIL is not indicated as a first line agent (1.1) To report SUSPECTED ADVERSE REACTIONS, contact Lundbeck at • Infantile Spasms - monotherapy in infants 1 month to 2 years of age for 1-800-455-1141 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. whom the potential benefits outweigh the potential risk of vision loss (1.2) ------------------------------DRUG INTERACTIONS----------------------------- ---------------------DOSAGE AND ADMINISTRATION---------------------- Decreased phenytoin plasma levels: dosage adjustment may be needed (7.1) Refractory Complex Partial Seizures • Adults (17 years of age and older): Initiate at 1000 mg/day (500 mg twice ----------------------USE IN SPECIFIC POPULATIONS----------------------- daily); increase total daily dose weekly in 500 mg/day increments, to the • Pregnancy: Based on animal data, may cause fetal harm (8.1) recommended dose of 3000 mg/day (1500 mg twice daily) (2.2) • Lactation: SABRIL is excreted in human milk (8.2) • Pediatric (2 to 16 years of age): The recommended dosage is based on body weight and administered as two divided doses (2.2) See 17 for PATIENT COUNSELING INFORMATION and Medication • The dosage may be increased in weekly intervals, depending on response Guide. (2.2) Revised: 1/2020 FULL PRESCRIBING INFORMATION: CONTENTS* 7.1 Antiepileptic Drugs 7.2 Oral Contraceptives WARNING: PERMANENT VISION LOSS 7.3 Drug-Laboratory Test Interactions 1 INDICATIONS AND USAGE 8 USE IN SPECIFIC POPULATIONS 1.1 Refractory Complex Partial Seizures (CPS) 8.1 Pregnancy 1.2 Infantile Spasms (IS) 8.2 Lactation 2 DOSAGE AND ADMINISTRATION 8.4 Pediatric Use 2.1 Important Dosing and Administration Instructions 8.5 Geriatric Use 2.2 Refractory Complex Partial Seizures 8.6 Renal Impairment 2.3 Infantile Spasms 9 DRUG ABUSE AND DEPENDENCE 2.4 Patients with Renal Impairment 9.1 Controlled Substance 2.5 Preparation and Administration Instructions for SABRIL Powder for 9.2 Abuse Oral Solution 9.3 Dependence 3 DOSAGE FORMS AND STRENGTHS 10 OVERDOSAGE 4 CONTRAINDICATIONS 10.1 Signs, Symptoms, and Laboratory Findings of Overdosage 5 WARNINGS AND PRECAUTIONS 10.2 Management of Overdosage 5.1 Permanent Vision Loss 11 DESCRIPTION 5.2 Vigabatrin REMS Program 12 CLINICAL PHARMACOLOGY 5.3 Magnetic Resonance Imaging (MRI) Abnormalities in Infants 12.1 Mechanism of Action 5.4 Neurotoxicity 12.2 Pharmacodynamics 5.5 Suicidal Behavior and Ideation 12.3 Pharmacokinetics 5.6 Withdrawal of Antiepileptic Drugs (AEDs) 13 NONCLINICAL TOXICOLOGY 5.7 Anemia 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.8 Somnolence and Fatigue 14 CLINICAL STUDIES 5.9 Peripheral Neuropathy 14.1 Complex Partial Seizures 5.10 Weight Gain 14.2 Infantile Spasms 5.11 Edema 16 HOW SUPPLIED/STORAGE AND HANDLING 6 ADVERSE REACTIONS 16.1 How Supplied 6.1 Clinical Trial Experience 16.2 Storage and Handling 6.2 Postmarketing Experience 17 PATIENT COUNSELING INFORMATION 7 DRUG INTERACTIONS * Sections or subsections omitted from the full prescribing information are not listed. Page 2 of 26 FULL PRESCRIBING INFORMATION WARNING: PERMANENT VISION LOSS • SABRIL can cause permanent bilateral concentric visual field constriction, including tunnel vision that can result in disability. In some cases, SABRIL also can damage the central retina and may decrease visual acuity [see Warnings and Precautions (5.1)]. • The onset of vision loss from SABRIL is unpredictable, and can occur within weeks of starting treatment or sooner, or at any time after starting treatment, even after months or years. • Symptoms of vision loss from SABRIL are unlikely to be recognized by patients or caregivers before vision loss is severe. Vision loss of milder severity, while often unrecognized by the patient or caregiver, can still adversely affect function. • The risk of vision loss increases with increasing dose and cumulative exposure, but there is no dose or exposure known to be free of risk of vision loss. • Vision assessment is recommended at baseline (no later than 4 weeks after starting SABRIL), at least every 3 months during therapy, and about 3 to 6 months after the discontinuation of therapy. • Once detected, vision loss due to SABRIL is not reversible. It is expected that, even with frequent monitoring, some patients will develop severe vision loss. • Consider drug discontinuation, balancing benefit and risk, if vision loss is documented. • Risk of new or worsening vision loss continues as long as SABRIL is used. It is possible that vision loss can worsen despite discontinuation of SABRIL. • Because of the risk of vision loss, SABRIL should be withdrawn from patients with refractory complex partial seizures who fail to show substantial clinical benefit within 3 months of initiation and within 2-4 weeks of initiation for patients with infantile spasms, or sooner if treatment failure becomes obvious. Patient response to and continued need for SABRIL should be periodically reassessed. • SABRIL should not be used in patients with, or at high risk of, other types of irreversible vision loss unless the benefits of treatment clearly outweigh the risks. • SABRIL should not be used with other drugs associated with serious adverse ophthalmic effects such as retinopathy or glaucoma unless the benefits clearly outweigh the risks. • Use the lowest dosage and shortest exposure to SABRIL consistent with clinical objectives [see Dosage and Administration (2.1)]. Because of the risk of permanent vision loss, SABRIL is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the Vigabatrin REMS Program [see Warnings and Precautions (5.2)]. Further information is available at www.vigabatrinREMS.com or 1-866-244-8175. 1 INDICATIONS AND USAGE 1.1 Refractory Complex Partial Seizures (CPS) SABRIL is indicated as adjunctive therapy for adults and pediatric patients 2 years of age and older with refractory complex partial seizures who have inadequately responded to several alternative treatments and for whom the potential benefits outweigh the risk of vision loss [see Warnings and Precautions (5.1)]. SABRIL is not indicated as a first line agent for complex partial seizures. 1.2 Infantile Spasms (IS) SABRIL is indicated as monotherapy for pediatric patients with infantile spasms 1 month to