Pharmaceuticals and Medical Devices Safety Information No. 310 February 2014 Table of Contents 1. Thrombosis with YAZ Combination Tablets for Dysmenorrhea .. 6 2. Rivaroxaban and Interstitial Pneumonia ............................................ 12 3. Direct Patient Reporting System for Adverse Drug Reactions .. 17 4. Important Safety Information ................................................................. 21 1 Atazanavir Sulfate ...................................................................................... 21 2 Crizotinib .................................................................................................... 24 3 Clopidogrel Sulfate-containing Products .................................................... 28 4 Sodium Valproate ...................................................................................... 32 5 Drospirenone/Ethinylestradiol Betadex ...................................................... 35 6 Rivaroxaban ............................................................................................... 36 5. Revision of Precautions (No. 253) ....................................................... 37 Rufinamide (and 8 others) 6. List of Products Subject to Early Post-marketing Phase Vigilance ............................................... 41 This Pharmaceuticals and Medical Devices Safety Information (PMDSI) is issued based on safety information collected by the Ministry of Health, Labour and Welfare (MHLW). It is intended to facilitate safer use of pharmaceuticals and medical devices by healthcare providers. The PMDSI is available on the Pharmaceuticals and Medical Devices Agency (PMDA) Medical Product Information web page (http://www.pmda.go.jp/english/index.html) and on the MHLW website (http://www.mhlw.go.jp/, Only available in Japanese language). Published by Translated by Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency Pharmaceutical and Food Safety Bureau, Office of Safety I, Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-8916 Japan 100-0013 Japan E-mail: [email protected] This English version of PMDSI is intended to be a reference material to provide convenience for users. In the event of inconsistency between the Japanese original and this English translation, the former shall prevail. The PMDA shall not be responsible for any consequence resulting from use of this English version. Pharmaceuticals and Medical Devices Safety Information No. 310 February 2014 Pharmaceutical and Food Safety Bureau, Ministry of Health, Labour and Welfare, Japan [ Outline of Information ] No. Subject Measures Outline of Information Page Fatal cases of thrombosis, in which a causal relationship with YAZ cannot be ruled out, have been reported. The MHLW instructed the Marketing authorization holders (MAHs) to revise Thrombosis with YAZ P Precautions in the package inserts and to distribute 1 Combination Tablets 6 C the Dear Healthcare Professional Letters of Rapid for Dysmenorrhea Safety Communications (Blue Letter) on January 17, 2014. This section provides information included in the Blue Letter. Several cases of interstitial pneumonia, including a fatal case in which a causal relationship with revaroxaban cannot be ruled out, have been Rivaroxaban and P 2 reported. The MHLW instructed MAHs to revise 12 Interstitial Pneumonia C Precautions on February 6, 2014. This section provides information on the revision of Precautions. The PMDA is conducting a pilot project of the Direct Patient Reporting System for Adverse Drug Direct Patient Reactions and started to make submitted reports Reporting System for 3 publicly available. 17 Adverse Drug This section provides information on these reports Reactions and an outline of the Direct Patient Reporting System. Atazanavir Sulfate (and 5 others): Regarding the revision of the Precautions section of package inserts of drugs in accordance with the Notification Important Safety P 4 dated January 7, January17, and February 6, 2014, 21 Information C the contents of important revisions and case summaries that served as the basis for these revisions are provided in this section. Revision of Precautions 5 Rufinamide (and 8 others) 37 (No. 253) List of Products Subject to Early Post- Lists products subject to Early Post-marketing 6 41 marketing Phase Phase Vigilance as of February 1, 2014. Vigilance D: Distribution of Dear Healthcare Professional Letters P: Revision of Precautions C: Case Reports Pharmaceuticals and Medical Devices Safety Information No. 310 - 2 - February 2014 PMDA medi-navi (Pharmaceuticals and Medical Devices Information E-mail Alert Service) The PMDA is providing the “PMDA medi-navi” a Pharmaceuticals and Medical Devices Information E-mail Alert Service (Only available in Japanese language), when important safety information regarding pharmaceuticals and medical devices including Dear Healthcare Professional Letters or Revision of Precautions is issued. This e-mail service will enable you to obtain safety information faster and more efficiently, free of charge. Please feel free to use this service for your faster information collection. See our website for details of the service. http://www.info.pmda.go.jp/info/idx-push.html Reporting of safety information such as adverse reactions to the Minister of Health, Labour and Welfare is a duty of medical and pharmaceutical providers. If medical and pharmaceutical providers such as physicians, dentists, and pharmacists detect adverse reactions, infections associated with drugs or medical devices, or medical device adverse events, it is mandatory for such providers to report them to the Minister of Health, Labour and Welfare directly or through the marketing authorization holder. As medical and pharmaceutical providers, drugstore and pharmacy personnel are also required to report safety issues related to drugs and medical devices. Pharmaceuticals and Medical Devices Safety Information No. 310 - 3 - February 2014 Abbreviations 3TC Lamivudine ABC Abacavir ACE Angiotensin-converting enzyme ADRs Adverse drug reactions ALK Anaplastic lymphoma kinase ALP Alkaline phosphatase ALT (GPT) Alanine aminotransferase (Glutamate pyruvate transaminase) APTT Activated partial thromboplastin time AST (GOT) Aspartate aminotransferase (Glutamate oxaloacetate transaminase) ATV/r Atazanavir/ritonavir AZT Zidovudine BAL Bronchoalveolar lavage BMI Body mass index bpm Beats per minute BUN Blood urea nitrogen C3 Complement 3 C4 Complement 4 CCr Creatinine clearance CD4 Cluster of differentiation 4 CH50 50% hemolytic unit of complement CHDF Continuous hemodiafiltration Cr Creatinine CRP C-reactive protein CT Computed tomography DLST Drug lymphocyte stimulation test ECOG PS Eastern Cooperative Oncology Group Performance status EFV Efavirenz eGFR estimated glomerular filtration rate EPPV Early Post-marketing Phase Vigilance FFP Fresh frozen plasma HAART Highly active antiretroviral therapy HbA1c Hemoglobin A1c HBc-Ab Hepatitis B core antibody HBe-Ab Hepatitis B envelope antibody HBe-Ag Hepatitis B envelope antigen HBs-Ab Hepatitis B surface antibody HBs-Ag Hepatitis B surface antigen HBV-DNA Hepatitis B virus-Deoxyribonucleic acid HCV-RNA Hepatitis C virus-Ribonucleic acid HHV-6 Human herpesvirus 6 HIV-1 Human immunodeficiency virus type 1 HPF High power field HR Heart rate IgA Immunoglobulin A Pharmaceuticals and Medical Devices Safety Information No. 310 - 4 - February 2014 IgE Immunoglobulin E IgG Immunoglobulin G IgM Immunoglobulin M IU International unit JCS Japan Coma Scale KL-6 Sialylated carbohydrate antigen KL-6 (Krebs von den Lunge-6) LAD Left anterior descending coronary artery LDH Lactate dehydrogenase LVEF Left ventricular ejection fraction MAH Marketing authorization holder MRI Magnetic resonance imaging NAG N-acetylglucosaminidase PCI Percutaneous coronary intervention PCR Polymerase chain reaction PLT Platelet PSL Prednisolone PT Prothrombin Time PT-INR Prothrombin time - international normalized ratio RA Radial artery RAHA Rheumatoid arthritis hemagglutinatin RBC Red blood cell RCC Red cell concentrates s-Cr Serum creatinine SP-D Surfactant protein D SpO2 Oxygen saturation TBLB Transbronchial lung biopsy TDF Tenofovir WBC White blood cell β-2MG β-2 microglobulin γ-GTP gamma-glutamyl transpeptidase Pharmaceuticals and Medical Devices Safety Information No. 310 - 5 - February 2014 1 Thrombosis with YAZ Combination Tablets for Dysmenorrhea Brand Name (name of Active ingredient Active ingredient company) Brand Name Drospirenone, ethinylestradiol YAZ Combination Tablets (Bayer (name of company) betadex Yakuhin, Ltd.) Therapeutic Category Mixed hormone preparations Indications Dysmenorrhoea 1. Introduction YAZ Combination Tablets (hereinafter referred to as "YAZ"), which contain 3 mg of drospirenone, a synthetic progestogen, and 0.02 mg of ethinylestradiol, a synthetic estrogen, were approved in Japan for the indication of "Dysmenorrhoea" in July 2010. According to the marketing authorization holder (MAH), it is estimated to be used for approximately 187,000 Women-Year*. Recently, thrombosis has been reported associated with administration of YAZ, leading to fatal outcome in some cases in Japan. As there was a possible lack of appropriate diagnosis and treatment despite the fact that the patients had symptoms suggestive of thrombosis, MHLW instructed the MAH to revise Precautions and distribute Dear Healthcare Professional Letters of Rapid Safety Communication