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FDA Drug Warnings - April 2024

axicabtagene ciloleucel

Yescarta

tisagenlecleucel

Kymriah

NEW WARNING

The FDA has required prescribing information for B-cell maturation antigen (BCMA)-directed and CD19-directed genetically modified autologous chimeric antigen receptor T-cell immunotherapies to be revised to include a Boxed Warning related to the risk of T-cell malignancies. The warning states that T-cell malignancies have occurred after treatment with these immunotherapies and that serious outcomes, including hospitalization and death, have occurred.

Health care providers are directed to provide lifelong monitoring of patients for secondary malignancies, including T-cell malignancies, after treatment with BCMA- and CD19-directed genetically modified autologous T-cell immunotherapies. Patients should be advised of the risk for secondary malignancies and that lifelong monitoring is necessary.

Adverse effects from the use of BCMA- and CD19-directed genetically modified autologous T-cell immunotherapies should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.

Released: April 2024

Nursing Drug Handbook

© 2024 Wolters Kluwer

Drug Warnings Archive

FDA Drug Warnings - April 2024
axicabtagene ciloleucelYescartatisagenlecleucelKymriahNEW WARNINGThe FDA has required prescribing information for B-cell maturation antigen (BCMA)-directed and CD19-directed genetically modified autologous chimeric antigen receptor T-cell immunotherapies to be revised to include a Boxed Warning related to the risk of T-cell malignancies. The warning states that T-cell malignancies have occurred after treatment with these immunotherapies and that serious outcomes, including hospitalization and death, have occurred.Health care providers are directed to provide lifelong monitoring of patients for secondary malignancies, including T-cell malignancies, after treatment with BCMA- and CD19-directed genetically modified autologous T-cell immunotherapies. Patients should be advised of the risk for secondary malignancies and that lifelong monitoring is necessary.Adverse effects from the use of BCMA- and CD19-directed genetically modified autologous T-cell immunotherapies should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: April 2024Nursing Drug Handbook© 2024 Wolters Kluwer
FDA Drug Warnings - March 2024
denosumabProliaNEW WARNINGThe FDA is requiring the prescribing information for denosumab (Prolia) include a Boxed Warning stating that Prolia increases the risk of severe hypocalcemia in patients with advanced chronic kidney disease (CKD), especially those patients on dialysis. Hypocalcemia resulting in hospitalization, life-threatening events and death have occurred. Chronic kidney disease–mineral bone disorder (CKD–MBD) markedly increases the risk of hypocalcemia.Symptoms of severe hypocalcemia can include confusion, seizures, irregular heart rhythm, fainting, facial twitching, uncontrolled muscle spasms, or weakness, tingling or numbness. However, some patients may be asymptomatic.Health care providers should evaluate patients with advanced CKD for CKD–MBD before the start of treatment. Treatment with Prolia in patients with advanced CKD should be supervised by a health care provider with expertise in the diagnosis and management of CKD–MBD. Patients should be prescribed an adequate intake of calcium and vitamin D during treatment and taught to monitor for and report symptoms of hypocalcemia. Calcium levels should be monitored closely, and hypocalcemia corrected prior to and during treatment.Adverse effects from the use of Prolia should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: March 2024Nursing Drug Handbook© 2024 Wolters Kluwer
FDA Drug Warnings - February 2024
clobazam and levetiracetamVarious manufacturersNEW WARNINGThe FDA has issued a drug safety communication to alert patients and health care professionals to the risk of drug reactions with eosinophilia and systemic symptoms (DRESS) associated with the use of antiseizure medications clobazam (Onafi, Sympazan) and levetiracetam (Keppra, Keppra XR, Elepsia XR, Spritam). The occurrence of DRESS is rare but serious and can become life-threatening if not identified and treated promptly. It can start as a rash and quickly progress, causing liver, kidney, lung, heart, or pancreas injury; hospitalization; and death.Health care professionals should monitor for DRESS (facial swelling, fever, rash, swollen lymph nodes, painful oral sores or sores around the eyes, sore throat, trouble swallowing or breathing, unusual bruising or bleeding, severe weakness or fatigue, or severe muscle pain). Signs and symptoms often begin 2 to 8 weeks after initiation of the drug. Symptoms and their severity can widely vary. Patients should be instructed to watch for signs and symptoms of DRESS and to stop the drug and seek immediate medical attention for suspected DRESS.Adverse effects from the use of clobazam or levetiracetam should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: February 2024Nursing Drug Handbook© 2024 Wolters Kluwer
FDA Drug Warnings - June 2023
onasemnogene abeparvovec-xioiZolgensmaNEW WARNINGThe FDA has required the Boxed Warning in the prescribing information for onasemnogene abeparvovec-xioi be expanded to include that the drug may cause acute liver failure with fatal outcomes. In addition, assessments of liver function by clinical exam and blood work (AST, ALT, total bilirubin, PT) should occur before the infusion and continue to be monitored for at least 3 months after infusion and as clinically indicated.  Adverse effects from the use of onasemnogene abeparvovec-xioi should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: June 2023Nursing Drug Handbook© 2023 Wolters Kluwer  opioid drug classVarious manufacturersNEW WARNINGThe FDA has issued a Drug Safety Communication regarding all opioid medications. The FDA is requiring updates to the prescribing information for all opioid pain medications to provide additional guidance for safe use. Opioid medications include:buprenorphinebutorphanol tartratecodeine phosphate–acetaminophencodeine sulfatebutalbital–acetaminophen–caffeine–codeine–phosphate butalbital–aspirin–caffeine–codeine phosphatefentaNYL citrateHYDROcodone bitartrateHYDROcodone bitartrate–acetaminophenHYDROcodone bitartrate–ibuprofenHYDROmorphone hydrochloridemeperidine hydrochloridemethadone hydrochloridemorphine hydrochloridenalbuphine hydrochlorideoliceridineoxyCODONEoxyCODONE hydrochlorideoxyCODONE hydrochloride–acetaminophenoxyCODONE hydrochloride–aspirinoxyMORphone hydrochlorideSUFentaniltapentadol hydrochloridetraMADol hydrochloridetraMADol hydrochloride–acetaminophen Highlights of the changes include that the prescribing information should state: the risk of overdose increases as the dosage increases for all opioid medications.immediate-release formulations shouldn't be used for an extended time unless the individual patient's pain remains severe enough to require them and alternative treatment options aren't providing relief.for acute pain, immediate-release formulations may only be needed for a few days.extended-release or long-acting formulations should be reserved for severe and persistent pain that requires a daily opioid for an extended time and that they shouldn't be used on an as-needed basis.opioids may cause opioid-induced hyperalgesia (OIH), symptoms of which include increased pain level with opioid dose increase, decreased pain level with opioid dose reduction or pain from ordinarily nonpainful stimuli without underlying disease progression, opioid tolerance or withdrawal, or addictive behavior. If OIH is suspected, the opioid dose should be decreased, or the patient switched to an alternative opioid. The Drug Safety Communication includes that health care providers should encourage patients to read the Medication Guide they receive with their filled prescription in addition to teaching the patient safe drug administration, storage, and disposal.  Adverse effects from the use of opioids should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: June 2023Nursing Drug Handbook© 2023 Wolters Kluwer
FDA Drug Warnings - January 2023
denosumabProliaNEW WARNINGThe FDA released a Drug Safety Communication to alert health care providers and patients on dialysis that denosumab may increase the risk of hypocalcemia. Severe and symptomatic hypocalcemia, including episodes requiring hospitalization and leading to death, have occurred. Prescribers should consider the risks of hypocalcemia before use in this patient population. Adequate calcium and vitamin D supplementation and frequent blood calcium monitoring may help decrease the likelihood or severity of these risks.Patients on dialysis should be advised to immediately seek help if they experience symptoms of hypocalcemia such as unusual tingling or numbness in the hands, arms, legs, or feet; painful muscle spasms or cramps; laryngeal or lung spasms causing difficulty breathing; vomiting; seizures; or irregular heart rhythm.Adverse effects from the use of denosumab should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787. Released: January 2023Nursing Drug Handbook© 2023 Wolters Kluwer
FDA Drug Warnings - June 2022
buprenorphineTransmucosal (buccal film or sublingual) NEW WARNINGThe FDA has published a Drug Safety Communication warning that dental problems have occurred with use of buprenorphine products that are dissolved in the mouth. Tooth decay, cavities, oral infections, and loss of teeth have been reported, even in patients with no history of dental issues. The FDA is requiring a warning be added to buprenorphine prescribing information.Prior to use of the transmucosal products, the health care provider should obtain an oral health history and refer patients to a dentist as soon as possible after starting the drug for a baseline dental evaluation, caries risk assessment, and caries preventative plan, and to encourage regular dental follow up.Patients using the transmucosal formulations should be instructed to allow the drug to completely dissolve then gently rinse their teeth and gums with water and swallow the water. Patients should wait at least one hour before brushing their teeth.Adverse effects from the use of transmucosal buprenorphine should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: June 2022Nursing Drug Handbook© 2022 Wolters Kluwer
FDA Drug Warnings - February 2022
Janus kinase (JAK) inhibitorsVarious manufacturersNEW WARNINGThe FDA has issued a Drug Safety Communication to inform patients and health care providers that the Boxed Warning in the prescribing information for JAK inhibitors indicated for the treatment of arthritis and other inflammatory conditions is being revised.JAK inhibitors include baricitinib (Olumiant), tofacitinib (Xeljanz and Xeljanz XR), and upadacitinib (Rinvoq).The Boxed Warning information related to the risks of serious heart-related events, cancer, blood clots, and death must state that health care providers should consider the benefits and risk for each patient prior to starting or continuing therapy with baricitinib, tofacitinib, and upadacitinib. The risks of these events are increased in patients who are current or past smokers, those with other CV risk factors, those who develop a malignancy, and those with a known malignancy other than successfully treated nonmelanoma skin cancer. Because of these risks, use of these drugs should be reserved for patients who have had an inadequate response or intolerance to one or more tumor necrosis factor blocker.Patients should be advised of the benefits and risk of these drugs and to seek emergency medical attention if they experience signs and symptoms of a heart attack, stroke, or blood clot.Adverse effects from the use of JAK inhibitors should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: February 2022Nursing Drug Handbook© 2022 Wolters Kluwer
FDA Drug Warnings - August 2021
raxibacumabGeneric onlyNEW WARNINGThe FDA has required prescribing information for raxibacumab to carry a boxed warning to alert health care providers and patients of the risk of hypersensitivity reactions and anaphylaxis. Hypersensitivity reactions, including anaphylaxis, have been reported during or after intravenous administration.Administration of raxibacumab must be in a monitored setting where appropriate equipment, medication (including epinephrine), and personnel trained to manage hypersensitivity, anaphylaxis, and shock are available. Patients must be closely monitored for hypersensitivity reactions (rash, urticaria, pruritus, chills, chest and throat tightness, lip and throat swelling, hypotension) during and after administration. If signs or symptoms occur, the infusion must be stopped and the patient treated appropriately.Patients should be told of the risk for hypersensitivity reactions and instructed to report signs and symptoms immediately.Adverse effects from the use of raxibacumab should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: August 2021Nursing Drug Handbook© 2021 Wolters Kluwer
FDA Drug Warnings - June 2021
lamotrigineLamictalNEW WARNINGThe FDA has published a Drug Safety Communication to advise patients and health care providers of a potential for increased risk of serious or life-threatening arrhythmias in patients with heart disease who are taking lamotrigine.The FDA advises using the drug cautiously in patients with structural and functional heart disorders, including heart failure, valvular heart disease, congenital heart disease, conduction system disease, ventricular arrhythmias, cardiac channelopathies, ischemic heart disease, or multiple risk factors for coronary artery disease, especially when used in combination with sodium channel-blocking drugs, such as carbamazepine, phenytoin, and topiramate. Health care providers should assess whether the potential benefits of lamotrigine use outweigh the risk of arrhythmia for each patient.Patients should be educated to seek immediate medical attention for abnormal heart rate or irregular rhythm, or symptoms such as a racing heartbeat, skipped or slow heartbeat, shortness of breath, dizziness, or fainting.Adverse effects from the use of lamotrigine should be reported to the FDA's MedWatch Adverse Event Reporting Program either online, by phone at 1-800-332-1088, by fax at 1-800-FDA-0178, or by mail at MedWatch 5600 Fishers Lane Rockville, MD 20852-9787.Released: June 2021© 2021 Wolters Kluwer

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