ZYMAXID

ZYMAXID- gatifloxacin solution/ drops
Allergan, Inc.

1 INDICATIONS AND USAGE

ZYMAXID^® is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms:

• Aerobic gram-positive bacteria:
  Staphylococcus aureus
  Staphylococcus epidermidis
  Streptococcus mitis group*
  Streptococcus oralis *
  Streptococcus pneumoniae

• Aerobic gram-negative bacteria:
  Haemophilus influenzae

*Efficacy for these organisms were studied in fewer than 10 infections.

2 DOSAGE AND ADMINISTRATION

• Day 1: Instill one drop every two hours in the affected eye(s) while awake, up to 8 times.
  
• Day 2 through Day 7: Instill one drop two to four times daily in the affected eye(s) while awake.

3 DOSAGE FORMS AND STRENGTHS

Ophthalmic solution: 0.5% gatifloxacin (5 mg/mL)

4 CONTRAINDICATIONS

​ ZYMAXID^® is contraindicated in patients with a history of hypersensitivity to gatifloxacin, to other quinolones, or to any of the components in this medication [see Warnings and Precautions ( 5.1)].

5 WARNINGS AND PRECAUTIONS

5.1 Hypersensitivity

​ Some patients receiving topical ophthalmic gatifloxacin experienced hypersensitivity reactions including anaphylactic reactions, angioedema (including pharyngeal, laryngeal, or facial edema), dyspnea, urticaria, and itching, even following a single dose. Rare cases of Stevens-Johnson Syndrome were reported in association with topical ophthalmic gatifloxacin use. If an allergic reaction to gatifloxacin occurs, discontinue the drug [see Patient Counseling Information ( 17)].

5.2 Growth of Resistant Organisms with Prolonged Use

Prolonged use of ZYMAXID ^® may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy. Whenever clinical judgment dictates, examine the patient with the aid of magnification, such as slit lamp biomicroscopy and where appropriate, fluorescein staining.

5. 3 Corneal Endothelial Cell Injury

ZYMAXID ^® is for topical ophthalmic use. ZYMAXID ^® may cause corneal endothelial cell injury if introduced directly into the anterior chamber of the eye.

6 ADVERSE REACTIONS

The following serious adverse reactions are described elsewhere in the labeling:

• Hypersensitivity [see Contraindications ( 4) and Warnings and Precautions ( 5.1) ]
  
• Growth of Resistant Organisms With Prolonged Use [see Warnings and Precautions ( 5.2) ]
  
• Corneal Endothelial Cell Injury [see Warnings and Precautions ( 5.3) ]

6. 1 Clinical Studies Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.

In clinical studies of patients with bacterial conjunctivitis treated with ZYMAXID ^® (N=717), the most frequently reported adverse reactions occurring in ≥ 1 % of patients were: worsening of the conjunctivitis, eye irritation, dysgeusia, and eye pain.

Additional adverse reactions reported with other formulations of gatifloxacin ophthalmic solution in other clinical studies included chemosis, conjunctival hemorrhage, dry eye, eye discharge, eyelid edema, headache, increased lacrimation, keratitis, red eye, papillary conjunctivitis, and reduced visual acuity.

6.2 Postmarketing Experience

The following adverse reactions have been identified during post-approval use of ZYMAXID ^® or with other formulations of gatifloxacin ophthalmic solution. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These reactions included anaphylactic reactions and angioedema (including pharyngeal, oral or facial edema), blepharitis, dyspnea, eye pruritus, eye swelling (including corneal and conjunctival edema), hypersensitivity, including signs and symptoms of eye allergy and allergic dermatitis, nausea, pruritus (including pruritus generalized, rash, urticaria), and vision blurred.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Risk Summary
There are no available data on the use of ZYMAXID^® in pregnant women to inform a drug-associated risk. Administration of oral gatifloxacin to pregnant rats and rabbits throughout organogenesis did not produce adverse development outcomes at clinically relevant doses. Administration of gatifloxacin to rats during late gestation through lactation did not produce adverse maternal, fetal or neonatal effects at clinically relevant doses.

Data
Animal Data
Oral administration of gatifloxacin to pregnant rats throughout organogenesis produced teratogenic effects in rat fetuses, including skeletal/craniofacial malformations, delayed ossification, atrial enlargement, and reduced fetal weight, at doses greater than or equal to 150 mg/kg/day (approximately 600-fold higher than the maximum recommended human ophthalmic dose [MRHOD] for ZYMAXID^® of 0.04 mg/kg/day, on a mg/m² basis). No teratogenic effects were observed in rat or rabbit fetuses at doses of gatifloxacin up to 50 mg/kg/day (approximately 200- and 400-fold higher than the MRHOD, respectively, on a mg/m² basis).

In a perinatal/postnatal study in rats, oral administration of gatifloxacin during late gestation through lactation produced an increase in late gestation fetal loss and neonatal/perinatal mortality at 200 mg/kg/day (approximately 800-fold higher than the MRHOD on a mg/m² basis).

8.2 Lactation

Risk Summary
There is no information regarding the presence of ZYMAXID^® in human milk, the effect of gatifloxacin on breastfed infants, or the effect of gatifloxacin on milk production. Gatifloxacin was found in the breast milk of rats following oral administration of gatifloxacin during lactation. However, systemic levels of gatifloxacin following topical ocular administration are low [see Clinical Pharmacology ( 12.3) ], and it is not known whether gatifloxacin would be present in maternal milk at measurable levels following topical ocular administration. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZYMAXID^® and any potential adverse effects on the breastfed child from ZYMAXID^®.

8.4 Pediatric Use

The safety and effectiveness of ZYMAXID ^® in infants below one year of age have not been established. ZYMAXID ^® has been demonstrated in clinical trials to be safe and effective for the treatment of bacterial conjunctivitis in pediatric patients one year or older [ see Clinical Studies ( 14) ] .