ACANYA - clindamycin phosphate and benzoyl peroxide gel 
Coria Laboratories

----------

HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use ACANYA Gel safely and effectively. See full prescribing information for ACANYA Gel.
 
ACANYA®
(clindamycin phosphate and benzoyl peroxide) Gel, 1.2%/2.5%
For topical use

Initial U.S. Approval: 2000


INDICATIONS AND USAGE

ACANYA Gel is a lincosamide antibiotic and bacteriocidal/keratolytic combination product indicated for the topical treatment of acne vulgaris in patients 12 years or older. (1)

The safety and efficacy of the use of this product in the treatment of any other disorders have not been evaluated. (1.1)


DOSAGE AND ADMINISTRATION

  • Apply a pea-sized amount of ACANYA Gel to the face once daily. (2)
  • ACANYA Gel is not for oral, ophthalmic, or intravaginal use. (2)

DOSAGE FORMS AND STRENGTHS

ACANYA Gel contains clindamycin phosphate 1.2% and benzoyl peroxide 2.5% in a topical gel. (3)


CONTRAINDICATIONS

ACANYA Gel is contraindicated in patients with a history of regional enteritis, ulcerative colitis, or antibiotic–associated colitis. (4)


WARNINGS AND PRECAUTIONS

  • Colitis: Orally and parenterally administered clindamycin has been associated with severe colitis, which may result in death. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. ACANYA Gel should be discontinued if significant diarrhea occurs. (5.1)
  • Ultraviolet Light and Environmental Exposure: Minimize sun exposure following drug application. (5.2)

ADVERSE REACTIONS

The following selected adverse reactions occurred in less than 0.2% of patients treated with ACANYA Gel: application site pain (0.1%); application site exfoliation (0.1%); and application site irritation (0.1%). (6.1)


To report SUSPECTED ADVERSE REACTIONS, contact Coria Laboratories, at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch


DRUG INTERACTIONS

  • ACANYA Gel should not be used in combination with erythromycin-containing products because of its clindamycin component. (7.1)


See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling

Revised: 02/2011

FULL PRESCRIBING INFORMATION: CONTENTS*
* Sections or subsections omitted from the full prescribing information are not listed

1 INDICATIONS AND USAGE

1.1 Important Limitations of Use

2 DOSAGE AND ADMINISTRATION

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

5 WARNINGS AND PRECAUTIONS

5.1 Colitis

5.2 Ultraviolet Light and Environmental Exposure

6 ADVERSE REACTIONS

6.1 Clinical Studies Experience

6.2 Postmarketing Experience

7 DRUG INTERACTIONS

7.1 Erythromycin

7.2 Concomitant Topical Medications

7.3 Neuromuscular Blocking Agents

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

8.3 Nursing Mothers

8.4 Pediatric Use

8.5 Geriatric Use

11 DESCRIPTION

12 CLINICAL PHARMACOLOGY

12.1 Mechanisms of Action

12.3 Pharmacokinetics

12.4 Microbiology

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14 CLINICAL STUDIES

16 HOW SUPPLIED, DISPENSING INSTRUCTIONS AND STORAGE AND HANDLING

16.1 How Supplied

16.2 Dispensing Instructions for the Pharmacist

16.3 Storage and Handling

17 PATIENT COUNSELING INFORMATION

17.1 Instructions for Use

17.2 Skin Irritation

17.3 Colitis

17.4 Allergic Reactions

17.5 Ultraviolet Light and Environmental Exposure

17.6 FDA-Approved Patient Labeling


FULL PRESCRIBING INFORMATION

1 INDICATIONS AND USAGE

ACANYA® Gel is indicated for the topical treatment of acne vulgaris in patients 12 years or older.

1.1 Important Limitations of Use

The safety and efficacy of the use of this product in the treatment of any other disorders have not been evaluated.

2 DOSAGE AND ADMINISTRATION

Apply a pea-sized amount of ACANYA Gel to the face once daily.

Use of ACANYA Gel beyond 12 weeks has not been evaluated. ACANYA Gel is not for oral, ophthalmic, or intravaginal use.

3 DOSAGE FORMS AND STRENGTHS

Each gram of ACANYA Gel contains, as dispensed, 10 mg (1%) clindamycin as phosphate, and 25 mg (2.5%) benzoyl peroxide in a white to off-white, opaque, smooth gel.

4 CONTRAINDICATIONS

ACANYA Gel is contraindicated in patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.

5 WARNINGS AND PRECAUTIONS

5.1 Colitis

Systemic absorption of clindamycin has been demonstrated following topical use of clindamycin. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. When significant diarrhea occurs, ACANYA Gel should be discontinued.

Severe colitis has occurred following oral and parenteral administration of clindamycin with an onset of up to several weeks following cessation of therapy. Antiperistaltic agents such as opiates and diphenoxylate with atropine may prolong and/or worsen severe colitis. Severe colitis may result in death.

Studies indicate toxin(s) produced by Clostridia is one primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe persistent diarrhea and severe abdominal cramps and may be associated with the passage of blood and mucus. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically.

Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation and treatment with an antibacterial drug clinically effective against C. difficile colitis.

5.2 Ultraviolet Light and Environmental Exposure

Minimize sun exposure following drug application [See Nonclinical Toxicology (13.1)].

6 ADVERSE REACTIONS

6.1 Clinical Studies Experience

Because clinical trials are conducted under prescribed conditions, adverse reaction rates observed in the clinical trial may not reflect the rates observed in practice. Because clinical trials are also conducted under widely varying conditions, adverse reactions observed in the clinical trials of a drug cannot always be directly compared to rates in the clinical trials of another drug. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse reactions that appear to be related to drug use and for approximating rates.

The following selected adverse reactions occurred in less than 0.2% of patients treated with ACANYA Gel: application site pain (0.1%); application site exfoliation (0.1%); and application site irritation (0.1%).

During clinical trials, patients were assessed for local cutaneous signs and symptoms of erythema, scaling, itching, burning and stinging. Most local skin reactions increased and peaked around week 4 and continually decreased over time reaching near baseline levels by week 12. The percentage of patients that had symptoms present before treatment, the maximum value recorded during treatment, and the percent with symptoms present at week 12 are shown in Table 1.

Table 1: Local Skin Reactions - Percent of Patients with Symptoms Present. Combined Results from the Two Phase 3 Trials (N = 773)
Before Treatment
(Baseline)
Maximum During
Treatment
End of Treatment
(Week 12)
MildMod.*SevereMildMod.*SevereMildMod.*Severe
*
Mod. = Moderate
  Erythema2240255< 11520
  Scaling8< 101830810
  Itching102015206< 10
  Burning3< 108202< 10
  Stinging2< 106101< 10

6.2 Postmarketing Experience

Anaphylaxis, as well as allergic reactions leading to hospitalizations, has been reported in postmarketing use of products containing clindamycin/benzoyl peroxide.

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.

7 DRUG INTERACTIONS

7.1 Erythromycin

ACANYA Gel should not be used in combination with topical or oral erythromycin-containing products due to its clindamycin component. In vitro studies have shown antagonism between erythromycin and clindamycin. The clinical significance of this in vitro antagonism is not known.

7.2 Concomitant Topical Medications

Concomitant topical acne therapy should be used with caution because a possible cumulative irritancy effect may occur, especially with the use of peeling, desquamating, or abrasive agents.

7.3 Neuromuscular Blocking Agents

Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, ACANYA Gel should be used with caution in patients receiving such agents.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category C.

There are no well-controlled trials in pregnant women treated with ACANYA Gel. It also is not known whether ACANYA Gel can cause fetal harm when administered to a pregnant woman. ACANYA Gel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Animal reproductive/developmental toxicity studies have not been conducted with ACANYA Gel or benzoyl peroxide. Developmental toxicity studies of clindamycin performed in rats and mice using oral doses of up to 600 mg/kg/day (240 and 120 times amount of clindamycin in the highest recommended adult human dose based on mg/m2, respectively) or subcutaneous doses of up to 200 mg/kg/day (80 and 40 times the amount of clindamycin in the highest recommended adult human dose based on mg/m2, respectively) revealed no evidence of teratogenicity.

8.3 Nursing Mothers

It is not known whether clindamycin is excreted in human milk after topical application of ACANYA Gel. However, orally and parenterally administered clindamycin has been reported to appear in breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to use ACANYA Gel while nursing, taking into account the importance of the drug to the mother.

8.4 Pediatric Use

Safety and effectiveness of ACANYA Gel in pediatric patients under the age of 12 have not been evaluated.

Clinical trials of ACANYA Gel included patients 12-17 years of age. [See Clinical Studies (14)]

8.5 Geriatric Use

Clinical studies of ACANYA Gel did not include sufficient numbers of patients aged 65 and older to determine whether they respond differently from younger patients.

11 DESCRIPTION

ACANYA (clindamycin phosphate and benzoyl peroxide) Gel, 1.2%/2.5% is a combination product with two active ingredients in an aqueous gel formulation. Clindamycin phosphate is a water-soluble ester of the semi-synthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent antibiotic lincomycin.

The chemical name for clindamycin phosphate is Methyl 7-chloro-6,7,8-trideoxy-6-(1-methyl-trans-4-propyl-L-2-pyrrolidinecarboxamido)-1-thio-L-threo-α-D-galacto-octopyranoside 2-(dihydrogen phosphate). The structural formula for clindamycin phosphate is represented below:

Clindamycin phosphate:

Chemical Structure

Molecular Formula: C18H34ClN2O8PS          Molecular Weight: 504.97

Benzoyl peroxide is an antibacterial and keratolytic agent. The structural formula for benzoyl peroxide is represented below:

Benzoyl peroxide:

Chemical Structure

Molecular Formula: C14H10O4          Molecular Weight: 242.23

ACANYA Gel contains the following inactive ingredients: purified water, carbomer 980, propylene glycol, and potassium hydroxide. Each gram of ACANYA Gel contains 1.2% of clindamycin phosphate which is equivalent to 1% clindamycin.

12 CLINICAL PHARMACOLOGY

12.1 Mechanisms of Action

Clindamycin

[See Microbiology (12.4)].

Benzoyl Peroxide

Benzoyl peroxide is an oxidizing agent with bacteriocidal and keratolytic effects.

12.3 Pharmacokinetics

An in vivo bioavailability study has not been conducted with ACANYA Gel. Benzoyl peroxide has been shown to be absorbed by the skin where it is converted to benzoic acid.

12.4 Microbiology

Clindamycin binds to the 50S ribosomal subunits of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing bacterial protein synthesis.

Clindamycin and benzoyl peroxide individually have been shown to have in vitro activity against Propionibacterium acnes, an organism which has been associated with acne vulgaris; however, the clinical significance of this activity against P. acnes is not known and was not examined in clinical trials with ACANYA Gel.

P. acnes resistance to clindamycin has been documented. Resistance to clindamycin is often associated with resistance to erythromycin.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity, mutagenicity and impairment of fertility testing of ACANYA Gel have not been performed.

Benzoyl peroxide has been shown to be a tumor promoter and progression agent in a number of animal studies. Benzoyl peroxide in acetone at doses of 5 and 10 mg administered topically twice per week for 20 weeks induced skin tumors in transgenic Tg.AC mice. The clinical significance of this is unknown.

Carcinogenicity studies have been conducted with a gel formulation containing 1% clindamycin and 5% benzoyl peroxide. In a 2-year dermal carcinogenicity study in mice, treatment with the gel formulation at doses of 900, 2700, and 15000 mg/kg/day (1.8, 5.4, and 30 times amount of clindamycin and 3.6, 10.8, and 60 times amount of benzoyl peroxide in the highest recommended adult human dose of 2.5 g ACANYA Gel based on mg/m2, respectively) did not cause any increase in tumors. However, topical treatment with a different gel formulation containing 1% clindamycin and 5% benzoyl peroxide at doses of 100, 500, and 2000 mg/kg/day caused a dose-dependent increase in the incidence of keratoacanthoma at the treated skin site of male rats in a 2-year dermal carcinogenicity study in rats. In an oral (gavage) carcinogenicity study in rats, treatment with the gel formulation at doses of 300, 900 and 3000 mg/kg/day (1.2, 3.6, and 12 times amount of clindamycin and 2.4, 7.2, and 24 times amount of benzoyl peroxide in the highest recommended adult human dose of 2.5 g ACANYA Gel based on mg/m2, respectively) for up to 97 weeks did not cause any increase in tumors. In a 52-week dermal photocarcinogenicity study in hairless mice, (40 weeks of treatment followed by 12 weeks of observation), the median time to onset of skin tumor formation decreased and the number of tumors per mouse increased relative to controls following chronic concurrent topical administration of the higher concentration benzoyl peroxide formulation (5000 and 10000 mg/kg/day, 5 days/week) and exposure to ultraviolet radiation.

Clindamycin phosphate was not genotoxic in the human lymphocyte chromosome aberration assay. Benzoyl peroxide has been found to cause DNA strand breaks in a variety of mammalian cell types, to be mutagenic in S. typhimurium tests by some but not all investigators, and to cause sister chromatid exchanges in Chinese hamster ovary cells.

Fertility studies have not been performed with ACANYA Gel or benzoyl peroxide, but fertility and mating ability have been studied with clindamycin. Fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (approximately 120 times the amount of clindamycin in the highest recommended adult human dose of 2.5 g ACANYA Gel, based on mg/m2) revealed no effects on fertility or mating ability.

14 CLINICAL STUDIES

The safety and efficacy of once daily use of ACANYA Gel were assessed in two 12-week multi-center, randomized, blinded studies in patients 12 years and older with moderate to severe acne vulgaris. The two studies were identical in design and compared ACANYA Gel to clindamycin in the vehicle gel, benzoyl peroxide in the vehicle gel, and the vehicle gel alone. The co-primary efficacy variables were:

(1)
Mean absolute change from baseline at week 12 in
  • Inflammatory lesion counts
  • Non-inflammatory lesion counts
(2)
Percent of subjects who had a two grade improvement from baseline on an Evaluator's Global Severity (EGS) score.

The EGS scoring scale used in all of the clinical trials for ACANYA Gel is as follows:

GradeDescription
ClearNormal, clear skin with no evidence of acne vulgaris
Almost ClearRare non-inflammatory lesions present, with rare non-inflamed papules (papules must be resolving and may be hyperpigmented, though not pink-red)
MildSome non-inflammatory lesions are present, with few inflammatory lesions (papules/pustules only; no nodulocystic lesions)
ModerateNon-inflammatory lesions predominate, with multiple inflammatory lesions evident: several to many comedones and papules/pustules, and there may or may not be one small nodulo-cystic lesion
SevereInflammatory lesions are more apparent, many comedones and papules/pustules, there may or may not be a few nodulocystic lesions
Very SevereHighly inflammatory lesions predominate, variable number of comedones, many papules/pustules and many nodulocystic lesions

The results of Study 1 at week 12 are presented in the table below:

ACANYA
Gel
Clindamycin
Gel
Benzoyl
Peroxide
Gel
Vehicle
Gel
Study 1N = 399N = 408N = 406N = 201
EGSS Clear or Almost Clear115 (29%)84 (21%)76 (19%)29 (14%)
-----------------
2 grade reduction from baseline131 (33%)100 (25%)96 (24%)38 (19%)
Inflammatory Lesions:
  Mean
  absolute
  change
14.812.213.09.0
  Mean
  percent (%)
  reduction
55.0%47.1%49.3%34.5%
Non-Inflammatory Lesions:
  Mean
  absolute
  change
22.117.920.613.2
  Mean
  percent (%)
  reduction
45.3%38.0%40.2%28.6%

The results of Study 2 at week 12 are presented in the table below:

ACANYA
Gel
Clindamycin GelBenzoyl
Peroxide
Gel
Vehicle Gel
Study 2N = 398N = 404N = 403N = 194
EGSS
Clear or Almost Clear
113 (28%)94 (23%)94 (23%)21 (11%)
-------------------------------
2 grade reduction from baseline147 (37%)114 (28%)114 (28%)27 (14%)
Inflammatory Lesions:
  Mean absolute change13.711.311.25.7
  Mean percent (%) reduction54.2%45.3%45.7%23.3%
Non-Inflammatory Lesions:
  Mean absolute change19.014.915.28.3
  Mean percent (%) reduction41.2%34.3%34.5%19.2%

16 HOW SUPPLIED, DISPENSING INSTRUCTIONS AND STORAGE AND HANDLING

16.1 How Supplied

ACANYA Gel is supplied as a 50 g pump (NDC 13548-132-50).

16.2 Dispensing Instructions for the Pharmacist

16.3 Storage and Handling

17 PATIENT COUNSELING INFORMATION

See FDA-Approved Patient Labeling

17.1 Instructions for Use

17.2 Skin Irritation

ACANYA Gel may cause irritation such as erythema, scaling, itching, burning, or stinging.

Patients should report any signs or symptoms of local skin irritation to their physician.

17.3 Colitis

In the event a patient treated with ACANYA Gel experiences severe diarrhea or gastrointestinal discomfort, ACANYA Gel should be discontinued and a physician should be contacted.

17.4 Allergic Reactions

Patients who develop allergic reactions, such as severe swelling or shortness of breath, should discontinue ACANYA Gel and contact their physician immediately. In addition, patients should report any signs of local adverse reactions to their physician.

17.5 Ultraviolet Light and Environmental Exposure

Patient should minimize exposure to natural and avoid artificial sunlight (tanning beds or UVA/B treatment) while using ACANYA Gel. To minimize exposure to sunlight, a wide-brimmed hat or other protective clothing should be worn and a sunscreen with SPF 15 rating or higher should be used.

17.6 FDA-Approved Patient Labeling

PATIENT INFORMATION
ACANYA® (AH-CAN΄-YAH)
(clindamycin phosphate and benzoyl peroxide) Gel, 1.2%/2.5%

IMPORTANT: For use on skin only (topical use). Do not get ACANYA Gel in your mouth, eyes, or vagina, or on your lips.

Read the Patient Information that comes with ACANYA Gel before you start using it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.

What is ACANYA Gel?

ACANYA Gel is a prescription medicine used on the skin (topical) to treat acne vulgaris in people 12 years and older. ACANYA Gel contains clindamycin phosphate and benzoyl peroxide.

It is not known if ACANYA Gel is safe and effective for use longer than 12 weeks.

It is not known if ACANYA Gel is safe and effective in children under 12 years of age.

Who should not use ACANYA Gel?

Do not use ACANYA Gel if you have:

Talk with your doctor if you are not sure if you have one of these conditions.

What should I tell my doctor before using ACANYA Gel?

Before using ACANYA Gel, tell your doctor about all of your medical conditions, including if you:

Tell your doctor about all the medicines and skin products you use. Especially tell your doctor if you will have surgery with general anesthesia. One of the medicines in ACANYA Gel (clindamycin) can affect how certain medicines work when used in general anesthesia.

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

How should I use ACANYA Gel?

Instructions for applying ACANYA Gel

What should I avoid while using ACANYA Gel?

What are possible side effects with ACANYA Gel?

ACANYA Gel can cause serious side effects including:

Common side effects with ACANYA Gel include:

Talk to your doctor about any side effect that bothers you or that does not go away.

These are not all the possible side effects with ACANYA Gel. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

You may also report side effects to CORIA Laboratories at 1-800-321-4576.

How should I store ACANYA Gel?

Keep ACANYA Gel and all medicines out of the reach of children.

General information about ACANYA Gel

Medicines are sometimes prescribed for conditions that are not mentioned in Patient Information leaflets. Do not use ACANYA Gel for a condition for which it was not prescribed. Do not give ACANYA Gel to other people, even if they have the same condition you have. It may harm them.

This leaflet summarizes the most important information about ACANYA Gel. If you would like more information, talk with your doctor. You can also ask your doctor or pharmacist for information about ACANYA Gel that is written for healthcare professionals.

For more information about ACANYA Gel, call 1-800-321-4576.

What are the ingredients in ACANYA Gel?

Active Ingredients: clindamycin phosphate 1.2% and benzoyl peroxide 2.5%

Inactive Ingredients: purified water, carbomer 980, propylene glycol, and potassium hydroxide

Issued 10/2010

Marketed by:
Coria Laboratories, a division of Valeant Pharmaceuticals North America, Fort Worth, TX 76107

Manufactured by:
Contract Pharmaceuticals Limited Niagara, Buffalo, NY 14213

U.S. Patents 5,733,886 and 6,117,843
Additional Patents Pending

09-0076

PRINCIPAL DISPLAY PANEL - 50 gram Carton

NEW READY-TO-USE FORMULATION
NDC 13548-132-50

Acanya®
(Clindamycin Phosphate and
Benzoyl Peroxide) Gel, 1.2%/ 2.5%

Rx ONLY

FOR TOPICAL USE ONLY

One premixed 50-gram pump dispenser

PRINCIPAL DISPLAY PANEL - 50 gram Carton

ACANYA 
clindamycin phosphate and benzoyl peroxide   gel
Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)13548-132
Route of AdministrationTOPICALDEA Schedule    
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Clindamycin Phosphate (Clindamycin) Clindamycin Phosphate10 mg  in 1 g
Benzoyl Peroxide (Benzoyl Peroxide) Benzoyl Peroxide25 mg  in 1 g
Inactive Ingredients
Ingredient NameStrength
Water 
Carbomer Homopolymer Type C 
propylene glycol 
potassium hydroxide 
Product Characteristics
Color    Score    
ShapeSize
FlavorImprint Code
Contains    
Packaging
#NDCPackage DescriptionMultilevel Packaging
113548-132-501 BOTTLE In 1 CARTONcontains a BOTTLE, PUMP
150 g In 1 BOTTLE, PUMPThis package is contained within the CARTON (13548-132-50)

Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA05081907/26/2010

Labeler - Coria Laboratories (010977972)
Registrant - Valeant Pharmaceuticals North America (042230623)
Establishment
NameAddressID/FEIOperations
Contract Pharmaceuticals Ltd. Niagara, Buffalo, NY603942942MANUFACTURE
Revised: 02/2011Coria Laboratories