SYNALAR- fluocinolone acetonide solution 
SYNALAR TS- fluocinolone acetonide 
Medimetriks Pharmaceuticals, Inc.

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SYNALAR®
(fluocinolone acetonide)
Topical Solution, 0.01%

Rx Only

DESCRIPTION

SYNALAR® (fluocinolone acetonide) Topical Solution, 0.01% is intended for topical administration. The active component is the corticosteroid fluocinolone acetonide, which has the chemical name pregna-1,4-diene-3,20-dione,6,9-difluoro-11,21-dihydroxy-16,17-[(1-methylethylidene)bis (oxy)]-,(6α,11β,16α)-. It has the following chemical structure:

Chemical Structure

SYNALAR® Solution contains fluocinolone acetonide 0.1 mg/mL in a water-washable base of citric acid and propylene glycol.

CLINICAL PHARMACOLOGY

Topical corticosteroids share anti-inflammatory, anti-pruritic and vasoconstrictive actions.

The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids. There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man.

Pharmacokinetics

The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings.

Topical corticosteroids can be absorbed from normal intact skin. Inflammation and/or other disease processes in the skin increase percutaneous absorption. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Thus, occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses (see DOSAGE AND ADMINISTRATION).

Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Corticosteroids are bound to plasma proteins in varying degrees. Corticosteroids are metabolized primarily in the liver and are then excreted by the kidneys. Some of the topical corticosteroids and their metabolites are also excreted into the bile.

INDICATIONS AND USAGE

SYNALAR® Solution is indicated for the relief of the inflammatory and pruritic manifestations of corticosteriod-responsive dermatoses.

CONTRAINDICATIONS

Topical corticosteroids are contraindicated in those patients with a history of hypersensitivity to any of the components of the preparation.

PRECAUTIONS

General

Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients.

Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings.

Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid.

Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (see PRECAUTIONS—Pediatric Use).

If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.

As with any topical corticosteroid product, prolonged use may produce atrophy of the skin and subcutaneous tissues. When used on intertriginous or flexor areas, or on the face, this may occur even with short-term use.

In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.

Information for the Patient

Patients using topical corticosteroids should receive the following information and instructions:

  1. This medication is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes.
  2. Patients should be advised not to use this medication for any disorder other than that for which it was prescribed.
  3. The treated skin area should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by the physician.
  4. Patients should report any signs of local adverse reactions, especially under occlusive dressing.
  5. Parents of pediatric patients should be advised not to use tight-fitting diapers or plastic pants on a child being treated in the diaper area, as these garments may constitute occlusive dressings.

Laboratory Tests

The following tests may be helpful in evaluating the HPA axis suppression:

  Urinary free cortisol test
  ACTH stimulation test

Carcinogenesis, Mutagenesis, and Impairment of Fertility

Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect on fertility of topical corticosteroids.

Studies to determine mutagenicity with prednisolone and hydrocortisone have revealed negative results.

Pregnancy Category C

Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.

Nursing Mothers

It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

Pediatric Use

Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio.

Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and intracranial hypertension have been reported in children receiving topical corticosteroids. Manifestations of adrenal suppression in children include linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.

Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children.

ADVERSE REACTIONS

The following local adverse reactions are reported infrequently with topical corticosteroids, but may occur more frequently with the use of occlusive dressings. These reactions are listed in an approximate decreasing order of occurrence:

 
Burning
 
Itching
 
Irritation
 
Dryness
 
Folliculitis
 
Hypertrichosis
 
Acneiform eruptions
 
Hypopigmentation
 
Perioral dermatitis
 
Allergic contact dermatitis
 
Maceration of the skin
 
Secondary infection
 
Skin atrophy
 
Striae
 
Miliaria

OVERDOSAGE

Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects (see PRECAUTIONS).

DOSAGE AND ADMINISTRATION

SYNALAR® Solution is generally applied to the affected area as a thin film from two to four times daily depending on the severity of the condition. In hairy sites, the hair should be parted to allow direct contact with the lesion.

Occlusive dressing may be used for the management of psoriasis or recalcitrant conditions.

If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.

HOW SUPPLIED

SYNALAR® (fluocinolone acetonide) Topical Solution, 0.01%
  60 mL Bottle with applicator tip – NDC 43538-920-60
  90 mL Bottle with applicator tip – NDC 43538-920-90

STORAGE

Store at room temperature 15-25°C (59-77°F); avoid freezing and excessive heat above 40°C (104°F). Store in an upright position.

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

Manufactured for:

MEDIMETRIKS
PHARMACEUTICALS, INC.

383 Route 46 West, Fairfield, NJ 07004-2402 USA
www.medimetriks.com

Manufactured by: Teligent Pharma, Inc., Buena, NJ 08310

IP030-R6

Rev. 6/18

PRINCIPAL DISPLAY PANEL - 60 mL Bottle Carton

NDC 43538-920-60

For Topical Use Only

Not For Ophthalmic Use

60 mL

RX Only

SYNALAR®
(fluocinolone acetonide)
Topical Solution, 0.01%

MEDIMETRIKS
PHARMACEUTICALS, INC.

PRINCIPAL DISPLAY PANEL - 60 mL Bottle Carton

PRINCIPAL DISPLAY PANEL - Kit Carton

NDC 43538-921-60

For Topical Use Only
Not For Ophthalmic Use

60 mL

Rx Only

SYNALAR®
(fluocinolone acetonide)
Topical Solution, 0.01%

TS KIT

KIT CONTAINS:

1 -
SYNALAR®
(fluocinolone acetonide)
Topical Solution, 0.01%
60 mL Bottle
1 -
Rehyla® Hair & Body Cleanser
16 oz. (454 g) Bottle

MEDIMETRIKS
PHARMACEUTICALS, INC.

PRINCIPAL DISPLAY PANEL - Kit Carton
SYNALAR 
fluocinolone acetonide solution
Product Information
Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:43538-920
Route of AdministrationTOPICAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
fluocinolone acetonide (UNII: 0CD5FD6S2M) (fluocinolone acetonide - UNII:0CD5FD6S2M) fluocinolone acetonide0.1 mg  in 1 mL
Inactive Ingredients
Ingredient NameStrength
anhydrous citric acid (UNII: XF417D3PSL)  
propylene glycol (UNII: 6DC9Q167V3)  
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:43538-920-601 in 1 CARTON05/31/201210/01/2023
160 mL in 1 BOTTLE, WITH APPLICATOR; Type 0: Not a Combination Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01529605/31/201210/01/2023
SYNALAR TS 
fluocinolone acetonide kit
Product Information
Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:43538-921
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:43538-921-601 in 1 CARTON08/15/201210/01/2023
Quantity of Parts
Part #Package QuantityTotal Product Quantity
Part 11 BOTTLE, WITH APPLICATOR 60 mL
Part 21 BOTTLE, PUMP 454 g
Part 1 of 2
SYNALAR 
fluocinolone acetonide solution
Product Information
Route of AdministrationTOPICAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Fluocinolone Acetonide (UNII: 0CD5FD6S2M) (Fluocinolone Acetonide - UNII:0CD5FD6S2M) Fluocinolone Acetonide0.1 mg  in 1 mL
Inactive Ingredients
Ingredient NameStrength
anhydrous citric acid (UNII: XF417D3PSL)  
PROPYLENE GLYCOL (UNII: 6DC9Q167V3)  
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
160 mL in 1 BOTTLE, WITH APPLICATOR; Type 0: Not a Combination Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01529605/31/2012
Part 2 of 2
REHYLA HAIR AND BODY 
cleansing (cold creams, cleansing lotions, liquids, and pads) cream
Product Information
Route of AdministrationTOPICAL
Other Ingredients
Ingredient KindIngredient NameQuantity
INGRwater (UNII: 059QF0KO0R)  
INGRsodium c14-16 olefin sulfonate (UNII: O9W3D3YF5U)  
INGRglyceryl stearate se (UNII: FCZ5MH785I)  
INGRglycerin (UNII: PDC6A3C0OX)  
INGRcocamidopropyl betaine (UNII: 5OCF3O11KX)  
INGRcetyl alcohol (UNII: 936JST6JCN)  
INGRpeg-7 glyceryl cocoate (UNII: VNX7251543)  
INGRdimethicone (UNII: 92RU3N3Y1O)  
INGRcocamidopropyl hydroxysultaine (UNII: 62V75NI93W)  
INGRdisodium lauryl sulfosuccinate (UNII: P160Q81342)  
INGRmyristyl myristate (UNII: 4042ZC00DY)  
INGRcaprylyl glycol (UNII: 00YIU5438U)  
INGRcholesterol (UNII: 97C5T2UQ7J)  
INGRdecyl glucoside (UNII: Z17H97EA6Y)  
INGRpropylene glycol (UNII: 6DC9Q167V3)  
INGRphenoxyethanol (UNII: HIE492ZZ3T)  
INGRedetate disodium (UNII: 7FLD91C86K)  
INGRhexylene glycol (UNII: KEH0A3F75J)  
INGRsalicylic acid (UNII: O414PZ4LPZ)  
INGRchamaemelum nobile flower (UNII: O2T154T6OG)  
INGRhyaluronate sodium (UNII: YSE9PPT4TH)  
INGRmica (UNII: V8A1AW0880)  
INGRtitanium dioxide (UNII: 15FIX9V2JP)  
INGRxanthan gum (UNII: TTV12P4NEE)  
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1454 g in 1 BOTTLE, PUMP; Type 0: Not a Combination Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
COSMETIC06/01/2012
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01529608/15/201210/01/2023
Labeler - Medimetriks Pharmaceuticals, Inc. (019903816)
Establishment
NameAddressID/FEIBusiness Operations
Teligent Pharma Inc.011036910MANUFACTURE(43538-920) , PACK(43538-920) , LABEL(43538-920) , ANALYSIS(43538-920)
Establishment
NameAddressID/FEIBusiness Operations
Marketing Advertising Promotions, Inc.797063526PACK(43538-921)

Revised: 10/2023
 
Medimetriks Pharmaceuticals, Inc.