MEDICATION GUIDE

ZENATANETM (ZEN – a – tān)
(isotretinoin capsules)

Read the Medication Guide that comes with Zenatane™ before you start taking it and each time you get a prescription. There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. 

What is the most important information I should know about Zenatane™?

• Zenatane™ is used to treat a type of severe acne (nodular acne) that has not been helped by other treatments, including antibiotics.
• Because Zenatane™ can cause birth defects, Zenatane™ is only for patients who can understand and agree to carry out all of the instructions in the iPLEDGE program.
• Zenatane™ may cause serious mental health problems.  

1.  Birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births. Female patients who are pregnant or who plan to become pregnant must not take Zenatane™. Female patients must not get pregnant:

• for one month before starting Zenatane™
• while taking Zenatane™
• for one month after stopping Zenatane™ 

If you get pregnant while taking Zenatane™, stop taking it right away and call your doctor. Doctors and patients should report all cases of pregnancy to:

• FDA MedWatch at 1-800-FDA-1088, and
• the iPLEDGE pregnancy registry at 1-866-495-0654

2. Serious mental health problems. Zenatane™ may cause:

• depression
• psychosis (seeing or hearing things that are not real)
• suicide. Some patients taking Zenatane™ have had thoughts about hurting themselves or putting an end to their own lives (suicidal thoughts). Some people tried to end their own lives. And some people have ended their own lives.  

Stop Zenatane™ and call your doctor right away if you or a family member notices that you have any of the following signs and symptoms of depression or psychosis:

• start to feel sad or have crying spells
• lose interest in activities you once enjoyed
• sleep too much or have trouble sleeping
• become more irritable, angry, or aggressive than usual (for example, temper outbursts, thoughts of violence)
• have a change in your appetite or body weight
• have trouble concentrating
• withdraw from your friends or family
• feel like you have no energy
• have feelings of worthlessness or guilt
• start having thoughts about hurting yourself or taking your own life (suicidal thoughts)
• start acting on dangerous impulses start seeing or hearing things that are not real  

After stopping Zenatane™, you may also need follow-up mental health care if you had any of these symptoms.

What is Zenatane™?

Zenatane™ is a medicine taken by mouth to treat the most severe form of acne (nodular acne) that cannot be cleared up by any other acne treatments, including antibiotics. Zenatane™ can cause serious side effects (see “What is the most important information I should know about Zenatane™?”). Zenatane™ can only be:

• prescribed by doctors that are registered in the iPLEDGE program
• dispensed by a pharmacy that is registered with the iPLEDGE program
• given to patients who are registered in the iPLEDGE program and agree to do everything required in the program

What is severe nodular acne?

Severe nodular acne is when many red, swollen, tender lumps form in the skin. These can be the size of pencil erasers or larger. If untreated, nodular acne can lead to permanent scars.

Who should not take Zenatane™?

• Do not take Zenatane™ if you are pregnant, plan to become pregnant, or become pregnant during Zenatane™ treatment. Zenatane™ causes severe birth defects. See “What is the most important information I should know about Zenatane™?”
• Do not take Zenatane™ if you are allergic to anything in it. See the end of this Medication Guide for a complete list of ingredients in Zenatane™.

What should I tell my doctor before taking Zenatane™?

Tell your doctor if you or a family member has any of the following health conditions:

• mental problems
• asthma
• liver disease
• diabetes
• heart disease
• bone loss (osteoporosis) or weak bones
• an eating problem called anorexia nervosa (where people eat too little)
• food or medicine allergies  

Tell your doctor if you are pregnant or breast-feeding. Zenatane must not be used by women who are pregnant or breast feeding. 

Tell your doctor about all of the medicines you take including prescription and non­prescription medicines, vitamins and herbal supplements. Zenatane™ and certain other medicines can interact with each other, sometimes causing serious side effects. Especially tell your doctor if you take:

• Vitamin A supplements. Vitamin A in high doses has many of the same side effects as Zenatane™. Taking both together may increase your chance of getting side effects.
• Tetracycline antibiotics. Tetracycline antibiotics taken with Zenatane™ can increase the chances of getting increased pressure in the brain.
• Progestin-only birth control pills (mini-pills). They may not work while you take Zenatane™. Ask your doctor or pharmacist if you are not sure what type you are using.
• Dilantin (phenytoin). This medicine taken with Zenatane™ may weaken your bones.
• Corticosteroid medicines. These medicines taken with Zenatane™ may weaken your bones.
• St. John’s Wort. This herbal supplement may make birth control pills work less effectively.  

These medicines should not be used with Zenatane™ unless your doctor tells you it is okay.

Know the medicines you take. Keep a list of them to show to your doctor and pharmacist. Do not take any new medicine without talking with your doctor.

How should I take Zenatane™?

• You must take Zenatane™ exactly as prescribed. You must also follow all the instructions of the iPLEDGE program. Before prescribing Zenatane™, your doctor will:
• explain the iPLEDGE program to you
• have you sign the Patient Information/Informed Consent Form (for all patients). Female patients who can get pregnant must also sign another consent form.  

You will not be prescribed Zenatane™ if you cannot agree to or follow all the instructions of the iPLEDGE program.

• You will get no more than a 30 day supply of Zenatane™ at a time. This is to make sure you are following the Zenatane™ iPLEDGE program. You should talk with your doctor each month about side effects.
• The amount of Zenatane™ you take has been specially chosen for you. It is based on your body weight, and may change during treatment.
• Take Zenatane™ 2 times a day with a meal, unless your doctor tells you otherwise. Swallow yourZenatane™ capsules whole with a full glass of liquid. Do not chew or suck on the capsule. Zenatane™ can hurt the tube that connects your mouth to your stomach (esophagus) if it is not swallowed whole.
• If you miss a dose, just skip that dose. Do not take 2 doses at the same time.
• If you take too much Zenatane™ or overdose, call your doctor or poison control center right away.  
• Your acne may get worse when you first start taking Zenatane™. This should last only a short while. Talk with your doctor if this is a problem for you.
• You must return to your doctor as directed to make sure you don’t have signs of serious side effects. Your doctor may do blood tests to check for serious side effects from Zenatane™. Female patients who can get pregnant will get a pregnancy test each month.
• Female patients who can get pregnant must agree to use two separate forms of effective birth control at the same time one month before, while taking, and for one month after taking Zenatane™. You must access the iPLEDGE system to answer questions about the program requirements and to enter your two chosen forms of birth control. To access the iPLEDGE system, go to www.ipledgeprogram.com or  call 1-866-495-0654.
  You must talk about effective birth control methods with your doctor or go for a free visit to talk about birth control with another doctor or family planning expert. Your doctor can arrange this free visit, which will be paid for by the company that makes Zenatane™.
  If you have sex at any time without using two forms of effective birth control, get pregnant, or miss your expected period, stop using Zenatane™ and call your doctor right away.

What should I avoid while taking Zenatane™?

• Do not get pregnant while taking Zenatane™ and for one month after stopping Zenatane™. See “What is the most important information I should know about Zenatane™?”
• Do not breast feed while taking Zenatane™ and for one month after stopping Zenatane™. We do not know if Zenatane™ can pass through your milk and harm the baby.
• Do not give blood while you take Zenatane™ and for one month after stopping Zenatane™. If someone who is pregnant gets your donated blood, her baby may be exposed to Zenatane™and may be born with birth defects.
• Do not take other medicines or herbal products with Zenatane™ unless you talk to your doctor. See “What should I tell my doctor before taking Zenatane™?”
• Do not drive at night until you know if Zenatane™ has affected your vision. Zenatane™ may decrease your ability to see in the dark.
• Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while you are using Zenatane™ and for at least 6 months after you stop. Zenatane™ can increase your chance of scarring from these procedures. Check with your doctor for advice about when you can have cosmetic procedures.
• Avoid sunlight and ultraviolet lights as much as possible. Tanning machines use ultraviolet lights. Zenatane™ may make your skin more sensitive to light.  
• Do not share Zenatane™ with other people. It can cause birth defects and other serious health problems.  

What are the possible side effects of Zenatane™?

• Zenatane™ can cause birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births. See “What is the most important information I should know about Zenatane™?”
• Zenatane™ may cause serious mental health problems. See “What is the most important information I should know about Zenatane™?”
• serious brain problems. Zenatane™ can increase the pressure in your brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking Zenatane™ and call your doctor right away if you get any of these signs of increased brain pressure:
• bad headache
• blurred vision
• dizziness
• nausea or vomiting
• seizures (convulsions)
• stroke
• skin problems. Skin rash can occur in patients taking Zenatane™. In some patients a rash can be serious. Stop using Zenatane™ and call your doctor right away if you develop conjunctivitis (red or inflamed eyes, like “pink eye”), a rash with a fever, blisters on legs, arms or face and/or sores in your mouth, throat, nose, eyes, or if your skin begins to peel.
• stomach area (abdomen) problems. Certain symptoms may mean that your internal organs are being damaged. These organs include the liver, pancreas, bowel (intestines), and esophagus (connection between mouth and stomach). If your organs are damaged, they may not get better even after you stop taking Zenatane™. Stop taking Zenatane™ and call your doctor if you get:
• severe stomach, chest or bowel pain
• trouble swallowing or painful swallowing
• new or worsening heartburn
• diarrhea
• rectal bleeding
• yellowing of your skin or eyes
• dark urine
• bone and muscle problems. Zenatane™ may affect bones, muscles, and ligaments and cause pain in your joints or muscles. Tell your doctor if you plan hard physical activity during treatment with Zenatane™. Tell your doctor if you get:
• back pain
• joint pain
• broken bone. Tell all healthcare providers that you take Zenatane™ if you break a bone.

Stop Zenatane™ and call your doctor right away if you have muscle weakness. Muscle weakness with or without pain can be a sign of serious muscle damage. Zenatane™ may stop long bone growth in teenagers who are still growing.

• hearing problems. Stop using Zenatane™ and call your doctor if your hearing gets worse or if you have ringing in your ears. Your hearing loss may be permanent.
• vision problems. Zenatane™ may affect your ability to see in the dark. This condition usually clears up after you stop taking Zenatane™, but it may be permanent. Other serious eye effects can occur. Stop taking Zenatane™ and call your doctor right away if you have any problems with your vision or dryness of the eyes that is painful or constant. If you wear contact lenses, you may have trouble wearing them while taking Zenatane™ and after treatment.
• lipid (fats and cholesterol in blood) problems. Zenatane™ can raise the level of fats and cholesterol in your blood. This can be a serious problem. Return to your doctor for blood tests to check your lipids and to get any needed treatment. These problems usually go away when Zenatane™ treatment is finished.
• serious allergic reactions. Stop taking Zenatane™ and get emergency care right away if you develop hives, a swollen face or mouth, or have trouble breathing. Stop taking Zenatane™ and call your doctor if you get a fever, rash, or red patches or bruises on your legs.
• blood sugar problems. Zenatane™ may cause blood sugar problems including diabetes. Tell your doctor if you are very thirsty or urinate a lot.
• decreased red and white blood cells. Call your doctor if you have trouble breathing, faint, or feel weak.
• The common, less serious side effects of Zenatane™ are dry skin, chapped lips, dry eyes, and dry nose that may lead to nosebleeds. Call your doctor if you get any side effect that bothers you or that does not go away.  

These are not all of the possible side effects with Zenatane™. Your doctor or pharmacist can give you more detailed information.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or Dr. Reddys at 1-866-733-3952.

How should I store Zenatane™?

• Store at 68° to 77°F (20° to 25°C). Protect from light.
• Keep Zenatane™ and all medicines out of the reach of children.  

General Information about Zenatane™Medicines are sometimes prescribed for conditions that are not mentioned in Medication Guides. Do not use Zenatane™ for a condition for which it was not prescribed. Do not give Zenatane™ to other people, even if they have the same symptoms that you have. It may harm them.                                                                                                                                                                                                                                                                                              This Medication Guide summarizes the most important information about Zenatane™. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Zenatane™ that is written for healthcare professionals.

You can also call iPLEDGE program at 1-866-495-0654 or visit www.ipledgeprogram.com.

What are the ingredients in Zenatane™?

Active Ingredient: isotretinoin

Inactive Ingredients: butylated hydroxyanisole, edetate disodium, hydrogenated vegetable oil (Type-I and Type-II), medium chain triglyceride, refined soybean oil and white wax. Gelatin capsules contain gelatin, glycerin, methylparaben, propyl paraben, lake blend blue(LB-332) containing D&C Yellow No.10, FD&C Blue No.1 (for 10 mg), lake blend red  (LB-1574) containing D&C Red No.27, D&C Red No.30 (for 20 mg), lake blend green (LB-333)  containing D&C Yellow No.10, FD&C Blue No.1 (for 40 mg), lake blend white (TLB-1774) containing FD&C Blue No.2, titanium dioxide, and opacode black S-1-27794 containing iron oxide black, N-butyl alcohol, propylene glycol, industrial methylene spirit and shellac.

This Medication Guide has been approved by the U.S. Food and Drug Administration.

Dilantin is a registered trademark of Warner-Lambert Company LLC.

To reorder additional Medication Guides contact Dr. Reddy’s Customer Service at 1-866-733-3952.

Rx Only

Manufactured by:

Cipla Limited

Kurkumbh Village

Pune – 413 802 INDIA

Manufactured for:

Dr. Reddy’s Laboratories Limited

Bachupally – 500 090 INDIA 

Issued: 0213

Zenatane is a trademark of Dr. Reddy's Laboratories, Inc. and/or its affiliates.