TARINA 24 FE- norethindrone acetate and ethinyl estradiol and ferrous fumarate 
Afaxys Pharma, LLC

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HIGHLIGHTS OF PRESCRIBING INFORMATION

These highlights do not include all the information needed to use TARINA  24 Fe safely and effectively. See Full Prescribing Information for TARINA 24 Fe.

Tarina   ® 24 Fe (norethindrone acetate and ethinyl estradiol tablets and ferrous fumarate tablets) for Oral Use

Initial U.S. Approval: 1968

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS

See Full Prescribing Information for complete boxed warning.

  • Tarina 24 Fe is contraindicated in women over 35 years old who smoke. (4)
  • Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. (4)

RECENT MAJOR CHANGES

Contraindications (4)                                                           08/2017
Warnings (5.3)                                                                   08/2017

INDICATIONS AND USAGE

Tarina 24 Fe is a progestin/estrogen COC indicated for use by women to prevent pregnancy. (1) The efficacy of Tarina 24 Fe in women with a body mass index (BMI) of greater than 35 kg/m2 has not been evaluated. (1, 8.8)

DOSAGE AND ADMINISTRATION

  • Take one tablet by mouth at the same time every day for 28 days (2.1)
  • Take tablets in the order directed on the blister pack (2.1)
  • Tarina 24 Fe may be administered without regard to meals (12.3)

DOSAGE FORMS AND STRENGTHS

Tarina 24 Fe consists of 28 tablets in the following order (3):

  • 24 light yellow to yellow tablets (active), each containing 1 mg norethindrone acetate USP and 20 mcg ethinyl estradiol USP.
  •  4 brown tablets (non-hormonal placebo), each containing 75 mg ferrous fumarate. The ferrous fumarate tablets do not serve any therapeutic purpose.

CONTRAINDICATIONS

  • A high risk of arterial or venous thrombotic diseases (4)
  • Liver tumors or liver disease (4)
  • Undiagnosed abnormal uterine bleeding (4)
  • Breast cancer or other estrogen- or progestin-sensitive cancer (4)
  •  Pregnancy (4)
  • Co-administration with Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (4)

WARNINGS AND PRECAUTIONS

  • Thrombotic Disorders and Other Vascular Problems: Stop Tarina 24 Fe if a thrombotic event occurs. Stop at least 4 weeks before through 2 weeks after major surgery. Start no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
  • Liver disease: Discontinue Tarina 24 Fe if jaundice occurs. (5.2)
  • High blood pressure: If used in women with well-controlled hypertension, monitor blood pressure and stop Tarina 24 Fe if blood pressure rises significantly. (5.4)
  • Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Tarina 24 Fe. Consider an alternative contraceptive method for women with uncontrolled dyslipidemia. (5.6)
  • Headache: Evaluate significant change in headaches and discontinue Tarina 24 Fe if indicated. (5.7)
  •  Bleeding Irregularities and Amenorrhea: Evaluate irregular bleeding or amenorrhea. (5.8)

ADVERSE REACTIONS

  • The most common adverse reactions (greater than or equal to 2%) were: headache, vaginal candidiasis, nausea, menstrual cramps, breast tenderness, mood changes, bacterial vaginitis, acne, and weight gain. (6.1)  

To report SUSPECTED ADVERSE REACTIONS, contact Afaxys Pharma, LLC at 1-855-888-2476 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

DRUG INTERACTIONS

  • Drugs or herbal products that induce certain enzymes (for example CYP3A4) may decrease the effectiveness of COCs or increase breakthrough bleeding. Counsel patients to use a back-up method or alternative method of contraception when enzyme inducers are used with COCs. (7.1)

USE IN SPECIFIC POPULATIONS

  •  Nursing mothers: Advise use of another contraceptive method. Tarina 24 Fe can decrease milk production. (8.3)

See 17 for PATIENT COUNSELING INFORMATION.

Revised: 10/2018

FULL PRESCRIBING INFORMATION: CONTENTS*

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS

1 INDICATIONS AND USAGE

2 DOSAGE AND ADMINISTRATION

2.1 How to Start Tarina 24 Fe

2.2 How to Take Tarina 24 Fe

2.3 Missed Tablets

2.4 Advice in Case of Gastrointestinal Disturbances

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

5 WARNINGS AND PRECAUTIONS

5.1 Thrombotic Disorders and Other Vascular Problems

5.2 Liver Disease

5.3 Risk of Liver Enzyme Elevations with Concomitant Hepatitis C Treatment

5.4 High Blood Pressure

5.5 Gallbladder Disease

5.6 Carbohydrate and Lipid Metabolic Effects

5.7 Headache

5.8 Bleeding Irregularities and Amenorrhea

5.9 COC Use Before or During Early Pregnancy

5.10 Depression

5.11 Carcinoma of the Breast and Cervix

5.12 Effect on Binding Globulins

5.13 Monitoring

5.14 Hereditary Angioedema

5.15 Chloasma

6 ADVERSE REACTIONS

6.1 Clinical Trial Experience

6.2 Postmarketing Experience

7 DRUG INTERACTIONS

7.1 Effects of Other Drugs on Combined Oral Contraceptives

7.2 Effects of Combined Oral Contraceptives on Other Drugs

7.3 Concomitant Use with HCV Combination Therapy – Liver Enzyme Elevation

7.4 Interactions with Laboratory Tests

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

8.3 Nursing Mothers

8.4 Pediatric Use

8.5 Geriatric Use

8.6 Hepatic Impairment

8.7 Renal Impairment

8.8 Body Mass Index

10 OVERDOSAGE

11 DESCRIPTION

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

12.2 Pharmacodynamics

12.3 Pharmacokinetics

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14 CLINICAL STUDIES

16 HOW SUPPLIED/STORAGE AND HANDLING

16.1 How Supplied

16.2 Storage Conditions

17 PATIENT COUNSELING INFORMATION

*
Sections or subsections omitted from the full prescribing information are not listed.

FULL PRESCRIBING INFORMATION

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS


Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke [see Contraindications (4)].

1 INDICATIONS AND USAGE

 Tarina 24 Fe is indicated for use by women to prevent pregnancy [see Clinical Studies (14)].


The efficacy of Tarina 24 Fe in women with a body mass index (BMI) of greater than 35 kg/m2 has not been evaluated.

2 DOSAGE AND ADMINISTRATION

2.1 How to Start Tarina 24 Fe

Tarina 24 Fe is available in a blister pack [see How Supplied/Storage and Handling (16)]. Tarina 24  Fe may be started using either a Day 1 start or a Sunday start (see Table 1). For the first cycle of a Sunday Start regimen, an additional method of contraception must be used until after the first 7 consecutive days of administration.

2.2 How to Take Tarina 24 Fe

Table 1: Instructions for Administration of Tarina 24 Fe
Starting COCs in women not currently using hormonal contraception (Day 1 Start or Sunday Start)
 
Important:
Consider the possibility of ovulation and conception prior to initiation of this product.
 
 
Tablet Color:
·    Tarina 24  Fe active tablets are light yellow to yellow (Day 1 to Day 24).
·   Tarina 24  Fe inactive tablets are brown (Day 25 to Day 28).
Day 1 Start:
·    Take first light yellow to yellow active tablet without regard to meals on the first day of menses.
·    Take subsequent active tablets once daily at the same time each day for a total of 24 days.
·    Take one brown inactive tablet daily for 4 days and at the same time of day that active tablets were taken.
·    Begin each subsequent pack on the same day of the week as the first cycle pack (i.e., on the day after taking the last inactive tablet).
Sunday Start:
For each 28-day course, take in the following order:
·    Take the light yellow to yellow active tablet without regard to meals on the first Sunday after the onset of menses. Due to the potential risk of becoming pregnant, use additional non-hormonal contraception (such as condoms and spermicide) for the first 7 days of the patient’s first cycle pack of Tarina 24 Fe .
·    Take subsequent active tablets once daily at the same time each day for a total of 24 days.
·    Take one brown tablet (ferrous fumarate) daily for the following 4 days and at the same time of day that active tablets were taken. A scheduled period should occur during the 4 days that the brown tablets are taken.
·     Begin each subsequent pack on the same day of the week as the first cycle pack (i.e., on the Sunday after taking the last inactive tablet) and additional non-hormonal contraceptive is not needed.
Switching to Tarina 24 Fe from another oral contraceptive
Start on the same day that a new pack of the previous oral contraceptive would have started.
Switching from another contraceptive method to Tarina 24 Fe
Start Tarina 24 Fe:
·    Transdermal patch
·    On the day when next application would have been scheduled.
·    Vaginal ring
·    On the day when next insertion would have been scheduled.
·    Injection
·    On the day when next injection would have been scheduled.
·    Intrauterine contraceptive
·    On the day of removal
·    If the IUD is not removed on first day of the patient’s menstrual cycle, additional non-hormonal contraceptive (such as condoms and spermicide) is needed for the first seven days of the first cycle pack.
·    Implant
·    On the day of removal
Complete instructions on proper tablet usage are located in the FDA-approved patient labeling.  


Starting Tarina 24 Fe after Abortion or Miscarriage

First-trimester


  • After a first-trimester abortion or miscarriage, Tarina 24 Fe may be started immediately. An additional method of contraception is not needed if Tarina 24 Fe is started immediately.

  • If Tarina 24 Fe is not started within 5 days after termination of the pregnancy, the patient must use additional non-hormonal contraception (such as condoms and spermicide) for the first 7 days of her first 28-day course of Tarina 24 Fe.

Second-trimester


  • Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start Tarina 24 Fe following the instructions in Table 1 for Sunday start. Use additional non-hormonal contraception (such as condoms and spermicide) for the first 7 days of the patient’s first 28-day course of Tarina 24 Fe [see Contraindications (4), Warnings and Precautions (5.1), and FDA-approved Patient Labeling].

Starting Tarina 24 Fe after Childbirth


  • Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with Tarina 24 Fe  following the instructions in Table 1 for women not currently using hormonal contraception.

2.3 Missed Tablets


Table 2: Instructions for Missed Tarina 24 Fe Tablets
  • If one active tablet is missed in Weeks 1, 2 or 3
Take the tablet as soon as possible. Take the next pill at the regular time, and continue taking one tablet a day until the pack is finished. Back-up contraception is not needed
 
  • If two consecutive active tablets are missed in Week 1 or Week 2
Take the two missed tablets as soon as possible and the next two active tablets the next day. Continue taking one tablet a day until the pack is finished. Additional non-hormonal contraception (such as condoms and spermicide) must be used as back-up if the patient has sex within 7 days after missing tablets.
  • If two consecutive active tablets are missed in Week 3 or Week 4 or three or more consecutive active tablets are missed at any time
Day 1 Start: Throw out the rest of the pack and start a new pack that same day.
Sunday Start: Continue taking one tablet a day until Sunday, then throw out the rest of the pack and start a new pack that same day. Additional non-hormonal contraception (such as condoms and spermicide) must be used as back-up if the patient has sex within 7 days after missing tablets.


2.4 Advice in Case of Gastrointestinal Disturbances

In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures must be taken. If vomiting or diarrhea occurs within 3 to 4 hours after taking a light yellow to yellow tablet, handle this as a missed tablet [see FDA-Approved Patient Labeling].

3 DOSAGE FORMS AND STRENGTHS

Tarina 24 Fe (norethindrone acetate and ethinyl estradiol tablets USP and ferrous fumarate tablets) is available in blister packs.


Each blister pack (28 tablets) contains in the following order:



4 CONTRAINDICATIONS

Do not prescribe Tarina 24 Fe to women who are known to have the following conditions:



5 WARNINGS AND PRECAUTIONS

5.1 Thrombotic Disorders and Other Vascular Problems

  • Stop Tarina 24 Fe if an arterial thrombotic event or venous thromboembolic (VTE) event occurs.

  • Stop Tarina 24 Fe if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions. Evaluate for retinal vein thrombosis immediately [see Adverse Reactions (6.2)].

  • If feasible, stop Tarina 24 Fe at least 4 weeks before and through 2 weeks after major surgery or other surgeries known to have an elevated risk of VTE as well as during the following prolonged immobilization.

  • Start Tarina 24 Fe no earlier than 4 weeks after delivery, in women who are not breastfeeding. The risk of postpartum VTE decreases after the third postpartum week, whereas the risk of ovulation increases after the third postpartum week.

  • The use of COCs increases the risk of VTE. However, pregnancy increases the risk of VTE as much or more than the use of COCs. The risk of VTE in women using COCs is 3 to 9 cases per 10,000 woman-years. The risk of VTE is highest during the first year of use of a COCs and when restarting oral contraception after a break of 4 weeks or longer. The risk of thromboembolic disease due to COCs gradually disappears after COC use is discontinued.

  • Use of COCs also increases the risk of arterial thromboses such as strokes and myocardial infarctions, especially in women with other risk factors for these events. COCs have been shown to increase both the relative and attributable risks of cerebrovascular events (thrombotic and hemorrhagic strokes). This risk increases with age, particularly in women over 35 years of age who smoke.

  • Use COCs with caution in women with cardiovascular disease risk factors.

5.2 Liver Disease

Impaired Liver Function


Do not use Tarina 24 Fe in women with liver disease, such as acute viral hepatitis or severe (decompensated) cirrhosis of liver [see Contraindications (4)]. Acute or chronic disturbances of liver function may necessitate the discontinuation of COC use until markers of liver function return to normal and COC causation has been excluded. Discontinue Tarina 24 Fe if jaundice develops.


Liver Tumors


Tarina 24 Fe is contraindicated in women with benign and malignant liver tumors [see Contraindications (4)]. Hepatic adenomas are associated with COC use. An estimate of the attributable risk is 3.3 cases per 100,000 COC users. Rupture of hepatic adenomas may cause death through intra-abdominal hemorrhage.


Studies have shown an increased risk of developing hepatocellular carcinoma in long-term (greater than 8 years) COC users. However, the risk of liver cancers in COC users is less than one case per million users.

5.3 Risk of Liver Enzyme Elevations with Concomitant Hepatitis C Treatment

During clinical trials with the Hepatitis C combination drug regimen that contains ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, ALT elevations greater than 5 times the upper limit of normal (ULN), including some cases greater than 20 times the ULN, were significantly more frequent in women using ethinyl estradiol-containing medications, such as COCs. Discontinue Tarina 24 Fe prior to starting therapy with the combination drug regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir [see Contraindications (4)].  Tarina 24 Fe can be restarted approximately 2 weeks following completion of treatment with the Hepatitis C combination drug regimen.

5.4 High Blood Pressure

Tarina 24 Fe is contraindicated in women with uncontrolled hypertension or hypertension with vascular disease [see Contraindications (4)]. For women with well-controlled hypertension, monitor blood pressure and stop Tarina 24 Fe if blood pressure rises significantly.


An increase in blood pressure has been reported in women taking COCs, and this increase is more likely in older women with extended duration of use. The incidence of hypertension increases with increasing concentrations of progestin.

5.5 Gallbladder Disease

Studies suggest a small increased relative risk of developing gallbladder disease among COC users. Use of COCs may worsen existing gallbladder disease. A past history of COC-related cholestasis predicts an increased risk with subsequent COC use. Women with a history of pregnancy-related cholestasis may be at an increased risk for COC related cholestasis.

5.6 Carbohydrate and Lipid Metabolic Effects

Carefully monitor prediabetic and diabetic women who are taking Tarina 24 Fe. COCs may decrease glucose tolerance.


Consider alternative contraception for women with uncontrolled dyslipidemias. A small proportion of women will have adverse lipid changes while on COCs.


Women with hypertriglyceridemia, or a family history thereof, may be at an increased risk of pancreatitis when using COCs.

5.7 Headache

If a woman taking Tarina 24 Fe develops new headaches that are recurrent, persistent, or severe, evaluate the cause and discontinue Tarina 24 Fe if indicated.


Consider discontinuation of Tarina 24 Fe in the case of increased frequency or severity of migraine during COC use (which may be prodromal of a cerebrovascular event).

5.8 Bleeding Irregularities and Amenorrhea

Unscheduled Bleeding and Spotting


Unscheduled (breakthrough or intracyclic) bleeding and spotting sometimes occur in patients on COCs, especially during the first three months of use. If bleeding persists or occurs after previously regular cycles, check for causes such as pregnancy or malignancy. If pathology and pregnancy are excluded, bleeding irregularities may resolve over time or with a change to a different contraceptive product.


In a clinical trial of Tarina 24 Fe, the frequency and duration of unscheduled bleeding and/or spotting was assessed in 743 women (3,823 28-day cycles). A total of 10 subjects (1.3%) discontinued Tarina 24 Fe, at least in part, due to bleeding or spotting. Based on data from the clinical trial, [24 to 38%] of women using Tarina 24 Fe experienced unscheduled bleeding per cycle in the six months of the trial. The percent of women who experienced unscheduled bleeding tended to decrease over time.


Amenorrhea and Oligomenorrhea


Women who use Tarina 24 Fe may experience absence of withdrawal bleeding, even if they are not pregnant. In the clinical trial with Tarina 24 Fe, 31 to 41% of the women using Tarina 24 Fe did not have a withdrawal menses in at least one of 6 cycles of use.

Some women may experience amenorrhea or oligomenorrhea after discontinuation of COCs, especially when such a condition was preexistent.


If scheduled (withdrawal) bleeding does not occur, consider the possibility of pregnancy. If the patient has not adhered to the prescribed dosing schedule (missed one or more active tablets or started taking them on a day later than she should have), consider the possibility of pregnancy at the time of the first missed period and take appropriate diagnostic measures. If the patient has adhered to the prescribed regimen and misses two consecutive periods, rule out pregnancy.

5.9 COC Use Before or During Early Pregnancy

Extensive epidemiologic studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy. Studies also do not suggest a teratogenic effect, particularly in so far as cardiac anomalies and limb reduction defects are concerned, when oral contraceptives are taken inadvertently during early pregnancy. Discontinue Tarina 24 Fe use if pregnancy is confirmed.


Administration of COCs to induce withdrawal bleeding should not be used as a test for pregnancy [see Use in Specific Populations (8.1)].

5.10 Depression

Carefully observe women with a history of depression and discontinue Tarina 24 Fe if depression recurs to a serious degree.

5.11 Carcinoma of the Breast and Cervix

Tarina 24 Fe is contraindicated in women who currently have or have had breast cancer because breast cancer is a hormonally-sensitive [see Contraindications (4)].


There is substantial evidence that COCs do not increase the incidence of breast cancer. Although some past studies have suggested that COCs might increase the incidence of breast cancer, more recent studies have not confirmed such findings.


Some studies suggest that COCs are associated with an increase in the risk of cervical cancer or intraepithelial neoplasia. However, there is controversy about the extent to which these findings may be due to differences in sexual behavior and other factors.

5.12 Effect on Binding Globulins

The estrogen component of COCs may raise the serum concentrations of thyroxine-binding globulin, sex hormone-binding globulin, and cortisol-binding globulin. The dose of replacement thyroid hormone or cortisol therapy may need to be increased.

5.13 Monitoring

A woman who is taking COCs should have a yearly visit with her healthcare provider for a blood pressure check and for other indicated healthcare.

5.14 Hereditary Angioedema

In women with hereditary angioedema, exogenous estrogens may induce or exacerbate symptoms of angioedema.

5.15 Chloasma

Chloasma may occasionally occur, especially in women with a history of chloasma gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while taking Tarina 24 Fe.

6 ADVERSE REACTIONS

The following serious adverse reactions with the use of COCs are discussed elsewhere in the labeling:



Adverse reactions commonly reported by COC users are:


6.1 Clinical Trial Experience

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


The safety of Tarina 24 Fe was evaluated in 743 subjects who participated in an open-label, randomized, active-controlled, multicenter clinical trial of Tarina 24 Fe for contraception. This trial examined healthy, non-pregnant volunteers aged 18 to 45 years, who were sexually active and had a body mass index of less than or equal to 35 kg/m2. Subjects were followed for up to six 28-day cycles providing a total of 3,823 treatment-cycles of exposure.


Common Adverse Reactions (greater than or equal to 2% of all subjects): The most common adverse reactions reported by at least 2% of the 743 women using Tarina 24 Fe were the following, in order of decreasing incidence: headache (6.3%), vaginal candidiasis (6.1%), nausea (4.6%), menstrual cramps (4.4%), breast tenderness (3.4%), mood changes (including mood swings (2.2%) and depression (1.1%), bacterial vaginitis (3.1%), acne (2.7%), and weight gain (2.0%).


Adverse Reactions Leading to Study Discontinuation: Among the 743 women using Tarina 24 Fe, 46 women (6.2%) withdrew because of an adverse event. Adverse events occurring in 3 or more subjects leading to discontinuation of treatment were, in decreasing order: abnormal bleeding (0.9%), nausea (0.8%), mood changes (0.8%), menstrual cramps (0.4%), increased blood pressure (0.4%), and irregular bleeding (0.4%).

6.2 Postmarketing Experience

The following adverse reactions have been identified during post approval use of Tarina 24 Fe. Because these reactions are reported voluntarily from a population of uncertain size, it is difficult to reliably estimate their frequency or evaluate a causal relationship to drug exposure.


Cardiovascular: chest pain, palpitations, tachycardia, angina pectoris, myocardial infarction.


Endocrine disorders: hypothyroidism, hyperthyroidism.


Eye disorders: blurred vision, visual impairment, transient blindness, corneal thinning, change in corneal curvature (steepening).


GI disorders: nausea, vomiting, abdominal pain, constipation, pancreatitis.


Hepatobiliary disorders: cholelithiasis, cholecystitis, hepatic adenoma, hemangioma of liver.


Immune system disorders: anaphylactic reactions, including urticaria, angioedema, and

severe reactions with respiratory and circulatory symptoms.


Infections: vaginal infection.


Metabolism and nutrition disorders: change in weight or appetite (increase or decrease).


hypoglycemia, diabetes mellitus, anemia.


Musculoskeletal and connective tissue disorders: myalgia.


Skin and subcutaneous disorders: alopecia, rash (generalized and allergic), pruritus, skin

discoloration, night sweats, swelling face or lips, hirsutism, skin burning sensation, erythema

multiforme, erythema nodosum, hemorrhagic eruption.


Nervous system disorders: headache, dizziness, migraine, hyperesthesia, paraesthesia, hypoaesthesia, somnolence, loss of consciousness, sensory disturbance.


Psychiatric disorders: mood swings, depression, insomnia, anxiety, suicidal ideation, panic attack, changes in libido, bipolar disorder, dissociation, homicidal ideation.


Renal and urinary disorders: pollakiuria, dysuria, cystitis-like syndrome.


Reproductive system and breast disorders: breast changes (tenderness, pain, enlargement, and secretion), premenstrual syndrome, ovarian cyst, pelvic pain, ovarian cyst ruptured, pelvic fluid collection.


Vascular disorders: hot flush, thrombosis/embolism (coronary artery, pulmonary, cerebral, deep vein), migraine, transient ischemic attack, ischemic stroke.

7 DRUG INTERACTIONS

Consult the labeling of concurrently used drugs to obtain further information about interactions with oral contraceptives or the potential for enzyme alterations.

7.1 Effects of Other Drugs on Combined Oral Contraceptives

Substances decreasing the plasma concentrations of COCs and potentially diminishing the efficacy of COCs:


Drugs or herbal products that induce certain enzymes, including cytochrome P450 3A4 (CYP3A4), may decrease the plasma concentrations of COCs and potentially diminish the effectiveness of COCs or increase breakthrough bleeding. Some drugs or herbal products that may decrease the effectiveness of oral contraceptives including phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, and products containing St. John’s wort. Interactions between COCs and other drugs may lead to breakthrough bleeding and/or contraceptive failure. Counsel women to use an alternative method of contraception or a back-up method when enzyme inducers are used with COCs, and to continue back-up contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability.


Substances increasing the plasma concentrations of COCs:


Co-administration of atorvastatin or rosuvastatin and certain COCs containing ethinyl estradiol (EE) increase AUC values for EE by approximately 20 to 25%. Ascorbic acid and acetaminophen may increase plasma EE concentrations, possibly by inhibition of conjugation. CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. 


Human immunodeficiency virus (HIV)/Hepatitis C virus (HCV) protease inhibitors and non-nucleoside reverse transcriptase inhibitors:


Significant changes (increase or decrease) in the plasma concentrations of estrogen and/or progestin have been noted in some cases of co-administration with HIV protease inhibitors (decrease [e.g., nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir] or increase [e.g., indinavir and atazanavir/ritonavir])/HCV protease inhibitors or with non-nucleoside reverse transcriptase inhibitors (decrease [e.g., nevirapine] or increase [e.g., etravirine]).

7.2 Effects of Combined Oral Contraceptives on Other Drugs

COCs containing EE may inhibit the metabolism of other compounds (e.g., cyclosporine, prednisolone, theophylline, tizanidine, and voriconazole) and increase their plasma concentrations. COCs have been shown to decrease plasma concentrations of acetaminophen, clofibric acid, morphine, salicylic acid, and temazepam. Significant decrease in plasma concentration of lamotrigine has been shown, likely due to induction of lamotrigine glucuronidation. This may reduce seizure control; therefore, dosage adjustments of lamotrigine may be necessary.


Women on thyroid hormone replacement therapy may need increased doses of thyroid hormone because the serum concentration of thyroid-binding globulin increases with use of COCs [see Warnings and Precautions (5.12)].

7.3 Concomitant Use with HCV Combination Therapy – Liver Enzyme Elevation

Do not co-administer Tarina 24 Fe with HCV drug combinations containing ombitasvir/ paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations [see Warnings and Precautions (5.3)].

7.4 Interactions with Laboratory Tests

The use of contraceptive steroids may influence the results of certain laboratory tests, such as coagulation factors, lipids, glucose tolerance, and binding proteins.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

There is little or no increased risk of birth defects in women who inadvertently use COCs during early pregnancy. Epidemiologic studies and meta-analyses have not found an increased risk of genital or non-genital birth defects (including cardiac anomalies and limb reduction defects) following exposure to low dose COCs prior to conception or during early pregnancy.


Do not administer COCs to induce withdrawal bleeding as a test for pregnancy. Do not use COCs during pregnancy to treat threatened or habitual abortion.


Women who do not breastfeed should not start COCs earlier than 4 weeks postpartum.

8.3 Nursing Mothers

Advise the nursing mother to use another contraceptive method, when possible, until she has weaned her child. COCs can reduce milk production in breastfeeding mothers. This is less likely to occur once breastfeeding is well-established; however, it can occur at any time in some women. Small amounts of oral contraceptive steroids and/or metabolites are present in breast milk.

8.4 Pediatric Use

Safety and efficacy of Tarina 24 Fe have been established in women of reproductive age. Efficacy is expected to be the same in postpubertal adolescents under the age of 18 years as for users 18 years and older. Use of this product before menarche is not indicated.

8.5 Geriatric Use

Tarina 24 Fe has not been studied in postmenopausal women and is not indicated in this population.

8.6 Hepatic Impairment

The pharmacokinetics of Tarina 24 Fe has not been studied in subjects with hepatic impairment. However, steroid hormones may be poorly metabolized in patients with hepatic impairment. Acute or chronic disturbances of liver function may necessitate the discontinuation of COC use until markers of liver function return to normal and COC causation has been excluded [see Contraindications (4) and Warnings and Precautions (5.2)].

8.7 Renal Impairment

The pharmacokinetics of Tarina 24 Fe has not been studied in women with renal impairment.

8.8 Body Mass Index

The safety and efficacy of Tarina 24 Fe in women with a body mass index (BMI) greater than 35 kg/m2 has not been evaluated [see Clinical Studies (14)].

10 OVERDOSAGE

There have been no reports of serious ill effects from overdose of oral contraceptives, including ingestion by children. Overdosage may cause withdrawal bleeding in females and nausea.

11 DESCRIPTION

 Tarina 24 Fe is a combination oral contraceptive for oral administration consisting of active tablets containing norethindrone acetate, a progestin, and ethinyl estradiol, an estrogen, and placebo tablets containing ferrous fumarate, which serve no therapeutic purpose.





The chemical name of ethinyl estradiol is 19-nor-17α-pregna-1,3,5(10)-trien-20-yne-3,17-diol. The molecular formula of ethinyl estradiol is C20H24O2 and the structural formula is:


Structure-1 


The chemical name of norethindrone acetate is 17-hydroxy-19-nor-17α-pregn-4-en-20-yn-3-one acetate. The molecular formula of norethindrone acetate is C22H28O3 and the structural formula is:


Structure-2 



 

 

USP Dissolution Test Pending.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

COCs lower the risk of becoming pregnant primarily by suppressing ovulation. Other possible mechanisms may include cervical mucus changes that inhibit sperm penetration and endometrial changes that reduce the likelihood of implantation.

12.2 Pharmacodynamics

No specific pharmacodynamic studies were conducted with Tarina 24 Fe.

12.3 Pharmacokinetics

Absorption


Norethindrone acetate appears to be completely and rapidly deacetylated to norethindrone after oral administration, because the disposition of norethindrone acetate is indistinguishable from that of orally administered norethindrone. Norethindrone acetate and ethinyl estradiol are rapidly absorbed from Tarina 24 Fe tablets, with maximum plasma concentrations of norethindrone and ethinyl estradiol occurring 1 to 4 hours postdose. Both are subject to first-pass metabolism after oral dosing, resulting in an absolute bioavailability of approximately 64% for norethindrone and 43% for ethinyl estradiol.

The plasma norethindrone and ethinyl estradiol pharmacokinetics following single- and multiple-dose administrations of Tarina 24 Fe tablets in 17 healthy female volunteers are provided in Figures 1 and 2, and Table 3.

Following multiple-dose administration of Tarina 24 Fe tablets, mean maximum concentrations of norethindrone and ethinyl estradiol were increased by 95% and 27%, respectively, as compared to single-dose administration. Mean norethindrone and ethinyl estradiol exposures (AUC values) were increased by 164% and 51% respectively, as compared to single-dose administration of Tarina 24 Fe tablets.

Steady-state with respect to norethindrone was reached by Day 17 and steady-state with respect to ethinyl estradiol was reached by Day 13.

Mean SHBG concentrations were increased by 150% from baseline (57.5 nmol/L) to    144 nmol/L at steady-state.


Figure 1. Mean Plasma Norethindrone Concentration-Time Profiles Following Single- and Multiple-Dose Oral Administration of Tarina 24 Fe Tablets to Healthy Female Volunteers Under Fasting Condition (n = 17)

Figure-1



Figure 2. Mean Plasma Ethinyl Estradiol Concentration-Time Profiles Following Single- and Multiple-Dose Oral Administration of Tarina 24 Fe Tablets to Healthy Female Volunteers Under Fasting Condition (n = 17)

Figure-2


Table 3. Summary of Norethindrone (NE) and Ethinyl Estradiol (EE) Pharmacokinetics Following Single- and Multiple-Dose Oral Administration of Tarina 24 Fe Tablets to Healthy Female Volunteers Under Fasting Condition (n = 17)

 
Regimen
 
Analyte
 
Arithmetic Mean(% CV) by Pharmacokinetic Parameter
Cmax (pg/mL)
tmax
(hr)
AUC(0−24) (pg/mL•h)
Cmin (pg/mL)
t½ (hr)
Cavg (pg/mL)
 
 
 
Day 1 (Single Dose)
NE
8420 (31)
1.0
(0.7 to 4.0)
33390 (40)
--
--
--
EE
64.5 (27)
1.3
(0.7 to 4.0)
465.4 (26)
--
--
--
SHBG
--
--
--
57.5
(37)b
--
--
Day 24
(Multiple Dose)
NE
16400 (26)
1.3
(0.7 to 4.0)
88160 (30)
880 (51)
8.4
3670 (30)
EE
81.9 (24)
1.7
(1.0 to 2.0)
701.3
(28)
11.4
(43)
14.5
29.2
(28)
SHBG
--
--
--
144
(24)
--
--

Cmax = Maximum plasma concentration

tmax = Time of Cmax

Cmin = minimum plasma concentration at steady-state

AUC(0−24) = Area under plasma concentration versus time curve from 0 to 24 hours

t½ = Apparent first-order terminal elimination half-life

Cavg = Average plasma concentration = AUC(0–24)/24

% CV = Coefficient of Variation (%)

SHBG = Sex Hormone Binding Globulin (nmol/L)

a The harmonic mean (0.693/mean apparent elimination rate constant) is reported for t½, and the median (range) is reported for tmax.

b The SHBG concentration reported here is the pre-dose concentration.


Food Effect


A single-dose administration of Tarina 24 Fe tablet with food decreased the maximum concentration of norethindrone by 11% and increased the extent of absorption by 27% and decreased the maximum concentration of ethinyl estradiol by 30% but not the extent of absorption.


Distribution


Volume of distribution of norethindrone and ethinyl estradiol ranges from 2 to 4 L/kg. Plasma protein binding of both steroids is extensive (greater than 95%); norethindrone binds to both albumin and SHBG, whereas ethinyl estradiol binds only to albumin. Although ethinyl estradiol does not bind to SHBG, it induces SHBG synthesis.


Metabolism


Norethindrone undergoes extensive biotransformation, primarily via reduction, followed by sulfate and glucuronide conjugation. The majority of metabolites in the circulation are sulfates, with glucuronides accounting for most of the urinary metabolites.


Ethinyl estradiol is also extensively metabolized, both by oxidation and by conjugation with sulfate and glucuronide. Sulfates are the major circulating conjugates of ethinyl estradiol and glucuronides predominate in urine. The primary oxidative metabolite is 2-hydroxy ethinyl estradiol, formed by the CYP3A4 isoform of cytochrome P450. Part of the first-pass metabolism of ethinyl estradiol is believed to occur in gastrointestinal mucosa. Ethinyl estradiol may undergo enterohepatic circulation.


Excretion


Norethindrone and ethinyl estradiol are excreted in both urine and feces, primarily as metabolites. Plasma clearance values for norethindrone and ethinyl estradiol are similar (approximately 0.4 L/hr/kg). Steady-state elimination half-lives of norethindrone and ethinyl estradiol following administration of Tarina 24 Fe tablets are approximately 8 hours and 14 hours, respectively.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

[See Warnings and Precautions (5.2, 5.11) and Use in Specific Populations (8.1).]

14 CLINICAL STUDIES

In an active-controlled clinical trial, 743 women 18 to 45 years of age were studied to assess the efficacy of Tarina 24 Fe, for up to six 28-day cycles. The racial demographic of women randomized to Tarina 24 Fe was: 69.5% Caucasian, 15.5% African-American, 10.4% Hispanic, 2.3% Asian and 2.3% Native American/Other. Women with body mass index (BMI) greater than 35 mg/m2 were excluded from the study. The weight range for those women treated was 90 to 260 pounds, with a mean weight of 147 pounds. Among the women in the study randomized to Tarina 24 Fe, 38.9% had not used hormonal contraception immediately prior to enrolling in this study.


A total of 583 women completed 6 cycles of treatment. There were a total of 5 on-treatment pregnancies among women aged 18 to 45 years in 3,565 treatment cycles during which no back-up contraception was used. The Pearl Index for Tarina 24 Fe was 1.82 (95% confidence interval 0.59 to 4.25).

16 HOW SUPPLIED/STORAGE AND HANDLING

16.1 How Supplied

Tarina®24 Fe is available in blister packs containing 28 tablets. The Blister Packs are packed in pouches (NDC 50102-224-21) and the pouches are packaged in cartons:

pouch containing one Blister pack                  NDC 50102-224-21

Carton of 3 Pouches                                          NDC 50102-224-23

Each blister pack (28 tablets) contains in the following order:

  • 24 light yellow to yellow, round, flat-faced, beveled-edge, uncoated (active) tablets debossed with ‘S’ on one side and ‘64’ on other side and each containing 1 mg of norethindrone acetate USP and 20 mcg of ethinyl estradiol USP.

  • 4 brown, mottled, round, flat-faced, beveled-edge (non-hormonal placebo) tablets debossed with ‘S’ on one side and ‘57’ on other side and each containing 75 mg ferrous fumarate USP. The ferrous fumarate tablets do not serve any therapeutic purpose.

16.2 Storage Conditions

  • Store at 20º to 25ºC (68º to 77ºF) [see USP Controlled Room Temperature].
  • Protect from light.

17 PATIENT COUNSELING INFORMATION

See FDA-approved Patient Labeling (Patient Information and Instructions for Use).


Counsel patients about the following information:










 

PATIENT INFORMATION

Tarina 24® Fe

(norethindrone acetate and ethinyl estradiol tablets USP

and ferrous fumarate tablets)

What is the most important information I should know about Tarina 24 Fe?

Do not use Tarina 24 Fe if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects from hormonal birth control pills, including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.


What is Tarina 24 Fe?


Tarina 24 Fe is a birth control pill (hormonal contraceptive) used by women to prevent pregnancy.


How does Tarina 24 Fe  work for contraception?


Your chance of getting pregnant depends on how well you follow the directions for taking your birth control pills. The better you follow the directions, the less chance you have of getting pregnant.


Based on the results from the clinical study, about 1 to 4 out of 100 women may get pregnant during the first year they use Tarina 24 Fe.


The following chart shows the chance of getting pregnant for women who use different methods of birth control. Each box on the chart contains a list of birth control methods that are similar in effectiveness. The most effective methods are at the top of the chart. The box on the bottom of the chart shows the chance of getting pregnant for women who do not use birth control and are trying to get pregnant.
Figure

Who should not take Tarina 24 Fe?


Do not take Tarina 24 Fe if you:



If any of these conditions happen while you are taking Tarina 24 Fe, stop taking Tarina 24 Fe right away and talk to your healthcare provider. Use non-hormonal contraception (such as condoms and spermicide) when you stop taking Tarina 24 Fe.


What should I tell my healthcare provider before taking Tarina 24 Fe?

Tell your healthcare provider if you:






Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.


Tarina 24 Fe may affect the way other medicines work, and other medicines may affect how well Tarina 24 Fe works.


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


How should I take Tarina 24 Fe?

Read the Instructions for Use at the end of this Patient Information.

What are the possible serious side effects of Tarina 24 Fe?



Serious blood clots can happen especially if you smoke, are obese, or are older than 35 years of age. Serious blood clots are more likely to happen when you:




Call your healthcare provider or go to a hospital emergency room right away if you have:


Other serious side effects include:




What are the most common side effects of Tarina 24 Fe?



These are not all the possible side effects of Tarina 24 Fe. For more information, ask your healthcare provider or pharmacist.


You may report side effects to the FDA at 1-800-FDA-1088.

What else should I know about taking Tarina 24 Fe?


How should I store Tarina 24 Fe?



General information about the safe and effective use of Tarina 24 Fe.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Tarina 24 Fe for a condition for which it was not prescribed. Do not give Tarina 24 Fe to other people.


This Patient Information summarizes the most important information about Tarina 24 Fe. You can ask your pharmacist or healthcare provider for information about Tarina 24 Fe that is written for health professionals.


For more information, call Afaxys Pharma, LLC at 1-855-888-2467.

Do birth control pills cause cancer?


Birth control pills do not seem to cause breast cancer. However, if you have breast cancer now, or have had it in the past, do not use birth control pills because some breast cancers are sensitive to hormones.


Women who use birth control pills may have a slightly higher chance of getting cervical cancer. However, this may be due to other reasons such as having more sexual partners.

What if I want to become pregnant?


You may stop taking the pill whenever you wish. Consider a visit with your healthcare provider for a pre-pregnancy checkup before you stop taking the pill.


What should I know about my period when taking Tarina 24 Fe ?


Your periods may be lighter and shorter than usual. Some women may miss a period. Irregular vaginal bleeding or spotting may happen while you are taking Tarina 24 Fe, especially during the first few months of use. This usually is not a serious problem. It is important to continue taking your pills on a regular schedule to prevent a pregnancy.


What are the ingredients in Tarina 24 Fe ?

Active ingredients:

Light yellow to yellow pills: norethindrone acetate and ethinyl estradiol

Inactive ingredients:

Light yellow to yellow pills: compressible sugar, croscarmellose sodium, D & C Yellow No. 10 Aluminum Lake, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone and vitamin E.


Brown pills:  ferrous fumarate, croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, Nat spearmint FL SD #11475, povidone and sucralose.


INSTRUCTIONS FOR USE


Tarina 24 Fe 

(norethindrone acetate and ethinyl estradiol tablets USP

and ferrous fumarate tablets)

Important Information about taking Tarina 24 Fe 










Before you start taking Tarina 24 Fe :




When should I start taking Tarina 24 Fe ?

If you start taking Tarina 24 Fe  and you have not used a hormonal birth control method before:




If you start taking Tarina 24 Fe  and you are switching from another birth control pill:




If you start taking Tarina 24 Fe  and previously used a vaginal ring or transdermal patch:


If you start taking Tarina 24 Fe  and you are switching from a progestin-only method such as an implant or injection:



If you start taking Tarina 24 Fe  and you are switching from an intrauterine device or system (IUD or IUS):




Keep a calendar to track your period:

If this is the first time you are taking birth control pills, read, “When should I start taking Tarina 24 Fe ?” above. Follow these instructions for either a Sunday Start or a Day 1 Start.

Sunday Start:


You will use a Sunday Start if your healthcare provider told you to take your first pill on a Sunday.







Day 1 Start:


You will use a Day 1 Start if your doctor told you to take your first pill (Day 1) on the first day of your period.




Instructions for using your blister pack:


The Tarina 24 Fe  blister pack has 24 "active" light yellow to yellow pills (with hormones) to be taken for 24 days, followed by 4 "reminder" brown pills (without hormones) to be taken for the next 4 days.

figure4

Look for:


What if should I do if I miss any Tarina 24 Fe  light yellow to yellow pills?

If you miss 1 light yellow to yellow pill in Weeks 1, 2, or 3, follow these steps:





If you miss 2 light yellow to yellow pills in a row in Week 1 or Week 2 of your pack, follow these steps:




If you miss 2 light yellow to yellow pills in a row in Week 3 or Week 4, or you miss 3 or more light yellow to yellow pills in a row at any time, follow these steps:








If you miss any of the 4 brown “reminder” pills in Week 4, throw away the pills you missed and keep taking 1 pill each day until the pack is empty. You do not need to use a back-up method of birth control.

If you have any questions or are unsure about the information in this leaflet, call your healthcare provider.


This Patient Information and Instructions for Use has been approved by the U.S. Food and Drug Administration.


Manufactured for:
Afaxys Pharma, LLC
Charleston, SC, 29403, USA.

Manufactured by:
Aurobindo Pharma Limited
Unit-VII (SEZ)
Mahaboob Nagar (Dt)-509302, India

Issued: 10/2018

PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 1 mg/20 mcg Pouch Label

NDC 50102-224-21
28 Day Regimen 

Rx only
Tarina24 Fe provides
24 days of active therapy 

Tarina 24 Fe
(Norethindrone Acetate and Ethinyl Estradiol
Tablets USP and Ferrous Fumarate Tablets)
1 mg/20 mcg

28 DAY REGIMEN
Each light yellow to yellow tablet contains norethindrone
acetate USP, 1 mg: ethinyl estradiol USP, 20 mcg; each brown
tablet contains ferrous fumarate USP, 75 mg.

Each pouch contains 24 light yellow to yellow tablets and 4
brown tablets.

This product (like all oral contraceptives) is
intended to prevent pregnancy. It does not
protect against HIV infection (AIDS) and other
sexually transmitted diseases. 

This pouch contains 
one blister card  of 28 tablets

afaxys℗  



PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 1 mg/20 mcg Pouch Label

PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 1 mg/20 mcg Pouch Carton Label

NDC 50102-224-23
28 Day Regimen

Tarina 24 Fe provides
24 days of active therapy

Tarina 24 Fe
(Norethindrone Acetate and Ethinyl Estradiol
Tablets USP 
and Ferrous Fumarate Tablets)
1 mg/20 mcg

This product (like all oral contraceptives) is intended to prevent pregnancy. It does not
protect against HIV
infection (AIDS) and other sexually transmitted diseases.

This carton contains  pouches.

Each pouch contains 1 blister card of 28 tablets.

afaxys

PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 1 mg/20 mcg Pouch Carton Label

TARINA 24 FE 
norethindrone acetate and ethinyl estradiol and ferrous fumarate kit
Product Information
Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:50102-224
Packaging
# Item Code Package Description Marketing Start Date Marketing End Date
1 NDC:50102-224-23 3 in 1 CARTON 06/15/2017
1 NDC:50102-224-21 1 in 1 POUCH
1 1 in 1 BLISTER PACK; Type 0: Not a Combination Product
Quantity of Parts
Part # Package Quantity Total Product Quantity
Part 1 24 
Part 2
Part 1 of 2
NORETHINDRONE ACETATE AND ETHINYL ESTRADIOL 
norethindrone acetate and ethinyl estradiol tablet
Product Information
Route of Administration ORAL
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
NORETHINDRONE ACETATE (UNII: 9S44LIC7OJ) (NORETHINDRONE - UNII:T18F433X4S) NORETHINDRONE ACETATE 1 mg
ETHINYL ESTRADIOL (UNII: 423D2T571U) (ETHINYL ESTRADIOL - UNII:423D2T571U) ETHINYL ESTRADIOL 20 ug
Inactive Ingredients
Ingredient Name Strength
RAW SUGAR (UNII: 8M707QY5GH)  
CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)  
LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
MAGNESIUM STEARATE (UNII: 70097M6I30)  
MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
POVIDONE, UNSPECIFIED (UNII: FZ989GH94E)  
.ALPHA.-TOCOPHEROL (UNII: H4N855PNZ1)  
Product Characteristics
Color YELLOW (light yellow to yellow) Score no score
Shape ROUND (Flat Faced, Beveled Edge) Size 6mm
Flavor Imprint Code S;64
Contains     
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA207504 06/15/2017
Part 2 of 2
FERROUS FUMARATE 
ferrous fumarate tablet
Product Information
Route of Administration ORAL
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
FERROUS FUMARATE (UNII: R5L488RY0Q) (FERROUS CATION - UNII:GW89581OWR) FERROUS CATION 75 mg
Inactive Ingredients
Ingredient Name Strength
CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)  
LACTOSE MONOHYDRATE (UNII: EWQ57Q8I5X)  
MAGNESIUM STEARATE (UNII: 70097M6I30)  
MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
SPEARMINT OIL (UNII: C3M81465G5)  
POVIDONE, UNSPECIFIED (UNII: FZ989GH94E)  
SUCRALOSE (UNII: 96K6UQ3ZD4)  
Product Characteristics
Color BROWN Score no score
Shape ROUND (Mottled, Flat Faced, Beveled Edge) Size 6mm
Flavor Imprint Code S;57
Contains     
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA207504 06/15/2017
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA207504 06/15/2017
Labeler - Afaxys Pharma, LLC (080508656)
Registrant - Aurobindo Pharma Limited (650082092)
Establishment
Name Address ID/FEI Business Operations
Aurobindo Pharma Limited 650381903 ANALYSIS(50102-224) , MANUFACTURE(50102-224)

Revised: 6/2019
Document Id: 763ac765-0e1e-4adc-8a46-2d48f36ab207
Set id: 557fa655-c40f-4ecb-bd18-4820c7e15e4b
Version: 2
Effective Time: 20190627
 
Afaxys Pharma, LLC