Label: DEXTENZA- dexamethasone insert

  • NDC Code(s): 70382-204-01, 70382-204-10, 70382-204-88, 70382-204-99
  • Packager: Ocular Therapeutix, Inc.
  • Category: HUMAN PRESCRIPTION DRUG LABEL
  • DEA Schedule: None
  • Marketing Status: New Drug Application

Drug Label Information

Updated November 2, 2020

If you are a consumer or patient please visit this version.

  • HIGHLIGHTS OF PRESCRIBING INFORMATION
    These highlights do not include all the information needed to use DEXTENZA safely and effectively. See full prescribing information for DEXTENZA.
    DEXTENZA® (dexamethasone ophthalmic insert) 0.4 mg, for intracanalicular use
    Initial U.S. Approval: 1958

    RECENT MAJOR CHANGES

    Indications and Usage (1) 06/2019

    INDICATIONS AND USAGE

    DEXTENZA® is a corticosteroid indicated for the treatment of ocular inflammation and pain following ophthalmic surgery (1).

    DOSAGE AND ADMINISTRATION

    DEXTENZA is an ophthalmic insert that is inserted in the lower lacrimal punctum and into the canaliculus. A single DEXTENZA releases a 0.4 mg dose of dexamethasone for up to 30 days following insertion (2).

    DOSAGE FORMS AND STRENGTHS

    Ophthalmic intracanalicular insert containing a 0.4 mg dose of dexamethasone (3).

    CONTRAINDICATIONS

    Active ocular infections (4).

    WARNINGS AND PRECAUTIONS

    • Intraocular Pressure Increase: Monitor intraocular pressure (5.1).
    • Bacterial Infections: Steroids may mask signs of infections and enhance existing infections (5.2).
    • Viral Infections: Ocular steroids may prolong the course and exacerbate the severity of ocular viral infections (5.3).
    • Fungal Infections: Consider fungal invasion in any persistent corneal ulceration (5.4).
    • Delayed Healing: Ocular steroids may slow the rate of ocular healing. (5.5).

    ADVERSE REACTIONS

    The most commonly reported adverse reactions were anterior chamber inflammation and elevations in intraocular pressure. These occurred in approximately 6-10% of patients (6.1).

    To report SUSPECTED ADVERSE REACTIONS, contact Ocular Therapeutix at 1-800-DEXTENZA (339-8369) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

    See 17 for PATIENT COUNSELING INFORMATION.

    Revised: 6/2019

  • Table of Contents
  • 1 INDICATIONS AND USAGE

    DEXTENZA® (dexamethasone ophthalmic insert) is a corticosteroid indicated for the treatment of ocular inflammation and pain following ophthalmic surgery (1).

  • 2 DOSAGE AND ADMINISTRATION

    2.1 General Dosing Information

    DEXTENZA is an ophthalmic insert that is inserted in the lower lacrimal punctum into the canaliculus. A single DEXTENZA insert releases a 0.4 mg dose of dexamethasone for up to 30 days following insertion.

    DEXTENZA is resorbable and does not require removal. Saline irrigation or manual expression can be performed to remove the insert if necessary. DEXTENZA is intended for single-use only.

    2.2 Administration

    Do not use if pouch has been damaged or opened. Do not re-sterilize.

    1. Carefully remove foam carrier and transfer to a clean and dry area.
    2. If necessary, dilate the punctum with an ophthalmic dilator. Care should be taken not to perforate the canaliculus during dilation or insertion of DEXTENZA. If perforation occurs, do not insert DEXTENZA.
    3. After drying the punctal area, using blunt (non-toothed) forceps, grasp DEXTENZA and insert into the lower lacrimal canaliculus. DEXTENZA should be placed just below the punctal opening. Excessive squeezing of DEXTENZA may cause deformation.
    4. To aid in the hydration of DEXTENZA, 1 to 2 drops of balanced salt solution can be instilled into the punctum. DEXTENZA hydrates quickly upon contact with moisture. If DEXTENZA begins to hydrate before fully inserted, discard the product and use a new DEXTENZA.
    5. DEXTENZA can be visualized when illuminated by a blue light source (e.g., slit lamp or hand held blue light) with yellow filter.
  • 3 DOSAGE FORMS AND STRENGTHS

    Ophthalmic insert: fluorescent yellow, 3 mm cylindrical-shaped insert containing dexamethasone, 0.4 mg.

  • 4 CONTRAINDICATIONS

    DEXTENZA is contraindicated in patients with active corneal, conjunctival or canalicular infections, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella; mycobacterial infections; fungal diseases of the eye, and dacryocystitis.

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Intraocular Pressure Increase

    Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be monitored during the course of the treatment.

    5.2 Bacterial Infection

    Corticosteroids may suppress the host response and thus increase the hazard for secondary ocular infections. In acute purulent conditions, steroids may mask infection and enhance existing infection [see Contraindications (4)].

    5.3 Viral Infections

    Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex) [see Contraindications (4)].

    5.4 Fungal Infections

    Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate [see Contraindications (4)].

    5.5 Delayed Healing

    The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

  • 6 ADVERSE REACTIONS

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

    • Intraocular Pressure Increase [see Warnings and Precautions (5.1)]
    • Bacterial Infection [see Warnings and Precautions (5.2)]
    • Viral Infection [see Warnings and Precautions (5.3)]
    • Fungal Infection [see Warnings and Precautions (5.4)]
    • Delayed Healing [see Warnings and Precautions (5.5)]

    6.1 Clinical Trials 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 rates in the clinical trials of another drug and may not reflect the rates observed in practice. Adverse reactions associated with ophthalmic steroids include elevated intraocular pressure, which may be associated with optic nerve damage, visual acuity and field defects, posterior subcapsular cataract formation; delayed wound healing; secondary ocular infection from pathogens including herpes simplex, and perforation of the globe where there is thinning of the cornea or sclera [see Warnings and Precautions (5)].

    DEXTENZA was studied in four randomized, vehicle-controlled studies (n = 567). The mean age of the population was 68 years (range 35 to 87 years), 59% were female, and 83% were white. Forty-seven percent had brown iris color and 30% had blue iris color. The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: anterior chamber inflammation including iritis and iridocyclitis (10%); intraocular pressure increased (6%); visual acuity reduced (2%); cystoid macular edema (1%); corneal edema (1%); eye pain (1%) and conjunctival hyperemia (1%).

    The most common non-ocular adverse reaction that occurred in patients treated with DEXTENZA was headache (1%).

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Risk Summary

    There are no adequate or well-controlled studies with DEXTENZA in pregnant women to inform a drug-associated risk for major birth defects and miscarriage. In animal reproduction studies, administration of topical ocular dexamethasone to pregnant mice and rabbits during organogenesis produced embryofetal lethality, cleft palate and multiple visceral malformations [see Animal Data].

    Data

    Animal Data

    Topical ocular administration of 0.15% dexamethasone (0.75 mg/kg/day) on gestational days 10 to 13 produced embryofetal lethality and a high incidence of cleft palate in a mouse study. A daily dose of 0.75 mg/kg/day in the mouse is approximately 5 times the entire dose of dexamethasone in the DEXTENZA product, on a mg/m2 basis. In a rabbit study, topical ocular administration of 0.1% dexamethasone throughout organogenesis (0.36 mg /day, on gestational day 6 followed by 0.24 mg/day on gestational days 7-18) produced intestinal anomalies, intestinal aplasia, gastroschisis and hypoplastic kidneys. A daily dose of 0.24 mg/day is approximately 6 times the entire dose of dexamethasone in the DEXTENZA product, on a mg/m2 basis.

    8.2 Lactation

    Systemically administered corticosteroids appear in human milk and could suppress growth and interfere with endogenous corticosteroid production; however the systemic concentration of dexamethasone following administration of DEXTENZA is low [see Clinical Pharmacology (12.3)]. There is no information regarding the presence of DEXTENZA in human milk, the effects of the drug on the breastfed infant or the effects of the drug on milk production to inform risk of DEXTENZA to an infant during lactation. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for DEXTENZA and any potential adverse effects on the breastfed child from DEXTENZA.

    8.4 Pediatric Use

    Safety and effectiveness in pediatric patients have not been established.

    8.5 Geriatric Use

    No overall differences in safety or effectiveness have been observed between elderly and younger patients.

  • 11 DESCRIPTION

    DEXTENZA (dexamethasone ophthalmic insert) is a fluorescent yellow, 3 mm cylindrical-shaped, resorbable, sterile insert for intracanalicular use. DEXTENZA contains 0.4 mg dexamethasone in a polyethylene glycol (PEG) based hydrogel conjugated with fluorescein. DEXTENZA does not contain an antimicrobial preservative. The active ingredient is represented by the chemical structure:

    Chemical Structure

    The chemical name for dexamethasone is 9-Fluoro-11β,17,21-trihydroxy-16α-methylpregna-1,4-diene-3,20-dione. It has a molecular formula of C22H29FO5 and a molecular weight of 392.47 g/mol. Dexamethasone is a crystalline powder.

    Each DEXTENZA contains: Active ingredients: 0.4 mg dexamethasone. Inactive ingredients: 4-arm polyethylene glycol (PEG) N-hydroxysuccinimidyl glutarate (20K), trilysine acetate, N-hydroxysuccinimide-fluorescein, sodium phosphate dibasic, sodium phosphate monobasic, water for injection.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    Dexamethasone, a corticosteroid, has been shown to suppress inflammation by inhibiting multiple inflammatory cytokines resulting in decreased edema, fibrin deposition, capillary leakage and migration of inflammatory cells.

    12.3 Pharmacokinetics

    Plasma samples were obtained from 16 healthy volunteers prior to insertion of DEXTENZA and on Day 1 (at 1, 2, 4, 8, 16 hours), 2 (24 hours), 4, 8, 15, 22 and 29 following the insertion of DEXTENZA.

    Plasma concentrations of dexamethasone were detectable (above 50 pg/mL, the lower limit of quantification of the assay) in 11% of samples (21 of 189), and ranged from 0.05 ng/mL to 0.81 ng/mL.

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    No adequate studies in animals have been conducted to determine whether DEXTENZA has the potential for carcinogenesis.

    Dexamethasone was not mutagenic in the Ames/Salmonella assay, both with and without metabolic activation. Dexamethasone was genotoxic in two in vitro assays using human lymphocytes (chromosomal aberration assay and sister chromatid exchange assay) and was genotoxic in two mouse in vivo assays (micronucleus assay and sister chromatid exchange assay).

    Fertility studies have not been conducted in animals using DEXTENZA.

  • 14 CLINICAL STUDIES

    In three randomized, multicenter, double-masked, parallel group, vehicle-controlled trials, patients received DEXTENZA or its vehicle immediately upon completion of cataract surgery. In all three trials, DEXTENZA had a higher proportion of patients than the vehicle group who were pain free on post-operative Day 8. On post-operative Day 14, in two of the three studies, DEXTENZA had a higher proportion of patients than the vehicle group who had an absence of anterior chamber cells that was statistically significant. Results are shown in Table 1 and Table 2.

    Table 1: Percentage of Patients with Absence of Anterior Chamber Cells
    Study 1Study 2Study 3
    DEXTENZA
    (N=164)
    Vehicle
    (N=83)
    Difference
    (95% CI)
    DEXTENZA
    (N=161)
    Vehicle
    (N=80)
    Difference
    (95% CI)
    DEXTENZA
    (N=216)
    Vehicle
    (N=222)
    Difference
    (95% CI)
    Visitn (%)n (%)n (%)n (%)n (%)n (%)
    Day 1454 (33%) 12 (14%) 18% (8%, 29%) 63 (39%) 25 (31%) 8% (-5%, 21%) 113 (52%) 69 (31%) 21 % (12%, 30%)
    Table 2: Percentage of Patients with Absence of Pain
    Study 1Study 2Study 3
    DEXTENZA
    (N=164)
    Vehicle
    (N=83)
    Difference
    (95% CI)
    DEXTENZA
    (N=161)
    Vehicle
    (N=80)
    Difference
    (95% CI)
    DEXTENZA
    (N=216)
    Vehicle
    (N=222)
    Difference
    (95% CI)
    Visitn (%)n (%)n (%)n (%)n (%)n (%)
    Day 8131 (80%) 36 (43%) 37% (24%, 49%) 124 (77%) 47 (59%) 18% (6%, 31%) 172 (80%) 136 (61%) 18% (10%, 27%)
  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    DEXTENZA is supplied sterile in a foam carrier within a foil laminate pouch containing:

    NDC 70382-204-10 Carton containing 10 pouches (10 inserts)
    NDC 70382-204-01 Carton containing 1 pouch (1 insert)

    Do not use if pouch has been damaged or broken.

    DEXTENZA is intended for single dose only.

    Storage: Store refrigerated, between 2°C and 8°C (36°F and 46°F). Do not freeze. Protect from light, keep in package until use.

  • 17 PATIENT COUNSELING INFORMATION

    Advise patients to consult their surgeon if pain, redness, or itching develops.

    Ocular
    Therapeutix™

    Ocular Therapeutix, Inc.
    Bedford, MA 01730 USA

  • PRINCIPAL DISPLAY PANEL

    Principal Display Panel – Dextenza 1 ct Box Label

    NDC 70382-204-01

    0.4 mg insert

    1 insert

    Dextenza®

    (dexamethasone ophthalmic insert) 0.4mg

    for intracanalicular use

    Rx only

    Ocular

    Therapeutix™

    Principal Display Panel – Dextenza 1 ct Box Label
  • PRINCIPAL DISPLAY PANEL

    Principal Display Panel – Dextenza 10 ct Box Label

    NDC 70382-204-10

    0.4 mg insert

    10 inserts

    Dextenza®

    (dexamethasone ophthalmic insert) 0.4mg

    for intracanalicular use

    Rx only

    Ocular

    Therapeutix™

    Principal Display Panel – Dextenza 10 ct Box Label
  • PRINCIPAL DISPLAY PANEL

    Principal Display Panel – Dextenza Sample 1 ct Box Label

    NDC 70382-204-99

    0.4 mg insert

    1 inserts

    Dextenza®

    (dexamethasone ophthalmic insert) 0.4mg

    for intracanalicular use

    Rx only

    SAMPLE

    Not for resale.

    US Patent Nos.

    7,648,713 8,409,606 8,563,027 9,254,267

    Ocular

    Therapeutix™

    Principal Display Panel – Dextenza Sample 1 ct Box Label
  • PRINCIPAL DISPLAY PANEL

    Principal Display Panel – Dextenza Pouch Label

    Dextenza®

    (dexamethasone ophthalmic insert) 0.4mg

    for intracanalicular use

    Ocular Therapeutix, Inc.

    Bedford, MA 01730 USA

    NDC 70382-204-88

    Rx only

    LOT:

    EXP DATE:

    DIRECTIONS FOR USE: See enclosed package
    insert. Do not use if pouch has been damaged
    or broken. DEXTENZA is intended for single dose only.

    CONTENTS: One DEXTENZA insert in foam carrier.

    STORAGE: Refrigerate between 2 ° C - 8 ° C
    (36° F - 46° F). Do not freeze. Protect from light,
    keep in package until use.

    STERILE: Do not re-sterilize.

    PCR-780-12173

    Principal Display Panel – Dextenza Pouch Label
  • INGREDIENTS AND APPEARANCE
    DEXTENZA 
    dexamethasone insert
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:70382-204
    Route of AdministrationOPHTHALMIC, INTRACANALICULAR
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    dexamethasone (UNII: 7S5I7G3JQL) (dexamethasone - UNII:7S5I7G3JQL) dexamethasone0.4 mg
    Inactive Ingredients
    Ingredient NameStrength
    POLYETHYLENE GLYCOL, UNSPECIFIED (UNII: 3WJQ0SDW1A)  
    LYSYLLYSYLLYSINE (UNII: Y7F82M80K8)  
    FLUORESCEIN (UNII: TPY09G7XIR)  
    SODIUM PHOSPHATE, DIBASIC, ANHYDROUS (UNII: 22ADO53M6F)  
    SODIUM PHOSPHATE, MONOBASIC, ANHYDROUS (UNII: KH7I04HPUU)  
    Product Characteristics
    Coloryellow (yellow) Score    
    ShapeSize
    FlavorImprint Code
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:70382-204-011 in 1 BOX, UNIT-DOSE01/07/2019
    1NDC:70382-204-881 in 1 POUCH; Type 0: Not a Combination Product
    2NDC:70382-204-1010 in 1 BOX, UNIT-DOSE01/07/2019
    2NDC:70382-204-881 in 1 POUCH; Type 0: Not a Combination Product
    3NDC:70382-204-991 in 1 BOX, UNIT-DOSE01/07/2019
    3NDC:70382-204-881 in 1 POUCH; Type 0: Not a Combination Product
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    NDANDA20874201/07/2019
    Labeler - Ocular Therapeutix, Inc. (063391985)
    Establishment
    NameAddressID/FEIBusiness Operations
    Isomedix Operations, Steris Corporation117383794STERILIZE(70382-204)
    Establishment
    NameAddressID/FEIBusiness Operations
    Ocular Therapeutix, Inc.080122594MANUFACTURE(70382-204)
    Establishment
    NameAddressID/FEIBusiness Operations
    Packaging Coordinators, Inc.078525133LABEL(70382-204) , PACK(70382-204)