MEDICATION GUIDE

AMNESTEEM (AM-NES-TEAM)

(Isotretinoin Capsules)

Read the Medication Guide that comes with Amnesteem 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 Amnesteem?

• Amnesteem® is used to treat a type of severe acne (nodular acne) that has not been helped by other treatments, including antibiotics.
• Because Amnesteem can cause birth defects, Amnesteem is only for patients who can understand and agree to carry out all of the instructions in the iPLEDGE program.
• Amnesteem 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 Amnesteem. Female patients must not get pregn1:
   • for 1 month before starting Amnesteem
   • while taking Amnesteem
   • for 1 month after stopping Amnesteem.

   If you get pregnant while taking Amnesteem, 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. Amnesteem may cause:
   • depression
   • psychosis (seeing or hearing things that are not real)
   • suicide. Some patients taking Amnesteem 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 Amnesteem 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 Amnesteem, you may also need follow-up mental health care if you had any of these symptoms.

What is Amnesteem?

Amnesteem 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. Amnesteem can cause serious side effects (see “What is the most important information I should know about Amnesteem?”). Amnesteem 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 Amnesteem?

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

What should I tell my doctor before taking Amnesteem?

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. Amnesteem 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 non-prescription medicines, vitamins and herbal supplements. Amnesteem 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 Amnesteem. Taking both together may increase your chance of getting side effects.
• Tetracycline antibiotics. Tetracycline antibiotics taken with Amnesteem 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 Amnesteem. Ask your doctor or pharmacist if you are not sure what type you are using.
• Dilantin (phenytoin). This medicine taken with Amnesteem may weaken your bones.
• Corticosteroid medicines. These medicines taken with Amnesteem 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 Amnesteem 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 Amnesteem?

• You must take Amnesteem exactly as prescribed. You must also follow all the instructions of the iPLEDGE program. Before prescribing Amnesteem, 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 Amnesteem 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 Amnesteem at a time. This is to make sure you are following the Amnesteem iPLEDGE program. You should talk with your doctor each month about side effects.
• The amount of Amnesteem you take has been specially chosen for you. It is based on your body weight, and may change during treatment.
• Take Amnesteem 2 times a day with a meal, unless your doctor tells you otherwise. Swallow your Amnesteem capsules whole with a full glass of liquid. Do not chew or suck on the capsule. Amnesteem 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 two doses at the same time.
• If you take too much Amnesteem or overdose, call your doctor or poison control center right away.
• Your acne may get worse when you first start taking Amnesteem. 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 Amnesteem. 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 Amnesteem. 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 Amnesteem.

If you have sex at any time without using two forms of effective birth control, get pregnant or miss your expected period, stop using Amnesteem and call your doctor right away.

What should I avoid while taking Amnesteem?

• Do not get pregnant while taking Amnesteem and for one month after stopping Amnesteem. See “What is the most important information I should know about Amnesteem?”
• Do not breast-feed while taking Amnesteem and for one month after stopping Amnesteem. We do not know if Amnesteem can pass through your milk and harm the baby.
• Do not give blood while you take Amnesteem and for one month after stopping Amnesteem. If someone who is pregnant gets your donated blood, her baby may be exposed to Amnesteem and may be born with birth defects.
• Do not take other medicines or herbal products with Amnesteem unless you talk to your doctor. See “What should I tell my doctor before taking Amnesteem?”
• Do not drive at night until you know if Amnesteem has affected your vision. Amnesteem 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 Amnesteem and for at least 6 months after you stop. Amnesteem 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. Amnesteem may make your skin more sensitive to light.
• Do not share Amnesteem with other people. It can cause birth defects and other serious health problems.

What are the possible side effects of Amnesteem?

• Amnesteem 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 Amnesteem?”
• Amnesteem may cause serious mental health problems. See “What is the most important information I should know about Amnesteem?”
• serious brain problems. Amnesteem can increase the pressure in your brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking Amnesteem 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 Amnesteem. In some patients a rash can be serious. Stop using Amnesteem 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 Amnesteem. Stop taking Amnesteem 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. Amnesteem 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 Amnesteem. Tell your doctor if you get:
  • back pain
  • joint pain
  • broken bone. Tell all healthcare providers that you take Amnesteem if you break a bone.

  Stop Amnesteem 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.

  Amnesteem may stop long bone growth in teenagers who are still growing.

• hearing problems. Stop using Amnesteem 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. Amnesteem may affect your ability to see in the dark. This condition usually clears up after you stop taking Amnesteem, but it may be permanent. Other serious eye effects can occur. Stop taking Amnesteem 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 Amnesteem and after treatment.
• lipid (fats and cholesterol in blood) problems. Amnesteem 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 Amnesteem treatment is finished.
• serious allergic reactions. Stop taking Amnesteem and get emergency care right away if you develop hives, a swollen face or mouth or have trouble breathing. Stop taking Amnesteem and call your doctor if you get a fever, rash or red patches or bruises on your legs.
• blood sugar problems. Amnesteem 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 Amnesteem 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 Amnesteem. 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.

How should I store Amnesteem?

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

General Information about Amnesteem

Medicines are sometimes prescribed for conditions that are not mentioned in Medication Guides. Do not use Amnesteem for a condition for which it was not prescribed. Do not give Amnesteem 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 Amnesteem. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Amnesteem 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 Amnesteem?

Active Ingredient: Isotretinoin

Inactive Ingredients: butylated hydroxyanisole, edetate disodium, hydrogenated vegetable oil, soybean oil and yellow wax. Gelatin capsules contain glycerin, with the following dye systems: 10 mg – black ink and red iron oxide paste; 20 mg – black ink, red iron oxide paste, titanium dioxide and yellow iron oxide paste; 40 mg – black ink, red iron oxide paste, titanium dioxide and yellow iron oxide paste.

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

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

Manufactured by:
Catalent Pharma Solutions
74 rue Principale
67930 Beinheim
France

Packaged by:
Catalent Pharma Solutions
Philadelphia, PA 19114 U.S.A.

Manufactured for:
Mylan Pharmaceuticals Inc.
Morgantown, WV 26505 U.S.A. 

REVISED MAY 2012
ISOT:R4/MG:ISOT:R3