DRUGS & SUPPLEMENTS

Alfuzosine L.P.

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Alfuzosine L.P. uses


1 INDICATIONS AND USAGE

Alfuzosine L.P. extended-release tablets, USP are indicated for the treatment of signs and symptoms of benign prostatic hyperplasia.

Alfuzosine L.P. extended-release tablet, USP is an alpha adrenergic antagonist, indicated for the treatment of signs and symptoms of benign prostatic hyperplasia.

Important Limitations of Use:

Alfuzosine L.P. extended-release tablets, USP are not indicated for treatment of hypertension. (1.1)

Alfuzosine L.P. extended-release tablets, USP are not indicated for use in the pediatric population. (1.1, 8.4, 12.3)

1.1 Important Limitations of Use

Alfuzosine L.P. extended-release tablets, USP are not indicated for the treatment of hypertension.

Alfuzosine L.P. extended-release tablets, USP are not indicated for use in the pediatric population.

2 DOSAGE AND ADMINISTRATION

The recommended dosage is one 10 mg Alfuzosine L.P. extended-release tablet once daily. The extent of absorption of alfuzosin is 50% lower under fasting conditions. Therefore, Alfuzosine L.P. extended-release tablets should be taken with food and with the same meal each day. The tablets should not be chewed or crushed.

10 mg once daily with food and with the same meal each day. (2)

Tablets should not be chewed or crushed (2, 12.3)

3 DOSAGE FORMS AND STRENGTHS

Alfuzosine L.P. extended-release tablet 10 mg is available as a yellow, round, flat-faced beveled-edge tablet. Engraved "APO" on one side, "ALF" over "10" on the other side.

Extended-release tablet: 10 mg (3)

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4 CONTRAINDICATIONS

Alfuzosine L.P. extended-release tablets are contraindicated for use:


  • in patients with moderate or severe hepatic impairment (Childs-Pugh categories B and C), since alfuzosin blood levels are increased in these patients [see Use in Specific Populations (8.7) and Clinical Pharmacology (12.3) ].


  • with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, and ritonavir, since alfuzosin blood levels are increased [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)].


  • in patients with known hypersensitivity, such as urticaria and angioedema, to Alfuzosine L.P. or any component of Alfuzosine L.P. extended-release tablets [see Adverse Reactions (6.2)]

  • Moderate or severe hepatic impairment (4, 8.7, 12.3)
  • Co-administration with potent CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, ritonavir) (4, 5.4, 7.1, 12.3)
  • Known hypersensitivity (e.g., urticaria or angioedema) to alfuzosin or any of the ingredients (4, 6.2)

5 WARNINGS AND PRECAUTIONS

  • Postural hypotension/syncope: Care should be taken in patients with symptomatic hypotension or who have had a hypotensive response to other medications or are concomitantly treated with antihypertensive medication or nitrates
  • Use with caution in patients with severe renal impairment (creatinine clearance <30 mL/min) (5.2, 8.6, 12.3)
  • Use with caution in patients with mild hepatic impairment (5.3, 8.7, 12.3)
  • Should not be used in combination with other alpha adrenergic antagonists (5.4, 7.2)
  • Prostate carcinoma should be ruled out prior to treatment (5.5)
  • Intraoperative Floppy Iris Syndrome (IFIS) during cataract surgery may require modifications to the surgical technique (5.6)
  • Discontinue Alfuzosine L.P. extended-release tablets if symptoms of angina pectoris appear or worsen (5.8)
  • Use with caution in patients with a history of QT prolongation or who are taking medications which prolong the QT interval (5.9, 12.2)

5.1 Postural Hypotension

Postural hypotension with or without symptoms (e.g., dizziness) may develop within a few hours following administration of Alfuzosine L.P. extended-release tablets. As with other alpha adrenergic antagonists, there is a potential for syncope. Patients should be warned of the possible occurrence of such events and should avoid situations where injury could result should syncope occur. There may be an increased risk of hypotension/postural hypotension and syncope when taking Alfuzosine L.P. extended-release tablets concomitantly with anti-hypertensive medication and nitrates. Care should be taken when Alfuzosine L.P. extended-release tablets are administered to patients with symptomatic hypotension or patients who have had a hypotensive response to other medications.

5.2 Patients with Renal Impairment

Caution should be exercised when Alfuzosine L.P. extended-release tablets are administered in patients with severe renal impairment [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3) ].

5.3 Patients with Hepatic Impairment

Alfuzosine L.P. extended-release tablets are contraindicated for use in patients with moderate or severe hepatic impairment [see Contraindications (4), Use in Specific Populations (8.7) and Clinical Pharmacology (12.3) ]. Although the pharmacokinetics of Alfuzosine L.P. extended-release tablets have not been studied in patients with mild hepatic impairment, caution should be exercised when Alfuzosine L.P. extended-release tablets are administered to such patients [see Use in Specific Populations (8.7) and Clinical Pharmacology (12.3) ].

5.4 Drug-Drug Interactions

Potent CYP3A4 Inhibitors

Alfuzosine L.P. extended-release tablets are contraindicated for use with potent CYP3A4 inhibitors since alfuzosin blood levels are increased [see Contraindications (4), Drug Interactions (7.1) and Clinical Pharmacology (12.3) ].

Other alpha adrenergic antagonists

Alfuzosine L.P. extended-release tablets are an alpha adrenergic antagonist and should not be used in combination with other alpha adrenergic antagonist [see Drug Interactions (7.2)].

Phosphodiesterase-5 (PDE5) Inhibitors

PDE5-inhibitors are also vasodilators. Caution is advised for concomitant use of PDE5-inhibitors and Alfuzosine L.P. extended-release tablets, as this combination can potentially cause symptomatic hypotension [see Drug Interactions (7.4) ].

5.5 Prostatic Carcinoma

Carcinoma of the prostate and benign prostatic hyperplasia (BPH) cause many of the same symptoms. These two diseases frequently coexist. Therefore, patients thought to have BPH should be examined to rule out the presence of carcinoma of the prostate prior to starting treatment with Alfuzosine L.P. extended-release tablets.

5.6 Intraoperative Floppy Iris Syndrome

IFIS has been observed during cataract surgery in some patients on or previously treated with alpha adrenergic antagonists. This variant of small pupil syndrome is characterized by the combination of a flaccid iris that billows in response to intraoperative irrigation currents, progressive intraoperative miosis despite preoperative dilation with standard mydriatic drugs, and potential prolapse of the iris toward the phacoemulsification incisions. The patient’s ophthalmologist should be prepared for possible modifications to their surgical technique, such as the utilization of iris hooks, iris dilator rings, or viscoelastic substances.

There does not appear to be a benefit of stopping alpha adrenergic antagonist therapy prior to cataract surgery.

5.7 Priapism

Rarely, alfuzosin, like other alpha adrenergic antagonists, has been associated with priapism (persistent painful penile erection unrelated to sexual activity). Because this condition can lead to permanent impotence if not properly treated, patients should be advised about the seriousness of the condition [ see Adverse Reactions (6.2) and Patient Counseling Information (17.3)] .

5.8 Coronary Insufficiency

If symptoms of angina pectoris should appear or worsen, Alfuzosine L.P. extended-release tablets should be discontinued.

5.9 Patients with Congenital or Acquired QT Prolongation

Use with caution in patients with acquired or congenital QT prolongation or who are taking medications that prolong the QT interval .

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6 ADVERSE REACTIONS

Most common adverse reactions in clinical studies : dizziness, upper respiratory tract infection, headache, fatigue. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Apotex Corp. at 1-800-706-5575 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

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 clinical practice.

The incidence of adverse reactions has been ascertained from 3 placebo-controlled clinical trials involving 1,608 men where daily doses of 10 and 15 mg alfuzosin were evaluated. In these 3 trials, 473 men received Alfuzosine L.P. 10 mg extended-release tablets. In these trials, 4% of patients taking Alfuzosine L.P. 10 mg extended-release tablets withdrew from the trial due to adverse reactions, compared with 3% in the placebo group.

Table 1 summarizes adverse reactions that occurred in ≥2% of patients receiving Alfuzosine L.P. extended-release tablets, and at a higher incidence than that of the placebo group. In general, the adverse reactions seen in long-term use were similar in type and frequency to the events described below for the 3-month trials.

Table 1 - Adverse Reactions Occurring in ≥2% of Alfuzosine L.P. Extended-Release Tablets-Treated Patients and More Frequently than with Placebo in 3-Month Placebo-Controlled Clinical Trials

Adverse Reaction Placebo

(n=678)

Alfuzosin hydrochoride

(n=473)

Dizziness 19 (2.8%) 27 (5.7%)
Upper respiratory tract infection 4 (0.6%) 14 (3.0%)
Headache 12 (1.8%) 14 (3.0%)
Fatigue 12 (1.8%) 13 (2.7%)

The following adverse reactions, reported by between 1% and 2% of patients receiving Alfuzosine L.P. and occurring more frequently than with placebo, are listed alphabetically by body system and by decreasing frequency within body system:

Body as a whole: pain

Gastrointestinal system: abdominal pain, dyspepsia, constipation, nausea

Reproductive system: impotence

Respiratory system: bronchitis, sinusitis, pharyngitis

Signs and Symptoms of Orthostasis in Clinical Trials: The adverse reactions related to orthostasis that occurred in the double-blind phase 3 trials with alfuzosin 10 mg are summarized in Table 2. Approximately 20% to 30% of patients in these trials were taking antihypertensive medication.

Table 2- Number (%) of Patients with Symptoms Possibly Associated with Orthostasis in 3-Month Placebo-Controlled Clinical Trials

Symptoms Placebo

(n=678)

Alfuzosin hydrochoride

(n=473)

Dizziness 19 (2.8%) 27 (5.7%)
Hypotension or postural hypotension 0 2 (0.4%)
Syncope 0 1 (0.2%)

Testing for blood pressure changes or orthostatic hypotension was conducted in three controlled studies. Decreased systolic blood pressure (≤90 mm Hg, with a decrease ≥20 mm Hg from baseline) was observed in none of the 674 placebo patients and 1 (0.2%) of the 469 Alfuzosine L.P. patients. Decreased diastolic blood pressure (≤50 mm Hg, with a decrease ≥15 mm Hg from baseline) was observed in 3 (0.4%) of the placebo patients and in 4 (0.9%) of the alfuzosin hydrochloride patients. A positive orthostatic test (decrease in systolic blood pressure of ≥20 mm Hg upon standing from the supine position) was seen in 52 (7.7%) of placebo patients and in 31 (6.6%) of the Alfuzosine L.P. patients.


6.2 Post-Marketing Experience

The following adverse reactions have been identified during post approval use of Alfuzosine L.P. extended-release tablets. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

General disorders

Edema


Cardiac disorders

Tachycardia, chest pain, angina pectoris in patients with pre-existing coronary artery disease, atrial fibrillation


Gastrointestinal disorders

Diarrhea


Hepatobiliary disorders

Hepatocellular and cholestatic liver injury (including cases with jaundice leading to drug discontinuation)


Respiratory system disorders

Rhinitis

Reproductive system disorders

Priapism


Skin and subcutaneous tissue disorders

Rash, pruritis, urticaria, angioedema, toxic epidermal necrolysis


Vascular disorders

Flushing

Blood and lymphatic system disorders

Thrombocytopenia

During cataract surgery, a variant of small pupil syndrome known as Intraoperative Floppy Iris Syndrome (IFIS) has been reported in some patients on or previously treated with alpha adrenergic antagonists .

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7 DRUG INTERACTIONS

  • Concomitant use of PDE5 inhibitors with alpha adrenergic antagonists, including Alfuzosine L.P. extended-release tablets, can potentially cause symptomatic hypotension

7.1 CYP3A4 inhibitors

Alfuzosine L.P. extended-release tablets are contraindicated for use with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, or ritonavir, since alfuzosin blood levels are increased .

7.2 Alpha adrenergic antagonists

The pharmacokinetic and pharmacodynamic interactions between Alfuzosine L.P. extended-release tablets and other alpha adrenergic antagonists have not been determined. However, interactions may be expected, and Alfuzosine L.P. extended-release tablets should not be used in combination with other alpha adrenergic antagonists .

7.3 Antihypertensive Medication and Nitrates

There may be an increased risk of hypotension/postural hypotension and syncope when taking Alfuzosine L.P. extended-release tablets concomitantly with anti-hypertensive medication and nitrates .

7.4 PDE5 Inhibitors

Caution is advised when alpha adrenergic antagonists, including Alfuzosine L.P. extended-release tablets, are co-administered with PDE5 inhibitors. Alpha adrenergic antagonists and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can potentially cause symptomatic hypotension [see Warnings and Precautions (5.4) ].

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8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category B. Alfuzosine L.P. extended-release tablets are not indicated for use in women, and there are no studies of alfuzosin in pregnant women

Alfuzosin was not teratogenic, embryotoxic or fetotoxic in rats at plasma exposure levels up to 1200 times (maternal oral dose of 250 mg/kg/day) the maximum recommended human dose (MRHD) of 10 mg. In rabbits administered up to 3 times the MRHD (based on body surface area) (maternal oral dose of 100 mg/kg/day) no embryofetal toxicity or teratogenicity was observed. Gestation was slightly prolonged in rats at exposure levels (based on AUC of unbound drug) approximately 12 times (greater than 5 mg/kg/day oral maternal dose) the MRHD, but difficulties with parturition were not observed.

8.4 Pediatric Use

Alfuzosine L.P. extended-release tablets are not indicated for use in the pediatric population.

Efficacy of Alfuzosine L.P. was not demonstrated in a randomized, double-blind, placebo-controlled, efficacy and safety trial conducted in 172 patients ages 2 to 16 years with elevated detrusor leak point pressure (LPP≥40 cm H2O) of neurologic origin treated with alfuzosin hydrochloride using pediatric formulations. The trial included a 12-week efficacy phase followed by a 40-week safety extension period. No statistically significant difference in the proportion of patients achieving a detrusor leak point pressure of <40 cmH20 was observed between the alfuzosin and placebo groups.

During the placebo-controlled trial, the adverse reactions reported in ≥2% of patients treated with alfuzosin and at a higher incidence than in the placebo group were: pyrexia, headache, respiratory tract infection, cough, epistaxis and diarrhea. The adverse reactions reported for the whole 12-month trial period, which included the open-label extension, were similar in type and frequency to the reactions observed during the 12-week period. Alfuzosin hydrochloride was not studied in patients below the age of 2.

8.5 Geriatric Use

Of the total number of subjects in clinical studies of Alfuzosine L.P., 48% were 65 years of age and over, whereas 11% were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, but greater sensitivity of some older individuals cannot be ruled out [ see Clinical Pharmacology ] .

8.6 Renal impairment

Systemic exposure was increased by approximately 50% in pharmacokinetic studies of patients with mild, moderate, and severe renal impairment . In phase 3 studies, the safety profile of patients with mild (n=172) or moderate (n=56) renal impairment was similar to the patients with normal renal function in those studies. Safety data are available in only a limited number of patients (n=6) with creatinine clearance below 30 mL/min; therefore, caution should be exercised when Alfuzosine L.P. is administered in patients with severe renal impairment .

8.7 Hepatic impairment

The pharmacokinetics of Alfuzosine L.P. have not been studied in patients with mild hepatic impairment. Alfuzosine L.P. is contraindicated for use in patients with moderate or severe hepatic impairment .

10 OVERDOSAGE

Should overdose of Alfuzosine L.P. extended-release tablets lead to hypotension, support of the cardiovascular system is of first importance. Restoration of blood pressure and normalization of heart rate may be accomplished by keeping the patient in the supine position. If this measure is inadequate, then the administration of intravenous fluids should be considered. If necessary, vasopressors should then be used, and the renal function should be monitored and supported as needed. Alfuzosin is 82% to 90% protein bound; therefore, dialysis may not be of benefit.

11 DESCRIPTION

Each Alfuzosine L.P. extended-release tablet, USP contains 10 mg Alfuzosine L.P., USP as the active ingredient. Alfuzosine L.P., USP is a white to off-white powder that melts at 231° to 233°C. It is freely soluble in water, sparingly soluble in alcohol, and practically insoluble in dichloromethane.

Alfuzosine L.P., USP is (R,S)-N-[3-[(4-amino-6,7-dimethoxy-2-quinazolinyl) methylamino] propyl] tetrahydro-2-furancarboxamide hydrochloride. The empirical formula of Alfuzosine L.P., USP is C19H27N5O4-HCl. The molecular weight of Alfuzosine L.P., USP is 425.92. Its structural formula is:

The tablet also contains the following inactive ingredients: dibasic calcium phosphate dihydrate (USP), hydroxypropyl methylcellulose (USP), magnesium stearate (NF), polyvinyl acetate phthalate (NF) and yellow ferric oxide (NF).

Meets USP Dissolution Test 3.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Alfuzosin is a selective antagonist of post-synaptic alpha1-adrenoreceptors, which are located in the prostate, bladder base, bladder neck, prostatic capsule, and prostatic urethra.

12.2 Pharmacodynamics

Alfuzosin exhibits selectivity for alpha adrenergic receptors in the lower urinary tract. Blockade of these adrenoreceptors can cause smooth muscle in the bladder neck and prostate to relax, resulting in an improvement in urine flow and a reduction in symptoms of BPH.

Cardiac Electrophysiology

The effect of 10 mg and 40 mg alfuzosin on QT interval was evaluated in a double-blind, randomized, placebo and active-controlled, 4-way crossover single dose study in 45 healthy white male subjects aged 19 to 45 years. The QT interval was measured at the time of peak alfuzosin plasma concentrations. The 40 mg dose of alfuzosin was chosen because this dose achieves higher blood levels than those achieved with the co-administration of Alfuzosine L.P. extended-release tablets and ketoconazole 400 mg. Table 3 summarizes the effect on uncorrected QT and mean corrected QT interval (QTc) with different methods of correction (Fridericia, population-specific and subject-specific correction methods) at the time of peak alfuzosin plasma concentrations. No single one of these correction methodologies is known to be more valid. The mean change of heart rate associated with a 10 mg dose of alfuzosin in this study was 5.2 beats/minute and 5.8 beats/minute with 40 mg alfuzosin. The change in heart rate with moxifloxacin was 2.8 beats/minute.

Table 3. Mean QT and QTc changes in msec (95% CI) from baseline at Tmax (relative to placebo) with different methodologies to correct for effect of heart rate.

Drug/Dose QT Fridericia

method

Population-

specific

method

Subject-

specific

method

Alfuzosin

10 mg

-5.8

(-10.2, -1.4)

4.9

(0.9, 8.8)

1.8

(-1.4, 5.0)

1.8

(-1.3, 5.0)

Alfuzosin

40 mg

-4.2

(-8.5, 0.2)

7.7

(1.9, 13.5)

4.2

(-0.6, 9.0)

4.3

(-0.5, 9.2)

Moxifloxacin

* 400 mg

6.9

(2.3, 11.5)

12.7

(8.6, 16.8)

11.0

(7.0, 15.0)

11.1

(7.2, 15.0)


*Active control

The QT effect appeared greater for 40 mg compared to 10 mg alfuzosin. The effect of the highest alfuzosin dose (four times the therapeutic dose) studied did not appear as large as that of the active control moxifloxacin at its therapeutic dose. This study, however, was not designed to make direct statistical comparisons between the drugs or the dose levels. There has been no signal of Torsade de Pointes in the extensive post-marketing experience with alfuzosin outside the United States.

A separate post-marketing QT study evaluated the effect of the co-administration of 10 mg alfuzosin with a drug of similar QT effect size. In this study, the mean placebo-subtracted QTcF increase of alfuzosin 10 mg alone was 1.9 msec (upperbound 95% CI, 5.5 msec). The concomitant administration of the two drugs showed an increased QT effect when compared with either drug alone. This QTcF increase [5.9 msec (UB 95% CI, 9.4 msec)] was not more than additive. Although this study was not designed to make direct statistical comparisons between drugs, the QT increase with both drugs given together appeared to be lower than the QTcF increase seen with the positive control moxifloxacin 400 mg [10.2 msec (UB 95% CI, 13.8 msec)]. The clinical impact of these QTc changes is unknown.

12.3 Pharmacokinetics

The pharmacokinetics of Alfuzosine L.P. extended-release tablets have been evaluated in adult healthy male volunteers after single and/or multiple administration with daily doses ranging from 7.5 mg to 30 mg, and in patients with BPH at doses from 7.5 mg to 15 mg.

Absorption

The absolute bioavailability of Alfuzosine L.P. extended-release 10 mg tablets under fed conditions is 49%. Following multiple dosing of 10 mg Alfuzosine L.P. extended-release tablets under fed conditions, the time to maximum concentration is 8 hours. Cmax and AUC0-24 are 13.6 (SD = 5.6) ng/mL and 194 (SD = 75) ng·h/mL, respectively. Alfuzosine L.P. extended-release tablets exhibits linear kinetics following single and multiple dosing up to 30 mg. Steady-state plasma levels are reached with the second dose of Alfuzosine L.P. administration. Steady-state alfuzosin plasma concentrations are 1.2- to 1.6-fold higher than those observed after a single administration.

Effect of Food

As illustrated in Figure 1, the extent of absorption is 50% lower under fasting conditions. Therefore, Alfuzosine L.P. extended-release tablets should be taken with food and with the same meal each day .


Figure 1 – Mean (SEM) Alfuzosin Plasma Concentration-Time Profiles after a Single Administration of Alfuzosine L.P. Extended-Release 10 mg tablets to 8 Healthy Middle-Aged Male Volunteers in Fed and Fasted States

Distribution

The volume of distribution following intravenous administration in healthy male middle-aged volunteers was 3.2 L/kg. Results of in vitro studies indicate that alfuzosin is moderately bound to human plasma proteins (82% to 90%), with linear binding over a wide concentration range (5 to 5,000 ng/mL).

Metabolism

Alfuzosin undergoes extensive metabolism by the liver, with only 11% of the administered dose excreted unchanged in the urine. Alfuzosin is metabolized by three metabolic pathways: oxidation, O-demethylation, and N-dealkylation. The metabolites are not pharmacologically active. CYP3A4 is the principal hepatic enzyme isoform involved in its metabolism.

Excretion

Following oral administration of 14C-labeled alfuzosin solution, the recovery of radioactivity after 7 days (expressed as a percentage of the administered dose) was 69% in feces and 24% in urine. Following oral administration of Alfuzosine L.P. extended-release 10 mg tablets, the apparent elimination half-life is 10 hours.

Specific Populations

Geriatric Use

In a pharmacokinetic assessment during phase 3 clinical studies in patients with BPH, there was no relationship between peak plasma concentrations of alfuzosin and age. However, trough levels were positively correlated with age. The concentrations in subjects ≥75 years of age were approximately 35% greater than in those below 65 years of age.

Renal Impairment

The Pharmacokinetic profiles of Alfuzosine L.P. extended-release 10 mg tablets in subjects with normal renal function (CLCR>80 mL/min), mild impairment (CLCR 60 to 80 mL/min), moderate impairment (CLCR 30 to 59 mL/min), and severe impairment (CLCR <30 mL/min) were compared. These clearances were calculated by the Cockcroft-Gault formula. Relative to subjects with normal renal function, the mean Cmax and AUC values were increased by approximately 50% in patients with mild, moderate, or severe renal impairment .

Hepatic Impairment

The pharmacokinetics of Alfuzosine L.P. extended-release tablets have not been studied in patients with mild hepatic impairment. In patients with moderate or severe hepatic insufficiency (Child-Pugh categories B and C), the plasma apparent clearance (CL/F) was reduced to approximately one-third to one-fourth that observed in healthy subjects. This reduction in clearance results in three to four-fold higher plasma concentrations of alfuzosin in these patients compared to healthy subjects. Therefore, Alfuzosine L.P. extended-release tablets are contraindicated in patients with moderate to severe hepatic impairment .

Pediatric Use

Alfuzosine L.P. extended-release tablets are not indicated for use in the pediatric population.

Drug-Drug Interactions

Metabolic Interactions

CYP3A4 is the principal hepatic enzyme isoform involved in the metabolism of alfuzosin.

Potent CYP3A4 Inhibitors

Repeated oral administration of 400 mg/day of ketoconazole, a potent inhibitor of CYP3A4, increased alfuzosin Cmax by 2.3-fold and AUClast by 3.2-fold, following a single 10 mg dose of alfuzosin.

In another study, repeated oral administration of a lower (200 mg/day) dose of ketoconazole increased alfuzosin Cmax by 2.1-fold and AUClast by 2.5-fold, following a single 10 mg dose of alfuzosin.

Therefore, Alfuzosine L.P. extended-release tablets are contraindicated for co-administration with potent inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole, or ritonavir) because of increased alfuzosin exposure [see Contraindications (4), Warnings and Precautions (5.4) and Drug Interactions (7.1)].

Moderate CYP3A4 Inhibitors

Diltiazem

Repeated co-administration of 240 mg/day of diltiazem, a moderately-potent inhibitor of CYP3A4, with 7.5 mg/day (2.5 mg three times daily) alfuzosin (equivalent to the exposure with Alfuzosine L.P. extended-release tablets) increased the Cmax and AUC0-24 of alfuzosin 1.5- and 1.3-fold, respectively. Alfuzosin increased the Cmax and AUC0-12 of diltiazem 1.4-fold. Although no changes in blood pressure were observed in this study, diltiazem is an antihypertensive medication and the combination of Alfuzosine L.P. extended-release tablets and antihypertensive medications has the potential to cause hypotension in some patients .

In human liver microsomes, at concentrations that are achieved at the therapeutic dose, alfuzosin did not inhibit CYP1A2, 2A6, 2C9, 2C19, 2D6 or 3A4 isoenzymes. In primary culture of human hepatocytes, alfuzosin did not induce CYP1A, 2A6 or 3A4 isoenzymes.

Other Interactions

Warfarin

Multiple dose administration of an immediate release tablet formulation of alfuzosin 5 mg twice daily for six days to six healthy male volunteers did not affect the pharmacological response to a single 25 mg oral dose of warfarin.

Digoxin

Repeated co-administration of Alfuzosine L.P. extended-release 10 mg tablets and digoxin 0.25 mg/day for 7 days did not influence the steady-state pharmacokinetics of either drug.

Cimetidine

Repeated administration of 1 g/day cimetidine increased both alfuzosin Cmax and AUC values by 20%.

Atenolol

Single administration of 100 mg atenolol with a single dose of 2.5 mg of an immediate release alfuzosin tablet in eight healthy young male volunteers increased alfuzosin Cmax and AUC values by 28% and 21%, respectively. Alfuzosin increased atenolol Cmax and AUC values by 26% and 14%, respectively. In this study, the combination of alfuzosin with atenolol caused significant reductions in mean blood pressure and in mean heart rate. .

Hydrochlorothiazide

Single administration of 25 mg hydrochlorothiazide did not modify the pharmacokinetic parameters of alfuzosin. There was no evidence of pharmacodynamic interaction between alfuzosin and hydrochlorothiazide in the 8 patients in this study.


13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

There was no evidence of a drug-related increase in the incidence of tumors in mice following dietary administration of 100 mg/kg/day alfuzosin for 98 weeks (13 and 15 times the maximum recommended human dose [MRHD] of 10 mg based on AUC of unbound drug), in females and males, respectively. The highest dose tested in female mice may not have constituted a maximally tolerated dose. Likewise, there was no evidence of a drug-related increase in the incidence of tumors in rats following dietary administration of 100 mg/kg/day alfuzosin for 104 weeks (53 and 37 times the MRHD in females and males, respectively).

Alfuzosin showed no evidence of mutagenic effect in the Ames and mouse lymphoma assays, and was free of any clastogenic effects in the Chinese hamster ovary cell and in vivo mouse micronucleus assays. Alfuzosin treatment did not induce DNA repair in a human cell line.

There was no evidence of reproductive organ toxicity when male rats were administered oral doses of several hundred times (250 mg/kg/day for 26 weeks) the MRHD of alfuzosin. No impairment of fertility was observed following oral (gavage) administration to male rats at doses of up to 125 mg/kg/day for 70 days. Estrous cycling was inhibited in rats and dogs at approximately 12 and 18 times the MRHD respectively (doses of 25 mg/kg and 20 mg/kg, respectively), but did not result in impaired fertility in female rats.

14 CLINICAL STUDIES

Three randomized placebo-controlled, double-blind, parallel-arm, 12-week trials were conducted with the 10 mg daily dose of alfuzosin. In these three trials, 1,608 patients [mean age 64.2 years, range 49-92 years; Caucasian (96.1%), Black (1.6%), Asian (1.1%), Other (1.2%)] were randomized and 473 patients received Alfuzosine L.P. extended-release tablets 10 mg daily. Table 4 provides the results of the three trials that evaluated the 10 mg dose.

There were two primary efficacy variables in these three studies. The International Prostate Symptom Score (IPSS, or AUA Symptom Score) consists of seven questions that assess the severity of both irritative (frequency, urgency, nocturia) and obstructive (incomplete emptying, stopping and starting, weak stream, and pushing or straining) symptoms, with possible scores ranging from 0 to 35 with higher numerical scores on the IPSS total symptom score representing greater severity of symptoms. The second efficacy variable was peak urinary flow rate. The peak flow rate was measured just prior to the next dose in study 2 and on average at 16 hours post-dosing in trials 1 and 3. There was a statistically significant reduction from baseline to last assessment (Week 12) in the IPSS total symptom score versus placebo in all three studies, indicating a reduction in symptom severity (Table 5 and Figures 2, 3, and 4).

Table 4 - Mean Change (SD) from Baseline to week 12 in International Prostate Symptom Score in Three Randomized, Controlled, Double Blind Trials

Symptom

Score

Trial 1 Trial 2 Trial 3
Placebo

(n=167)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=170)

Placebo

(n=152)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=137)

Placebo

(n=150)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=151)

Total

symptom

score

Baseline 18.2

(6.4)

18.2 (6.3) 17.7

(4.1)

17.3 (3.5) 17.7

(5.0)

18.0 (5.4)
Changea -1.6

(5.8)

-3.6 (4.8) -4.9

(5.9)

-6.9 (4.9) -4.6

(5.8)

-6.5 (5.2)
p-value 0.001 0.002 0.007

aDifference between baseline and week 12.

Figure 2 - Mean Change from Baseline in IPSS Total Symptom Score: Trial 1

Figure 3 - Mean Change from Baseline in IPSS Total Symptom Score: Trial 2

Figure 4 - Mean Change from Baseline in IPSS Total Symptom Score: Trial 3

Peak urinary flow rate was increased statistically significantly from baseline to last assessment (Week 12) versus placebo in trials 1 and 2 (Table 5 and Figures 5, 6, and 7).

Table 5 - Mean (SD) Change from Baseline to Week 12 in Peak Urine Flow Rate (mL/sec) in Three Randomized, Controlled, Double-Blind Trials

Trial 1 Trial 2 Trial 3
Placebo

(n=167)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=170)

Placebo

(n=147)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=136)

Placebo

(n=150)

Alfuzosin HCl Extended Release Tablets

10 mg

(n=151)

Mean Peak

flow rate

Baseline 10.2 (4.0) 9.9 (3.9) 9.2 (2.0) 9.4 (1.9) 9.3 (2.6) 9.5 (3.0)
Changea 0.2 (3.5) 1.7 (4.2) 1.4 (3.2) 2.3 (3.6) 0.9 (3.0) 1.5 (3.3)
p-value 0.0004 0.03 0.22

aDifference between baseline and week 12.


Figure 5 - Mean Change from Baseline in Peak Urine Flow Rate (mL/s): Trial 1

Figure 6 - Mean Change from Baseline in Peak Urine Flow Rate (mL/s): Trial 2

Figure 7 - Mean Change from Baseline in Peak Urine Flow Rate (mL/s): Trial 3

Mean total IPSS decreased at the first scheduled observation at Day 28 and mean peak flow rate increased starting at the first scheduled observation at Day 14 in trials 2 and 3 and Day 28 in trial 1.

16 HOW SUPPLIED/STORAGE AND HANDLING

Alfuzosine L.P. extended-release tablets, USP 10 mg are yellow, round, flat-faced beveled-edge tablets. Engraved “APO” on one side, “ALF” over “10” on the other side. They are supplied as follows:

Bottles of 30 (NDC 60505-2850-3)

Bottles of 100 (NDC 60505-2850-1)

Bottles of 500 (NDC 60505-2850-5)

Bottles of 1000 (NDC 60505-2850-8)

Bottles of 8000 (NDC 60505-2850-7)

Blisters of 100 (10 x 10) (NDC 60505-2850-0)

Store at 20° to 25°C (68° to 77°F); excursions permitted from 15° to 30°C (59° to 86°F). Dispense in a tight, light-resistant container. Protect from light and moisture.

Keep Alfuzosine L.P. extended-release tablets, USP out of reach of children.

17 PATIENT COUNSELING INFORMATION

See FDA-approved patient labeling.

17.1 Hypotension/Syncope

Patients should be told about the possible occurrence of symptoms related to postural hypotension, such as dizziness, when beginning Alfuzosine L.P. extended-release tablets, and they should be cautioned about driving, operating machinery, or performing hazardous tasks during this period. This is important for those with low blood pressure or who are taking antihypertensive medications or nitrates [see Warnings and Precautions ].

17.2 Intraoperative Floppy Iris Syndrome

Patients should be instructed to tell their ophthalmologist about their use of Alfuzosine L.P. extended-release tablets before cataract surgery or other procedures involving the eyes, even if the patient is no longer taking Alfuzosine L.P. extended-release tablets [see Warnings and Precautions (5.6)].

17.3 Priapism

Patients should be advised about the possibility of priapism resulting from treatment with Alfuzosine L.P. extended-release tablets and medications in the same class. Although this reaction is extremely rare, but if not brought to immediate medical attention, can lead to permanent erectile dysfunction [see Warnings and Precautions (5.7) ].

17.4 Instructions of use

Alfuzosine L.P. extended-release tablets should be taken with food and with the same meal each day. Patients should be advised not to crush or chew Alfuzosine L.P. extended-release tablets.

APOTEX INC

Alfuzosine L.P. EXTENDED-RELEASE TABLETS, USP

10 mg

Manufactured by Manufactured for
Apotex Inc. Apotex Corp.
Toronto, Ontario Weston, Florida
Canada, M9L 1T9 33326

Revised: June 2014

Revision: 8

FDA-Approved Patient Labeling

Patient Information

Alfuzosine L.P. Extended-Release Tablets , USP

(al fue' zoe sin hye'' droe klor' ide).

Read the Patient Information that comes with Alfuzosine L.P. extended-release tablets before you start using it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your condition or your treatment. You and your doctor should talk about all your medicines, including Alfuzosine L.P. extended-release tablets, now and at your regular checkups.

What is the most important information I should know about Alfuzosine L.P. extended-release tablets?

Alfuzosine L.P. extended-release tablets can cause serious side effects, including a sudden drop in blood pressure, especially when you start treatment.

This may cause you to faint, or to feel dizzy or lightheaded.

  • Your risk of having this problem may be increased if you take Alfuzosine L.P. extended-release tablets with certain other medicine that lowers blood pressure:
    • medicines for high blood pressure
    • a nitrate medicine for angina

    Ask your doctor if you are not sure if you are taking one of these medicines

  • Do not drive, operate machinery, or do any dangerous activities until you know how Alfuzosine L.P. extended-release tablets affect you. This is especially important if you already have a problem with low blood pressure or take medicines to treat high blood pressure.
  • If you begin to feel dizzy or lightheaded, lie down with your legs and feet up. If your symptoms do not improve call your doctor.

What are Alfuzosine L.P. extended-release tablets?

Alfuzosine L.P. extended-release tablet is a prescription medicine that is called an "alpha-blocker". Alfuzosine L.P. extended-release tablets are used in adult men to treat the symptoms of benign prostatic hyperplasia (BPH). Alfuzosine L.P. extended-release tablets may help to relax the muscles in the prostate and the bladder which may lessen the symptoms of BPH and improve urine flow.

Before prescribing Alfuzosine L.P. extended-release tablets, your doctor may examine your prostate gland and do a blood test called a prostate specific antigen (PSA) test to check for prostate cancer. Prostate cancer and BPH can cause the same symptoms. Prostate cancer needs a different treatment.

Alfuzosine L.P. extended-release tablets are not for use in women or children.

Some medicines called "alpha-blockers" are used to treat high blood pressure. Alfuzosine L.P. extended-release tablets are not for the treatment of high blood pressure.

Who should not take Alfuzosine L.P. extended-release tablets?

Do not take Alfuzosine L.P. extended-release tablets if you:

  • have certain liver problems
  • take antifungal medicines like ketoconazole (Nizoral) or itraconazole (Sporanox)
  • take anti-HIV medicines like ritonavir (Norvir, Kaletra)
  • are allergic to Alfuzosine L.P. or any of the ingredients in Alfuzosine L.P. extended-release tablets. See the end of this leaflet for a complete list of ingredients in Alfuzosine L.P. extended-release tablets.

Before taking Alfuzosine L.P. extended-release tablets, tell your doctor if you:

  • have liver problems
  • have kidney problems
  • have had low blood pressure, especially after taking another medicine. Signs of low blood pressure are fainting, dizziness, and lightheadedness.
  • have a heart problem called angina
  • or any family members have a rare heart condition known as congenital prolongation of the QT interval.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Some of your other medicines may affect the way Alfuzosine L.P. extended-release tablets work and cause serious side effects. See “What is the most important information I should know about Alfuzosine L.P. extended-release tablets?”

Especially tell your doctor if you take:


  • another alpha blocker medicine

  • a medicine to treat high blood pressure
  • a medicine to treat angina a medicine to treat erectile dysfunction (ED)
  • the antifungal medicines like ketoconazole (Nizoral ) or itraconazole (Sporanox)
  • the anti-HIV medicine like, ritonavir (Norvir, Kaletra)

Ask your doctor or pharmacist if you are not sure if your medicine is one of those listed above.

What you need to know while taking Alfuzosine L.P. extended-release tablets?

  • If you have an eye surgery for cataract (clouding of the eye) planned, tell your ophthalmologist that you are using Alfuzosine L.P. extended-release tablets or have previously been treated with an alpha-blocker.

How do I take Alfuzosine L.P. extended-release tablets?

  • Take Alfuzosine L.P. extended-release tablets exactly as your doctor prescribes it.
  • Take one Alfuzosine L.P. extended-release tablet after the same meal each day. Do not take it on an empty stomach.
  • Swallow the Alfuzosine L.P. extended-release tablet whole. Do not crush, split, or chew Alfuzosine L.P. extended-release tablets.
  • If you take too much Alfuzosine L.P. extended-release tablets call your local poison control center or emergency room right away.

What are the possible side effects of Alfuzosine L.P. extended-release tablets?

Alfuzosine L.P. extended-release tablets can cause serious side effects, including:

  • See “What is the most important information I should know about Alfuzosine L.P. extended-release tablets?”

  • A painful erection that will not go away. Alfuzosine L.P. extended-release tablets can cause a painful erection (priapism), which cannot be relieved by having sex. If this happens, get medical help right away. If priapism is not treated, you may not be able to get an erection in the future.

The most common side effects with Alfuzosine L.P. extended-release tablets are:

  • dizziness
  • headache
  • tiredness

Call your doctor if you get any side effect that bothers you.

These are not all the side effects of Alfuzosine L.P. extended-release tablets. For more information ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to Apotex Corp. at 1-800-706-5575 or FDA at 1-800-FDA-1088.

How do I store Alfuzosine L.P. extended-release tablets?

  • Store Alfuzosine L.P. extended-release tablets between 59°F and 86°F (15°C and 30°C).
  • Protect from light and moisture.

Keep Alfuzosine L.P. extended-release tablets and all medicines out of the reach of children.

General information about Alfuzosine L.P. extended-release tablets:

Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use Alfuzosine L.P. extended-release tablets for a condition for which it was not prescribed. Do not give Alfuzosine L.P. extended-release tablets to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about Alfuzosine L.P. extended-release tablets. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about Alfuzosine L.P. extended-release tablets that is written for health professionals.

Additional information on Apotex’s product can be obtained by contacting DI Spedia, Apotex’s Drug Information Service at 1-800-667-4708. Information on Apotex’s product can also be found at: http://www.apotexcorp.com/

What are the ingredients of Alfuzosine L.P. extended-release tablets?

Active Ingredient: Alfuzosine L.P.

Inactive Ingredients: dibasic calcium phosphate dihydrate (USP), hydroxypropyl methylcellulose (USP), magnesium stearate (NF), polyvinyl acetate phthalate (NF) and yellow ferric oxide (NF).


APOTEX INC.

Alfuzosine L.P. EXTENDED-RELEASE TABLETS, USP

10 mg

Manufactured by Manufactured for
Apotex Inc. Apotex Corp.
Toronto, Ontario Weston, Florida
Canada, M9L 1T9 33326

Revised: June 2014

Revision: 7

PACKAGE LABEL - PRINCIPAL DISPLAY PANEL - 10 MG LABEL

APOTEX CORP. NDC 60505-2850-1

Alfuzosine L.P. Extended-Release Tablets

10 mg

Rx Only

100 Tablets

Alfuzosine L.P. pharmaceutical active ingredients containing related brand and generic drugs:

infoActive ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Alfuzosine L.P. available forms, composition, doses:

infoForm of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Alfuzosine L.P. destination | category:

infoDestination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Alfuzosine L.P. Anatomical Therapeutic Chemical codes:

infoA medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Alfuzosine L.P. pharmaceutical companies:

infoPharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. Dailymed."ALFUZOSIN HYDROCHLORIDE TABLET, EXTENDED RELEASE [APOTEX CORP.]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. "alfuzosin". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
  3. "alfuzosin". http://www.drugbank.ca/drugs/DB0034... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Alfuzosine L.P.?

Depending on the reaction of the Alfuzosine L.P. after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Alfuzosine L.P. not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Alfuzosine L.P. addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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Review

sDrugs.com conducted a study on Alfuzosine L.P., and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Alfuzosine L.P. consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Arunabha Ray, MD Pharmacology

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