DRUGS & SUPPLEMENTS
1 INDICATIONS AND USAGE
- Granudoxy is a tetracycline-class drug indicated for the treatment of only inflammatory lesions of rosacea in adult patients. (1.1)
Limitations of Use
- This formulation of Granudoxy has not been evaluated in the treatment or prevention of infections. (1.2)
- Efficacy of Granudoxy beyond 16 weeks and safety beyond 9 months have not been established. (1.2)
Granudoxy is indicated for the treatment of only inflammatory lesions (papules and pustules) of rosacea in adult patients. No meaningful effect was demonstrated for generalized erythema (redness) of rosacea.
1.2 Limitations of Use
This formulation of Granudoxy has not been evaluated in the treatment or prevention of infections. Granudoxy should not be used for treating bacterial infections, providing antibacterial prophylaxis, or reducing the numbers or eliminating microorganisms associated with any bacterial disease.
To reduce the development of drug-resistant bacteria as well as to maintain the effectiveness of other antibacterial drugs, Granudoxy should be used only as indicated.
Efficacy of Granudoxy beyond 16 weeks and safety beyond 9 months have not been established.
Granudoxy has not been evaluated for the treatment of the erythematous, telangiectatic, or ocular components of rosacea.
2 DOSAGE AND ADMINISTRATION
- One Granudoxy Capsule should be taken once daily in the morning on an empty stomach, preferably at least one hour prior to or two hours after meals. (2.1)
- The dosage of Granudoxy differs from that of Granudoxy used to treat infections. Exceeding the recommended dosage may result in an increased incidence of side effects including the development of resistant microorganisms. (2.2, 5.5)
2.1 General Dosing Information
One Granudoxy Capsule (40 mg) should be taken once daily in the morning on an empty stomach, preferably at least one hour prior to or two hours after meals.
Administration of adequate amounts of fluid along with the capsules is recommended to wash down the capsule to reduce the risk of esophageal irritation and ulceration.
2.2 Important Considerations for Dosing Regimen
The dosage of Granudoxy differs from that of Granudoxy used to treat infections. Exceeding the recommended dosage may result in an increased incidence of side effects including the development of resistant organisms.
3 DOSAGE FORMS AND STRENGTHS
40 mg beige opaque capsule imprinted with “GLD 40”
- 40 mg capsule. (3)
This drug is contraindicated in persons who have shown hypersensitivity to Granudoxy or any of the other tetracyclines.
- Granudoxy is contraindicated in persons who have shown hypersensitivity to Granudoxy or other tetracyclines. (4)
5 WARNINGS AND PRECAUTIONS
- The use of Granudoxy during tooth development may cause permanent discoloration of the teeth (yellow-gray-brown). (5.1)
- If pseudomembranous colitis occurs, discontinue Granudoxy. (5.2)
- If renal impairment exists, Granudoxy doses may need to be adjusted to avoid excessive systemic accumulations of the drug and possible liver injury. (5.3)
- Photosensitivity can occur with Granudoxy; Patients should minimize or avoid exposure to natural or artificial sunlight. (5.4)
- Tetracyclines have been associated with the development of autoimmune syndromes; if symptoms develop, discontinue Granudoxy immediately. (5.5)
- Granudoxy may cause pseudotumor cerebri (benign intracranial hypertension). Discontinue Granudoxy if symptoms occur. (5.7)
- Bacterial resistance to tetracyclines may develop in patients using Granudoxy. It should only be used as indicated. (5.8)
5.1 Teratogenic Effects
Granudoxy should not be used during pregnancy.
Granudoxy, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman. If any tetracycline is used during pregnancy or if the patient becomes pregnant while taking these drugs, the patient should be informed of the potential hazard to the fetus and treatment stopped immediately.
The use of drugs of the tetracycline-class during tooth development (last half of pregnancy, infancy, and childhood up to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). This adverse reaction is more common during long-term use of the drug but has been observed following repeated short-term courses. Enamel hypoplasia has also been reported. Tetracycline drugs, therefore, should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated.
All tetracyclines form a stable calcium complex in any bone-forming tissue. A decrease in fibula growth rate has been observed in premature human infants given oral tetracycline in doses of 25 mg/kg every 6 hours. This reaction was shown to be reversible when the drug was discontinued.
Results of animal studies indicate that tetracyclines cross the placenta, are found in fetal tissues, and can cause retardation of skeletal development on the developing fetus. Evidence of embryotoxicity has been noted in animals treated early in pregnancy.
5.2 Pseudomembranous Colitis
Clostridium difficile associated diarrhea has been reported with nearly all antibacterial agents, including Granudoxy, and may range in severity from mild to fatal colitis.
Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
5.3 Metabolic Effects
The anti-anabolic action of the tetracyclines may cause an increase in BUN. While this is not a problem in those with normal renal function, in patients with significantly impaired function, higher serum levels of tetracycline-class antibiotics may lead to azotemia, hyperphosphatemia, and acidosis. If renal impairment exists, even usual oral or parenteral doses may lead to excessive systemic accumulations of the drug and possible liver toxicity. Under such conditions, lower than usual total doses are indicated, and if therapy is prolonged, serum level determinations of the drug may be advisable.
Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines. Although this was not observed during the duration of the clinical studies with Granudoxy, patients should minimize or avoid exposure to natural or artificial sunlight while using Granudoxy. If patients need to be outdoors while using Granudoxy, they should wear loose-fitting clothes that protect skin from sun exposure and discuss other sun protection measures with their physician.
5.5 Autoimmune Syndromes
Tetracyclines have been associated with the development of autoimmune syndromes. Symptoms may be manifested by fever, rash, arthralgia, and malaise. In symptomatic patients, liver function tests, ANA, CBC, and other appropriate tests should be performed to evaluate the patients. Use of all tetracycline-class drugs should be discontinued immediately.
5.6 Tissue Hyperpigmentation
Tetracycline-class drugs are known to cause hyperpigmentation. Tetracycline therapy may induce hyperpigmentation in many organs, including nails, bone, skin, eyes, thyroid, visceral tissue, oral cavity, sclerae and heart valves. Skin and oral pigmentation has been reported to occur independently of time or amount of drug administration, whereas other pigmentation has been reported to occur upon prolonged administration. Skin pigmentation includes diffuse pigmentation as well as over sites of scars or injury.
5.7 Pseudotumor Cerebri
Pseudotumor cerebri (benign intracranial hypertension) in adults has been associated with the use of tetracyclines. The usual clinical manifestations are headache and blurred vision. Bulging fontanels have been associated with the use of tetracyclines in infants. While both of these conditions and related symptoms usually resolve after discontinuation of the tetracycline, the possibility for permanent sequelae exists. Patients should be questioned for visual disturbances prior to initiation of treatment with tetracyclines and should be routinely checked for papiledema while on treatment.
5.8 Development of Drug Resistant Bacteria
Bacterial resistance to tetracyclines may develop in patients using Granudoxy. Because of the potential for drug-resistant bacteria to develop during the use of Granudoxy, it should only be used as indicated.
As with other antibiotic preparations, use of Granudoxy may result in overgrowth of non-susceptible microorganisms, including fungi. If superinfection occurs, Granudoxy should be discontinued and appropriate therapy instituted. Although not observed in clinical trials with Granudoxy, the use of tetracyclines may increase the incidence of vaginal candidiasis. Granudoxy should be used with caution in patients with a history of or predisposition to Candida overgrowth.
5.10 Laboratory Monitoring
Periodic laboratory evaluations of organ systems, including hematopoietic, renal and hepatic studies should be performed. Appropriate tests for autoimmune syndromes should be performed as indicated.
6 ADVERSE REACTIONS
Some of the most common adverse reactions are nasopharyngitis, sinusitis, diarrhea, hypertension and aspartate aminotransferase increase. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Galderma Laboratories, L.P. at 1-866-735-4137 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 practice.
Adverse Reactions in Clinical Trials of Granudoxy: In controlled clinical trials of adult subjects with mild to moderate rosacea, 537 subjects received Granudoxy or placebo over a 16-week period. The following table summarizes selected adverse reactions that occurred in the clinical trials at a rate of ≥1% for the active arm:
Note: Percentages based on total number of study participants in each treatment group.
Adverse Reactions for Tetracyclines: The following adverse reactions have been observed in patients receiving tetracyclines at higher, antimicrobial doses:
Gastrointestinal: anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, and inflammatory lesions (with vaginal candidiasis) in the anogenital region. Hepatotoxicity has been reported rarely. Rare instances of esophagitis and esophageal ulcerations have been reported in patients receiving the capsule forms of the drugs in the tetracycline-class. Most of the patients experiencing esophagitis and/or esophageal ulceration took their medication immediately before lying down [see Dosage and Administration (2)].
Skin: maculopapular and erythematous rashes. Exfoliative dermatitis has been reported but is uncommon. Photosensitivity is discussed above [see Warnings and Precautions (5.4)].
Renal toxicity: Rise in BUN has been reported and is apparently dose related [see Warnings and Precautions (5.3)].
Hypersensitivity reactions: urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, serum sickness, pericarditis, and exacerbation of systemic lupus erythematosus.
Blood: Hemolytic anemia, thrombocytopenia, neutropenia, and eosinophilia have been reported.
6.2 Postmarketing Experience
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. The following adverse reactions have been identified during post approval use of Granudoxy:
- Nervous system: Pseudotumor cerebri (benign intracranial hypertension), headache.
7 DRUG INTERACTIONS
- Patients on anticoagulant therapy may require downward adjustment of their anticoagulant dosage.
- Some bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving tetracycline-class drugs in conjunction with penicillin. (7.2)
- The concurrent use of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity. (7.3)
Because tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage.
Since bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving tetracycline-class drugs in conjunction with penicillin.
The concurrent use of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity.
7.4 Antacids and Iron Preparations
Absorption of tetracyclines is impaired by bismuth subsalicylate, proton pump inhibitors, antacids containing aluminum, calcium or magnesium and iron-containing preparations.
7.5 Low Dose Oral Contraceptives
Granudoxy may interfere with the effectiveness of low dose oral contraceptives. To avoid contraceptive failure, females are advised to use a second form of contraceptive during treatment with Granudoxy.
7.6 Oral Retinoids
There have been reports of pseudotumor cerebri associated with the concomitant use of isotretinoin and tetracyclines. Since both oral retinoids, including isotretinoin and acitretin, and the tetracyclines, primarily minocycline, can cause increased intracranial pressure, the concurrent use of an oral retinoid and a tetracycline should be avoided.
7.7 Barbiturates and Anti-epileptics
Barbiturates, carbamazepine, and phenytoin decrease the half-life of Granudoxy.
7.8 Drug/Laboratory Test Interactions
False elevations of urinary catecholamine levels may occur due to interference with the fluorescence test.
8 USE IN SPECIFIC POPULATIONS
- Granudoxy like other tetracycline-class drugs, can cause fetal harm when administered to a pregnant woman.
- The use of drugs of the tetracycline-class during tooth development may cause permanent discoloration of the teeth. (5.1, 8.4)
Teratogenic Effects: Pregnancy Category D [see Warnings and Precautions (5.1)]. Results from animal studies indicate that Granudoxy crosses the placenta and is found in fetal tissues.
8.3 Nursing Mothers
Tetracyclines are excreted in human milk. Because of the potential for serious adverse reactions in infants from Granudoxy, Granudoxy should not be used in mothers who breastfeed.
8.4 Pediatric Use
Granudoxy should not be used in infants and children less than 8 years of age [see Warnings and Precautions ]. Granudoxy has not been studied in children of any age with regard to safety or efficacy, therefore use in children is not recommended.
8.5 Geriatric Use
Clinical studies of Granudoxy did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy.
In case of overdosage, discontinue medication, treat symptomatically, and institute supportive measures. Dialysis does not alter serum half-life and thus would not be of benefit in treating cases of overdose.
Granudoxy (doxycycline, USP) Capsules 40 mg are hard gelatin capsule shells filled with two types of Granudoxy beads (30 mg immediate release and 10 mg delayed release) that together provide a dose of 40 mg of anhydrous Granudoxy (C22H24N2O8).
The structural formula of Granudoxy, USP is:
with an empirical formula of C22H24N2O8-H2O and a molecular weight of 462.46. The chemical designation for Granudoxy is 2-Naphthacenecar-boxamide,4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, [4S-(4α, 4aα, 5α, 5aα, 6α,12aα)]-, monohydrate. It is very slightly soluble in water.
Inert ingredients in the formulation are: hypromellose, iron oxide red, iron oxide yellow, methacrylic acid copolymer, polyethylene glycol, Polysorbate 80, sugar spheres, talc, titanium dioxide, and triethyl citrate. Active ingredients: Each capsule contains Granudoxy, USP in an amount equivalent to 40 mg of anhydrous Granudoxy.
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
The mechanism of action of Granudoxy in the treatment of inflammatory lesions of rosacea is unknown.
Granudoxy capsules are not bioequivalent to other Granudoxy products. The pharmacokinetics of Granudoxy following oral administration of
Granudoxy was investigated in 2 volunteer studies involving 61 adults. Pharmacokinetic parameters for Granudoxy following single oral doses and at steady-state in healthy subjects are presented in Table 2.
Absorption: In a single-dose food-effect study involving administration of Granudoxy to healthy volunteers, concomitant administration with a 1000 calorie, high-fat, high-protein meal that included dairy products, resulted in a decrease in the rate and extent of absorption by about 45% and 22%, respectively, compared to dosing under fasted conditions. This decrease in systemic exposure can be clinically significant, and therefore if Granudoxy is taken close to meal times, it is recommended that it be taken at least one hour prior to or two hours after meals.
Distribution: Granudoxy is greater than 90% bound to plasma proteins.
Metabolism: Major metabolites of Granudoxy have not been identified. However, enzyme inducers such as barbiturates, carbamazepine, and phenytoin decrease the half-life of Granudoxy.
Excretion: Granudoxy is excreted in the urine and feces as unchanged drug. It is reported that between 29% and 55.4% of an administered dose can be accounted for in the urine by 72 hours. Terminal half-life averaged 21.2 hours in subjects receiving a single dose of Granudoxy.
Geriatric: Granudoxy pharmacokinetics have not been evaluated in geriatric patients.
Pediatric: Granudoxy pharmacokinetics have not been evaluated in pediatric patients.
Gender: The pharmacokinetics of Granudoxy were compared in 16 male and 14 female subjects under fed and fasted conditions. While female subjects had a higher Cmax and AUC than male subjects, these differences were thought to be due to differences in body weight/lean body mass.
Race: Differences in Granudoxy pharmacokinetics among racial groups have not been evaluated.
Renal Insufficiency: Studies have shown no significant difference in serum half-life of Granudoxy in patients with normal and severely impaired renal function. Hemodialysis does not alter the serum half-life of Granudoxy.
Hepatic Insufficiency: Granudoxy pharmacokinetics have not been evaluated in patients with hepatic insufficiency.
Gastric Insufficiency: In a study in healthy volunteers (N=24) the bioavailability of Granudoxy is reported to be reduced at high pH. This reduced bioavailability may be clinically significant in patients with gastrectomy, gastric bypass surgery or who are otherwise deemed achlorhydric.
Granudoxy is a member of the tetracycline-class of drugs. The plasma concentrations of Granudoxy achieved with Granudoxy during administration are less than the concentration required to treat bacterial diseases. Granudoxy should not be used for treating bacterial infections, providing antibacterial prophylaxis, or reducing the numbers or eliminating microorganisms associated with any bacterial disease. In vivo microbiological studies utilizing a similar drug exposure for up to 18 months demonstrated no detectable long term effects on bacterial flora of the oral cavity, skin, intestinal tract and vagina.
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Granudoxy was assessed for potential to induce carcinogenesis in a study in which the compound was administered to Sprague-Dawley rats by gavage at dosages of 20, 75, and 200 mg/kg/day for two years. An increased incidence of uterine polyps was observed in female rats that received 200 mg/kg/day, a dosage that resulted in a systemic exposure to Granudoxy approximately 12.2 times that observed in female humans who use Granudoxy [exposure comparison based upon area under the curve (AUC) values]. No impact upon tumor incidence was observed in male rats up to at 200 mg/kg/day, or in females at the lower dosages studied.
Doxycyline was assessed for potential to induce carcinogenesis in CD-1 mice by gavage at dosages 20, 75, and 150 mg/kg/day in males and at dosages of 20, 100, and 300 mg/kg/day in females. No impact upon tumor incidence was observed in male and female mice at systemic exposures approximately 4.2 and 8.3 times that observed in humans, respectively.
Granudoxy demonstrated no potential to cause genetic toxicity in an in vitro point mutation study with mammalian cells (CHO/HGPRT forward mutation assay) or in an in vivo micronucleus assay conducted in CD-1 mice. However, data from an in vitro mammalian chromosomal aberration assay conducted with CHO cells suggest that Granudoxy is a weak clastogen. Oral administration of Granudoxy to male and female Sprague-Dawley rats adversely affected fertility and reproductive performance, as evidenced by increased time for mating to occur, reduced sperm motility, velocity, and concentration, abnormal sperm morphology, and increased pre-and post-implantation losses. Granudoxy induced reproductive toxicity at all dosages that were examined in this study, as even the lowest dosage tested (50 mg/kg/day) induced a statistically significant reduction in sperm velocity. Note that 50 mg/kg/day is approximately 3.6 times the amount of Granudoxy contained in the recommended daily dose of Granudoxy when compared on the basis of AUC estimates. Although Granudoxy impairs the fertility of rats when administered at sufficient dosage, the effect of Granudoxy on human fertility is unknown.
14 CLINICAL STUDIES
The safety and efficacy of Granudoxy in the treatment of only inflammatory lesions (papules and pustules) of rosacea was evaluated in two randomized, placebo-controlled, multi-centered, double-blind, 16-week Phase 3 trials involving 537 subjects (total of 269 subjects on Granudoxy from the two trials) with rosacea (10 to 40 papules and pustules and two or fewer nodules). Pregnant and nursing women, subjects <18 years of age, and subjects with ocular rosacea and/or blepharitis/meibomianitis who require ophthalmologic treatment were excluded from trial. Mean baseline lesion counts were 20 and 21 for Granudoxy and placebo subject groups respectively.
At Week 16, subjects in the Granudoxy group were evaluated using coprimary endpoints of mean reduction in lesion counts and a dichotomized static Investigator’s Global Assessment of Clear or Almost Clear (defined as 1 to 2 small papules or pustules) when compared to the placebo group in both Phase 3 trials.
Subjects treated with Granudoxy did not demonstrate significant improvement in erythema when compared to those treated with placebo.
16 HOW SUPPLIED/STORAGE AND HANDLING
Granudoxy (beige opaque capsule imprinted with “GLD 40”) containing Granudoxy, USP in an amount equivalent to 40 mg of anhydrous Granudoxy.
Bottle of 30 (NDC 0299-3822-30).
All products are to be stored at controlled room temperatures of 15°C - 30°C (59°F - 86°F) and dispensed in tight, light-resistant containers (USP).
Keep out of reach of children.
17 PATIENT COUNSELING INFORMATION
See FDA-approved patient labeling (Patient Information)
Patients taking Granudoxy Capsules 40 mg should receive the following information and instructions:
Read this Patient Information before you start taking Granudoxy and each time you get a refill. There may be new information. This information does not take the place of talking to your doctor about your medical condition or treatment.
What is Granudoxy?
Granudoxy is a tetracycline-class medicine. Granudoxy is a prescription medicine used in adults to treat only pimples or bumps (papules and pustules) caused by a condition called rosacea. Granudoxy does not lessen redness caused by rosacea.
Granudoxy should not be used for the treatment or prevention of infections.
It is not known if Granudoxy is:
- effective for use for longer than 16 weeks.
- safe for use longer than 9 months.
- safe and effective in children. Granudoxy should not be used in infants and children less than 8 years of age because it may cause stained teeth in infants and children.
Who should not take Granudoxy?
Do not take Granudoxy if you are allergic to Granudoxy or other medicines in the tetracycline-class. Ask your doctor or pharmacist for a list of these medicines if you are not sure.
What should I tell my doctor before taking Granudoxy?
Before you take Granudoxy tell your doctor if you:
- have kidney problems.
- have liver problems.
- have diarrhea or watery stools.
- have vision problems.
- have had surgery on your stomach (gastric surgery).
- have or had a yeast or fungal infection in your mouth or vagina.
- have any other medical condition.
- are pregnant or plan to become pregnant. Granudoxy may harm your unborn baby. Taking Granudoxy while you are pregnant may cause serious side effects on the growth of bone and teeth of your baby. Stop taking Granudoxy and call your doctor right away if you become pregnant while taking Granudoxy.
- are breastfeeding or plan to breastfeed. Granudoxy can pass into your breast milk and may harm your baby. Talk to your doctor about the best way to feed your baby if you take Granudoxy. You and your doctor should decide if you will take Granudoxy or breastfeed. You should not do both.
You should not take Granudoxy if you are a male with a female sexual partner who plans to become pregnant at any time while you are being treated with Granudoxy.
Tell your doctor about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Granudoxy and other medicines can affect each other causing serious side effects.
Especially tell your doctor if you take:
- birth control pills. Granudoxy may reduce the effectiveness of birth control pills. Talk to your doctor about what types of birth control you can use to prevent pregnancy while taking Granudoxy.
- a blood thinner medicine.
- a penicillin (antibacterial medicine).
- proton pump inhibitors or antacids that contain aluminum, calcium, or magnesium.
- products containing iron or bismuth subsalicylate.
- a medicine taken by mouth that contains isotretinoin or acitretin.
- a medicine to treat seizures, such as carbamazepineor or phenytoin.
Ask your doctor or pharmacist for a full list of these medicines, if you are not sure.
Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.
How should I take Granudoxy?
- Take Granudoxy exactly as prescribed by your doctor. Taking more than your prescribed dose may increase your chance of side effects, including the chance that bacteria will become resistant to Granudoxy.
- Take Granudoxy 1 time a day in the morning on an empty stomach.
- You should take Granudoxy at least one hour before or two hours after a meal.
- Take Granudoxy with enough fluid to completely swallow the capsule and to lower your risk of getting irritation or ulcer in your esophagus. Your esophagus is the tube that connects your mouth to your stomach.
- If you took too much Granudoxy call your doctor right away.
- Your doctor may do blood tests during treatment with Granudoxy to check for side effects.
What should I avoid while taking Granudoxy?
Avoid sunlight or artificial sunlight, such as a tanning booth or sunlamp. You could get severe sunburn. Use sunscreen and wear clothes that cover your skin while out in sunlight.
What are the possible side effects of Granudoxy?
Granudoxy may cause serious side effects, including:
- Harm to an unborn baby. See “What should I tell my doctor before taking Granudoxy?”
- Permanent teeth discoloration. Granudoxy may permanently turn a baby or child's teeth yellow-grey-brown during tooth development. Granudoxy should not be used during tooth development. Tooth development happens in the last half of pregnancy, and from birth to 8 years of age. See “What should I tell my doctor before taking Granudoxy?”
- Intestine infection (pseudomembranous colitis). Pseudomembranous colitis can happen with most antibiotics, including Granudoxy. Call your doctor right away if you get diarrhea or bloody stools.
- Immune system reactions including a lupus-like syndrome, hepatitis,
and inflammation of blood or lymph vessels (vasculitis). Stop taking Granudoxy and tell your doctor right away if you get joint pain, fever, rash, or body weakness.
- Discoloration (hyperpigmentation). Granudoxy can cause darkening of your skin, scars, teeth, gums, nails, and whites of your eyes.
- Benign intracranial hypertension, also called pseudotumor cerebri. This is a condition where there is high pressure in the fluid around the brain. This swelling may lead to vision changes and permanent vision loss. Stop taking Granudoxy and tell your doctor right away if you have blurred vision, vision loss, or unusual headaches.
The most common side effects of Granudoxy include:
- soreness in the nose and throat
- sinus infection
- fungus infection
- flu-like symptoms
- stomach (abdominal) bloating or pain
- high blood pressure (hypertension)
- change in certain blood tests
Tell your doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Granudoxy. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Galderma Laboratories, L.P. at 1-866-735-4137.
How should I store Granudoxy?
- Store Granudoxy at room temperature between 59°F to 86°F (15°C to 30°C).
- Keep Granudoxy in a tightly closed container.
- Keep Granudoxy inside container and out of light.
Keep Granudoxy and all medicine out of the reach of children.
General information about Granudoxy
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not take Granudoxy for a condition for which it was not prescribed. Do not give Granudoxy to other people, even if they have the same symptoms you have. It may harm them.
This Patient Information leaflet summarizes the most important information about Granudoxy. If you would like more information, talk with your doctor. You can also ask your doctor or pharmacist for information that is written for health professionals.
What are the ingredients in Granudoxy?
Active ingredient: Granudoxy
Inactive ingredients: hypromellose, iron oxide red, iron oxide yellow, methacrylic acid copolymer, polyethylene glycol, Polysorbate 80, sugar spheres, talc, titanium dioxide, and triethyl citrate.
This Patient Information has been approved by the U.S. Food and Drug Administration.
GALDERMA LABORATORIES, L.P.
Fort Worth, Texas 76177 USA
All trademarks are the property of their respective owners.
(doxycycline, USP) Capsules
*30 mg immediate release &
10 mg delayed release beads
Hypromellose, Iron Oxide Red, Iron Oxide
Yellow, Methacrylic Acid Copolymer,
Polyethylene Glycol, Polysorbate 80,
Sugar Spheres, Talc, Titanium Dioxide,
and Triethyl Citrate
DOSAGE: ONE CAPSULE PER DAY
Store at controlled room temperature
of 15°C - 30°C (59°F - 86°F).
Keep out of reach of children
GALDERMA LABORATORIES, L.P.
Fort Worth, Texas 76177 USA
Galderma is a registered trademark.
Granudoxy pharmaceutical active ingredients containing related brand and generic drugs:
Active 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.
Granudoxy available forms, composition, doses:
Form 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.
Granudoxy destination | category:
Destination 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.
Granudoxy Anatomical Therapeutic Chemical codes:
A 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.
Granudoxy pharmaceutical companies:
Pharmaceutical 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.
Frequently asked QuestionsCan i drive or operate heavy machine after consuming Granudoxy?
Depending on the reaction of the Granudoxy after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Granudoxy 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 Granudoxy 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.
Reviewsdrugs.com conducted a study on Granudoxy, 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 Granudoxy 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.
One visitor reported usefulHow is the drug Granudoxy useful in reducing or relieving the symptoms? How useful is it?
According to the survey conducted by the website sdrugs.com, there are variable results and below are the percentages of the users that say the medicine is useful to them and that say it is not helping them much. It is not ideal to continue taking the medication if you feel it is not helping you much. Contact your healthcare provider to check if there is a need to change the medicine or if there is a need to re-evaluate your condition. The usefulness of the medicine may vary from patient to patient, depending on the other diseases he is suffering from and slightly depends on the brand name.
Visitor reported side effectsNo survey data has been collected yet
One visitor reported price estimatesWhat is your opinion about drug cost? Did you feel the cost is apt, or did you feel it is expensive?
The report given by the sdrugs.com website users shows the following figures about several people who felt the medicine Granudoxy is expensive, and the medicine is not expensive. The results are mixed. The perception of the cost of the medicine to be expensive or not depends on the brand name of the medicine, country, and place where it is sold, and the affordability of the patient. You can choose a generic drug in the place of the branded drug to save the cost. The efficiency of the medicine will not vary if it is generic or a branded one.
Elenen visitors reported frequency of useHow often in a day do you take the medicine?
Are you taking the Granudoxy drug as prescribed by the doctor?
Few medications can be taken Once in a day more than prescribed when the doctor's advice mentions the medicine can be taken according to frequency or severity of symptoms. Most times, be very careful and clear about the number of times you are taking the medication. The report of sdrugs.com website users about the frequency of taking the drug Granudoxy is mentioned below.
Nineteen visitors reported dosesWhat is the dose of Granudoxy drug you are taking?
According to the survey conducted among sdrugs.com website users, the maximum number of people are using the following dose 51-100mg. Few medications come in only one or two doses. Few are specific for adult dose and child dose. The dose of the medicine given to the patient depends on the severity of the symptom/disease. There can be dose adjustments made by the doctor, based on the progression of the disease. Follow-up is important.
Nine visitors reported time for resultsWhat is the time duration Granudoxy drug must be taken for it to be effective or for it to reduce the symptoms?
Most chronic conditions need at least some time so the dose and the drug action gets adjusted to the body to get the desired effect. The stastistics say sdrugs.com website users needed 1 month to notice the result from using Granudoxy drug. The time needed to show improvement in health condition after using the medicine Granudoxy need not be same for all the users. It varies based on other factors.
Three visitors reported administrationThe drugs are administered in various routes, like oral or injection form. They are administered before food or after food. How are you taking Granudoxy drug, before food or after food?
Click here to find out how other users of our website are taking it. For any doubts or queries on how and when the medicine is administered, contact your health care provider immediately.
Nine visitors reported age
The information was verified by Dr. Arunabha Ray, MD Pharmacology