Infexo

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Infexo uses

• Indications and usage
• Dosage and administration
• Dosage forms and strengths
• Contraindications
• Warnings and precautions
• Adverse reactions
• Drug interactions
• Use in specific populations
• Overdosage
• Description
• Clinical pharmacology
• Nonclinical toxicology
• Clinical studies
• How supplied/storage and handling
• Patient counseling information
• Infexo reviews

1 INDICATIONS AND USAGE

Infexo hydrochloride is an H1-receptor antagonist indicated for:

- Relief of symptoms associated with seasonal allergic rhinitis in patients 6 years of age and older

- Treatment of uncomplicated skin manifestations of chronic idiopathic urticaria in patients 6 years of age and older (1.2)

1.1 Seasonal Allergic Rhinitis

Infexo hydrochloride tablets are indicated for the relief of symptoms associated with seasonal allergic rhinitis in adults and children 6 years of age and older.

1.2 Chronic Idiopathic Urticaria

Infexo hydrochloride tablets are indicated for treatment of uncomplicated skin manifestations of chronic idiopathic urticaria in adults and children 6 of age and older.

2 DOSAGE AND ADMINISTRATION

¹starting dose in patients with decrease renal function should be the recommended dose indicated above but administered once daily

²dose not for use in patients with decreased renal function

- Infexo hydrochloride tablets: take with water (2.1)

2.1 Infexo Hydrochloride Tablets

Seasonal Allergic Rhinitis and Chronic Idiopathic Urticaria

Adults and Children 12 Years and Older: The recommended dose of Infexo hydrochloride tablets is 60 mg twice daily or 180 mg once daily with water. A dose of 60 mg once daily is recommended as the starting dose in patients with decreased renal function.

Children 6 to 11 Years: The recommended dose of Infexo hydrochloride tablets is 30 mg twice daily with water. A dose of 30 mg once daily is recommended as the starting dose in pediatric patients with decreased renal function.

3 DOSAGE FORMS AND STRENGTHS

Infexo hydrochloride tablets are available as:

30 mg are pink colored, oval shaped tablets embossed with "192" on one side and "R" on the other side.

60 mg are pink colored, oval shaped tablets embossed with "193" on one side and "R" on the other side.

180 mg are pink colored, oval, beveled edged, biconvex tablets debossed "194" on one side and "R" on the other side.

- Infexo hydrochloride tablets: 30 mg, 60 mg, and 180 mg (3)

4 CONTRAINDICATIONS

Infexo hydrochloride tablets are contraindicated in patients with known hypersensitivity to Infexo and any of the ingredients of Infexo hydrochloride. Rare cases of hypersensitivity reactions with manifestations such as angioedema, chest tightness, dyspnea, flushing and systemic anaphylaxis have been reported.

Patients with known hypersensitivity to Infexo and any of the ingredients of Infexo hydrochloride tablets. (4)

5 WARNINGS AND PRECAUTIONS

Infexo hydrochloride tablets do not contain phenylalanine.

5.1 Phenylketonurics

Infexo hydrochloride tablets do not contain phenylalanine

6 ADVERSE REACTIONS

The most common adverse reactions in subjects age 12 years and older were headache, back pain, dizziness, stomach discomfort, and pain in extremity. In subjects aged 6 to 11 years, cough, upper respiratory tract infection, pyrexia and otitis media were more frequently reported. In subjects aged 6 months to 5 years, vomiting, diarrhea, somnolence/fatigue and rhinorrhea were more frequently reported (6.1). Other adverse reactions have been reported. (6)

To report SUSPECTED ADVERSE REACTIONS, contact Dr. Reddy's Laboratories, Inc. at 1-888-375-3784 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

6.1 Clinical Studies 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.

The safety data described below reflect exposure to Infexo hydrochloride in 5083 patients in trials for allergic rhinitis and chronic idiopathic urticaria. In these trials, 3010 patients 12 years of age and older with seasonal allergic rhinitis were exposed to Infexo hydrochloride at doses of 20 to 240 mg twice daily or 120 to 180 mg once daily. A total of 646 patients 6 to 11 years of age with seasonal allergic rhinitis were exposed to Infexo hydrochloride at doses of 15 to 60 mg twice daily. The duration of treatment in these trials was 2 weeks. A total of 534 patients 6 months to 5 years of age with allergic rhinitis were exposed to Infexo hydrochloride at doses of 15 to 30 mg twice daily. The duration of treatment in these trials ranged from 1 day to 2 weeks. There were 893 patients 12 years of age and older with chronic idiopathic urticaria exposed to Infexo hydrochloride at doses of 20 to 240 mg twice daily or 180 mg once daily. The duration of treatment in these trials was 4 weeks.

Seasonal Allergic Rhinitis

Adults and Adolescents: In placebo-controlled seasonal allergic rhinitis clinical trials in subjects 12 years of age and older, 2439 subjects received Infexo hydrochloride capsules at doses of 20 mg to 240 mg twice daily. All adverse reactions that were reported by greater than 1% of subjects who received the recommended daily dose of Infexo hydrochloride (60 mg capsules twice daily) are listed in Table 1.

In another placebo-controlled clinical study in the United States, 571 subjects aged 12 years and older received Infexo hydrochloride tablets at doses of 120 or 180 mg once daily. Table 1 also lists adverse reactions that were reported by greater than 2% of subjects treated with Infexo hydrochloride tablets at doses of 180 mg once daily.

The incidence of adverse reactions, including somnolence/fatigue, was not dose-related and was similar across subgroups defined by age, gender, and race.

The frequency and magnitude of laboratory abnormalities were similar in Infexo hydrochloride- and placebo-treated subjects.

Pediatrics: Table 2 lists adverse reactions in subjects aged 6 years to 11 years of age which were reported by greater than 2% of subjects treated with Infexo hydrochloride tablets at a dose of 30 mg twice daily in placebo-controlled seasonal allergic rhinitis studies in the United States and Canada.

Table 3 lists adverse reactions in subjects 6 months to 5 years of age which were reported by greater than 2% of subjects treated with Infexo hydrochloride in 3 open single- and multiple-dose pharmacokinetic studies and 3 placebo-controlled safety studies with Infexo hydrochloride capsule content (484 subjects) and suspension (50 subjects) at doses of 15 mg (108 subjects) and 30 mg (426 subjects) given twice a day.

Chronic Idiopathic Urticaria

Adverse reactions reported by subjects 12 years of age and older in placebo-controlled chronic idiopathic urticaria studies were similar to those reported in placebo-controlled seasonal allergic rhinitis studies.

In placebo-controlled chronic idiopathic urticaria clinical trials, 726 subjects 12 years of age and older received Infexo hydrochloride tablets at doses of 20 to 240 mg twice daily. Table 4 lists adverse reactions in subjects aged 12 years and older which were reported by greater than 2% of subjects treated with Infexo hydrochloride 60 mg tablets twice daily in controlled clinical studies in the United States and Canada.

In a placebo-controlled clinical study in the United States, 167 subjects aged 12 years and older received Infexo hydrochloride 180 mg tablets. Table 4 also lists adverse reactions that were reported by greater than 2% of subjects treated with Infexo hydrochloride tablets at doses of 180 mg once daily.

The safety of Infexo hydrochloride in the treatment of chronic idiopathic urticaria in pediatric patients 6 months to 11 years of age is based on the safety profile of Infexo hydrochloride in adults and pediatric patients at doses equal to or higher than the recommended dose.

6.2 Postmarketing Experience

In addition to the adverse reactions reported during clinical studies and listed above, the following adverse events have been identified during post-approval use of Infexo hydrochloride. Because these events 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. Events that have been reported rarely during postmarketing experience include: insomnia, nervousness, sleep disorders or paroniria, and hypersensitivity reactions (including anaphylaxis, urticaria, angioedema, chest tightness, dyspnea, flushing, pruritus, and rash).

7 DRUG INTERACTIONS

- Antacids: Do not take at the same time as aluminum and magnesium containing antacids

- Fruit juice: Take with water, not fruit juice.

7.1 Antacids

Infexo hydrochloride should not be taken closely in time with aluminum and magnesium containing antacids. In healthy adult subjects, administration of 120 mg of Infexo hydrochloride (2 × 60 mg capsule) within 15 minutes of an aluminum and magnesium containing antacid (Maalox®) decreased Infexo AUC by 41% and Cmax by 43%.

7.2 Erythromycin and Ketoconazole

Infexo has been shown to exhibit minimal metabolism. However, co–administration of Infexo hydrochloride with either ketoconazole or erythromycin led to increased plasma concentrations of Infexo in healthy adult subjects. Infexo had no effect on the pharmacokinetics of either erythromycin or ketoconazole. In 2 separate studies in healthy adult subjects, Infexo hydrochloride 120 mg twice daily (240 mg total daily dose) was co-administered with either erythromycin 500 mg every 8 hours or ketoconazole 400 mg once daily under steady-state conditions to healthy adult subjects (n=24, each study). No differences in adverse events or QTc interval were observed when subjects were administered Infexo hydrochloride alone or in combination with either erythromycin or ketoconazole. The findings of these studies are summarized in the following table:

The changes in plasma levels were within the range of plasma levels achieved in adequate and well-controlled clinical trials.

The mechanism of these interactions has been evaluated in in vitro, in situ, and in vivo animal models. These studies indicate that ketoconazole or erythromycin co-administration enhances Infexo gastrointestinal absorption. This observed increase in the bioavailability of Infexo may be due to transport-related effects, such as p-glycoprotein. In vivo animal studies also suggest that in addition to enhancing absorption, ketoconazole decreases Infexo gastrointestinal secretion, while erythromycin may also decrease biliary excretion.

7.3 Fruit Juices

Fruit juices such as grapefruit, orange and apple may reduce the bioavailability and exposure of Infexo. This is based on the results from 3 clinical studies using histamine induced skin wheals and flares coupled with population pharmacokinetic analysis. The size of wheal and flare were significantly larger when Infexo hydrochloride was administered with either grapefruit or orange juices compared to water. Based on the literature reports, the same effects may be extrapolated to other fruit juices such as apple juice. The clinical significance of these observations is unknown. In addition, based on the population pharmacokinetics analysis of the combined data from grapefruit and orange juices studies with the data from a bioequivalence study, the bioavailability of Infexo was reduced by 36%. Therefore, to maximize the effects of Infexo, it is recommended that Infexo hydrochloride tablets should be taken with water.

8 USE IN SPECIFIC POPULATIONS

- Pregnancy: Use only if benefit justifies risk to fetus

- Nursing Mothers: Use with caution(8.3)

8.1 Pregnancy

Teratogenic Effects: Pregnancy Category C. There was no evidence of teratogenicity in rats or rabbits at oral doses of terfenadine up to 300 mg/kg (which led to Infexo exposures that were approximately 4 and 30 times, respectively, the exposure at the maximum recommended human daily oral dose of 180 mg of Infexo hydrochloride based on comparison of AUCs).

In mice, no adverse effects and no teratogenic effects during gestation were observed with Infexo hydrochloride at oral doses up to 3730 mg/kg (which led to Infexo exposures that were approximately 15 times the exposure at the maximum recommended human daily oral dose of 180 mg of Infexo hydrochloride based on comparison of AUCs).

There are no adequate and well controlled studies in pregnant women. Infexo hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects: Dose-related decreases in pup weight gain and survival were observed in rats exposed to an oral dose of 150 mg/kg of terfenadine (which led to Infexo exposures that were approximately 3 times the exposure at the maximum recommended human daily oral dose of 180 mg of Infexo hydrochloride based on comparison of AUCs).

8.3 Nursing Mothers

It is not known if Infexo is excreted in human milk. There are no adequate and well-controlled studies in women during lactation. Because many drugs are excreted in human milk, caution should be exercised when Infexo hydrochloride is administered to a nursing woman.

8.4 Pediatric Use

The recommended doses of Infexo hydrochloride in pediatric patients 6 months to 11 years of age are based on cross-study comparison of the pharmacokinetics of Infexo in adults and pediatric subjects and on the safety profile of Infexo hydrochloride in both adult and pediatric subjects at doses equal to or higher than the recommended doses. The safety and effectiveness of Infexo hydrochloride in pediatric patients under 6 months of age have not been established.

The safety of Infexo hydrochloride is based on the administration of Infexo hydrochloride tablets at a dose of 30 mg twice daily demonstrated in 438 pediatric subjects 6 years to 11 years of age in 2 placebo-controlled 2-week seasonal allergic rhinitis trials. The safety of Infexo hydrochloride at doses of 15 mg and 30 mg given once and twice a day has been demonstrated in 969 pediatric subjects with allergic rhinitis in 3 pharmacokinetic studies and 3 safety studies. The safety of Infexo hydrochloride for the treatment of chronic idiopathic urticaria in subjects 6 months to 11 years of age is based on cross-study comparison of the pharmacokinetics of Infexo hydrochloride in adult and pediatric subjects and on the safety profile of Infexo in both adult and pediatric subjects at doses equal to or higher than the recommended dose.

The effectiveness of Infexo hydrochloride for the treatment of seasonal allergic rhinitis in subjects 6 to 11 years of age was demonstrated in 1 trial (n=411) in which Infexo hydrochloride tablets 30 mg twice daily significantly reduced total symptom scores compared to placebo, along with extrapolation of demonstrated efficacy in subjects aged 12 years and above, and the pharmacokinetic comparisons in adults and children. The effectiveness of Infexo hydrochloride 30 mg twice daily for the treatment of seasonal allergic rhinitis in patients 2 to 5 years of age is based on the pharmacokinetic comparisons in adult and pediatric subjects and an extrapolation of the demonstrated efficacy of Infexo hydrochloride in adult subjects with this condition and the likelihood that the disease course, pathophysiology, and the drug's effect are substantially similar in pediatric patients to those in adult patients. The effectiveness of Infexo hydrochloride for the treatment of chronic idiopathic urticaria in patients 6 months to 11 years of age is based on the pharmacokinetic comparisons in adults and children and an extrapolation of the demonstrated efficacy of Infexo hydrochloride in adults with this condition and the likelihood that the disease course, pathophysiology and the drug's effect are substantially similar in children to that of adult patients. Administration of a 15 mg dose of Infexo hydrochloride to pediatric subjects 6 months to less than 2 years of age and a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults.

8.5 Geriatric Use

Clinical studies of Infexo hydrochloride tablets and capsules did not include sufficient numbers of subjects aged 65 years and over to determine whether this population responds differently from younger subjects. Other reported clinical experience has not identified differences in responses between the geriatric and younger subjects. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

8.6 Renal Impairment

Based on increases in bioavailability and half-life, a dose of 60 mg once daily is recommended as the starting dose in adult patients with decreased renal function. For pediatric patients with decreased renal function (mild, moderate or severe renal impairment), the recommended starting dose of Infexo is 30 mg once daily for patients 2 to 11 years of age and 15 mg once daily for patients 6 months to less than 2 years of age.

8.7 Hepatic Impairment

The pharmacokinetics of Infexo hydrochloride in subjects with hepatic impairment did not differ substantially from that observed in healthy subjects.

10 OVERDOSAGE

Dizziness, drowsiness, and dry mouth have been reported with Infexo hydrochloride overdose. Single doses of Infexo hydrochloride up to 800 mg (6 healthy subjects at this dose level), and doses up to 690 mg twice daily for 1 month (3 healthy subjects at this dose level) or 240 mg once daily for 1 year (234 healthy subjects at this dose level) were administered without the development of clinically significant adverse events as compared to placebo.

In the event of overdose, consider standard measures to remove any unabsorbed drug. Symptomatic and supportive treatment is recommended. Following administration of terfenadine, hemodialysis did not effectively remove Infexo, the major active metabolite of terfenadine, from blood (up to 1.7% removed).

No deaths occurred at oral doses of Infexo hydrochloride up to 5000 mg/kg in mice (110 times the maximum recommended daily oral dose in adults and children based on mg/m2) and up to 5000 mg/kg in rats (230 times the maximum recommended daily oral dose in adults and 210 times the maximum recommended daily oral dose in children based on mg/m2). Additionally, no clinical signs of toxicity or gross pathological findings were observed. In dogs, no evidence of toxicity was observed at oral doses up to 2000 mg/kg (300 times the maximum recommended daily oral dose in adults and 280 times the maximum recommended daily oral dose in children based on mg/m2).

11 DESCRIPTION

Infexo hydrochloride, the active ingredient of Infexo hydrochloride tablets, is a histamine H1-receptor antagonist with the chemical name (±)-4-[1 hydroxy-4-[4-(hydroxydiphenylmethyl)-1-piperidinyl]-butyl]-α, α-dimethyl benzeneacetic acid hydrochloride. It has the following chemical structure

The molecular weight is 538.13 and the empirical formula is C32H39NO4-HCl.

Infexo hydrochloride is a white to off-white crystalline powder. It is freely soluble in methanol and ethanol, slightly soluble in chloroform and water, and insoluble in hexane. Infexo hydrochloride is a racemate and exists as a zwitterion in aqueous media at physiological pH.

Infexo hydrochloride is formulated as a tablet for oral administration. Each tablet contains 30, 60, or 180 mg Infexo hydrochloride (depending on the dosage strength) and the following excipients: colloidal silicon dioxide, corn starch, croscarmellose sodium, magnesium stearate, mannitol, and powder cellulose. The aqueous tablet film coating is made from (Opadry Pink 03B54504) containing FD&C Red no. 40, hypromellose 2910 6cP, iron oxide black, polyethylene glycol 400 and titanium dioxide.

Infexo Hydrochloride structural formula Chemical Structure

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Infexo hydrochloride, the major active metabolite of terfenadine, is an antihistamine with selective H1-receptor antagonist activity. Both enantiomers of Infexo hydrochloride displayed approximately equipotent antihistaminic effects. Infexo hydrochloride inhibited antigen-induced bronchospasm in sensitized guinea pigs and histamine release from peritoneal mast cells in rats. The clinical significance of these findings is unknown. In laboratory animals, no anticholinergic or alpha1-adrenergic blocking effects were observed. Moreover, no sedative or other central nervous system effects were observed. Radiolabeled tissue distribution studies in rats indicated that Infexo does not cross the blood-brain barrier.

12.2 Pharmacodynamics

Wheal and Flare: Human histamine skin wheal and flare studies in adults following single and twice daily doses of 20 and 40 mg Infexo hydrochloride demonstrated that the drug exhibits an antihistamine effect by 1 hour, achieves maximum effect at 2 to 3 hours, and an effect is still seen at 12 hours. There was no evidence of tolerance to these effects after 28 days of dosing. The clinical significance of these observations is unknown.

Histamine skin wheal and flare studies in 7 to 12 year old subjects showed that following a single dose of 30 or 60 mg, antihistamine effect was observed at 1 hour and reached a maximum by 3 hours. Greater than 49% inhibition of wheal area, and 74% inhibition of flare area were maintained for 8 hours following the 30 and 60 mg dose.

No statistically significant increase in mean QTc interval compared to placebo was observed in 714 adult subjects with seasonal allergic rhinitis given Infexo hydrochloride capsules in doses of 60 to 240 mg twice daily for 2 weeks. Pediatric subjects from 2 placebo- controlled trials treated with up to 60 mg Infexo hydrochloride twice daily demonstrated no significant treatment- or dose-related increases in QTc. In addition, no statistically significant increase in mean QTc interval compared to placebo was observed in 40 healthy adult subjects given Infexo hydrochloride as an oral solution at doses up to 400 mg twice daily for 6 days, or in 230 healthy adult subjects given Infexo hydrochloride 240 mg once daily for 1 year. In subjects with chronic idiopathic urticaria, there were no clinically relevant differences for any ECG intervals, including QTc, between those treated with Infexo hydrochloride 180 mg once daily (n = 163) and those treated with placebo (n = 91) for 4 weeks.

12.3 Pharmacokinetics

The pharmacokinetics of Infexo hydrochloride in subjects with seasonal allergic rhinitis and subjects with chronic urticaria were similar to those in healthy subjects.

Absorption:

Infexo Hydrochloride Tablets: Infexo hydrochloride was absorbed following oral administration of a single dose of two 60 mg capsules to healthy male subjects with a mean time to maximum plasma concentration occurring at 2.6 hours post-dose. After administration of a single 60 mg capsule to healthy adult subjects, the mean maximum plasma concentration (Cmax) was 131 ng/mL. Following single dose oral administrations of either the 60 and 180 mg tablet to healthy adult male subjects, mean Cmax were 142 and 494 ng/mL, respectively. The tablet formulations are bioequivalent to the capsule when administered at equal doses. Infexo hydrochloride pharmacokinetics are linear for oral doses up to a total daily dose of 240 mg (120 mg twice daily). The administration of the 60 mg capsule contents mixed with applesauce did not have a significant effect on the pharmacokinetics of Infexo in adults. Co-administration of 180 mg Infexo hydrochloride tablet with a high fat meal decreased the mean area under the curve (AUC) and (Cmax) of Infexo by 21 and 20% respectively.

Distribution:

Infexo hydrochloride is 60% to 70% bound to plasma proteins, primarily albumin and α1-acid glycoprotein.

Metabolism:

Approximately 5% of the total dose of Infexo hydrochloride was eliminated by hepatic metabolism.

Elimination:

The mean elimination half-life of Infexo was 14.4 hours following administration of 60 mg twice daily in healthy adult subjects. Human mass balance studies documented a recovery of approximately 80% and 11% of the [14C] Infexo hydrochloride dose in the feces and urine, respectively. Because the absolute bioavailability of Infexo hydrochloride has not been established, it is unknown if the fecal component represents primarily unabsorbed drug or is the result of biliary excretion.

Special Populations:

Pharmacokinetics in renally and hepatically impaired subjects and geriatric subjects, obtained after a single dose of 80 mg Infexo hydrochloride, were compared to those from healthy subjects in a separate study of similar design.

Renally Impaired:

In subjects with mild to moderate (creatinine clearance 41-80 mL/min) and severe (creatinine clearance 11-40 mL/min) renal impairment, peak plasma concentrations of Infexo were 87% and 111% greater, respectively, and mean elimination half-lives were 59% and 72% longer, respectively, than observed in healthy subjects. Peak plasma concentrations in subjects on dialysis (creatinine clearance ≤10 mL/min) were 82% greater and half-life was 31% longer than observed in healthy subjects. Based on increases in bioavailability and half-life, a dose of 60 mg once daily is recommended as the starting dose in adult patients with decreased renal function. For pediatric patients with decreased renal function, the recommended starting dose of Infexo is 30 mg once daily for patients 2 to 11 years of age and 15 mg once daily for patients 6 months to less than 2 years of age.

Hepatically Impaired:

The pharmacokinetics of Infexo hydrochloride in subjects with hepatic impairment did not differ substantially from that observed in healthy subjects.

Geriatric Subjects:

In older subjects (≥65 years old), peak plasma levels of Infexo were 99% greater than those observed in younger subjects (<65 years old). Mean Infexo elimination half-lives were similar to those observed in younger subjects.

Pediatric Subjects:

A population pharmacokinetic analysis was performed with data from 77 pediatric subjects (6 months to 12 years of age) with allergic rhinitis and 136 adult subjects. The individual apparent oral clearance estimates of Infexo were on average 44% and 36% lower in pediatric subjects 6 to 12 years (n=14) and 2 to 5 years of age (n=21), respectively, compared to adult subjects.

Administration of a 15 mg dose of Infexo hydrochloride to pediatric subjects 6 months to less than 2 years of age and a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults.

Effect of Gender:

Across several trials, no clinically significant gender-related differences were observed in the pharmacokinetics of Infexo hydrochloride.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

The carcinogenic potential of Infexo was assessed using terfenadine studies with adequate Infexo exposure. No evidence of carcinogenicity was observed in an 18-month study in mice and in a 24-month study in rats at oral doses up to 150 mg/kg of terfenadine (which led to Infexo exposures that were approximately 3 and 5 times the exposure at the maximum recommended daily oral dose of Infexo hydrochloride in adults [180 mg] and children [60 mg] respectively).

In in vitro (Bacterial Reverse Mutation, CHO/HGPRT Forward Mutation, and Rat Lymphocyte Chromosomal Aberration assays) and in vivo (Mouse Bone Marrow Micronucleus assay) tests, Infexo hydrochloride revealed no evidence of mutagenicity.

In rat fertility studies, dose-related reductions in implants and increases in postimplantation losses were observed at an oral dose of 150 mg/kg of terfenadine (which led to Infexo exposures that were approximately 3 times the exposure at the maximum recommended human daily oral dose of 180 mg of Infexo hydrochloride based on comparison of AUCs). In mice, Infexo hydrochloride produced no effect on male or female fertility at average oral doses up to 4438 mg/kg (which led to Infexo exposures that were approximately 13 times the exposure at the maximum recommended human daily oral dose of 180 mg of Infexo hydrochloride based on comparison of AUCs).

13.2 Animal Toxicology and/or Pharmacology

In dogs (30 mg/kg/orally twice daily for 5 days) and rabbits (10 mg/kg, intravenously over 1 hour), Infexo hydrochloride did not prolong QTc. In dogs, the plasma Infexo concentration was approximately 9 times the therapeutic plasma concentrations in adults receiving the maximum recommended human daily oral dose of 180 mg. In rabbits, the plasma Infexo concentration was approximately 20 times the therapeutic plasma concentration in adults receiving the maximum recommended human daily oral dose of 180 mg. No effect was observed on calcium channel current, delayed K+ channel current, or action potential duration in guinea pig myocytes, or on the delayed rectifier K+ channel cloned from human heart at concentrations up to 1 × 10-5 M of Infexo.

14 CLINICAL STUDIES

14.1 Seasonal Allergic Rhinitis

Adults: In three 2-week, multicenter, randomized, double-blind, placebo-controlled trials in subjects 12 to 68 years of age with seasonal allergic rhinitis, Infexo hydrochloride 60 mg twice daily significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo. Statistically significant reductions in symptom scores were observed following the first 60 mg dose, with the effect maintained throughout the 12-hour interval. In these studies, there was no additional reduction in total symptom scores with higher doses of Infexo hydrochloride up to 240 mg twice daily.

In one 2-week, multicenter, randomized, double-blind clinical trial in subjects 12 to 65 years of age with seasonal allergic rhinitis (n=863), Infexo hydrochloride 180 mg once daily significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo. Although the number of subjects in some of the subgroups was small, there were no significant differences in the effect of Infexo hydrochloride across subgroups of subjects defined by gender, age, and race. Onset of action for reduction in total symptom scores, excluding nasal congestion, was observed at 60 minutes compared to placebo following a single 60 mg Infexo hydrochloride dose administered to subjects with seasonal allergic rhinitis who were exposed to ragweed pollen in an environmental exposure unit. In 1 clinical trial conducted with Infexo hydrochloride 60 mg capsules, and in 1 clinical trial conducted with Infexo hydrochloride-D 12 Hour extended release tablets, onset of action was seen within 1 to 3 hours.

Pediatrics: Two 2-week, multicenter, randomized, placebo-controlled, double-blind trials in 877 pediatric subjects 6 to 11 years of age with seasonal allergic rhinitis were conducted at doses of 15, 30, and 60 mg (tablets) twice daily. In 1 of these 2 studies, conducted in 411 pediatric subjects, all 3 doses of Infexo hydrochloride significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo, however, a dose-response relationship was not seen. The 60 mg twice daily dose did not provide any additional benefit over the 30 mg twice daily dose in pediatric subjects 6 to 11 years of age. Administration of a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults..

14.2 Chronic Idiopathic Urticaria

Two 4-week, multicenter, randomized, double-blind, placebo-controlled clinical trials compared four different doses of Infexo hydrochloride tablet (20, 60, 120, and 240 mg twice daily) to placebo in subjects aged 12 to 70 years with chronic idiopathic urticaria (n=726). Efficacy was demonstrated by a significant reduction in mean pruritus scores (MPS), mean number of wheals (MNW), and mean total symptom scores (MTSS, the sum of the MPS and MNW score). Although all 4 doses were significantly superior to placebo, symptom reduction was greater and efficacy was maintained over the entire 4-week treatment period with Infexo hydrochloride doses of ≥60 mg twice daily. However, no additional benefit of the 120 or 240 mg Infexo hydrochloride twice daily dose was seen over the 60 mg twice daily dose in reducing symptom scores. There were no significant differences in the effect of Infexo hydrochloride across subgroups of subjects defined by gender, age, weight, and race.

In one 4-week, multicenter, randomized, double-blind, placebo-controlled clinical trial in subjects 12 years of age and older with chronic idiopathic urticaria (n=259), Infexo hydrochloride 180 mg once daily significantly reduced the mean number of wheals (MNW), the mean pruritus score (MPS), and the mean total symptom score (MTSS, the sum of the MPS and MNW scores). Similar reductions were observed for mean number of wheals and mean pruritus score at the end of the 24-hour dosing interval. Symptom reduction was greater with Infexo hydrochloride180 mg than with placebo. Improvement was demonstrated within 1 day of treatment with Infexo hydrochloride 180 mg and was maintained over the entire 4week treatment period. There were no significant differences in the effect of Infexo hydrochloride across subgroups of subjects defined by gender, age, and race.

16 HOW SUPPLIED/STORAGE AND HANDLING

16.1 Infexo Hydrochloride tablets

Infexo hydrochloride tablets, 180 mg are pink colored, oval, beveled edged, biconvex tablets debossed “194” on one side and “R” on the other side, and are supplied in bottles of 20 (49999-0771-20) 30 (49999-0771-30) 90 (49999-0771-90).

Store Infexo hydrochloride tablets at controlled room temperature 20° to 25°C (68°-77°F). Foil-backed blister packs containing Infexo hydrochloride tablets should be protected from excessive moisture.

17 PATIENT COUNSELING INFORMATION

Provide the following information to patients and parents/caregivers of pediatric patients taking Infexo hydrochloride tablets:

• Infexo hydrochloride tablets, are prescribed for the relief of symptoms of seasonal allergic rhinitis or for the relief of symptoms of chronic idiopathic urticaria (hives). Instruct patients to take Infexo hydrochloride only as prescribed. Do not exceed the recommended dose. If any untoward effects occur while taking Infexo hydrochloride, discontinue use and consult a doctor.
• Patients who are hypersensitive to any of the ingredients should not use these products.
• Patients who are pregnant or nursing should use these products only if the potential benefit justifies the potential risk to the fetus or nursing infant.
• Advise patients and parents/caregivers of pediatric patients to store the medication in a tightly closed container in a cool, dry place, away from small children.
• Advise patients and parents/caregivers not to take Infexo hydrochloride tablets with fruit juices.

For Infexo hydrochloride tablets: Advise patients to take the Infexo hydrochloride tablets with water.

Rx only

Manufactured by:

Dr. Reddy's Laboratories Limited

Bachepalli – 502 325 INDIA

Repackaged by

Quality Care Products, LLC

Infexo pharmaceutical active ingredients containing related brand and generic drugs:

• Fexofenadine

Infexo available forms, composition, doses:

• Tablets; Oral; Fexofenadine 120 mg
• Tablets; Oral; Fexofenadine 180 mg

Infexo destination | category:

• Human:
• Antiallergics
• Antihistamines third-generation

Infexo Anatomical Therapeutic Chemical codes:

• R06AX26 - Fexofenadine

Infexo pharmaceutical companies:

• Esma Formulations

References

1. "fexofenadine". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
2. "fexofenadine". http://www.drugbank.ca/drugs/DB0095... (accessed August 28, 2018).
3. "fexofenadine: Link to the compound information in Wikipedia.". https://en.wikipedia.org/wiki/Fexof... (accessed August 28, 2018).

Frequently asked Questions

Depending on the reaction of the Infexo after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Infexo 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.

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