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Cold products, digoxin, defibrillators recalled

From the June ACP Hospitalist, copyright © 2009 by the American College of Physicians

By Jessica Berthold

Recalls, warnings

A recall of Influend Cough and Cold products sold on or after May 30, 2008 because they may be more potent than intended. Complications could include tachycardia, palpitations, arrhythmias, cardiovascular collapse with hypotension, dizziness, anxiety, headache and nervousness. Affected products include the 24-tablet Influend Cold and Cough (Lot# 800074) and Influend Severe Cold & Flu (Lot# 800075); and the 4-oz bottle of Influend JR. Cold & Cough (Lot# 800076) and Influend JR. Severe Cold & Flu (Lot# 800077).

A boxed warning and Risk Evaluation and Mitigation Strategy (REMS) for all botulinum toxin products due to reports of serious adverse events. Symptoms similar to those of botulism have mostly been reported in children with cerebral palsy being treated for muscle spasticity, an unapproved use, but have also been reported in adults treated for approved and unapproved uses.

A U.S. market phase-out of psoriasis drug efalizumab (Raptiva), due to a potential risk to patients of developing progressive multifocal leukoencephalopathy (PML). Physicians shouldn’t start patients on new treatment with the drug, and should immediately talk with patients currently using efalizumab about transitioning to alternate therapies.

A recall of Caraco brand digoxin (Lanoxin), USP 0.125 mg and USP 0.25 mg, because the pills may differ in size and contain more or less digoxin than indicated. The drugs affected by the recall were distributed before March 31, 2009 and are within the expiration date of September 2011.

A class 1 recall of ZOLL AED Plus Defibrillators, because they may fail to deliver a shock. The recall affects devices distributed from May 2004 through February 9, 2009.

A class 1 recall of multiple types of Centurion disposable trays and kits used for insertion of tubes, catheters and ports, due to package sealing that may affect the sterility of the devices. The products were distributed from November 24, 2008 through January 7, 2009.

A recall of libido supplement Libimax because it contains tadalafil, which may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. Patients with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates, and ED is a common problem in men with these conditions.

A recall of dozens of dietary supplements distributed by Universal ABC Beauty Supply International, Inc because they may contain undeclared sibutramine (Meridia). A list of affected products can be found online.

Approvals

Golimumab (Simponi), a monthly treatment for moderate-to-severe rheumatoid arthritis, active psoriatic arthritis, and active ankylosing spondylitis. The label includes a boxed warning about the risks for tuberculosis and invasive fungal infections. Side effects may include upper respiratory tract infection, sore throat and nasal congestion.

AVantage A/H5N1 Flu Test, a more rapid test for influenza A/H5N1, which is a subtype of the avian influenza A virus. The test uses throat or nose swabs collected from patients with flu-like symptoms and works in less than 40 minutes, compared to the 3-4 hours of previous tests.

Topiramate, the first generic version of Topamax, to prevent seizures.

Everolimus (Afinitor) oral tablets for patients whose advanced kidney cancer has progressed after treatment with other cancer therapies.

Artemether and lumefantrine tablets (Coartem) to treat acute, uncomplicated malaria infections in adults and children weighing at least five kilograms (about 11 pounds). The drug isn’t approved to prevent malaria or treat severe malaria. The most common side effects in adults are headache, anorexia, dizziness, physical weakness, joint pain and muscle pain. In children, more common side effects are fever, cough, vomiting, loss of appetite, and headache.

IXIARO, the only vaccine in the U.S. for Japanese encephalitis.

Upon submission of a manufacturer’s application, levenorgesterel (Plan B) can be marketed without prescription to women age 17 years and older, according to a federal court order.

Miscellaneous

Ceftriaxone (Rocephin) can be used concomitantly with intravenous calcium-containing products in patients older than 28 days. The FDA had warned physicians in 2007 against administering calcium-containing products and ceftriaxone within 48 hours of each other due to a risk for precipitation of ceftriaxone-calcium. Based on the results of two studies, the agency has now determined this risk is low in patients more than 28 days old.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated