ZAZOLE

Main information

  • Trade name:
  • ZAZOLE terconazole cream
  • Composition:
  • TERCONAZOLE 4 mg in 1 g
  • Prescription type:
  • PRESCRIPTION DRUG
  • Medicine domain:
  • Humans
  • Medicine type:
  • Allopathic drug

Documents

Localization

  • Available in:
  • ZAZOLE terconazole cream
    United States
  • Language:
  • English

Status

  • Source:
  • DailyMed - NLM - National Library of Medicine
  • Authorization status:
  • Abbreviated New Drug Application
  • Last update:
  • 06-11-2017

Summary of Product characteristics: dosage, interactions, side effects

ZAZOLE- terconazole cream

PharmaDerm A division of Fougera Pharmaceuticals Inc.

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ZAZOLE VAGINAL CREAM 0.4%

(terconazole vaginal cream 0.4%)

Rx only

DESCRIPTION

Zazole

Vaginal Cream 0.4% (terconazole vaginal cream 0.4%) is a white to off-white, water washable

cream for intravaginal administration containing 0.4% of the antifungal agent terconazole, cis-1-[p-[[2-

(2,4-Dichlorophenyl)-2-(1-H-1,2,4-triazol-1-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl]-4-

isopropylpiperazine compounded in a cream base consisting of butylated hydroxyanisole, cetyl alcohol,

isopropyl myristate, polysorbate 60, polysorbate 80, propylene glycol, stearyl alcohol, and purified

water. The structural formula of terconazole is as follows:

Terconazole, a triazole derivative, is a white to almost white powder with a molecular weight of

532.47. It is insoluble in water; sparingly soluble in ethanol; and soluble in butanol.

CLINICAL PHARMACOLOGY

Following intravaginal administration of terconazole in humans, absorption ranged from 5-8 % in three

hysterectomized subjects and 12-16 % in two non-hysterectomized subjects with tubal ligations.

Following oral (30 mg) administration of

C-labelled terconazole, the harmonic half-life of elimination

from the blood for the parent terconazole was 6.9 hours (range 4.0-11.3). Terconazole is extensively

metabolized; the plasma AUC for terconazole compared to the AUC for total radioactivity was 0.6 %.

Total radioactivity was eliminated from the blood with a harmonic half-life of 52.2 hours (range 44-

60). Excretion of radioactivity was both by renal (32-56 %) and fecal (47-52 %) routes.

In vitro, terconazole is highly protein bound (94.9 %) and the degree of binding is independent of drug

concentration.

Photosensitivity reactions were observed in some normal volunteers following repeated dermal

application of terconazole 2.0% and 0.8% creams under conditions of filtered artificial ultraviolet light.

Photosensitivity reactions have not been observed in U.S. and foreign clinical trials in patients who

were treated with terconazole vaginal cream 0.4%.

Microbiology: Terconazole exhibits fungicidal activity in vitro against Candida albicans. Antifungal

activity has also been demonstrated against other fungi. The MIC values of terconazole against most

®

Lactobacillus spp. typically found in the human vagina were ≥ 128 mcg/mL; therefore these beneficial

bacteria are not affected by drug treatment. The exact pharmacologic mode of action of terconazole is

uncertain; however, it may exert its antifungal activity by the disruption of normal fungal cell membrane

permeability. No resistance to terconazole has developed during successive passages of C. albicans.

INDICATIONS AND USAGE

Zazole

Vaginal Cream 0.4% is indicated for the local treatment of vulvovaginal candidiasis

(moniliasis). As Zazole

Vaginal Cream 0.4% is effective only for vulvovaginitis caused by the genus

Candida, the diagnosis should be confirmed by KOH smears and/or cultures.

CONTRAINDICATIONS

Patients known to be hypersensitive to terconazole or to any of the components of the cream.

WARNINGS

None.

PRECAUTIONS

General: Discontinue use and do not retreat with terconazole if sensitization, irritation, fever, chills or

flu-like symptoms are reported during use.

Laboratory Tests: If there is a lack of response to terconazole, appropriate microbiological studies

(standard KOH smear and/or cultures) should be repeated to confirm the diagnosis and rule out other

pathogens.

Drug Interactions:

The therapeutic effect of this product is not affected by oral contraceptive usage.

Carcinogenesis, Mutagenesis, Impairment of Fertility:

Carcinogenesis: Studies to determine the carcinogenic potential of terconazole have not been

performed.

Mutagenicity: Terconazole was not mutagenic when tested in vitro for induction of microbial point

mutations (Ames test), or for inducing cellular transformation, or in vivo for chromosome breaks

(micronucleus test) or dominant lethal mutations in mouse germ cells.

Impairment of Fertility: No impairment of fertility occurred when female rats were administered

terconazole orally up to 40 mg/kg/day for a three month period.

Pregnancy: Teratogenic Effects: Pregnancy Category C:

There was no evidence of teratogenicity when terconazole was administered orally up to 40 mg/kg/day

(100x the intravaginal human dose of the 0.4% vaginal cream formulation) in rats, or 20 mg/kg/day in

rabbits, or subcutaneously up to 20 mg/kg/day in rats. Dosages at or below 10 mg/kg/day produced no

embryotoxicity; however, there was a delay in fetal ossification at 10 mg/kg/day in rats. There was

some evidence of embryotoxicity in rabbits and rats at 20-40 mg/kg. In rats, this was reflected as a

decrease in litter size and number of viable young and reduced fetal weight. There was also delay in

ossification and an increase incidence of skeletal variants. The no-effect dose of 10 mg/kg/day resulted

in a mean peak plasma level of terconazole in pregnant rats of 0.176 mcg/mL which exceeds by 44 times

the mean peak plasma level (0.004 mcg/mL) seen in normal subjects after intravaginal administration of

terconazole vaginal cream 0.4%. This safety assessment does not account for possible exposure of the

fetus through direct transfer to terconazole from the irritated vagina by diffusion across amniotic

membranes.

Since terconazole is absorbed from the human vagina, it should not be used in the first trimester of

pregnancy unless the physician considers it essential to the welfare of the patient.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Animal studies have

shown that rat offspring exposed via the milk of treated (40 mg/kg/orally) dams showed decreased

survival during the first few post-partum days, but overall pup weight and weight gain were comparable

to or greater than controls throughout lactation. Because many drugs are excreted in human milk, and

because of the potential for adverse reaction in nursing infants from terconazole, a decision should be

made whether to discontinue nursing or to discontinue the drug, taking into account the importance of

the drug to the mother.

Pediatric Use: Safety and efficacy in children have not been established.

Geriatric Use: Clinical studies of terconazole vaginal cream 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 the elderly and

younger patients.

ADVERSE REACTIONS

During controlled clinical studies conducted in the United States, 521 patients with vulvovaginal

candidiasis were treated with terconazole vaginal cream 0.4%. Based on comparative analyses with

placebo, the adverse experiences considered most likely related to terconazole vaginal cream 0.4%

were headache (26% vs 17% with placebo) and body pain (2.1% vs 0% with placebo). Vulvovaginal

burning (5.2%), itching (2.3%) or irritation (3.1%) occurred less frequently with terconazole vaginal

cream 0.4% than with the vehicle placebo. Fever (1.7% vs 0.5% with placebo) and chills (0.4% vs

0.0% with placebo) have also been reported. The therapy-related dropout rate was 1.9%. The adverse

drug experience on terconazole most frequently causing discontinuation was vulvovaginal itching

(0.6%), which was lower than the incidence for placebo (0.9%).

OVERDOSAGE

Overdosage of terconazole in humans has not been reported to date. In the rat, the oral LD 50 values

were found to be 1741 and 849 mg/kg for the male and female, respectively. The oral LD 50 values for

the male and female dog were 1280 and≥ 640 mg/kg, respectively.

DOSAGE AND ADMINISTRATION

One full applicator (5 g) of Zazole

Vaginal Cream 0.4% (20 mg terconazole) should be administered

intravaginally once daily at bedtime for seven consecutive days. Before prescribing another course of

therapy, the diagnosis should be reconfirmed by smears and/or cultures and other pathogens commonly

associated with vulvovaginitis ruled out. The therapeutic effect of Zazole

Vaginal Cream 0.4% is not

affected by menstruation.

HOW SUPPLIED

Zazole

Vaginal Cream 0.4% (terconazole vaginal cream 0.4%) is available in the following size:

NDC 0462-0346-46 45 gram tubes with a measured dose applicator.

Store at 20°-25°C (68°-77°F)[see USP Controlled Room Temperature].

PharmaDerm

A division of Nycomed US Inc.

Melville, NY 11747 USA

www.pharmaderm.com

I8346C

R3/08

#299

ZAZOLE VAGINAL CREAM 0.4% (terconazole vaginal cream 0.4%)

PATIENT INSTRUCTIONS

7-DAY THERAPY

Filling the applicator:

Using the applicator:

Cleaning the applicator:

After each use, you should thoroughly clean the applicator by following the procedure below:

1. Pull the plunger out of the barrel.

2. Wash both pieces with lukewarm, soapy water, and dry them thoroughly.

3. Put the applicator back together by gently pushing the plunger into the barrel as far as it will go.

NOTE: Store at 20°-25°C (68°-77°F)[see USP Controlled Room Temperature].

See end flap for lot number and expiration date.

®

1. Remove the cap from the tube.

2. Use the pointed tip on the top of the cap,

twisting several times to puncture the

seal on the tube.

3. Screw the applicator onto the tube.

4. Squeeze the tube from the bottom and fill

the applicator until the plunger stops.

5. Unscrew the applicator from the tube.

1. Lie on your back with your knees drawn

up toward your chest.

2. Holding the applicator by the ribbed end

of the barrel, insert the filled applicator

into the vagina as far as it will

comfortably go.

3. Slowly press the plunger of the applicator

to release the cream into the vagina.

4. Remove the applicator from the vagina.

5. Apply one applicatorful each night for 7

nights at bedtime, as directed by your

doctor.

A WORD ABOUT YEAST INFECTIONS

Why do yeast infections occur?

Yeast infections are caused by an organism called Candida (KAN di duh). It may be present in small and

harmless amounts in the mouth, digestive tract, and vagina. Sometimes the natural balance of the vagina

becomes upset. This may lead to rapid growth of Candida, which results in a yeast infection. Symptoms

of a yeast infection include itching, burning, redness, and an abnormal discharge. Your doctor can make

the diagnosis of a yeast infection by evaluating your symptoms and looking at a sample of the discharge

under the microscope.

How can I prevent yeast infections?

Certain factors may increase your chance of developing a yeast infection. These factors don't actually

cause the problem, but they may create a situation that allows the yeast to grow rapidly.

Clothing: Tight jeans, nylon underwear, pantyhose, and wet bathing suits can hold in heat and

moisture (two conditions in which yeast organisms thrive). Looser pants or skirts, 100% cotton

underwear, and stockings may help avoid this problem.

Diet: Cutting down on sweets, milk products, and artificial sweeteners may reduce the risk of yeast

infections.

Antibiotics: Antibiotics work by eliminating disease-causing organisms. While they are helpful in

curing other problems, antibiotics may lead to an overgrowth of Candida in the vagina.

Pregnancy: Hormonal changes in the body during pregnancy encourage the growth of yeast. This is

a very common time for an infection to occur. Until the baby is born, it may be hard to completely

eliminate yeast infections. If you believe you are pregnant, tell your doctor.

Menstruation: Sometimes monthly changes in hormone levels may lead to yeast infections.

Diabetes: In addition to heat and moisture, yeast thrives on sugar. Because diabetics often have

sugar in their urine, their vaginas are rich in this substance. Careful control of diabetes may help

prevent yeast infections.

Controlling these factors can help eliminate yeast infections and may prevent them from coming back.

Some other helpful tips:

1. For best results, be sure to use the medication as prescribed by your doctor, even if you feel better

very quickly.

2. Avoid sexual intercourse, if your doctor advises you to do so.

3. If your partner has any penile itching, redness, or discomfort, he should consult his physician and

mention that you are being treated for a yeast infection.

4. You can use the medication even if you are having your menstrual period. However, you should not

use tampons because they may absorb the medication. Instead, use external pads or napkins until you

have finished your medication. You may also wish to wear a sanitary napkin if the vaginal medication

leaks.

5. Dry the genital area thoroughly after showering, bathing, or swimming. Change out of a wet bathing

suit or damp exercise clothes as soon as possible. A dry environment is less likely to encourage the

growth of yeast.

6. Wipe from front to rear (away from the vagina) after a bowel movement.

7. Don't douche unless your doctor specifically tells you to do so. Douching may disturb the vaginal

balance.

8. Don't scratch if you can help it. Scratching can cause more irritation and spread the infection.

9. Discuss with your physician any medication you are already taking. Certain types of medication can

make your vagina more susceptible to infection.

10. Eat nutritious meals to promote your general health.

PharmaDerm

A division of Nycomed US Inc.

Melville, NY 11747 USA

www.pharmaderm.com

I8346C

R3/08

#299

PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – 45 GRAM TUBE

NDC 0462-0346-46

Rx only

ZAZOLE

VAGINAL CREAM 0.4%

(terconazole vaginal cream 0.4%)

NET WT 45 grams

Quantity by weight not by volume

PharmaDerm

WARNING: Keep out of reach of children.

USUAL DOSAGE: See package insert.

For Vaginal Use Only

Compounded with: Butylated hydroxyanisole, cetyl alcohol,

isopropyl myristate, polysorbate 60, polysorbate 80,

propylene glycol, stearyl alcohol, and purified water.

Store at 20 -25 C (68 -77 F)

[see USP Controlled Room Temperature].

®

®

PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – 45 GRAM CARTON

NDC 0462-0346-46

Rx only

ZAZOLE

VAGINAL CREAM 0.4% (terconazole vaginal cream 0.4%)

Tube and Applicator

NET WT 45 grams Quantity by weight not by volume

PharmaDerm

®

®

ZAZOLE

terconazole cream

Product Information

Product T ype

HUMAN PRESCRIPTION DRUG

Ite m Code (Source )

NDC:0 46 2-0 346

Route of Administration

VAGINAL

Active Ingredient/Active Moiety

Ingredient Name

Basis of Strength

Stre ng th

TERCO NAZO LE (UNII: 0 KJ2VE6 6 4U) (TERCONAZOLE - UNII:0 KJ2VE6 6 4U)

TERCONAZOLE

4 mg in 1 g

Inactive Ingredients

Ingredient Name

Stre ng th

BUTYLATED HYDRO XYANISO LE (UNII: REK49 6 0 K2U)

CETYL ALCO HO L (UNII: 9 36 JST6 JCN)

ISO PRO PYL MYRISTATE (UNII: 0 RE8 K4LNJS)

PO LYSO RBATE 6 0 (UNII: CAL22UVI4M)

PO LYSO RBATE 8 0 (UNII: 6 OZP39 ZG8 H)

PharmaDerm A division of Fougera Pharmaceuticals Inc.

PRO PYLENE GLYCO L (UNII: 6 DC9 Q16 7V3)

STEARYL ALCO HO L (UNII: 2KR8 9 I4H1Y)

WATER (UNII: 0 59 QF0 KO0 R)

Packag ing

#

Item Code

Package Description

Marketing Start Date

Marketing End Date

1

NDC:0 46 2-0 346 -46

45 g in 1 TUBE, WITH APPLICATOR

Marketing Information

Marke ting Cate gory

Application Numbe r or Monograph Citation

Marke ting Start Date

Marke ting End Date

ANDA

ANDA0 76 712

0 2/18 /20 0 5

Labeler -

PharmaDerm A division of Fougera Pharmaceuticals Inc. (043838424)

Establishment

Name

Ad d re s s

ID/FEI

Busine ss Ope rations

Fo ugera Pharmaceuticals Inc.

0 438 38 424

ANALYSIS(0 46 2-0 346 ) , MANUFACTURE(0 46 2-0 346 )

Revised: 6/2012