Filtration of Ammonul

   
September 15, 2008

Via Overnight Delivery

RE: IMPORTANT SAFETY INFORMATION
Filtration Required for AMMONUL® (sodium phenylacetate and sodium benzoate) Injection 10%/10% (NDC No. 62592-720-50)


Dear Healthcare Professional,

Recently, Ucyclyd Pharma, Inc. (Ucyclyd), a wholly owned subsidiary of Medicis Pharmaceutical Corporation, detected particulate matter in our AMMONUL® (sodium phenylacetate and sodium benzoate) Injection 10%/10% product.

Due to the possibility that this particulate matter may impact the safe use of this product and to ensure optimal patient care, you are being instructed to use a Millex® Durapore GV 33 mm Sterile Syringe Filter (0.22 μm) during the admixture process when injecting Ammonul into the 10% Dextrose IV bag. Please note this particulate matter may not be readily seen on visual inspection, so a filter must be employed in all cases regardless of whether particulate matter is seen in the vial. Testing has confirmed the removal of this specific particulate when using this filter to admix AMMONUL®.

As a precautionary measure, Ucyclyd will package Millex® Durapore GV 33 mm Sterile Syringe Filters (0.22 μm) with all shipments of AMMONUL® until further notice. We apologize for any inconvenience this may have caused.

Ucyclyd shares your commitment to patient safety, and we appreciate your patience and cooperation through this period. To report suspected adverse reactions experienced with the use of this product, and/or quality problems, contact Ucyclyd at 1-800-900-6389 with a representative available 24 hours a day, 7 days a week. These events may also be reported to FDA’s MedWatch Program by phone at 1-800-FDA-1088, by fax at 1-
800-FDA-0178, by mail at MedWatch, FDA, 5600 Fishers Lane, Rockville, MD, 20852-9787, or on the MedWatch website at www.fda.gov/medwatch.

You may also visit the AMMONUL® website at www.Ammonul.com or FDA’s Drug Shortage website at www.fda.gov/cder/drug/shortages/default.htm for additional information.

Sincerely,
   
Steve Newhard
Senior Vice President, Quality and Technical Services

AMMONUL is a registered trademark of Ucyclyd Pharma, Inc.
Millex is a registered trademark of Millipore Corporation.
© 2008 Ucyclyd Pharma, Inc.

Click the following links for Safety Information or Full Prescribing Information on AMMONUL®.

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Toll-Free: 888-829-2593

Important Safety Information for AMMONUL Injection 10% / 10%

  • IMPORTANT: Filtration required. Due to the possibility that particulate matter may impact the safe use of this product and to ensure optimal patient care, you are instructed to use the Millex® Durapore GV 33 mm Sterile Syringe Filter (0.22 μm) during the admixture process when injecting AMMONUL into the 10% dextrose IV bag. Note that particulate matter may not be readily seen on visual inspection, so this filter must be employed in all cases regardless of whether particulate matter is seen in the vial.
  • The most common adverse reactions are vomiting (9%), hyperglycemia (7%), hypokalemia (7%), convulsions (6%), and mental impairment (6%).
  • Dilute AMMONUL with sterile 10% Dextrose Injection (D10W) before administration. Use a central venous catheter line; use of a peripheral line may cause burns.
  • Monitor patients for prolonged exposure to elevated plasma ammonia levels as this can rapidly result in injury to the brain or death. Promptly use any therapies necessary to reduce plasma ammonia levels.
  • Monitor plasma potassium levels carefully and treat as necessary.
  • Use caution if AMMONUL is administered to patients with congestive heart failure, severe renal insufficiency, or with a condition in which there is sodium retention with edema.
  • Monitor the infusion site for possible tissue infiltration since extravasation of AMMONUL into the perivenous tissues during high flow bolus infusion may lead to skin necrosis, especially in infants.
  • Do not administer repeat loading doses because of prolonged plasma levels achieved by phenylacetate in pharmacokinetic studies.
  • Monitor patient blood chemistry profiles and perform frequent blood pH and pCO2 measurements because AMMONUL may cause side effects typically associated with salicyclate overdose such as hyperventilation and metabolic acidosis.
  • Administration of valproic acid to patients with urea cycle disorders may exacerbate their condition and antagonize the efficacy of AMMONUL.

Click here for Full Prescribing Information for AMMONUL