GERIATRIC USE SECTION.

8.5Geriatric Use. Clinical trials of calcipotriene foam did not include sufficient numbers of subjects aged 65 years 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.

HOW SUPPLIED SECTION.

16HOW SUPPLIED/STORAGE AND HANDLING. 16.1How Supplied. Calcipotriene foam, 0.005%, is supplied as follows:60 aluminum canNDC 51862-512-60. 16.2Storage and Handling. Store at 20oC to 25C (68F to 77F); excursions permitted to 15C 30C (59F 86F).Flammable. Contents under pressure. Do not puncture or incinerate. Do not expose to heat or store at temperatures above 120F (49C).Keep out of reach of children.. Store at 20oC to 25C (68F to 77F); excursions permitted to 15C 30C (59F 86F).. Flammable. Contents under pressure. Do not puncture or incinerate. Do not expose to heat or store at temperatures above 120F (49C).. Keep out of reach of children.

INDICATIONS & USAGE SECTION.

1INDICATIONS AND USAGE. Calcipotriene foam is indicated for the topical treatment of plaque psoriasis of the scalp and body in adults and pediatric patients years of age and older.. Calcipotriene foam, is vitamin analog indicated for the topical treatment of plaque psoriasis of the scalp and body in adults and pediatric patients years of age and older. (1).

DESCRIPTION SECTION.

11DESCRIPTION. Calcipotriene foam contains the compound calcipotriene, synthetic vitamin D3 analog, in an aqueous-based emulsion foam vehicle for topical dermatologic use.Chemically, calcipotriene is (5Z,7E,22E,24S)-24-cyclopropyl-9,10-secochola-5,7,10(19), 22-tetraene- 1,3,24-triol. The structural formula is represented below:Molecular Formula: C27H40O3 Molecular Weight: 412.6Calcipotriene is white or off-white crystalline substance. Calcipotriene foam contains calcipotriene 50 mcg/g in an aqueous-based emulsion foam vehicle consisting of cetyl alcohol, dibasic sodium phosphate, dl--tocopherol, edetate disodium, isopropyl myristate, light mineral oil, polyoxyl 20 cetostearyl ether, propylene glycol, purified water, stearyl alcohol, and white petrolatum. Calcipotriene foam is dispensed from an aluminum can pressurized with hydrocarbon (propane/n-butane/isobutane) propellant.. Chemical Structure.

ADVERSE REACTIONS SECTION.

6ADVERSE REACTIONS. Adverse reactions reported in >= 1% of subjects treated with Calcipotriene foam and at higher incidence than subjects treated with vehicle were application site erythema and application site pain. (6.1)To report SUSPECTED ADVERSE REACTIONS, contact Mayne Pharma at 1-844-825-8500 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. (6). 6.1Clinical Trials Experience. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.Calcipotriene foam was studied in four vehicle-controlled trials. total of 1094 adult subjects with plaque psoriasis, including 654 exposed to calcipotriene foam, were treated twice daily for weeks. Adverse reactions reported in >=1% of subjects treated with calcipotriene foam and at higher incidence than subjects treated with vehicle were application site erythema (2%) and application site pain (3%). The incidence of these adverse reactions was similar between the body and scalp.In an open-label study, 19 pediatric subjects age 12 to less than 17 years applied calcipotriene foam twice daily for 14 days and once on Day 15. Adverse reactions included application site pain, application site pruritus and pruritus [see Clinical Pharmacology (12.2 and 12.3) and Pediatric Use (8.4)].In an open-label study, 36 pediatric subjects age to less than 12 years applied calcipotriene foam twice daily for up to weeks. Adverse reactions included application site pain and contact dermatitis [see Clinical Pharmacology (12.2 and 12.3) and Pediatric Use (8.4)].. 6.2Postmarketing Experience. The following adverse reactions have been identified during post approval use of calcipotriene foam. Because these reactions are reported voluntarily from population of uncertain size, it is not always possible to reliably estimate their frequency or establish causal relationship to drug exposure.. Skin and Subcutaneous: application site vesicles.

CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION.

13.1Carcinogenesis, Mutagenesis, Impairment of Fertility. Calcipotriene topically administered to mice for up to 24 months at dose levels of 3, 10, or 30 mcg/kg/day (corresponding to 9, 30, or 90 mcg /m2/day) showed no significant changes in tumor incidence when compared with controls.The genotoxic potential of calcipotriene was evaluated in an Ames assay, mouse lymphoma TK locus assay, human lymphocyte chromosome aberration assay, and mouse micronucleus assay. All assay results were negative.Studies in rats at oral doses up to 54 mcg /kg/day (318 mcg /m2/day) of calcipotriene indicated no impairment of fertility or general reproductive performance.

CLINICAL PHARMACOLOGY SECTION.

12CLINICAL PHARMACOLOGY. 12.1Mechanism of Action. Calcipotriene is synthetic vitamin D3 analog that has similar receptor binding affinity as natural vitamin D3. However, the exact mechanism of action contributing to the clinical efficacy in the treatment of psoriasis is unknown.. 12.2Pharmacodynamics. Effects on Calcium MetabolismIn 19 subjects with psoriasis aged 12 to less than 17 years treated with calcipotriene foam two times day for 15 days, there was no significant effect on indices of calcium metabolism including serum albumin adjusted calcium, urine calcium/creatinine ratio, iPTH, alkaline phosphatase, magnesium and phosphorus.The effects of calcipotriene foam, 0.005%, on calcium metabolism were evaluated in 18 pediatric subjects to 11 years of age receiving calcipotriene foam administered twice daily for minimum of 14 days (mean: 56 days, range: 14 to 69 days). These subjects had plaque psoriasis involving an average of 10% of the body surface area (BSA) (range: 0.5%-36.5%). There was no relationship between urinary calcium/creatinine ratio (comparing Week to Baseline) and BSA treated.. 12.3Pharmacokinetics. The systemic absorption of calcipotriene in subjects with psoriasis of the body was evaluated at steady state following application of either calcipotriene foam or calcipotriene ointment to body surface area of 5% to 10%. In the calcipotriene foam treatment group, 15 out of 16 subjects had calcipotriene plasma concentrations below the limit of quantitation (10 pg/mL), while in the calcipotriene ointment treated group, out of 16 subjects had measurable calcipotriene plasma concentrations at various time points. All measurable plasma calcipotriene concentrations were below 25 pg/mL.The pharmacokinetics of calcipotriene foam, 0.005% was investigated when applied topically for 15 days to 17 subjects aged 12 to less than 17 years with moderate plaque psoriasis involving mean BSA of 24%, excluding face and scalp, and mean scalp involvement of 43%. Systemic concentration of calcipotriene were not quantifiable in any of the subjects (limit of quantification 10 pg/mL).In 11 pediatric subjects to 11 years of age with plaque psoriasis involving mean BSA of 10%, plasma concentration of calcipotriene was measured following weeks of twice daily administration of calcipotriene foam. No subject had quantifiable calcipotriene plasma concentration (limit of quantification 10 pg/mL).The systemic disposition of calcipotriene is expected to be similar to that of the naturally occurring vitamin D. Absorbed calcipotriene is known to be converted to inactive metabolites within 24 hours of application and the metabolism occurs via similar pathway to the natural hormone.

CLINICAL STUDIES SECTION.

14CLINICAL STUDIES. In two multi-center, randomized, double-blind, vehicle-controlled clinical trials total of 659 subjects with psoriasis were randomized 2:1 to calcipotriene foam or vehicle; subjects applied the assigned treatment twice daily for weeks. Baseline disease severity was graded using 5-point Investigator Static Global Assessment scale (ISGA), on which subjects scored either mild or moderate as shown in Table 1.Table 1. Investigator Static Global Assessment (ISGA) Scale for BodyDisease SeverityGradeDefinitionClear0No evidence of scaling, erythema, or plaque thicknessAlmost clear1Occasional fine scale, faint erythema, and barely perceptible plaque thicknessMild2Fine scale with light coloration and mild plaque elevationModerate3Coarse scale with moderate red coloration and moderate plaque thicknessSevere4Thick tenacious scale with deep coloration and severe plaque thicknessEfficacy evaluation was carried out at Week with treatment success being defined as score of clear (grade 0) or almost clear (grade 1) and at least grade improvement from the baseline score. Approximately 30% of enrolled subjects were graded as mild on the ISGA scale. The study population ranged in age from 12 to 89 years with 10 subjects less than 18 years of age at baseline. The subjects were 54% male and 88% Caucasian. Table presents the efficacy results for each trial.Table 2. Number and Percent of Subjects Achieving Success for Body at Week in Each TrialTrial 1Trial 2Calcipotriene Foam = 223Vehicle Foam = 113Calcipotriene Foam = 214Vehicle Foam = 109Number (%) of Subjects with Treatment Success31 (14%)8 (7%)58 (27%)17 (16%)In one trial, subjects graded as mild at baseline showed greater response to vehicle than calcipotriene foam.Table presents the success rates by disease severity at baseline for each trial.Table 3. Number and Percent of Subjects Achieving Success for Body by Baseline ISGA Score and by TrialISGA Scores at BaselineTrial 1Trial 2Calcipotriene Foam (N 223)Vehicle Foam (N 113)Calcipotriene Foam (N 214)Vehicle Foam (N 109)Mild2/73 (2.7%)3/34 (8.8%)8/56 (14.3%)4/31 (12.9%)Moderate29/150 (19.3%)5/79 (6.3%)50/158 (31.6%)13/78 (16.7%)In another multi-center, randomized, double-blind, vehicle-controlled clinical trial, total of 363 subjects with moderate plaque psoriasis of the scalp and body were randomized 1:1 to calcipotriene foam or vehicle. Subjects applied the assigned treatment to the affected areas twice daily for weeks.Baseline disease severity of the scalp was graded using 6-point ISGA; score of moderate corresponded to grade 3.The primary efficacy evaluation for scalp involvement was carried out at Week with treatment success being defined as score of clear (grade 0) or almost clear (grade 1). The study population ranged in age from 12 to 97 years with 11 subjects less than 18 years of age at baseline. The subjects were 60% male and 87% Caucasian. Table presents the efficacy results for the trial.Table 4. Number and Percent of Subjects Achieving Success for Scalp at Week 8Trial 3Calcipotriene FoamVehicle FoamN 181N 182Number (%) of Subjects with Treatment Success74 (41%)44 (24%)The contribution to efficacy of individual components of the vehicle has not been established.

CLINICAL TRIALS EXPERIENCE SECTION.

6.1Clinical Trials Experience. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.Calcipotriene foam was studied in four vehicle-controlled trials. total of 1094 adult subjects with plaque psoriasis, including 654 exposed to calcipotriene foam, were treated twice daily for weeks. Adverse reactions reported in >=1% of subjects treated with calcipotriene foam and at higher incidence than subjects treated with vehicle were application site erythema (2%) and application site pain (3%). The incidence of these adverse reactions was similar between the body and scalp.In an open-label study, 19 pediatric subjects age 12 to less than 17 years applied calcipotriene foam twice daily for 14 days and once on Day 15. Adverse reactions included application site pain, application site pruritus and pruritus [see Clinical Pharmacology (12.2 and 12.3) and Pediatric Use (8.4)].In an open-label study, 36 pediatric subjects age to less than 12 years applied calcipotriene foam twice daily for up to weeks. Adverse reactions included application site pain and contact dermatitis [see Clinical Pharmacology (12.2 and 12.3) and Pediatric Use (8.4)].

CONTRAINDICATIONS SECTION.

4CONTRAINDICATIONS. Calcipotriene foam should not be used by patients with known hypercalcemia.. Do not use in patients with known hypercalcemia. (4). Do not use in patients with known hypercalcemia. (4).

DOSAGE & ADMINISTRATION SECTION.

2DOSAGE AND ADMINISTRATION. Calcipotriene foam is for topical use only. Calcipotriene foam is not for oral, ophthalmic, or intravaginal use.Apply thin layer of calcipotriene foam twice daily to the affected areas and rub in gently and completely. Avoid contact with the face and eyes.. For topical use only; not for oral, ophthalmic, or intravaginal use. (2)Apply twice daily. (2). For topical use only; not for oral, ophthalmic, or intravaginal use. (2). Apply twice daily. (2).

DOSAGE FORMS & STRENGTHS SECTION.

3DOSAGE FORMS AND STRENGTHS. 0.005%, white foam. Calcipotriene foam contains calcipotriene 50 mcg/g in an aqueous-based emulsion foam vehicle.. 0.005%, foam. (3).

INFORMATION FOR PATIENTS SECTION.

17PATIENT COUNSELING INFORMATION. Advise the patient to read the FDA-approved patient labeling (Patient Information).Inform the patient to adhere to the following instructions:Apply calcipotriene foam to the affected skin areas.Apply calcipotriene foam to the scalp when the hair is dry.Avoid fire, flame, and smoking during and immediately following application since calcipotriene foam is flammable.Avoid contact with the face and eyes. If calcipotriene foam gets on the face or in or near their eyes, rinse thoroughly with water.Talk to your doctor if your skin does not improve after treatment with calcipotriene foam for weeks.Wash your hands after applying calcipotriene foam unless your hands are the affected site.Do not place calcipotriene foam in the refrigerator or freezer.. Apply calcipotriene foam to the affected skin areas.. Apply calcipotriene foam to the scalp when the hair is dry.. Avoid fire, flame, and smoking during and immediately following application since calcipotriene foam is flammable.. Avoid contact with the face and eyes. If calcipotriene foam gets on the face or in or near their eyes, rinse thoroughly with water.. Talk to your doctor if your skin does not improve after treatment with calcipotriene foam for weeks.. Wash your hands after applying calcipotriene foam unless your hands are the affected site.. Do not place calcipotriene foam in the refrigerator or freezer.

INSTRUCTIONS FOR USE SECTION.

Instructions for Use Calcipotriene (KAL-si-poe-TYRE-een)Foam, 0.005%. Read this Instructions for Use before you start using calcipotriene foam and each time you get refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.Important Information:Calcipotriene foam is for use on the skin only (topical use). Do not use calcipotriene foam in your mouth, eyes, or vagina.Avoid getting calcipotriene foam on your face or in your eyes. If you accidentally get calcipotriene foam on your face or in your eyes, rinse well with water.How to apply calcipotriene foam to your body:Follow your healthcare providers instructions on how much calcipotriene foam to use and where to use it. Wash your hands after applying calcipotriene foam unless you are treating areas on your hands.Step 1. Before applying calcipotriene foam for the first time, break the tiny plastic piece at the base of the cans rim by gently pushing back (away from the piece) on the nozzle. See Figure A. Figure AStep 2: Shake the can of calcipotriene foam before use. See Figure B. Figure BStep 3: Turn the can of calcipotriene foam upside down and press the nozzle. See Figure C. Figure CStep 4. Dispense small amount of calcipotriene foam into the palm of your hand. See Figure D. Figure DStep 5. Use enough calcipotriene foam to cover the affected area with thin layer. Gently rub the foam into the affected area until it disappears into the skin. See Figures and Figure Figure FHow to apply calcipotriene foam to your scalp:Step 6. Apply calcipotriene foam to your scalp when your hair is dry. Part your hair and apply directly on the affected area. See Figure G. Wash your hands after applying calcipotriene foam. Figure GThis Instructions for Use has been approved by the U.S. Food and Drug Administration.Distributed by: Mayne Pharma, Greenville, NC 27834Revised: 12/2020. Calcipotriene foam is for use on the skin only (topical use). Do not use calcipotriene foam in your mouth, eyes, or vagina.. Avoid getting calcipotriene foam on your face or in your eyes. If you accidentally get calcipotriene foam on your face or in your eyes, rinse well with water.. Figure A. Figure B. Figure C. Figure D. Figure E. Figure F. Figure G.

LACTATION SECTION.

8.2Lactation. Risk SummaryThere are no data on the presence of topically administered calcipotriene in human or animal milk, the effects on the breastfed infant, or the effects on milk production. After topical administration of calcipotriene foam, concentrations of calcipotriene in plasma are low, and therefore, concentrations in human milk are likely to be low [see Clinical Pharmacology (12.3)]. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for and any potential adverse effects on the breastfed child from calcipotriene foam or from the underlying maternal condition.

MECHANISM OF ACTION SECTION.

12.1Mechanism of Action. Calcipotriene is synthetic vitamin D3 analog that has similar receptor binding affinity as natural vitamin D3. However, the exact mechanism of action contributing to the clinical efficacy in the treatment of psoriasis is unknown.

NONCLINICAL TOXICOLOGY SECTION.

13NONCLINICAL TOXICOLOGY. 13.1Carcinogenesis, Mutagenesis, Impairment of Fertility. Calcipotriene topically administered to mice for up to 24 months at dose levels of 3, 10, or 30 mcg/kg/day (corresponding to 9, 30, or 90 mcg /m2/day) showed no significant changes in tumor incidence when compared with controls.The genotoxic potential of calcipotriene was evaluated in an Ames assay, mouse lymphoma TK locus assay, human lymphocyte chromosome aberration assay, and mouse micronucleus assay. All assay results were negative.Studies in rats at oral doses up to 54 mcg /kg/day (318 mcg /m2/day) of calcipotriene indicated no impairment of fertility or general reproductive performance.

OVERDOSAGE SECTION.

10OVERDOSAGE. Topically applied calcipotriene can be absorbed in sufficient amounts to produce systemic effects. Elevated serum calcium has been observed with use of topical calcipotriene [See Warnings and Precautions (5.2)].

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL.

PRINCIPAL DISPLAY PANEL 60 grams Can Carton. NDC 51862-512-60Calcipotriene Foam, 0.005%60 gramsRx only For topical use onlySTORE UPRIGHTmayne pharmaRecyclable Aluminum Container. PRINCIPAL DISPLAY PANEL 60 grams Can Carton.

PEDIATRIC USE SECTION.

8.4Pediatric Use. The safety and effectiveness of calcipotriene foam have been established in pediatric patients age years and older for topical treatment of plaque psoriasis of the scalp and body.Use of calcipotriene foam in this age group is supported by two adequate and well controlled 8-week trials in adults and adolescents 12 years of age and older, with additional data from 15-day open-label safety and pharmacokinetics (PK) study conducted in 19 subjects 12 to less than 17 years of age; and an 8-week open-label safety and PK study in 36 subjects to 11 years of age with psoriasis. Data from 19 subjects aged 12 to less than 17 years and 18 subjects aged to 11 years showed no significant effects on indices of calcium metabolism. Systemic concentrations of calcipotriene were not quantifiable in the two studies in subjects aged years to less than 17 years. [see Clinical Studies (14), Clinical Pharmacology (12.2, 12.3) and Adverse Reactions (6.1)].The safety and effectiveness of calcipotriene foam in pediatric patients less than years of age have not been established.

PHARMACODYNAMICS SECTION.

12.2Pharmacodynamics. Effects on Calcium MetabolismIn 19 subjects with psoriasis aged 12 to less than 17 years treated with calcipotriene foam two times day for 15 days, there was no significant effect on indices of calcium metabolism including serum albumin adjusted calcium, urine calcium/creatinine ratio, iPTH, alkaline phosphatase, magnesium and phosphorus.The effects of calcipotriene foam, 0.005%, on calcium metabolism were evaluated in 18 pediatric subjects to 11 years of age receiving calcipotriene foam administered twice daily for minimum of 14 days (mean: 56 days, range: 14 to 69 days). These subjects had plaque psoriasis involving an average of 10% of the body surface area (BSA) (range: 0.5%-36.5%). There was no relationship between urinary calcium/creatinine ratio (comparing Week to Baseline) and BSA treated.

PHARMACOKINETICS SECTION.

12.3Pharmacokinetics. The systemic absorption of calcipotriene in subjects with psoriasis of the body was evaluated at steady state following application of either calcipotriene foam or calcipotriene ointment to body surface area of 5% to 10%. In the calcipotriene foam treatment group, 15 out of 16 subjects had calcipotriene plasma concentrations below the limit of quantitation (10 pg/mL), while in the calcipotriene ointment treated group, out of 16 subjects had measurable calcipotriene plasma concentrations at various time points. All measurable plasma calcipotriene concentrations were below 25 pg/mL.The pharmacokinetics of calcipotriene foam, 0.005% was investigated when applied topically for 15 days to 17 subjects aged 12 to less than 17 years with moderate plaque psoriasis involving mean BSA of 24%, excluding face and scalp, and mean scalp involvement of 43%. Systemic concentration of calcipotriene were not quantifiable in any of the subjects (limit of quantification 10 pg/mL).In 11 pediatric subjects to 11 years of age with plaque psoriasis involving mean BSA of 10%, plasma concentration of calcipotriene was measured following weeks of twice daily administration of calcipotriene foam. No subject had quantifiable calcipotriene plasma concentration (limit of quantification 10 pg/mL).The systemic disposition of calcipotriene is expected to be similar to that of the naturally occurring vitamin D. Absorbed calcipotriene is known to be converted to inactive metabolites within 24 hours of application and the metabolism occurs via similar pathway to the natural hormone.

POSTMARKETING EXPERIENCE SECTION.

6.2Postmarketing Experience. The following adverse reactions have been identified during post approval use of calcipotriene foam. Because these reactions are reported voluntarily from population of uncertain size, it is not always possible to reliably estimate their frequency or establish causal relationship to drug exposure.. Skin and Subcutaneous: application site vesicles.

PREGNANCY SECTION.

8.1Pregnancy. Risk SummaryAlthough there are no available data on the drug- associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes in pregnant women exposed to calcipotriene foam, systemic exposure to calcipotriene is likely to be low [see Clinical Pharmacology (12.2, 12.3)].In animal reproduction studies, oral administration of calcipotriene to pregnant rats and rabbits during the period of organogenesis resulted in an increased incidence of minor skeletal abnormalities, including enlarged fontanelles and extra ribs in rats and an increased incidence of minor skeletal abnormalities, including incomplete ossification of pubic bones and forelimb phalanges in rabbits (see Data). The available data do not allow the calculation of relevant comparisons between the systemic exposure of calcipotriene observed in animal studies to the systemic exposure that would be expected in humans after topical use of calcipotriene foam.The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is to 4% and 15 to 20%, respectively.. Data. Animal DataEmbryofetal development studies were conducted with calcipotriene after oral administration in rats and rabbits. Pregnant rats received daily oral administration of calcipotriene during the period of organogenesis. Fetuses from dams dosed with 54 mcg/kg/day (318 mcg/m2/day) exhibited significantly increased incidence of minor skeletal abnormalities consisting primarily of enlarged fontanelles and extra ribs. The enlarged fontanelles are most likely due to calcipotrienes effect upon calcium metabolism. There were no effects on the incidence of major malformations in fetuses. Pregnant rabbits received daily oral administration of calcipotriene during the period of organogenesis. Increased rabbit maternal and fetal toxicity was noted at 12 mcg/kg/day (132 mcg/m2/day). Fetuses from does dosed with 36 mcg/kg/day (396 mcg/m2/day) exhibited significantly increased incidence of minor skeletal abnormalities including incomplete ossification of pubic bones and forelimb phalanges. There were no effects on the incidence of major malformations in fetuses.

SPL PATIENT PACKAGE INSERT SECTION.

Patient Information Calcipotriene (KAL-si-poe-TYRE-een)Foam, 0.005%This Patient Information has been approved by the U.S. Food and Drug Administration. Revised: 12/2020Important: Calcipotriene Foam is for use on the skin only (topical use). Do not use calcipotriene foam in your mouth, eyes, or vagina.WHAT IS CALCIPOTRIENE FOAMCalcipotriene foam is prescription medicine used on the skin (topical) to treat plaque psoriasis of the scalp and body in people years of age and older. It is not known if calcipotriene foam is safe and effective in people under years old.Do not use Calcipotriene Foam if you have been told by your healthcare provider that you have high level of calcium in your blood (hypercalcemia).BEFORE USING CALCIPOTRIENE FOAM, TELL YOUR HEALTHCARE PROVIDER ABOUT ALL YOUR MEDICAL CONDITIONS, INCLUDING IF YOU:are pregnant or planning to become pregnant. It is not known if calcipotriene foam will harm your unborn baby.are breastfeeding or plan to breastfeed. It is not known if calcipotriene foam passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with calcipotriene foam.Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.Know the medicines you take. Keep list of your medicines with you to show your healthcare provider and pharmacist when you get new medicine.HOW SHOULD USE CALCIPOTRIENE FOAMUse calcipotriene foam exactly as your healthcare provider tells you to use it. See the detailed Instructions for Use at the end of this leaflet for directions about how to apply calcipotriene foam the right way.Calcipotriene foam is usually applied to the affected skin areas times each day.For your scalp, apply calcipotriene foam when your hair is dry.Talk with your healthcare provider if your skin does not improve after weeks of treatment with calcipotriene foam.Wash your hands after applying calcipotriene foam unless you are using the medicine to treat your hands.WHAT SHOULD AVOID WHILE USING CALCIPOTRIENE FOAMCalcipotriene foam is flammable. Avoid fire, flame, and smoking during and right after you apply calcipotriene foam.Avoid getting calcipotriene foam on your face or in or near your eyes. If calcipotriene foam gets on your face or in your eyes, rinse well with water.WHAT ARE THE POSSIBLE SIDE EFFECTS OF CALCIPOTRIENE FOAM Calcipotriene foam may cause serious side effects, including:Too much calcium in your blood. Your healthcare provider may tell you to stop using calcipotriene foam until your calcium levels become normal.The most common side effects of Calcipotriene foam include redness and pain of the treated skin areas.These are not all the possible side effects of calcipotriene foam. 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 Mayne Pharma at 1-844-825-8500.HOW SHOULD STORE CALCIPOTRIENE FOAMStore calcipotriene foam at room temperature, between 68F to 77F (20C to 25C).Do not store calcipotriene foam in the refrigerator or freezer.Do not expose calcipotriene foam to heat or store at temperatures above 120F (49C).Do not puncture or burn the calcipotriene foam can.Keep calcipotriene foam and all medicines out of the reach of children.GENERAL INFORMATION ABOUT THE SAFE AND EFFECTIVE USE OF CALCIPOTRIENE FOAM.Medicines are sometimes prescribed for purposes other than those listed in Patient Information leaflet. Do not use calcipotriene foam for condition for which it was not prescribed. Do not give calcipotriene foam to other people even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about calcipotriene foam that is written for health professionals.WHAT ARE THE INGREDIENTS IN CALCIPOTRIENE FOAMActive ingredient: calcipotrieneInactive ingredients: cetyl alcohol, dibasic sodium phosphate, dl--tocopherol, edetate disodium, isopropyl myristate, light mineral oil, polyoxyl 20 cetostearyl ether, propylene glycol, purified water, stearyl alcohol, and white petrolatum. The foam is dispensed from an aluminum can pressurized with hydrocarbon (propane/n-butane/isobutane) propellant.Distributed by: Mayne Pharma Greenville, NC 27834. are pregnant or planning to become pregnant. It is not known if calcipotriene foam will harm your unborn baby.. are breastfeeding or plan to breastfeed. It is not known if calcipotriene foam passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with calcipotriene foam.. Use calcipotriene foam exactly as your healthcare provider tells you to use it. See the detailed Instructions for Use at the end of this leaflet for directions about how to apply calcipotriene foam the right way.. Calcipotriene foam is usually applied to the affected skin areas times each day.. For your scalp, apply calcipotriene foam when your hair is dry.. Talk with your healthcare provider if your skin does not improve after weeks of treatment with calcipotriene foam.. Wash your hands after applying calcipotriene foam unless you are using the medicine to treat your hands.. Calcipotriene foam is flammable. Avoid fire, flame, and smoking during and right after you apply calcipotriene foam.. Avoid getting calcipotriene foam on your face or in or near your eyes. If calcipotriene foam gets on your face or in your eyes, rinse well with water.. Too much calcium in your blood. Your healthcare provider may tell you to stop using calcipotriene foam until your calcium levels become normal.. Store calcipotriene foam at room temperature, between 68F to 77F (20C to 25C).. Do not store calcipotriene foam in the refrigerator or freezer.. Do not expose calcipotriene foam to heat or store at temperatures above 120F (49C).. Do not puncture or burn the calcipotriene foam can.

SPL UNCLASSIFIED SECTION.

5.1Flammability. The propellant in calcipotriene foam is flammable. Instruct the patient to avoid fire, flame, and smoking during and immediately following application.

STORAGE AND HANDLING SECTION.

16.2Storage and Handling. Store at 20oC to 25C (68F to 77F); excursions permitted to 15C 30C (59F 86F).Flammable. Contents under pressure. Do not puncture or incinerate. Do not expose to heat or store at temperatures above 120F (49C).Keep out of reach of children.. Store at 20oC to 25C (68F to 77F); excursions permitted to 15C 30C (59F 86F).. Flammable. Contents under pressure. Do not puncture or incinerate. Do not expose to heat or store at temperatures above 120F (49C).. Keep out of reach of children.

USE IN SPECIFIC POPULATIONS SECTION.

8USE IN SPECIFIC POPULATIONS. 8.1Pregnancy. Risk SummaryAlthough there are no available data on the drug- associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes in pregnant women exposed to calcipotriene foam, systemic exposure to calcipotriene is likely to be low [see Clinical Pharmacology (12.2, 12.3)].In animal reproduction studies, oral administration of calcipotriene to pregnant rats and rabbits during the period of organogenesis resulted in an increased incidence of minor skeletal abnormalities, including enlarged fontanelles and extra ribs in rats and an increased incidence of minor skeletal abnormalities, including incomplete ossification of pubic bones and forelimb phalanges in rabbits (see Data). The available data do not allow the calculation of relevant comparisons between the systemic exposure of calcipotriene observed in animal studies to the systemic exposure that would be expected in humans after topical use of calcipotriene foam.The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is to 4% and 15 to 20%, respectively.. Data. Animal DataEmbryofetal development studies were conducted with calcipotriene after oral administration in rats and rabbits. Pregnant rats received daily oral administration of calcipotriene during the period of organogenesis. Fetuses from dams dosed with 54 mcg/kg/day (318 mcg/m2/day) exhibited significantly increased incidence of minor skeletal abnormalities consisting primarily of enlarged fontanelles and extra ribs. The enlarged fontanelles are most likely due to calcipotrienes effect upon calcium metabolism. There were no effects on the incidence of major malformations in fetuses. Pregnant rabbits received daily oral administration of calcipotriene during the period of organogenesis. Increased rabbit maternal and fetal toxicity was noted at 12 mcg/kg/day (132 mcg/m2/day). Fetuses from does dosed with 36 mcg/kg/day (396 mcg/m2/day) exhibited significantly increased incidence of minor skeletal abnormalities including incomplete ossification of pubic bones and forelimb phalanges. There were no effects on the incidence of major malformations in fetuses.. 8.2Lactation. Risk SummaryThere are no data on the presence of topically administered calcipotriene in human or animal milk, the effects on the breastfed infant, or the effects on milk production. After topical administration of calcipotriene foam, concentrations of calcipotriene in plasma are low, and therefore, concentrations in human milk are likely to be low [see Clinical Pharmacology (12.3)]. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for and any potential adverse effects on the breastfed child from calcipotriene foam or from the underlying maternal condition.. 8.4Pediatric Use. The safety and effectiveness of calcipotriene foam have been established in pediatric patients age years and older for topical treatment of plaque psoriasis of the scalp and body.Use of calcipotriene foam in this age group is supported by two adequate and well controlled 8-week trials in adults and adolescents 12 years of age and older, with additional data from 15-day open-label safety and pharmacokinetics (PK) study conducted in 19 subjects 12 to less than 17 years of age; and an 8-week open-label safety and PK study in 36 subjects to 11 years of age with psoriasis. Data from 19 subjects aged 12 to less than 17 years and 18 subjects aged to 11 years showed no significant effects on indices of calcium metabolism. Systemic concentrations of calcipotriene were not quantifiable in the two studies in subjects aged years to less than 17 years. [see Clinical Studies (14), Clinical Pharmacology (12.2, 12.3) and Adverse Reactions (6.1)].The safety and effectiveness of calcipotriene foam in pediatric patients less than years of age have not been established.. 8.5Geriatric Use. Clinical trials of calcipotriene foam did not include sufficient numbers of subjects aged 65 years 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.

WARNINGS AND PRECAUTIONS SECTION.

5WARNINGS AND PRECAUTIONS. Flammability: Contents are flammable. Instruct the patient the avoid fire, flame, and smoking during and immediately following application. (5.1)Effects on Calcium Metabolism: If elevation of serum calcium occurs, instruct patients to discontinue treatment until normal calcium levels are restored. (5.2). Flammability: Contents are flammable. Instruct the patient the avoid fire, flame, and smoking during and immediately following application. (5.1). Effects on Calcium Metabolism: If elevation of serum calcium occurs, instruct patients to discontinue treatment until normal calcium levels are restored. (5.2). 5.1Flammability. The propellant in calcipotriene foam is flammable. Instruct the patient to avoid fire, flame, and smoking during and immediately following application.. 5.2Effects on Calcium Metabolism. Elevation of serum calcium has occurred with use of calcipotriene. If elevation in serum calcium outside the normal range should occur, discontinue treatment until normal calcium levels are restored.