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EXTINA® Foam may result in contact sensitization, including photoallergenicity. [See ADVERSE REACTIONS]
The contents of EXTINA® Foam include alcohol and propane/butane, which are flammable. Avoid fire, flame and/or smoking during and immediately following application. Do not puncture and/or incinerate the containers. Do not expose containers to heat and/or store at temperatures above 120°F (49°C).
Hepatitis has been seen with orally administered ketoconazole (1:10,000 reported incidence). Lowered testosterone and ACTH–induced corticosteroid serum levels have been seen with high doses of orally administered ketoconazole. These effects have not been seen with topical ketoconazole.
Patient Counseling Information
See FDA-approved patient labeling.
Instructions For Use
- Avoid fire, flame and/or smoking during and immediately following application.
- Do not apply EXTINA® Foam directly to hands. Dispense onto a cool surface, and apply to the affected areas using the fingertips.
- EXTINA® Foam may cause skin irritation (application site burning and/or reactions)
- EXTINA® Foam may cause contact sensitization.
- As with any topical medication, patients should wash their hands after application.
- Inform a physician if the area of application shows signs of increased irritation and report any signs of adverse reactions.
Carcinogenesis, Mutagenesis, And Impairment Of Fertility
Long-term animal studies have not been performed to evaluate the carcinogenic or photo-carcinogenic potential of EXTINA® Foam.
In oral carcinogenicity studies in mice (18-months) and rats (24-months) at dose levels of 5, 20 and 80 mg/kg/day ketoconazole was not carcinogenic. The high dose in these studies was approximately 2.4 to 4.8 times the expected topical dose in humans based on a mg/m² comparison. In a bacterial reverse mutation assay, ketoconazole did not express any mutagenic potential. In three in vivo assays (sister chromatid exchange in humans, dominant lethal and micronucleus tests in mice), ketoconazole did not exhibit any genotoxic potential.
At oral dose levels of 75 mg/kg/day (4.5 times the expected topical human dose in mg/m²), ketoconazole impaired reproductive performance and fertility when administered to male rats (increased abnormal sperm, decreased sperm mobility and decreased pregnancy in mated females).
Use In Specific Populations
Pregnancy Category C: Ketoconazole has been shown to be teratogenic (syndactylia and oligodactylia) in the rat when given orally in the diet at 80 mg/kg/day (4.8 times the maximum expected human topical dose based on a mg/m² comparison, assuming 100% absorption from 8 g of foam). However, these effects may be partly related to maternal toxicity, which was also observed at this dose level. [See Pharmacokinetics]
No reproductive studies in animals have been performed with EXTINA® Foam. There are no adequate and well-controlled studies of EXTINA® Foam in pregnant women.
EXTINA® Foam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
It is not known whether EXTINA® Foam administered topically could result in sufficient systemic absorption to produce detectable quantities in breast milk. Because many drugs are excreted in human milk, caution should be exercised when EXTINA® Foam is administered to women who are breastfeeding.
The safety and effectiveness of EXTINA® Foam in pediatric patients less than 12 years of age have not been established.
Of the 672 subjects treated with EXTINA® Foam in the clinical trials, 44 (7%) were from 12 to 17 years of age. [See Clinical Studies]
Of the 672 subjects treated with EXTINA® Foam in the clinical trials, 107 (16%) were 65 years and over.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 3/24/2016
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