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Solagé should not be administered if the patient is also taking drugs known to be photosensitizers (e.g., thiazides, tetracyclines, fluoroquinolones, phenothiazines, sulfonamides) because of the possibility of augmented phototoxicity. Because of heightened burning susceptibility, exposure to sunlight (including sunlamps) to treated areas should be avoided or minimized during the use of Solagé. Patients must be advised to use protective clothing and comply with a comprehensive sun avoidance program when using Solagé. Data are not available to establish how or whether Solagé is degraded (either by sunlight or by normal interior lighting) following application to the skin. Patients with sunburn should be advised not to use Solagé until fully recovered. Patients who may have considerable sun exposure due to their occupation and those patients with inherent sensitivity to sunlight should exercise particular caution when using Solagé and ensure that the precautions outlined in the Patient Information are observed.
Solagé should be kept out of the eyes, mouth, paranasal creases, and mucous membranes.
Solagé is a dermal irritant and the results of continued irritation of the skin for greater than 52 weeks in chronic, long-term use are not known. Tretinoin has been reported to cause severe irritation on eczematous skin and should be used only with utmost caution in patients with this condition.
Solagé may cause skin irritation, erythema, burning, stinging or tingling, peeling, and pruritis. If the degree of such local irritation warrants, patients should be directed to use less medication, decrease the frequency of application, discontinue use temporarily, or discontinue use altogether. The efficacy at reduced frequencies of application has not been established.
Solagé should only be used as an adjunct to a comprehensive skin care and sun avoidance program. (see INDICATIONS).
If a drug sensitivity, chemical irritation, or a systemic adverse reaction develops, use of Solagé should be discontinued.
Weather extremes, such as wind or cold, may be more irritating to patients using Solagé.
Solagé should be used with caution by patients with a history, or family history, of vitiligo. One patient in the trials, whose brother had vitiligo, experienced hypopigmentation in areas that had not been treated with study medication. Some of these areas continued to worsen for at least one month post treatment with Solagé. Six weeks later the severity of the hypopigmentation had decreased from moderate to mild and 106 days post treatment, the patient had resolution of some but not all lesions.
Application of larger amounts of medication than recommended will not lead to more rapid or better results, and marked redness, peeling, discomfort, or hypopigmentation of the skin may occur.
Keep away from heat and open flame.
Carcinogenesis, Mutagenesis, and Impairment of Fertility
Although a dermal carcinogenicity study in CD-1 mice indicated that Solagé applied topically at daily doses up to 80 and 0.4 mg/kg (240 and 1.2 mg/m2) of mequinol and tretinoin, respectively, representing approximately 5 times the maximum possible systemic human exposure was not carcinogenic, in a photocarcinogenicity study utilizing Crl:Skh-1(hr/hr BR) hairless albino mice, median time to onset of tumors decreased. Also, the number of tumors increased in all dose groups administered 1.4, 4.3, or 14 Ál of Solagé /cm2 of skin (24 and 0.12, 72 and 0.36, or 240 and 1.2 mg/m2 of mequinol and tretinoin, respectively; 0.6, 1.9, or 6.5 times the daily human dose on a mg/m2 basis) following chronic topical dosing with intercurrent exposure to ultraviolet radiation for up to 40 weeks. Similar animal studies have shown an increased tumorigenic risk with the use of retinoids when followed by ultraviolet radiation. Although the significance of these studies to human use is not clear, patients using this product should be advised to avoid or minimize exposure to either sunlight or artificial ultraviolet irradiation sources.
Mequinol was non-mutagenic in the Ames/Salmonella assay using strains TA98, TA100, TA1535, and TA1537, all of which are insensitive to mutagenic effects of structurally-related quinones. Solagé was non-genotoxic in an in vivo dermal micronucleus assay in rats, but exposure of bone marrow to drug was not demonstrated.
A dermal reproduction study with Solagé in Sprague-Dawley rats at a daily dose of 80 and 0.4 mg/kg (480 and 2.4 mg/m2) of mequinol and tretinoin, respectively, approximately 11 times the corresponding maximum possible human exposure, assuming 100% bioavailability following topical application to 5% of the total body surface area, showed no impairment of fertility.
Use In Specific Populations
Teratogenic effects: Pregnancy Category X.
Although the magnitude of the potential for teratogenicity may not be well-defined, Solagé is labeled as a pregnancy category “X” because the potential risk of the use of this drug to treat this particular indication (solar lentigines) in a pregnant woman clearly outweighs any possible benefit (see CONTRAINDICATIONS). Solagé should not be used in women of childbearing potential.
It is not known to what extent mequinol and/or tretinoin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Solagé is administered to a nursing woman.
The safety and effectiveness of this product have not been established in pediatric patients. Solagé should not be used on children.
Of the total number of patients in clinical studies of Solagé, approximately 43% were 65 and older, while approximately 8% were 75 and over. No overall differences in effectiveness or safety were observed between these patients and younger patients.
Last reviewed on RxList: 1/19/2010
This monograph has been modified to include the generic and brand name in many instances.
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