May 18, 2009
The Food and Drug Administration is requiring manufacturers of two prescription topical testosterone gel products, AndroGel 1% and Testim 1%, to include a boxed warning on the products' labels after receiving reports of adverse effects in children who were inadvertently exposed to testosterone through contact with a person being treated with these products (secondary exposure).
The gels are approved for use in men who either no longer produce testosterone or produce it in very low amounts, and are often used by men living with HIV who have below normal testosterone levels.
Although the Precautions in the current labels instruct users to wash their hands after using the product and to cover the treated skin with clothing, FDA has received reports of secondary exposure to testosterone in children ranging in age from nine months to five years. In most of the cases, users of these products failed to follow appropriate use instructions, resulting in direct contact between treated skin and the child.
Signs of inappropriate virilization (development of male secondary sexual characteristics) in children and the possibility of secondary testosterone exposure should be brought to a health care provider's attention.
The required label changes will provide additional information about the risk of secondary exposure and the steps that should be taken to reduce this risk. The FDA also is requiring that the manufacturers of these products develop a Medication Guide as part of a Risk Evaluation and Mitigation Strategy to ensure that the benefits of these products continue to outweigh their potential risks.
The FDA recommends the following precautions be taken to minimize the potential for secondary exposure:
Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of these gels to the FDA's MedWatch Adverse Event Reporting program:
AndroGel 1% is manufactured by Marietta, Ga.-based Solvay Pharmaceuticals. Testim 1% is made by Auxilium Pharmaceuticals, Malvern, Pa.
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