Accolate (Zafirlukast) - Side Effects and Adverse Reactions

ADVERSE REACTIONS

Adults and Children 12 years of age and older

The safety database for ACCOLATE consists of more than 4000 healthy volunteers and patients who received ACCOLATE, of which 1723 were asthmatics enrolled in trials of 13 weeks duration or longer. A total of 671 patients received ACCOLATE for 1 year or longer. The majority of the patients were 18 years of age or older; however, 222 patients between the age of 12 and 18 years received ACCOLATE.

A comparison of adverse events reported by ≥1% of zafirlukast-treated patients, and at rates numerically greater than in placebo-treated patients, is shown for all trials in the table below.

	ACCOLATE	PLACEBO
Adverse Event	N=4058	N=2032
Headache	12.9%	11.7%
Infection	3.5%	3.4%
Nausea	3.1%	2.0%
Diarrhea	2.8%	2.1%
Pain (generalized)	1.9%	1.7%
Asthenia	1.8%	1.6%
Abdominal Pain	1.8%	1.1%
Accidental Injury	1.6%	1.5%
Dizziness	1.6%	1.5%
Myalgia	1.6%	1.5%
Fever	1.6%	1.1%
Back Pain	1.5%	1.2%
Vomiting	1.5%	1.1%
SGPT Elevation	1.5%	1.1%
Dyspepsia	1.3%	1.2%

The frequency of less common adverse events was comparable between ACCOLATE and placebo.

Rarely, elevations of one or more liver enzymes have occurred in patients receiving ACCOLATE in controlled clinical trials. In clinical trials, most of these have been observed at doses four times higher than the recommended dose. The following hepatic events (which have occurred predominantly in females) have been reported from postmarketing adverse event surveillance of patients who have received the recommended dose of ACCOLATE (40 mg/day): cases of symptomatic hepatitis (with or without hyperbilirubinemia) without other attributable cause; and rarely, hyperbilirubinemia without other elevated liver function tests. In most, but not all postmarketing reports, the patient’s symptoms abated and the liver enzymes returned to normal or near normal after stopping ACCOLATE. In rare cases, patients have presented with fulminant hepatitis or progressed to hepatic failure, liver transplantation and death (see WARNINGS, Hepatotoxicity and PRECAUTIONS, Information for Patients).

In clinical trials, an increased proportion of zafirlukast patients over the age of 55 years reported infections as compared to placebo-treated patients. A similar finding was not observed in other age groups studied. These infections were mostly mild or moderate in intensity and predominantly affected the respiratory tract. Infections occurred equally in both sexes, were dose-proportional to total milligrams of zafirlukast exposure, and were associated with coadministration of inhaled corticosteroids. The clinical significance of this finding is unknown.

In rare cases, patients on ACCOLATE therapy may present with systemic eosinophilia, eosinophilic pneumonia, or clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition which is often treated with systemic steroid therapy. These events usually, but not always, have been associated with the reduction of oral steroid therapy. Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. A causal association between ACCOLATE and these underlying conditions has not been established (see PRECAUTIONS, Eosinophilic Conditions).

Hypersensitivity reactions, including urticaria, angioedema and rashes, with or without blistering, have been reported in association with ACCOLATE therapy. Additionally, there have been reports of patients experiencing agranulocytosis, bleeding, bruising, or edema, arthralgia, myalgia, insomnia, malaise, and pruritus in association with ACCOLATE therapy.

Rare cases of patients experiencing increased theophylline levels with or without clinical signs or symptoms of theophylline toxicity after the addition of ACCOLATE to an existing theophylline regimen have been reported. The mechanism of the interaction between ACCOLATE and theophylline in these patients is unknown and not predicted by available in vitro metabolism data and the results of two clinical drug interaction studies (see CLINICAL PHARMACOLOGY and PRECAUTIONS, Drug Interactions).

Pediatric Patients 5 through 11 years of age

ACCOLATE has been evaluated for safety in 788 pediatric patients 5 through 11 years of age. Cumulatively, 313 pediatric patients were treated with ACCOLATE 10 mg twice daily or higher for at least 6 months, and 113 of them were treated for one year or longer in clinical trials. The safety profile of ACCOLATE 10 mg twice daily-versus placebo in the 4- and 6-week double-blind trials was generally similar to that observed in the adult clinical trials with ACCOLATE 20 mg twice daily.

In pediatric patients receiving ACCOLATE in multi-dose clinical trials, the following events occurred with a frequency of ≥ 2% and more frequently than in pediatric patients who received placebo, regardless of causality assessment: headache (4.5 vs. 4.2%) and abdominal pain (2.8 vs. 2.3%).

The post-marketing experience in this age group is similar to that seen in adults, including hepatic dysfunction, which may lead to liver failure.

REPORTS OF SIDE EFFECTS / ADVERSE REACTIONS RELATED TO ACCOLATE

Possible Accolate side effects / adverse reactions in 47 year old female

Reported by a individual with unspecified qualification from Japan on 2007-02-09

Patient: 47 year old female

Reactions: Productive Cough, Hepatic Function Abnormal, Blood Immunoglobulin A Decreased, Pyrexia, Blood Immunoglobulin G Decreased, Bacteria Sputum Identified, Immunoglobulins Decreased, Gamma-Glutamyltransferase Increased, Interstitial Lung Disease, Cough, Blood Immunoglobulin M Decreased, Blood Alkaline Phosphatase Increased, Blood Lactate Dehydrogenase Increased, Alanine Aminotransferase Increased, Eosinophil Count Increased, Eosinophilia, Bronchiectasis, Dysphonia, Aspartate Aminotransferase Increased, Bronchitis, Hypogammaglobulinaemia

Adverse event resulted in: hospitalization

Suspect drug(s):
Accolate
    Dosage: 20 mg, bid
    Administration route: Oral
    Indication: Asthma
    Start date: 2003-09-01
    End date: 2004-03-01

Mucosolvan
    Dosage: 45 mg/day
    Administration route: Oral
    Indication: Bronchiectasis
    Start date: 2003-09-01
    End date: 2004-08-01

Tegretol
    Dosage: 200 mg, bid
    Administration route: Oral
    Indication: Epilepsy
    Start date: 2002-05-13
    End date: 2004-10-26

Tegretol
    Dosage: 200 mg/day
    Administration route: Oral
    Start date: 2004-10-27
    End date: 2004-11-10

Tegretol
    Dosage: 200 mg/day
    Administration route: Oral
    Start date: 2002-05-02
    End date: 2002-05-12

Theo-DUR
    Dosage: 100 mg, qid
    Administration route: Oral
    Indication: Asthma
    Start date: 2003-09-01
    End date: 2004-03-01

Possible Accolate side effects / adverse reactions in 36 year old female

Reported by a individual with unspecified qualification from United States on 2007-04-13

Patient: 36 year old female weighing 127.0 kg (279.4 pounds)

Reactions: Overdose, Self Injurious Behaviour, Suicidal Ideation

Adverse event resulted in: hospitalization

Suspect drug(s):
Accolate

Other drugs received by patient: Synthroid; Lereca; Zoloft

Possible Accolate side effects / adverse reactions in 54 year old female

Reported by a health professional (non-physician/pharmacist) from United States on 2007-06-01

Patient: 54 year old female weighing 92.7 kg (203.9 pounds)

Reactions: Pneumonia Fungal, Hepatic Necrosis, Bronchopneumonia, Myocardial Ischaemia, Multi-Organ Failure, Pneumonia Bacterial, Sepsis, Acute Hepatic Failure, Aspergillosis, Diffuse Alveolar Damage, Renal Failure Acute

Adverse event resulted in: death, hospitalization

Suspect drug(s):
Accolate

Other drugs received by patient: Synthroid; Zoloft; Advair Diskus 100/50; Albuterol; Albuterol; Veetids; Singulair; Azmacort; Azmacort