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==USA FDA Fetal Risk Categories== | ==USA FDA Fetal Risk Categories== | ||
In the United States the government Food and Drug Administration (FDA) | [[File:Fdagov logo.jpg|thumb|FDA logo]] | ||
In the United States the government Food and Drug Administration (FDA) historically (before 2015) established the drug labelling classes (A, B, C, D, and X) to define their safety. Since 2015 this drug classification has been replaced with the "FDA Pregnancy and Lactation Labeling Rule" (PLLR).{{#pmid:27904304|PMID27904304}} As well as removing the previous letter classes it has added a | |||
new category of [[#Females and Males of Reproductive Potential]]. | |||
: | A 2011 study of USA data from 1976-2008 has shown:{{#pmid:21514558|PMID21514558}} | ||
* 6 million pregnancies every year | |||
* 50% of pregnant women reported taking at least one medication | |||
* Pregnant women take an average of 2.6 medications at any time during pregnancy | |||
* First trimester use of prescription medications has increased by more than 60% | |||
* Use of 4 or more medications in the first trimester has tripled (9.9% to 27.6%) | |||
* Small percentage of drugs contraindicated for use in pregnancy or while breast feeding | |||
** contraindicated example include - isotretinoin, mycophenolates | |||
[[File:FDA drug category changes 2015.jpg|800px]] | |||
{{Environmental}} | |||
:[[Abnormal Development - Drugs|'''Drugs Links''']]: [[Australian Drug Categories]] | [[USA Drug Categories]] | [[Human Abnormal Development]] | [[BGD_Tutorial_-_Applied_Embryology_and_Teratology|BGD Tutorial]] | |||
== | == Some Recent Findings == | ||
{| | |||
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* '''Recent changes in pregnancy and lactation labeling: retirement of risk categories'''<ref name="PMID24390829"><pubmed>24390829</pubmed></ref> "The rapid development and increased availability of novel pharmacologic therapies and pharmaceutical products has amplified the potential for drug exposure during pregnancy. Many drugs are beneficial for disease state management during pregnancy and provide significant fetal and maternal health benefits. However, a paucity of safety data combined with the imprecision of the current risk category system renders risk versus benefit assessment difficult. In response to decades of criticism, the U.S. Food and Drug Administration (FDA) is implementing a new pregnancy and lactation labeling rule designed to improve risk versus benefit assessment of drugs used in pregnant and nursing mothers. These recommendations will provide clear and detailed information for both patients and health care providers, and they will include three main categories: risk summary, clinical considerations, and data. The new labeling rules remove the previous letter risk categorization system (A, B, C, D, X). In this review, we summarize the upcoming FDA labeling changes and discuss their potential consequences on clinical practice." | |||
* '''Obstetric toxicology: teratogens'''<ref name="PMID23137407"><pubmed>23137407</pubmed></ref> "The emergency physician frequently encounters women who seek care because of pregnancy- and nonpregnancy-related complaints. Many medications are safe for use during pregnancy, including several that are listed as potential teratogens based on the Food and Drug Administration's (FDA) pregnancy classification; but it is important that the emergency physician know and recognize which drugs can be given in pregnancy and which drugs are absolutely contraindicated. Expert resources should be identified and used because the FDA's classification of drugs based on pregnancy risk does not represent the most up-to-date or accurate assessment of a drug's safety." | |||
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= | {| class="wikitable mw-collapsible mw-collapsed" | ||
! More recent papers | |||
|- | |||
| [[File:Mark_Hill.jpg|90px|left]] {{Most_Recent_Refs}} | |||
Search term: [http://www.ncbi.nlm.nih.gov/pubmed/?term=FDA+Fetal+Risk+Category ''tFDA Fetal Risk Category''] | |||
|} | |||
==FDA History== | |||
{{FDA history table}} | |||
{{FDA historic drug class collapsetable}} | |||
==FDA Pregnancy and Lactation Labeling Rule== | |||
:"The PLLR requires changes to the content and format for information presented in prescription drug labeling in the Physician Labeling Rule (PLR) format to assist health care providers in assessing benefit versus risk and in subsequent counseling of pregnant women and nursing mothers who need to take medication, thus allowing them to make informed and educated decisions for themselves and their children. The PLLR removes pregnancy letter categories – A, B, C, D and X. The PLLR also requires the label to be updated when information becomes outdated." | |||
[[File:FDA drug category changes 2015.jpg|800px]] | |||
:'''Links:''' [https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm Final Rule] | |||
==Pregnancy Exposure Registry== | |||
The USA has is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drugs (by trade name) during pregnancy. The information below is extracted from, and not a complete summary of, [https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm PLLR] requirements. | |||
==Pregnancy Risk Summary== | |||
Drugs with systemic absorption | |||
* When use of a drug is contraindicated during pregnancy, that information must be stated first in the Risk Summary | |||
* Risk statement based on human data | |||
* Risk statement based on animal data | |||
* Risk statement based on pharmacology | |||
* Background risk information in general population | |||
* Background risk information in disease population | |||
===Risk Based on Animal Data=== | |||
Systemic drug absorption | |||
There are no adequate and well-controlled studies of [TRADENAME] in pregnant women. The limited available information on [TRADENAME] use during pregnancy is not sufficient to inform a drug-associated risk of major birth defects or miscarriage. In animal reproduction studies, oral administration of [drug name] to pregnant rats and rabbits during the period of organogenesis at doses up to 40 and 20 times the maximum recommended human dose (MRHD), respectively, resulted in decreased fetal body weight gain and delayed skeletal ossification but no teratogenic effects were observed. Decreased fetal body weight and delayed skeletal ossification were not observed at doses up to 10 and 5 times the MRHD in rats and rabbits, respectively [see Data]. | |||
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risks of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15- 20%, respectively. | |||
===Pregnancy Clinical Considerations=== | |||
Clinical Considerations (five optional subheadings) | |||
# Disease-Associated Maternal and/or Embryo/Fetal Risk | |||
# Dose Adjustments During Pregnancy and the Post- Partum Period | |||
# Maternal Adverse Reactions | |||
# Fetal/Neonatal Adverse Reactions | |||
# Labor or Delivery | |||
===Lactation Risk Summary=== | |||
Systemic drug absorption | |||
* Presence of drug in milk (if unknown, must state so) | |||
** Concentration in milk | |||
** Actual or estimated infant daily dose | |||
* Effects of drug on the breastfed infant (if unknown, must state so) | |||
* Effects of the drug on milk production (if unknown, must state so) | |||
* Risk/Benefit Statement | |||
==Females and Males of Reproductive Potential== | |||
Include when there are requirements or recommendations for pregnancy testing and/or contraception and/or when human and/or animal data suggest drug effects on fertility. | |||
Three headings | |||
# Pregnancy Testing | |||
# Contraception | |||
# Infertility | |||
===Example of Labelling=== | |||
Based on its mechanism of action, TRADENAME can cause fetal harm when administered to a pregnant | |||
woman [see Use in Specific Populations (8.1)]. | |||
====Pregnancy Testing==== | |||
Female patients of reproductive potential should have a negative pregnancy test ... | |||
====Contraception==== | |||
''Females'' | |||
Advise female patients of reproductive potential to use effective contraception during treatment and for at least 2 weeks after the last dose of TRADENAME. Advise patients that TRADENAME can reduce the effectiveness of oral contraceptives and to use alternative effective contraception during treatment with TRADENAME [see Warnings and Precautions (5.x), Drug Interactions (7.x), Clinical Pharmacology (12.x)]. | |||
====Infertility==== | |||
''Females'' | |||
Decreased fertility and ovarian toxicity were observed in female rats treated with DRUGNAME. Advise female patients of reproductive potential ... | |||
''Males'' | |||
Effects on spermatogenesis have been observed in animals treated with DRUGNAME. Advise male patients of the potential risk... | |||
==Anesthetics== | |||
'''FDA September 2014''' - [http://www.fda.gov/Drugs/NewsEvents/ucm416597.htm Discussion - anesthetic drugs to infants and young children] | |||
==References== | |||
<references/> | |||
'''Search PubMed:''' [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=US%20Drug%20Categories US Drug Categories] | [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=Drug%20Categories Drug Categories] | [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=teratogenic%20drugs teratogenic drugs] | |||
==External Links== | |||
{{External Links}} | |||
* [https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm FDA Pregnancy and Lactation Labeling Rule] | |||
* '''U.S. Food and Drug Administration''' [http://www.fda.gov/ FDA] | |||
** [http://www.fda.gov/Drugs/default.htm Drugs] | |||
** [http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm National Drug Code Directory] | |||
** [http://www.gpo.gov/fdsys/pkg/FR-2008-05-29/pdf/E8-11806.pdf 2008 labeling statement PDF] | |||
* [http://toxnet.nlm.nih.gov/ TOXNET] - Databases on toxicology, hazardous chemicals, environmental health, and toxic releases. [http://toxnet.nlm.nih.gov/pda/ mobile] | |||
==Terms== | |||
{{Drug terms}} | |||
{{Glossary}} | |||
{{Footer}} | |||
[[Category:Abnormal Development]] [[Category:Environmental Abnormalities]] [[Category:Human Embryo]] [[Category:Human Fetus]][[Category:USA]][[Category:Drugs]] |
Latest revision as of 14:41, 11 April 2019
USA FDA Fetal Risk Categories
In the United States the government Food and Drug Administration (FDA) historically (before 2015) established the drug labelling classes (A, B, C, D, and X) to define their safety. Since 2015 this drug classification has been replaced with the "FDA Pregnancy and Lactation Labeling Rule" (PLLR).[1] As well as removing the previous letter classes it has added a new category of #Females and Males of Reproductive Potential.
A 2011 study of USA data from 1976-2008 has shown:[2]
- 6 million pregnancies every year
- 50% of pregnant women reported taking at least one medication
- Pregnant women take an average of 2.6 medications at any time during pregnancy
- First trimester use of prescription medications has increased by more than 60%
- Use of 4 or more medications in the first trimester has tripled (9.9% to 27.6%)
- Small percentage of drugs contraindicated for use in pregnancy or while breast feeding
- contraindicated example include - isotretinoin, mycophenolates
- Drugs Links: Australian Drug Categories | USA Drug Categories | Human Abnormal Development | BGD Tutorial
Some Recent Findings
|
More recent papers |
---|
This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: tFDA Fetal Risk Category |
FDA History
US FDA Historic Background | |
---|---|
Date | Events |
1906 | Food and Drugs Act is passed by Congress and prohibits interstate transportation of misbranded or adulterated foods, drinks, and drugs. |
1927 | Food and Drug Administration Agency is formed and given authority to enforce the Food and Drugs Act. |
1938 | Federal Food, Drug, and Cosmetic (FDC) Act is passed, requiring all drugs to have demonstrated safety prior to marketing. |
1951 | Durham-Humphrey Amendment established the category of prescription drugs and gave the FDA the power to determine if a drug should be prescription-only or over-the-counter. |
1962 | Kefauver-Harris Amendment passed after thalidomide was found to cause birth defects. It requires drug manufacturers to provide stronger evidence of safety and effectiveness prior to FDA approval for marketing. |
1966 | FDA issued requirement for animal studies referred to as “3-Segment Studies” to evaluate safety of drugs. The studies should be designed to address 1) fertility, 2) in utero development, and 3) perinatal and postnatal effects. |
1970 | FDA requires first package insert for women using oral contraceptives. |
1979 | As published in 1980, FDA establishes the ABCDX pregnancy risk categories and requires the packaging label to include one of these categories. |
1993 | FDA revises a policy that excluded women of childbearing potential from being participants in drug trials and requires improved assessments of medication responses specific to gender. |
2007 | New regulations are passed that require all studies of drugs that involve human participants to register with ClinicalTrials.gov.; some drugs to conduct postapproval studies or have a risk evaluation and mitigation strategy to monitor the drug once it is marketed; and package inserts to include contact information for reporting adverse reactions. |
2008 | FDA proposes changing the pregnancy labeling categories. |
2015 | Content and Format of Labeling for Human Prescription Drug and Biologic Products; Requirements for Pregnancy and Lactation Labeling (Final rule 79, FR 72064) is passed and requires the removal of the ABCDX labels from all prescription and biologic product labels and new requirements to include narrative descriptions. |
Table historic data[5] |
US FDA - Historic Drug Categories (pre-2015) | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
FDA Pregnancy and Lactation Labeling Rule
- "The PLLR requires changes to the content and format for information presented in prescription drug labeling in the Physician Labeling Rule (PLR) format to assist health care providers in assessing benefit versus risk and in subsequent counseling of pregnant women and nursing mothers who need to take medication, thus allowing them to make informed and educated decisions for themselves and their children. The PLLR removes pregnancy letter categories – A, B, C, D and X. The PLLR also requires the label to be updated when information becomes outdated."
- Links: Final Rule
Pregnancy Exposure Registry
The USA has is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drugs (by trade name) during pregnancy. The information below is extracted from, and not a complete summary of, PLLR requirements.
Pregnancy Risk Summary
Drugs with systemic absorption
- When use of a drug is contraindicated during pregnancy, that information must be stated first in the Risk Summary
- Risk statement based on human data
- Risk statement based on animal data
- Risk statement based on pharmacology
- Background risk information in general population
- Background risk information in disease population
Risk Based on Animal Data
Systemic drug absorption
There are no adequate and well-controlled studies of [TRADENAME] in pregnant women. The limited available information on [TRADENAME] use during pregnancy is not sufficient to inform a drug-associated risk of major birth defects or miscarriage. In animal reproduction studies, oral administration of [drug name] to pregnant rats and rabbits during the period of organogenesis at doses up to 40 and 20 times the maximum recommended human dose (MRHD), respectively, resulted in decreased fetal body weight gain and delayed skeletal ossification but no teratogenic effects were observed. Decreased fetal body weight and delayed skeletal ossification were not observed at doses up to 10 and 5 times the MRHD in rats and rabbits, respectively [see Data].
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risks of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15- 20%, respectively.
Pregnancy Clinical Considerations
Clinical Considerations (five optional subheadings)
- Disease-Associated Maternal and/or Embryo/Fetal Risk
- Dose Adjustments During Pregnancy and the Post- Partum Period
- Maternal Adverse Reactions
- Fetal/Neonatal Adverse Reactions
- Labor or Delivery
Lactation Risk Summary
Systemic drug absorption
- Presence of drug in milk (if unknown, must state so)
- Concentration in milk
- Actual or estimated infant daily dose
- Effects of drug on the breastfed infant (if unknown, must state so)
- Effects of the drug on milk production (if unknown, must state so)
- Risk/Benefit Statement
Females and Males of Reproductive Potential
Include when there are requirements or recommendations for pregnancy testing and/or contraception and/or when human and/or animal data suggest drug effects on fertility.
Three headings
- Pregnancy Testing
- Contraception
- Infertility
Example of Labelling
Based on its mechanism of action, TRADENAME can cause fetal harm when administered to a pregnant woman [see Use in Specific Populations (8.1)].
Pregnancy Testing
Female patients of reproductive potential should have a negative pregnancy test ...
Contraception
Females
Advise female patients of reproductive potential to use effective contraception during treatment and for at least 2 weeks after the last dose of TRADENAME. Advise patients that TRADENAME can reduce the effectiveness of oral contraceptives and to use alternative effective contraception during treatment with TRADENAME [see Warnings and Precautions (5.x), Drug Interactions (7.x), Clinical Pharmacology (12.x)].
Infertility
Females
Decreased fertility and ovarian toxicity were observed in female rats treated with DRUGNAME. Advise female patients of reproductive potential ...
Males
Effects on spermatogenesis have been observed in animals treated with DRUGNAME. Advise male patients of the potential risk...
Anesthetics
FDA September 2014 - Discussion - anesthetic drugs to infants and young children
References
- ↑ Pernia S & DeMaagd G. (2016). The New Pregnancy and Lactation Labeling Rule. P T , 41, 713-715. PMID: 27904304
- ↑ Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C & Hernández-Díaz S. (2011). Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008. Am. J. Obstet. Gynecol. , 205, 51.e1-8. PMID: 21514558 DOI.
- ↑ <pubmed>24390829</pubmed>
- ↑ <pubmed>23137407</pubmed>
- ↑ Brucker MC & King TL. (2017). The 2015 US Food and Drug Administration Pregnancy and Lactation Labeling Rule. J Midwifery Womens Health , 62, 308-316. PMID: 28556499 DOI.
Search PubMed: US Drug Categories | Drug Categories | teratogenic drugs
External Links
External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.
- FDA Pregnancy and Lactation Labeling Rule
- U.S. Food and Drug Administration FDA
- TOXNET - Databases on toxicology, hazardous chemicals, environmental health, and toxic releases. mobile
Terms
Drug Terms | ||
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Glossary Links
- Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link
Cite this page: Hill, M.A. (2024, April 23) Embryology USA Drug Categories. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/USA_Drug_Categories
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G