IMPORTANT SAFETY INFORMATION
QBRELIS® (lisinopril) Oral Solution, 1 mg/mL
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When pregnancy is detected, discontinue QBRELIS as soon as possible
(5.1).
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Drugs that act directly on the renin-angiotensin system can cause
injury and death to the developing fetus (5.1).
INDICATIONS:
QBRELIS is an angiotensin-converting enzyme (ACE) inhibitor indicated for:
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Treatment of hypertension in adult patients and pediatric patients 6
years of age and older to lower blood pressure (BP). Lowering BP
decreases the risk of fatal and nonfatal cardiovascular events,
primarily strokes and myocardial infarctions (MI).
- Reduction of signs and symptoms of systolic heart failure.
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Reduction of mortality in treatment of hemodynamically stable patients
within 24 hours of acute MI. Patients should receive, as appropriate,
the standard recommended treatments such as thrombolytics, aspirin, and
beta-blockers.
ADDITIONAL IMPORTANT SAFETY INFORMATION:
Contraindications:
QBRELIS is contraindicated in patients who are hypersensitive to
lisinopril or any component of QBRELIS, or in patients with a history of
hypersensitivity related to previous ACE inhibitor treatment.
QBRELIS is contraindicated in patients with hereditary or idiopathic
angioedema.
Do not co-administer aliskiren with Qbrelis in patients with diabetes.
QBRELIS is contraindicated in combination with a neprilysin inhibitor
(e.g., sacubitril). Do not administer QBRELIS within 36 hours of switching
to or from sacubitril/valsartan.
Warnings and Precautions:
Head and Neck Angioedema: Angioedema of the face, extremities, lips,
tongue, glottis, and/or larynx, including some fatal reactions, have
occurred in patients treated with ACE inhibitors, including QBRELIS, at
any time during treatment. Patients with a history of angioedema unrelated
to ACE inhibitor therapy may be at increased risk of angioedema while
receiving an ACE inhibitor. ACE inhibitors have been associated with a
higher rate of angioedema in Black than non-Black patients.
Intestinal angioedema has been reported with ACE inhibitors. Discontinue
QBRELIS and obtain appropriate therapy.
Anaphylactoid Reactions: Sudden and potentially life-threatening
anaphylactoid reactions have occurred in some patients dialyzed with
high-flux membranes treated concomitantly with an ACE inhibitor. In such
patients, dialysis must be stopped immediately, and aggressive therapy for
anaphylactoid reactions must be initiated. Symptoms have not been relieved
by antihistamines in these situations. In these patients, consideration
should be given to using a different type of dialysis membrane or a
different class of antihypertensive agent. Anaphylactoid reactions have
also been reported in patients undergoing low-density lipoprotein
apheresis with dextran sulfate absorption and in patients undergoing
desensitizing treatment with hymenoptera venom.
Impaired Renal Function: Monitor renal function in patients treated with
QBRELIS. Changes in renal function, including acute renal failure, can be
caused by drugs that inhibit the renin-angiotensin system (RAS). Patients
whose renal function may depend in part on the activity of the RAS (e.g.,
patients with renal artery stenosis, chronic kidney disease, severe
congestive heart failure, post-MI or volume depletion) may be at
particular risk of developing acute renal failure on QBRELIS. Consider
withholding or discontinuing therapy in patients who develop a clinically
significant decrease in renal function on QBRELIS.
Hypotension: QBRELIS can cause symptomatic hypotension, sometimes
complicated by oliguria, progressive azotemia, acute renal failure, or
death. QBRELIS should be started under close medical supervision and
followed closely for the first 2 weeks of treatment and whenever the dose
of QBRELIS and/or a diuretic is increased. Avoid the use of QBRELIS in
hemodynamically unstable patients after acute MI.
Surgery/Anesthesia: In patients undergoing major surgery or during
anesthesia with agents that produce hypotension, QBRELIS may block
angiotensin II formation secondary to compensatory renin release. If
hypotension occurs and it is considered to be due to this mechanism, it
can be corrected by volume expansion.
Hyperkalemia: Serum potassium should be monitored in patients receiving
QBRELIS. Drugs that inhibit the renin-angiotensin system can cause
hyperkalemia. Risk factors for the development of hyperkalemia include
renal insufficiency, diabetes mellitus, and the concomitant use of
potassium-sparing diuretics, potassium supplements, and/or
potassium-containing salt substitutes.
Hepatic Failure: ACE inhibitors have been associated with a syndrome that
starts with cholestatic jaundice and progresses to fulminant hepatic
necrosis and sometimes death. If jaundice or marked elevations of hepatic
enzymes develop, discontinue the ACE inhibitor and receive appropriate
medical treatment.
Adverse Reactions:
See Full Prescribing Information for additional Adverse Reactions (6).
Common adverse reactions where rate on lisinopril exceeds the rate on
placebo by at least 2% by use are:
- Hypertension: headache, dizziness, and cough.
- Systolic heart failure: hypotension and chest pain.
- Acute MI: hypotension and renal dysfunction.
Drug Interactions:
Initiation of QBRELIS in patients on diuretics may result in excessive
reduction of blood pressure. This can be minimized by either decreasing or
discontinuing the diuretic or increasing salt intake prior to initiating
QBRELIS treatment.
QBRELIS attenuates potassium loss caused by thiazide-type diuretics. If
concomitant use of such agents is indicated, monitor the patient’s serum
potassium frequently.
Concomitant administration of QBRELIS and antidiabetic medicines may cause
an increased blood-glucose-lowering effect.
In patients who are elderly, volume-depleted (including those on diuretic
therapy), or with compromised renal function, use of non-steroidal
anti-inflammatory agents (NSAIDs), including selective cyclooxygenase-2
(COX-2) inhibitors, with ACE inhibitors, including lisinopril, may result
in deterioration of renal function, including possible acute renal
failure. Monitor renal function periodically in patients receiving
lisinopril and NSAID therapy.
Dual Inhibition of the Renin-Angiotensin System (RAS): Dual blockade of
the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren
is associated with increased risks of hypotension, hyperkalemia, and
changes in renal function (including acute renal failure), compared to
monotherapy. Closely monitor BP, renal function and electrolytes in
patients receiving QBRELIS and agents that effect the RAS.
Avoid use of aliskiren with QBRELIS in patients with renal impairment.
Lithium toxicity has been reported in patients receiving lithium
concomitantly with drugs that cause elimination of sodium, including ACE
inhibitors. It is usually reversible upon discontinuation of lithium and
the ACE inhibitor. Monitor serum lithium levels during concurrent use.
Nitritoid reactions have been reported rarely in patients with injectable
gold (sodium aurothiomalate) and concomitant lisinopril therapy.
mTOR or neprilysin inhibitors: Patients receiving coadministration of an
ACE inhibitor and a mTOR inhibitor (e.g., temsirolimus, sirolimus,
everolimus) or a neprilysin inhibitor (e.g., sacubitril) may be at
increased risk for angioedema.
Use in Specific Populations:
See Full Prescribing Information for Additional Information (8).
Pregnancy
QBRELIS can cause fetal
harm.
See Full Prescribing Information for Additional Information (5.1,
8.1).
Lactation
Because of the potential for
severe adverse reactions in the breastfed infant, advise women not to
breastfeed while taking QBRELIS.
Pediatric Use
QBRELIS is not
recommended in children under the age of 6 years or in pediatric patients
with glomerular filtration rate < 30 mL/min/1.73m2.
This Important Safety Information does not include all the information
needed to use QBRELIS safely and effectively. Visit
QBRELIS.com
for
Full Prescribing Information.
To report SUSPECTED ADVERSE REACTIONS, contact Azurity Pharmaceuticals,
Inc. at
1-800-461-7449 or FDA at
1-800-FDA-1088 or
www.fda.gov/MedWatch.
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FDA-7.2