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CLINICAL PHARMACOLOGY Lactic acid is an alpha-hydroxy acid. It is a normal constituent of tissues and blood. The alpha-hydroxy acids (and their salts) may act as humectants when applied to the skin. This property may influence hydration of the stratum corneum. In addition, lactic acid, when applied to the skin, may act to decrease corneocyte cohesion. The mechanism(s) by which this is accomplished is not yet known. An in vitro study of percutaneous absorption of Lac-Hydrin (lactic acid) Lotion using human cadaver skin indicates that approximately 5.8% of the material was absorbed after 68 hours.

Find Lowest Prices on Lac-Hydrin® (ammonium lactate) Lotion, 12% For Dermatologic use only. Not for Ophthalmic, Oral or Intravaginal use. DESCRIPTION Lac-Hydrin specially formulates 12% lactic acid, neutralized with ammonium hydroxide, as ammonium lactate to provide a lotion pH of 4.5-5.5. Lac-Hydrin (ammonium lactate) Lotion, 12% also contains cetyl alcohol, fragrance, glycerin, glyceryl stearate, laureth-4, light mineral oil, magnesium aluminum silicate, methylcellulose, methyl- and propylparabens, PEG-100 stearate, polyoxyl 40 stearate, propylene glycol and water. Lactic acid is a racemic mixture of 2-hydroxypropanoic acid and has the following structural formula:

INDICATIONS Lac-Hydrin (lactic acid) is indicated for the treatment of dry, scaly skin (xerosis) and ichthyosis vulgaris and for temporary relief of itching associated with these conditions. DOSAGE AND ADMINISTRATION Shake well. Apply to the affected areas and rub in thoroughly. Use twice daily or as directed by a physician. HOW SUPPLIED Lac-Hydrin® (ammonium lactate) Lotion, 12% is available in a 225g (NDC 0072-5712-08) plastic bottle and a 400g (NDC 0072-5712-14) plastic bottle. Store at controlled room temperature 15°C-30°C (59°F-86°F). Manufactured for: Bristol-Myers Squibb Co. Princeton, NJ 08543 USA. by: Contract Pharmaceuticals Limited Niagara Buffalo, NY 14213 USA. FDA revision date: 11/9/2007

OVERDOSE The oral administration of Lac-Hydrin (lactic acid) to rats and mice showed this drug to be practically non-toxic (LD50>15 mL/kg). CONTRAINDICATIONS Lac-Hydrin (lactic acid) Lotion is contraindicated in those patients with a history of hypersensitivity to any of the label ingredients.

SIDE EFFECTS The most frequent adverse experiences in patients with xerosis are transient stinging (1 in 30 patients), burning (1 in 30 patients), erythema (1 in 50 patients) and peeling (1 in 60 patients). Other adverse reactions which occur less frequently are irritation, eczema, petechiae, dryness and hyperpigmentation. Due to the more severe initial skin conditions associated with ichthyosis, there was a higher incidence of transient stinging, burning and erythema (each occurring in 1 in 10 patients). DRUG INTERACTIONS No information provided.

WARNINGS Sun exposure to areas of the skin treated with Lac-Hydrin (ammonium lactate) Lotion, 12% should be minimized or avoided (see PRECAUTIONS). The use of Lac-Hydrin (lactic acid) Lotion should be discontinued if hypersensitivity is observed. PRECAUTIONS General For external use only. Stinging or burning may occur when applied to skin with fissures, erosions or that is otherwise abraded (for example, after shaving the legs). Caution is advised when used on the face because of the potential for irritation. The potential for post-inflammatory hypo- or hyperpigmentation has not been studied. Carcinogenesis, Mutagenesis, Impairment of Fertility The topical treatment of CD-1 mice with 12%, 21% or 30% ammonium lactate formulations for two years did not produce a significant increase in dermal or systemic tumors in the absence of increased exposure to ultraviolet radiation. The maximum systemic exposure of the mice in this study was 0.7 times the maximum possible systemic exposure in humans. However, a long-term photocarcinogenicity study in hairless albino mice suggested that topically applied 12% ammonium lactate formulations enhanced the rate of ultraviolet light-induced skin tumor formation. The mutagenic potential of ammonium lactate formulations was evaluated in the Ames assay and in the mousein vivo micronucleus assay, both of which were negative. In dermal Segment I and III studies with ammonium lactate formulations there were no effects observed in fertility or pre- or post-natal development parameters in rats at dose levels of 300 mg/kg/day (1800 mg/m²/day), approximately 0.4 times the human topical dose. Pregnancy Teratogenic Effects: Pregnancy Category B Animal reproduction studies have been performed in rats and rabbits at doses up to 0.7 and 1.5 times the human dose, respectively (600 mg/kg/day, corresponding to 3600 mg/m²/day in the rat and 7200 mg/m²/day in the rabbit) and have revealed no evidence of impaired fertility or harm to the fetus due to ammonium lactate formulations. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Lac-Hydrin (lactic acid) Lotion should be used during pregnancy only if clearly needed. Nursing Mothers Although lactic acid is a normal constituent of blood and tissues, it is not known to what extent this drug affects normal lactic acid levels in human milk. Because many drugs are excreted in human milk, caution should be exercised when Lac-Hydrin (lactic acid) is administered to a nursing woman. Pediatric Use Safety and effectiveness of Lac-Hydrin (lactic acid) have been demonstrated in infants and children. No unusual toxic effects were reported. Geriatric Use Clinical studies of Lac-Hydrin (ammonium lactate) Lotion, 12% did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious.