Prescription Drugs

CLINICAL PHARMACOLOGY Mechanism of Action The miconazole component of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is an antifungal agent. The mechanism of action of white petrolatum and zinc oxide for the adjunctive treatment of diaper dermatitis is unknown. Pharmacodynamics The human pharmacodynamics of Vusion (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is unknown [see CLINICAL PHARMACOLOGY for fungal pharmacodynamics]. Pharmacokinetics The topical absorption of miconazole from VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) was studied in immunocompetent male and female infants and children (n=17) with diaper dermatitis complicated by documented candidiasis (microscopic evidence of pseudohyphae and/or budding yeast) ranging in age from 1 month to 21 months. After multiple daily applications to the affected area at every diaper change (approximately 5-12 times per day) for 7 days, the plasma concentrations of miconazole were below the lower limit of quantitation (LOQ) of 0.5 ng/mL in 15 out of 17 (88%) subjects. In the other 2 remaining subjects, the plasma concentrations of miconazole were 0.57 and 0.58 ng/mL, respectively at a single timepoint (4 hours after the last application) on Day 7. Microbiology The miconazole nitrate component in this product has been shown to have in vitro activity against Candida albicans, an organism that is associated with diaper dermatitis. The activity of miconazole nitrate against C. albicans is based on the inhibition of the ergosterol biosynthesis in the cell membrane. The accumulation of ergosterol precursors and toxic peroxides results in cytolysis of the cell. In vitro minimal inhibitory concentration (MIC) test results for C. albicans isolates obtained from treatment failures in Clinical Study 1 (see Clinical Studies) does not appear to indicate that resistance to miconazole nitrate was the reason for treatment failure. The clinical significance of the in vitro activity of miconazole nitrate against C. albicans in the setting of diaper dermatitis is unclear. Clinical Studies Study 1 was a double-blind, multicenter study in which VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) was compared to the zinc oxide and white petrolatum combination treatment and included 236 infants and toddlers with diaper dermatitis, complicated by candidiasis as documented by KOH tests that demonstrated psuedohyphae and/or budding yeasts. Study medication was applied at every diaper change for 7 days. The primary endpoint was “Overall Cure” and required that subjects be both clinically cured (total resolution of all signs and symptoms of infection) and microbiologically cured (eradication of candidiasis). Primary efficacy was assessed 1 week following the end of treatment, at Day 14. Study results are shown in the following table. Overall Cure at Day 14 VUSION n=112 Zinc Oxide/White Petrolatum n=124 26 (23%) 12 (10%) Two additional studies provided supportive evidence of the clinical efficacy of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) in infants and toddlers with diaper dermatitis, some of whom cultured positive for C. albicans. However, candidal infection was not documented in the culture-positive subjects, as microscopic testing (e.g. KOH) was not done. Therefore, the positive culture results may have reflected colonization rather than infection.

Find Lowest Prices on VUSION® (miconazole nitrate, zinc oxide, and white petrolatum) Ointment, for Topical Use Only DESCRIPTION VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) contains the synthetic antifungal agent, miconazole nitrate (0.25%) USP, zinc oxide (15%) USP, and white petrolatum (81.35%) USP. The chemical name of miconazole nitrate is 1-[2, 4-dichloro-β-{(2,4-dichlorobenzyl)oxy} phenethyl] imidazole mononitrate with empirical formula C18H14Cl4N2O•HNO3 and molecular weight of 479.15. The structural formula of miconazole nitrate is as follows: The zinc oxide has an empirical formula of ZnO and a molecular weight of 81.39. The white petrolatum, which is obtained from petroleum and is wholly or nearly decolorized, is a purified mixture of semisolid saturated hydrocarbons having the general chemical formula CnH2n+2. The hydrocarbons consist mainly of branched and unbranched chains. White petrolatum contains butylated hydroxytoluene (BHT) as stabilizer. Each gram of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) contains 2.5 mg of miconazole nitrate USP, 150 mg of zinc oxide USP, and 813.5 mg of white petrolatum USP containing butylated hydroxytoluene, trihydroxystearin, and Chemoderm® 1001/B fragrance.1 VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is a smooth, uniform, white ointment.

INDICATIONS Indication VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) Ointment is indicated for the adjunctive treatment of diaper dermatitis only when complicated by documented candidiasis (microscopic evidence of pseudohyphae and/or budding yeast), in immunocompetent pediatric patients 4 weeks and older. A positive fungal culture for Candida albicans is not adequate evidence of candidal infection since colonization with C. albicans can result in a positive culture. The presence of candidal infection should be established by microscopic evaluation prior to initiating treatment. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should be used as part of a treatment regimen that includes measures directed at the underlying diaper dermatitis, including gentle cleansing of the diaper area and frequent diaper changes. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used as a substitute for frequent diaper changes. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used to prevent the occurrence of diaper dermatitis, since preventative use may result in the development of drug resistance. Limitations of Use The safety and efficacy of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) have not been demonstrated in immunocompromised patients, or in infants less than 4 weeks of age (premature or term). The safety and efficacy of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) have not been evaluated in incontinent adult patients. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used to prevent the occurrence of diaper dermatitis, such as in an adult institutional setting, since preventative use may result in the development of drug resistance. DOSAGE AND ADMINISTRATION VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is not for oral, ophthalmic, or intravaginal use. Before applying VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) , gently cleanse the skin with lukewarm water and pat dry with a soft towel. Avoid using any scented soaps, shampoos, or lotions on the diaper area. Apply VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) to the affected area at each diaper change for 7 days. Continue treatment for the full 7 days, even if there is improvement. The safety of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) when used for longer than 7 days is not known. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) for longer than 7 days. If symptoms have not improved by day 7, see your health care provider. Gently apply a thin layer of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) to the diaper area with the fingertips. Do not rub VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) into the skin as this may cause additional irritation. Thoroughly wash hands after applying VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . HOW SUPPLIED Dosage Forms And Strengths White ointment containing 0.25% miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is a smooth, uniform, white ointment supplied in an aluminum tube, as follows: 50g (NDC 0145-0002-04) Storage Conditions Store at controlled room temperature between 20°C and 25°C (68°F and 77°F); with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep out of reach of children. Manufactured for: Stiefel Laboratories, Inc. Coral Gables, FL 33134 USA. Manufactured by: DSM Pharmaceuticals, Inc. Greenville, NC 27834. Revised March 2010

PATIENT INFORMATION VUSION® (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) (Vu-sion) Ointment (0.25% miconazole nitrate, 15% zinc oxide and 81.35% white petrolatum) IMPORTANT: For Skin Use Only. Do not use in the mouth, eyes, or vagina. Read the Patient Information that comes with VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) before you use it on your child. This leaflet does not take the place of talking to your health care provider about your child's medical condition or treatment. If you have any questions or if you are not sure about any of the information on VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) , ask your health care provider, or pharmacist. What is VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) ? VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is a prescription skin medicine used to treat diaper rash that also has a yeast infection in children who are at least 4 weeks old and who have a normal immune system. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) contains medicines that will help treat the yeast infection and the diaper rash, but you must also change your child's diapers very often so that your child is not wearing a wet or soiled diaper. Even if you use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) , diaper rash will not go away if you do not keep your child's diaper area clean and dry. You should use water or a very mild cleanser to clean your child's diaper area. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is not to be used to prevent diaper rash or to be used for more than 7 days. Your health care provider will need to do a special test to tell if your child's diaper rash also has a yeast infection. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) on your child's diaper rash unless your health care provider tells you that there is also a yeast infection. Who should not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) ? VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is not for treatment of all cases of diaper rash. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is only for diaper rash that also has a yeast infection. Most cases of diaper rash do not need the yeast medicine that is in VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) because most cases of diaper rash do not also have a yeast infection. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) on any other children or other family member. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) on your child's diaper rash if they are allergic to anything in it. See the end of this leaflet for a list of ingredients in VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . Do not use on infants less than 4 weeks of age. Do not use in infants or children who do not have a normal immune system. How should I use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) on my child? VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is applied to the skin on your child's diaper area at each diaper change for 7 days. Apply VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) for the full 7 days even if the diaper rash starts to go away. Call your child's health care provider if the diaper rash gets worse or does not go away with 7 days of treatment with VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used for more than 7 days. To apply VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) : Gently, clean the skin on your child's diaper area with warm (not hot) water. You may also use a very mild soap. Pat the area dry with a soft towel. Use your fingertips and gently apply a thin layer of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) to your child's diaper area at each diaper change. Do not rub VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) into your child's skin. Rubbing the skin can cause more irritation. Wash your hands after applying VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) on your child. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is for skin use only. Call your child's health care provider or poison control center right away if any VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is swallowed. Call your child's health care provider if VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) gets in the eye. Keep out of reach of children. What other steps will help diaper rash go away? Check your child's diaper often. Change the diaper at the first sign of wetness. Clean your child's diaper area after each diaper change. Gently wipe the diaper area from the front to back using warm (not hot) water. You may also use a mild soap. Rinse the diaper area well. Pat dry with a soft towel. Keep the diaper area open to air when possible. Even if you use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) , diaper rash will not go away if you do not keep your child's diaper area clean and dry. What are the possible side effects of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) ? VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) may cause irritation. You should call your child's health care provider if irritation appears or if the diaper rash gets worse. How should I store VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) ? Keep VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) out of the reach of children to avoid the risk of accidental ingestion. Store VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) at room temperature between 68°F to 77°F (20°C to 25°C). General information about VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) for a condition for which it was not prescribed. Do not give VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) to other children or family members, even if they have the same symptoms your child has. It may harm them. This leaflet summarizes the most important information about VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . If you would like more information, talk to your child's health care provider. You can ask your child's health care provider or pharmacist for information about VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) that is written for healthcare professionals. Side effects may be reported to Stiefel Laboratories, Inc. at 1-866-440-5508 or the FDA at 1-800-FDA-1088. What are the ingredients in VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) ? Active Ingredients: miconazole nitrate, zinc oxide, and white petrolatum Inactive Ingredients: trihydroxystearin, butylated hydroxyltoluene (BHT), and Chemoderm® 1001/B fragrance This Patient Information leaflet has been approved by the U.S. Food and Drug Administration. The Patient Information leaflet was last revised: January 2010.

OVERDOSE No information provided. CONTRAINDICATIONS None

SIDE EFFECTS Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rate observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. A total of 835 infants and young children were evaluated in the clinical development program. Of 418 subjects in the VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) group, 58 (14%) reported one or more adverse events. Of 417 subjects in the zinc oxide/white petrolatum control group, 85 (20%) reported one or more adverse events. Adverse events that occurred at a rate of ≥ 1% for subjects who were treated with VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) were approximately the same in type and frequency as for subjects who were treated with zinc oxide/white petrolatum ointment. Post-marketing Experience The following adverse reactions have been identified during post approval use of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . Gastrointestinal Disorders: vomiting General Disorders and Administration site Conditions: burning sensation, condition aggravated, inflammation, pain Injury, Poisoning and Procedural Complications: accidental exposure Skin and Subcutaneous Tissue Disorders: blister, dermatitis contact, diaper dermatitis, dry skin, erythema, pruritus, rash, skin exfoliation Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. DRUG INTERACTIONS Drug-drug interaction studies were not conducted. Women who take a warfarin anticoagulant and use a miconazole intravaginal cream or suppository may be at risk for developing an increased prothrombin time, international normalized ratio (INR), and bleeding. The potential for this interaction between warfarin and VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is unknown.

WARNINGS Included as part of the PRECAUTIONS section. PRECAUTIONS If irritation occurs or if the disease worsens, discontinue use of the medication, and contact the health care provider. The safety and efficacy of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) have not been evaluated in incontinent adult patients. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used to prevent the occurrence of diaper dermatitis, such as in an adult institutional setting, since preventative use may result in the development of drug resistance. Patient Counseling Information See FDA-Approved Patient Labeling Patients using VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should be informed about the following information: VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is to be used only for diaper dermatitis that is complicated by documented candidiasis (i.e. documented by microscopic testing). VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used as a substitute for frequent diaper changes. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used to prevent diaper dermatitis. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used long term. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should be used only as directed by the health care provider. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) is for external use only. It is not for oral, ophthalmic, or intravaginal use. Gently cleanse the diaper area with lukewarm water or a very mild soap and pat the area dry with a soft towel before applying VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . Gently apply VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) to the diaper area with the fingertips after each diaper change. Do not rub VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) into the skin as this may cause additional irritation. Thoroughly wash hands after applying VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) . Treatment should be continued for 7 days, even if there is improvement. Do not use VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) for longer than 7 days. If symptoms have not improved by day 7, see your health care provider. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used on children for whom it is not prescribed. Nonclinical Toxicology Carcinogenesis, Mutagenesis, Impairment of Fertility The carcinogenic potential of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) in animals has not been evaluated. Miconazole nitrate was negative in a bacterial reverse mutation test, a chromosome aberration test in mice, and micronucleus assays in mice and rats. Miconazole nitrate had no adverse effect on fertility in a study in rats at oral doses of up to 320 mg/kg/day, which is 89 times the maximum possible topical exposure of caregivers, assuming 100% absorption. Use In Specific Populations Pregnancy Pregnancy Category C: There are no adequate and well-controlled studies of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) in pregnant women. Therefore, VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Miconazole nitrate administration has been shown to result in prolonged gestation and decreased numbers of live young in rats and in increased number of resorptions and decreased number of live young in rabbits at oral doses of 100 mg/kg/day and 80 mg/kg/day, which are 28 and 45 times the maximum possible topical exposure of caregivers, respectively, assuming 100% absorption. Nursing Mothers Safety and efficacy of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) have not been established in nursing mothers. It is not known if the active components of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) may be present in milk. Pediatric Use Efficacy was not demonstrated in infants less than 4 weeks of age. Safety and efficacy have not been established in very-low-birth-weight infants. VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) should not be used to prevent diaper dermatitis. The safety of VUSION (miconazole nitrate, 15% zinc oxide, and 81.35% white petrolatum) when used for longer than 7 days is not known. Do not use more than 7 days. Geriatric Use Safety and efficacy in a geriatric population have not been evaluated.