METROGEL

1 INDICATIONS AND USAGE METROGEL, 1% is indicated for the topical treatment of inflammatory lesions of rosacea. METROGEL, 1% is a nitroimidazole indicated for the topical treatment of inflammatory lesions of rosacea. ( 1 )

2 DOSAGE AND ADMINISTRATION Cleanse treated areas before the application of METROGEL. Apply and rub in a thin film of METROGEL once daily to affected area(s). Cosmetics may be applied after the application of METROGEL. For topical use only, not for oral, ophthalmic, or intravaginal use. Cleanse treated areas before the application of METROGEL. ( 2 ) Apply and rub in a thin film of METROGEL once daily to affected area(s). ( 2 ) Cosmetics may be applied after the application of METROGEL. ( 2 ) Not for oral, ophthalmic, or intravaginal use. ( 2 )

4 CONTRAINDICATIONS METROGEL is contraindicated in patients with a history of hypersensitivity to metronidazole or to any other ingredient in the formulation. METROGEL is contraindicated in those patients with a history of hypersensitivity to metronidazole or to any other ingredient in this formulation. ( 4 )

5 WARNINGS AND PRECAUTIONS Neurologic Disease : Peripheral neuropathy, characterized by numbness or paresthesia of an extremity has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediate reevaluate METROGEL therapy if abnormal neurologic signs appear. (5.1) Blood Dyscrasias : METROGEL is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia. (5.2) Contact Dermatitis : If dermatitis occurs, patients may need to discontinue use. ( 5.3 ) Eye Irritation : Topical metronidazole has been reported to cause tearing of the eyes. Avoid contact with the eyes. ( 5.4 ) 5.1 Neurologic Disease Peripheral neuropathy, characterized by numbness or paresthesia of an extremity, has been reported in patients treated with systemic metronidazole. Peripheral neuropathy has been reported with the post approval use of topical metronidazole. Immediately reevaluate METROGEL therapy if abnormal neurologic signs appear. Administer metronidazole with caution to patients with central nervous system diseases. 5.2 Blood Dyscrasias METROGEL is a nitroimidazole; use with care in patients with evidence of, or history of, blood dyscrasia. 5.3 Contact Dermatitis Irritant and allergic contact dermatitis have been reported with METROGEL. If dermatitis occurs, patients may need to discontinue use. 5.4 Eye Irritation Topical metronidazole has been reported to cause tearing of the eyes. Avoid contact with the eyes.

7 DRUG INTERACTIONS Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when prescribing for patients who are receiving anticoagulant treatment. Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin, resulting in a prolongation of prothrombin time. Use caution when administering METROGEL concomitantly to patients who are receiving anticoagulant treatment. ( 7 )

6 ADVERSE REACTIONS The following clinically significant adverse reactions are described elsewhere in the labeling: Neurologic Disease [ see Warnings and Precautions ( 5.1 ) ] Contact Dermatitis [ see Warnings and Precautions ( 5.3 ) ] Eye Irritation [ see Warnings and Precautions ( 5.4 ) ] Most common adverse reactions (incidence > 2%) are nasopharyngitis, upper respiratory tract infection, and headache. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Galderma Laboratories, L.P. at 1-866-735-4137, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates 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 practice. In a controlled clinical trial, 557 subjects used METROGEL and 189 subjects used the gel vehicle once daily for up to 10 weeks. The following table summarizes selected adverse reactions that occurred at a rate of ≥1% and at a higher rate than vehicle: Table 1: Adverse Reactions That Occurred at a Rate of ≥1% and Higher Than Vehicle in Subjects Treated with METROGEL for Up to 10 Weeks Preferred Term METROGEL Vehicle (N= 557) N (%) (N= 189) N (%) Influenza 8 (1.4) 1 (0.5) Upper respiratory tract infection 14 (2.5) 4 (2.1) Urinary tract infection 6 (1.1) 1 (0.5) Headache 12 (2.2) 1 (0.5) Contact dermatitis 7 (1.3) 1 (0.5) Hypertension 6 (1.1) 1 (0.5) Table 2:Local Cutaneous Signs and Symptoms of Irritation That Were Worse Than Baseline in Subjects Treated with METROGEL for Up to 10 Weeks METROGEL Vehicle Sign/Symptom (N= 544) N (%) (N= 184) N (%) Dryness 138 (25.4) 63 (34.2) Mild 93 (17.1) 41 (22.3) Moderate 42 (7.7) 20 (10.9) Severe 3 (0.6) 2 (1.1) Scaling 134 (24.6) 60 (32.6) Mild 88 (16.2) 32 (17.4) Moderate 43 (7.9) 27 (14.7) Severe 3 (0.6) 1 (0.5) Pruritus 86 (15.8) 35 (19.0) Mild 53 (9.7) 21 (11.4) Moderate 27 (5.0) 13 (7.1) Severe 6 (1.1) 1 (0.5) Stinging/burning 56 (10.3) 28 (15.2) Mild 39 (7.2) 18 (9.8) Moderate 7 (1.3) 9 (4.9) Severe 10 (1.8) 1 (0.5) The following additional adverse reactions have been reported with the topical use of metronidazole: transient redness, metallic taste, tingling or numbness of extremities, and nausea. 6.2 Post Marketing Experience The following adverse reaction has been identified during post-approval use of topical metronidazole. Because this reaction is reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate the frequency or establish a causal relationship to drug exposure. Nervous System Disorders: Peripheral neuropathy Ophthalmic Adverse Reactions: Tearing of the eyes

8.1 Pregnancy Risk Summary Available data have not established an association between metronidazole use during pregnancy and major birth defects, miscarriage or other adverse maternal or fetal outcomes. No fetotoxicity was observed after oral administration of metronidazole in pregnant rats or mice. The available data do not allow the calculation of relevant comparisons between the systemic exposures of metronidazole observed in animal studies to the systemic exposures that would be expected in humans after topical use of METROGEL. The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.