SALICYLIC ACID

Acella Pharmaceuticals, LLC

Salicylic Acid 6% Foam

FULL PRESCRIBING INFORMATION

DESCRIPTION

Salicylic Acid 6% Foam is applied topically and used in the removal of excessive keratin in hyperkeratotic skin disorders. Each gram of Salicylic Acid 6% Foam contains salicylic
acid 6% as the active ingredient, and the following inactive ingredients: dimethicone, ethylparaben, glycerin, methylcellulose, methylparaben, phenoxyethanol, polyoxyl 40 stearate,
polysorbate 20, polysorbate 80, povidone, propylene glycol, propylparaben, purified water, sodium citrate, sodium hydroxide, stearic acid and trolamine and in propellants butane
and propane.

CHEMICAL STRUCTURE

Salicylic acid is a 2-hydroxy derivative of benzoic acid having the following chemical structure:

Salicylic acid has been shown to produce desquamation of the horny layer of skin while not affecting qualitative or quantitative changes in structure of the viable epidermis. The
mechanism of action has been attributed to dissolution of intercellular cement substance. In a study of the percutaneous absorption of salicylic acid from Salicylic Acid 6% Foam in
four patients with extensive active psoriasis, Taylor and Halprin showed that peak serum levels never exceeded 5 mg/100 mL even though more than 60% of the applied salicylic
acid was absorbed. Systemic toxic reactions are usually associated with much higher serum leverls (30 to 40 mg/100mL). Peak serum levels occurred within 5 hours of the topical
application under occlusion. The sites were occluded for 10 hours over the entire body surface below the neck. Since salicylates are distributed in the extracellular space, patients
with a contracted extracellular space due to dehydration or diuretics have higher salicylate levels than those with a normal extracellular space. (See PRECAUTIONS).
The major metabolites identified in the urine after topical administration are salicyluric acid (52%), salicylate glucuronides (42%), and free salicylic acid (6%). The urinary
metabolites after percutaneous absorption differ from those after oral salicylate administration; those derived from percutaneous absorption contain more glucuronides and less
salicyluric and salicylic acid. Almost 95% of a single dose of salicylate is excreted within 24 hours of its entrance into the extracellular space.
Fifty to eighty percent of salicylate is protein bound to albumin. Salicylates compete with the binding of several drugs and can modify the action of these drugs. By similar
competetive mechanisms other drugs can influence the serum levels of salicylate. (See PRECAUTIONS).

The mechanism of action of topically applied salicylic acid has been attributed to the dissolution of intercellular cement substance.

Uses

INDICATIONS AND USAGE

For Dermatologic Use: Salicylic Acid 6% Foam is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders, including verrucae and the various ichthyoses,
keratosis palmaris and plantaris, keratosis pilaris, pityriasis rubra pilaris and psoriasis.

For Podiatric Use: Salicylic Acid 6% Foam is a topical aid in the removal of excessive keratin on dorsal and plantar hyperkeratotic lesions.

CONTRAINDICATIONS

Salicylic Acid 6% Foam should not be used in any patient known to be sensitive to salicylic acid or any other listed ingredients. Salicylic Acid 6% Foam should not be used in
children under 2 years of age.

WARNINGS

Salicylic Acid 6% Foam is for external use only. It is not for ophthalmic, oral, anal or intravaginal use. Contact with eyes, lips, broken or inflamed skin, and all mucous membranes
should be avoided. Salicylic Acid 6% Foam should not be used by persons who have a known hypersensitivity to salicylic acid or any of the other listed ingredients.
Prolonged use over large areas, especially in children and those patients with significant renal or hepatic impairment could result in salicylism. Concomitant use of other drugs
which may contribute to elevated serum salicylate levels should be avoided where the potential for toxicity is present. In children under 12 years of age and those patients with renal
or hepatic impairment, the area to be treated should be limited and the patient monitored closely for signs of salicylate toxicity: nausea, vomiting, dizziness, loss of hearing, tinnitus,
lethargy, hyperpnoea, diarrhea, psychic disturbances. In the event of salicylic acid toxicity, the use of Salicylic Acid 6% Foam should be discontinued. Fluids should be administered
to promote urinary excretion. Treatment with sodium bicarbonate (oral or intravenous) should be instituted as appropriate.
Condidering the potential of developing Reye’s syndrome, salicylate products should not be administered to children or teenagers with varicella or influenza, unless directed by a
physician.

PRECAUTIONS 
Salicylic Acid 6% Foam should be used only as directed by a physician and should not be used to treat any condition other than that for which it is prescribed. Salicylic Acid 6%
Foam should not be used on any skin area where inflammation or exudation is present as increased absorption may occur. If redness or irritation occurs, discontinue use and
consult with prescribing physician.

DRUG INTERACTIONS

(The following interactions are from a published review and include reports concerning both oral and topical salicylate administration. The relationship of these
interactions to the use of Salicylic Acid 6% Foam is not known.)
I.    Due to the competition of salicylate with other drugs for binding to serum albumin, the following drug interactions may occur:

Drug                                                                Description of Interaction
Tolbutamide; Sulfonylureas                        Hypoglycemia potentiated
Methotrexate                                                  Decrease tubular reabsorption; clinical toxicity from methotrexate can result
Oral Anticoagulants                                       Increased bleeding

II.   Drugs changing salicylate levels by altering renal tubular reabsorption:

Drug                                        Description
Corticosteroids                      Decreases plasma salicylate level; tapering doses of steroids may promote salicylism
Ammonium Sulfate                Increases plasma salicylate level

The following alterations of laboratory tests have been reported during salicylate therapy:
                 Laboratory Tests                                                               Effect of Salicylates

                   Thyroid Function                                                                                      Decreased PBI; increased T3 uptake

                    Urinary Sugar                                                                                         False negative with glucose oxidase; false positive with Clinitest with high-dose salicylat
                                                                                                                                 therapy (2 - 5 g qd)                                                                                                                    
                    5 Hydroxyindole Acetic Acid                                                                    False negative with fluorometric test

                   Acetone, Ketone Bodies                                                                           False positive FeCl3 in Gerhardt reaction; red color persists with boiling

                   17-OH Corticosteroids                                                                              False reduced values with >4.8 g qd salicylate

                    Vanilmandelic Acid                                                                                 False reduced values

                    Uric Acid                                                                                                May increase or decrease depending on dose

                    Prothrombin                                                                                            Decreased levels; slightly increased prothrombin time

Pregnancy (Category C) - Orally administered salicylic acid has been shown to be teratogenic in rats and monkeys. It is difficult to extrapolate from oral doses of acetylsalicylic acid
used in these studies to topical administration as the oral dose to monkeys may represent 4 times the maximum daily human dose of salicylic acid (as supplied in one tube, 40 g of
Salicylic Acid 6% Gel) when applied topically over a large body surface. There are no adequate and well-controlled studies in pregnant women. Salicylic Acid 6% Foam should be
used during pregnancy only if the potential benefit justifies the risk to the fetus.

Nursing Mothers - It is not known whether topically applied salicylic acid is excreted in human milk. Due to the fact that many drugs are excreted in human milk, caution should be
exercised by physicians when administering Salicylic Acid 6% Foam to nursing mothers and nursing mothers should certainly not apply Salicylic Acid 6% Foam to the chest area or
any other part of the body with which the nursing child’s mouth is likely to come in contact.
Because of the potential for serious advers reactions in nursing infants from the mother’s use of Salicylic Acid 6% Foam, a decision should be made whether to discontinue nursing
or to discontinue the drug, taking into account the importance of the drug to the mother.

 No data are available concerning the potential carcinogenic or reproductive effects of Salicylic Acid 6% Foam. It has been
shown to lack mutagenic potential in the Ames Salmonella test.

Transient stinging, burning, itching or irritation is possible. Peeling of the skin may increase as the salicylic acid works to loosen excess keratin. If excessive burning, stinging or
peeling occurs, discontinue use and consult a physician.

Unless otherwise directed by a prescribing physician, Salicylic Acid 6% Foam should be applied to the affected area twice a day. Salicylic Acid 6% Foam should be rubbed into the
skin until it is completely absorbed.

Salicylic Acid 6% Foam should be shaken vigorously before each application and inverted to administer.

Salicylic Acid 6% Foam is supplied in a 70 gram or 2.5 ounce aerosolized canister bearing the NDC# 42192-112-70.

Store at controlled room temperature 15° - 25°C(59° - 77°F).

Contains flammable materials. Contents under pressure. Do not puncture and/or incinerate the containers. Do not expose to temperatures over 120°F (48°C) even when empty.

NDC 42192-112-70

SALICYLIC ACID 6% FOAM

Hydrating Topical Foam

Rx Only

Net wt. 2.5 oz (70g)

Acella Pharmaceuticals

Dosage and Administration: Apply Salicylic Acid 6% foam topically to cover affected skin twice per day, or as directed by a physician. Rub in until completely absorbed.

Shake vigorously before each application and invert can to administer.

Store at room temperature 59degrees to 77 degrees F (15degrees to 15 degrees C)

See prescribing information for additional details.

Ingredients: Salicylic Acid 6%, Dimethicone, Ethylparaben, Glycerin, Methylcellulose, Methylparabaen, Phenoxyethanol, Polyoxyl 40 Stearate, Polysorbate 20, Polysorbate 80, Povidone, Propylene Glycol, Propylparaben, Purified Water, Sodium citrate, Sodium Hydroxide, Stearic Acid, and Trolamine and in propellants Butane and Propane.

Warning: contains flammable materials. Contents under pressure. Do not puncture or incinerate. Do not expose to temperatures over 120 degrees F (48 degrees C) even when empty. Keep out of reach of children.

Manufactured for

Acella Pharmaceuticals, LLC

Alpharetta, GA 30009

1-800-541-4802

Rev 0909v4