[Title 21 CFR ]
[Code of Federal Regulations (annual edition) - April 1, 2000 Edition]
[From the U.S. Government Printing Office]



[[Page i]]

          

                    21


          Parts 200 to 299

                         Revised as of April 1, 2000

Food and Drugs





          Containing a Codification of documents of general 
          applicability and future effect
          As of April 1, 2000
          With Ancillaries
          Published by
          the Office of the Federal Register
          National Archives and Records
          Administration

As a Special Edition of the Federal Register



[[Page ii]]

                                      




                     U.S. GOVERNMENT PRINTING OFFICE
                            WASHINGTON : 2000



               For sale by U.S. Government Printing Office
 Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328



[[Page iii]]




                            Table of Contents



                                                                    Page
  Explanation.................................................       v

  Title 21:
          Chapter I--Food and Drug Administration, Department 
          of Health and Human Services (Continued)                   3
  Finding Aids:
      Material Approved for Incorporation by Reference........     183
      Table of CFR Titles and Chapters........................     185
      Alphabetical List of Agencies Appearing in the CFR......     203
      List of CFR Sections Affected...........................     213



[[Page iv]]


      


                     ----------------------------

                     Cite this Code:  CFR
                     To cite the regulations in 
                       this volume use title, 
                       part and section number. 
                       Thus, 21 CFR 200.5 refers 
                       to title 21, part 200, 
                       section 5.

                     ----------------------------

[[Page v]]



                               EXPLANATION

    The Code of Federal Regulations is a codification of the general and 
permanent rules published in the Federal Register by the Executive 
departments and agencies of the Federal Government. The Code is divided 
into 50 titles which represent broad areas subject to Federal 
regulation. Each title is divided into chapters which usually bear the 
name of the issuing agency. Each chapter is further subdivided into 
parts covering specific regulatory areas.
    Each volume of the Code is revised at least once each calendar year 
and issued on a quarterly basis approximately as follows:

Title 1 through Title 16.................................as of January 1
Title 17 through Title 27..................................as of April 1
Title 28 through Title 41...................................as of July 1
Title 42 through Title 50................................as of October 1

    The appropriate revision date is printed on the cover of each 
volume.

LEGAL STATUS

    The contents of the Federal Register are required to be judicially 
noticed (44 U.S.C. 1507). The Code of Federal Regulations is prima facie 
evidence of the text of the original documents (44 U.S.C. 1510).

HOW TO USE THE CODE OF FEDERAL REGULATIONS

    The Code of Federal Regulations is kept up to date by the individual 
issues of the Federal Register. These two publications must be used 
together to determine the latest version of any given rule.
    To determine whether a Code volume has been amended since its 
revision date (in this case, April 1, 2000), consult the ``List of CFR 
Sections Affected (LSA),'' which is issued monthly, and the ``Cumulative 
List of Parts Affected,'' which appears in the Reader Aids section of 
the daily Federal Register. These two lists will identify the Federal 
Register page number of the latest amendment of any given rule.

EFFECTIVE AND EXPIRATION DATES

    Each volume of the Code contains amendments published in the Federal 
Register since the last revision of that volume of the Code. Source 
citations for the regulations are referred to by volume number and page 
number of the Federal Register and date of publication. Publication 
dates and effective dates are usually not the same and care must be 
exercised by the user in determining the actual effective date. In 
instances where the effective date is beyond the cut-off date for the 
Code a note has been inserted to reflect the future effective date. In 
those instances where a regulation published in the Federal Register 
states a date certain for expiration, an appropriate note will be 
inserted following the text.

OMB CONTROL NUMBERS

    The Paperwork Reduction Act of 1980 (Pub. L. 96-511) requires 
Federal agencies to display an OMB control number with their information 
collection request.

[[Page vi]]

Many agencies have begun publishing numerous OMB control numbers as 
amendments to existing regulations in the CFR. These OMB numbers are 
placed as close as possible to the applicable recordkeeping or reporting 
requirements.

OBSOLETE PROVISIONS

    Provisions that become obsolete before the revision date stated on 
the cover of each volume are not carried. Code users may find the text 
of provisions in effect on a given date in the past by using the 
appropriate numerical list of sections affected. For the period before 
January 1, 1986, consult either the List of CFR Sections Affected, 1949-
1963, 1964-1972, or 1973-1985, published in seven separate volumes. For 
the period beginning January 1, 1986, a ``List of CFR Sections 
Affected'' is published at the end of each CFR volume.

INCORPORATION BY REFERENCE

    What is incorporation by reference? Incorporation by reference was 
established by statute and allows Federal agencies to meet the 
requirement to publish regulations in the Federal Register by referring 
to materials already published elsewhere. For an incorporation to be 
valid, the Director of the Federal Register must approve it. The legal 
effect of incorporation by reference is that the material is treated as 
if it were published in full in the Federal Register (5 U.S.C. 552(a)). 
This material, like any other properly issued regulation, has the force 
of law.
    What is a proper incorporation by reference? The Director of the 
Federal Register will approve an incorporation by reference only when 
the requirements of 1 CFR part 51 are met. Some of the elements on which 
approval is based are:
    (a) The incorporation will substantially reduce the volume of 
material published in the Federal Register.
    (b) The matter incorporated is in fact available to the extent 
necessary to afford fairness and uniformity in the administrative 
process.
    (c) The incorporating document is drafted and submitted for 
publication in accordance with 1 CFR part 51.
    Properly approved incorporations by reference in this volume are 
listed in the Finding Aids at the end of this volume.
    What if the material incorporated by reference cannot be found? If 
you have any problem locating or obtaining a copy of material listed in 
the Finding Aids of this volume as an approved incorporation by 
reference, please contact the agency that issued the regulation 
containing that incorporation. If, after contacting the agency, you find 
the material is not available, please notify the Director of the Federal 
Register, National Archives and Records Administration, Washington DC 
20408, or call (202) 523-4534.

CFR INDEXES AND TABULAR GUIDES

    A subject index to the Code of Federal Regulations is contained in a 
separate volume, revised annually as of January 1, entitled CFR Index 
and Finding Aids. This volume contains the Parallel Table of Statutory 
Authorities and Agency Rules (Table I). A list of CFR titles, chapters, 
and parts and an alphabetical list of agencies publishing in the CFR are 
also included in this volume.
    An index to the text of ``Title 3--The President'' is carried within 
that volume.
    The Federal Register Index is issued monthly in cumulative form. 
This index is based on a consolidation of the ``Contents'' entries in 
the daily Federal Register.
    A List of CFR Sections Affected (LSA) is published monthly, keyed to 
the revision dates of the 50 CFR titles.

[[Page vii]]


REPUBLICATION OF MATERIAL

    There are no restrictions on the republication of material appearing 
in the Code of Federal Regulations.

INQUIRIES

    For a legal interpretation or explanation of any regulation in this 
volume, contact the issuing agency. The issuing agency's name appears at 
the top of odd-numbered pages.
    For inquiries concerning CFR reference assistance, call 202-523-5227 
or write to the Director, Office of the Federal Register, National 
Archives and Records Administration, Washington, DC 20408.

SALES

    The Government Printing Office (GPO) processes all sales and 
distribution of the CFR. For payment by credit card, call 202-512-1800, 
M-F, 8 a.m. to 4 p.m. e.s.t. or fax your order to 202-512-2233, 24 hours 
a day. For payment by check, write to the Superintendent of Documents, 
Attn: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954. For GPO 
Customer Service call 202-512-1803.

ELECTRONIC SERVICES

    The full text of the Code of Federal Regulations, the LSA (List of 
CFR Sections Affected), The United States Government Manual, the Federal 
Register, Public Laws, Weekly Compilation of Presidential Documents and 
the Privacy Act Compilation are available in electronic format at 
www.access.gpo.gov/nara (``GPO Access''). For more information, contact 
Electronic Information Dissemination Services, U.S. Government Printing 
Office. Phone 202-512-1530, or 888-293-6498 (toll-free). E-mail, 
[email protected].
    The Office of the Federal Register also offers a free service on the 
National Archives and Records Administration's (NARA) World Wide Web 
site for public law numbers, Federal Register finding aids, and related 
information. Connect to NARA's web site at www.nara.gov/fedreg. The NARA 
site also contains links to GPO Access.

                              Raymond A. Mosley,
                                    Director,
                          Office of the Federal Register.

April 1, 2000.



[[Page ix]]



                               THIS TITLE

    Title 21--Food and Drugs is composed of nine volumes. The parts in 
these volumes are arranged in the following order: Parts 1-99, 100-169, 
170-199, 200-299, 300-499, 500-599, 600-799, 800-1299 and 1300-end. The 
first eight volumes, containing parts 1-1299, comprise Chapter I--Food 
and Drug Administration, Department of Health and Human Services. The 
ninth volume, containing part 1300 to end, includes Chapter II--Drug 
Enforcement Administration, Department of Justice, and Chapter III--
Office of National Drug Control Policy. The contents of these volumes 
represent all current regulations codified under this title of the CFR 
as of April 1, 2000.

    Redesignation tables for Chapter I--Food and Drug Administration 
appear in the Finding Aids section for the volumes containing parts 170-
199 and 500-599.

    For this volume, Bonnie J. Fritts was Chief Editor. The Code of 
Federal Regulations publication program is under the direction of 
Frances D. McDonald, assisted by Alomha S. Morris.

[[Page x]]





[[Page 1]]



                        TITLE 21--FOOD AND DRUGS




                  (This book contains parts 200 to 299)

  --------------------------------------------------------------------
                                                                    Part

chapter i--Food and Drug Administration, Department of 
  Health and Human Services (Continued).....................         200

Cross References: Food Safety and Inspection Service, Department of 
  Agriculture: See Meat and Poultry Inspection, 9 CFR chapter III.

  Federal Trade Commission: See Commercial Practices, 16 CFR chapter I.

  U.S. Customs Service, Department of the Treasury: See Customs Duties, 
19 CFR chapter I.

  Internal Revenue Service, Department of the Treasury: See Internal 
Revenue, 26 CFR chapter I.

  Bureau of Alcohol, Tobacco, and Firearms, Department of the Treasury: 
See Alcohol, Tobacco Products and Firearms, 27 CFR chapter I.

[[Page 3]]



                CHAPTER I--FOOD AND DRUG ADMINISTRATION,






                        DEPARTMENT OF HEALTH AND






                             HUMAN SERVICES




                           (Parts 200 to 299)

  --------------------------------------------------------------------

                      SUBCHAPTER C--DRUGS: GENERAL

Part                                                                Page
200             General.....................................           5
201             Labeling....................................           8
202             Prescription drug advertising...............          72
203             Prescription drug marketing.................          81
205             Guidelines for State licensing of wholesale 
                    prescription drug distributors..........          93
206             Imprinting of solid oral dosage form drug 
                    products for human use..................          98
207             Registration of producers of drugs and 
                    listing of drugs in commercial 
                    distribution............................          99
208             Medication Guides for prescription drug 
                    products................................         109
210             Current good manufacturing practice in 
                    manufacturing, processing, packing, or 
                    holding of drugs; general...............         113
211             Current good manufacturing practice for 
                    finished pharmaceuticals................         115
216             Pharmacy compounding........................         135
225             Current good manufacturing practice for 
                    medicated feeds.........................         136
226             Current good manufacturing practice for Type 
                    A medicated articles....................         143
250             Special requirements for specific human 
                    drugs...................................         148
290             Controlled drugs............................         155
291             Drugs used for treatment of narcotic addicts         156
299             Drugs; official names and established names.         178

[[Page 5]]





                      SUBCHAPTER C--DRUGS: GENERAL





PART 200--GENERAL--Table of Contents




                      Subpart A--General Provisions

Sec.
200.5  Mailing of important information about drugs.
200.7  Supplying pharmacists with indications and dosage information.
200.10  Contract facilities (including consulting laboratories) utilized 
          as extramural facilities by pharmaceutical manufacturers.
200.11  Use of octadecylamine in steam lines of drug establishments.
200.15  Definition of term ``insulin''.

Subpart B [Reserved]

          Subpart C--Requirements for Specific Classes of Drugs

200.50  Ophthalmic preparations and dispensers.

Subpart D [Reserved]

           Subpart E--Prescription Drug Consumer Price Listing

200.200  Prescription drugs; reminder advertisements and reminder 
          labeling to provide price information to consumers.

    Authority: 21 U.S.C. 321, 331, 351, 352, 353, 355, 358, 360e, 371, 
374, 375.

    Source: 40 FR 13996, Mar. 27, 1975, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 200.5  Mailing of important information about drugs.

    Manufacturers and distributors of drugs and the Food and Drug 
Administration occasionally are required to mail important information 
about drugs to physicians and others responsible for patient care. In 
the public interest, such mail should be distinctive in appearance so 
that it will be promptly recognized and read. The Food and Drug 
Administration will make such mailings in accordance with the 
specifications set forth in this section. Manufacturers and distributors 
of drugs are asked to make such mailings as prescribed by this section 
and not to use the distinctive envelopes for ordinary mail.
    (a) Use first class mail and No. 10 white envelopes.
    (b) The name and address of the agency or the drug manufacturer or 
distributor is to appear in the upper left corner of the envelope.
    (c) The following statements are to appear in the far left third of 
the envelope front, in the type and size indicated, centered in a 
rectangular space approximately 3 inches wide and 2\1/4\ inches high 
with an approximately \3/8\ inch-wide border in the color indicated:
    (1) When the information concerns a significant hazard to health, 
the statement:

                                IMPORTANT

                                  DRUG

                                 WARNING


The statement shall be in three lines, all capitals, and centered. 
``Important'' shall be in 36 point Gothic Bold type. ``Drug'' and 
``Warning'' shall be in 36 point Gothic Condensed type. The rectangle's 
border and the statement therein shall be red.
    (2) When the information concerns important changes in drug package 
labeling, the statement:

                                IMPORTANT

                               PRESCRIBING

                               INFORMATION


The statement shall be in three lines, all capitals, and centered. 
``Important'' shall be in 36 point Gothic Bold type. ``Prescribing'' and 
``Information'' shall be in 36 point Gothic Condensed type. The 
rectangle's border and the statement therein shall be blue.
    (3) When the information concerns a correction of prescription drug 
advertising or labeling, the statement:


[[Page 6]]



                                IMPORTANT

                               CORRECTION

                                 OF DRUG

                               INFORMATION


The statement shall be in four lines, all capitals, and centered. 
``Important'' shall be in 36 point Gothic Bold type. ``Correction,'' 
``Of Drug,'' and ``Information'' shall be in 36 point Gothic Condensed 
type. The rectangle's border and the statement therein shall be brown.



Sec. 200.7  Supplying pharmacists with indications and dosage information.

    There are presently no regulations under the Federal Food, Drug, and 
Cosmetic Act that prevent a manufacturer of prescription drugs from 
sending the pharmacist data he needs on indications and dosage in 
exercising his important professional function of checking against 
possible mistakes in a prescription. The Food and Drug Administration 
believes manufacturers should be encouraged to supply such printed 
matter to the pharmacist for his professional information. Obviously, 
such printed matter should not be displayed to prospective purchasers to 
promote over-the-counter sale of prescription drugs.



Sec. 200.10  Contract facilities (including consulting laboratories) utilized as extramural facilities by pharmaceutical manufacturers.

    (a) Section 704(a) of the Federal Food, Drug, and Cosmetic Act 
specifically authorizes inspection of consulting laboratories as well as 
any factory, warehouse, or establishment in which prescription drugs are 
manufactured, processed, packed, or held.
    (b) The Food and Drug Administration is aware that many 
manufacturers of pharmaceutical products utilize extramural independent 
contract facilities, such as testing laboratories, contract packers or 
labelers, and custom grinders, and regards extramural facilities as an 
extension of the manufacturer's own facility.
    (c) The Food and Drug Administration reserves the right to disclose 
to the pharmaceutical manufacturer, or to the applicant of a new drug 
application (NDA) or to the sponsor of an Investigational New Drug (IND) 
Application, any information obtained during the inspection of an 
extramural facility having a specific bearing on the compliance of the 
manufacturer's, applicant's, or sponsor's product with the Federal Food, 
Drug, and Cosmetic Act. The Food and Drug Administration's position is 
that by the acceptance of such contract work, the extramural facility 
authorizes such disclosures.
    (d) The Food and Drug Administration does not consider results of 
validation studies of analytical and assay methods and control 
procedures to be trade secrets that may be withheld from the drug 
manufacturer by the contracted extramural facility.

[40 FR 13996, Mar. 27, 1975, as amended at 55 FR 11576, Mar. 29, 1990]



Sec. 200.11  Use of octadecylamine in steam lines of drug establishments.

    The Food and Drug Administration will not object to the use of 
octadecylamine in steam lines where the steam may be used for 
autoclaving surgical instruments and gauze if the octadecylamine in the 
steam is not more than 2.4 parts per million.



Sec. 200.15  Definition of term ``insulin.''

    For purposes of sections 801 and 802 of the act and this title, the 
term insulin means the active principle of the pancreas that affects the 
metabolism of carbohydrates in the animal body and which is of value in 
the treatment of diabetes mellitus. The term includes synthetic and 
biotechnologically derived products that are the same as, or similar to, 
naturally occurring insulins in structure, use, and intended effect and 
are of value in the treatment of diabetes mellitus.

[63 FR 26698, May 13, 1998]

Subpart B [Reserved]



          Subpart C--Requirements for Specific Classes of Drugs



Sec. 200.50  Ophthalmic preparations and dispensers.

    (a)(1) Informed medical opinion is in agreement that all 
preparations offered

[[Page 7]]

or intended for ophthalmic use, including preparations for cleansing the 
eyes, should be sterile. It is further evident that such preparations 
purport to be of such purity and quality as to be suitable for safe use 
in the eye.
    (2) The Food and Drug Administration concludes that all such 
preparations, if they are not sterile, fall below their professed 
standard of purity or quality and may be unsafe. In a statement of 
policy issued on September 1, 1964, the Food and Drug Administration 
ruled that liquid preparations offered or intended for ophthalmic use 
that are not sterile may be regarded as adulterated within the meaning 
of section 501(c) of the Federal Food, Drug, and Cosmetic Act (the act), 
and, further, may be deemed misbranded within the meaning of section 
502(j) of the act. This ruling is extended to affect all preparations 
for ophthalmic use. By this regulation, this ruling is applicable to 
ophthalmic preparations that are regulated as drugs. By the regulation 
in Sec. 800.10 of this chapter, this ruling is applicable to ophthalmic 
preparations that are regulated as medical devices.
    (3) The containers of ophthalmic preparations shall be sterile at 
the time of filling and closing, and the container or individual carton 
shall be so sealed that the contents cannot be used without destroying 
the seal. The packaging and labeling of ophthalmic preparations that are 
over-the-counter drugs shall also comply with Sec. 211.132 of this 
chapter on tamper-resistant packaging requirements.
    (b) Liquid ophthalmic preparations packed in multiple-dose 
containers should:
    (1) Contain one or more suitable and harmless substances that will 
inhibit the growth of microorganisms; or
    (2) Be so packaged as to volume and type of container and so labeled 
as to duration of use and with such necessary warnings as to afford 
adequate protection and minimize the hazard of injury resulting from 
contamination during use.

    (c) Eye cups, eye droppers, and other dispensers intended for 
ophthalmic use should be sterile, and may be regarded as falling below 
their professed standard of purity or quality if they are not sterile. 
These articles, which are regulated as drugs if packaged with the drugs 
with which they are to be used, should be packaged so as to maintain 
sterility until the package is opened and be labeled, on or within the 
retail package, so as to afford adequate directions and necessary 
warnings to minimize the hazard of injury resulting from contamination 
during use.


[40 FR 13996, Mar. 27, 1975, as amended at 47 FR 50455, Nov. 5, 1982]

Subpart D [Reserved]



           Subpart E--Prescription Drug Consumer Price Listing



Sec. 200.200  Prescription drugs; reminder advertisements and reminder labeling to provide price information to consumers.

    (a) Prescription drug reminder advertisements and reminder labeling 
intended to provide price information to consumers are exempt from the 
requirements of Secs. 201 .100 and 202.1 of this chapter if all of the 
following conditions are met:

    (1) The only purpose of the reminder advertisement or reminder 
labeling is to provide consumers with information concerning the price 
charged for a prescription for a particular drug product, and the 
reminder advertisement or reminder labeling contains no representation 
or suggestion concerning the drug product's safety, effectiveness, or 
indications for use.

    (2) The reminder advertisement or reminder labeling contains the 
proprietary name of the drug product, if any; the established (generic) 
name of the drug product, if any; the drug product's strength if the 
product contains a single active ingredient or if the product contains 
more than one active ingredient and a relevant strength can be 
associated with the product without indicating each active ingredient 
(the established name and quantity of each active ingredient are not 
required); the dosage form; and the price charged for a prescription for 
a specific quantity of the drug product.
    (3) The reminder advertisement or reminder labeling may also include 
other written, printed, or graphic matter,

[[Page 8]]

e.g., identification of professional or convenience services provided by 
the pharmacy: Provided, That such information is neither false nor 
misleading and contains no representation or suggestion concerning the 
drug product's safety, effectiveness, or indications for use.
    (4) The price stated in the reminder advertisement or reminder 
labeling as that charged for a prescription shall include all charges to 
the consumer including, but not limited to, the cost of the drug 
product, professional fees, and handling fees, if any. Mailing fees and 
delivery fees, if any, may be stated separately and without repetition.
    (b) This exemption from Secs. 201.100 and 202.1 of this chapter is 
applicable to all prescription drug reminder labeling and reminder 
advertisements solely intended to provide consumers with information 
regarding the price charged for prescriptions including price lists, 
catalogs, and other promotional material, whether mailed, posted in a 
pharmacy, placed in a newspaper, or aired on radio or television.
    (c) Any reminder advertisement or reminder labeling intended to 
provide consumers with prescription price information which is not in 
compliance with this section shall be the subject of appropriate 
regulatory action. Such action may be taken against the product and/or 
the responsible person.

[40 FR 58799, Dec. 18, 1975]



PART 201--LABELING--Table of Contents




                 Subpart A--General Labeling Provisions

Sec.
201.1  Drugs; name and place of business of manufacturer, packer, or 
          distributor.
201.2  Drugs and devices; National Drug Code numbers.
201.5  Drugs; adequate directions for use.
201.6  Drugs; misleading statements.
201.10  Drugs; statement of ingredients.
201.15  Drugs; prominence of required label statements.
201.16  Drugs; Spanish-language version of certain required statements.
201.17  Drugs; location of expiration date.
201.18  Drugs; significance of control numbers.
201.19  Drugs; use of term ``infant''.
201.20  Declaration of presence of FD&C Yellow No. 5 and/or FD&C Yellow 
          No. 6 in certain drugs for human use.
201.21  Declaration of presence of phenylalanine as a component of 
          aspartame in over-the-counter and prescription drugs for human 
          use.
201.22  Prescription drugs containing sulfites; required warning 
          statements.
201.23  Required pediatric studies.

 Subpart B--Labeling Requirements for Prescription Drugs and/or Insulin

201.50  Statement of identity.
201.51  Declaration of net quantity of contents.
201.55  Statement of dosage.
201.56  General requirements on content and format of labeling for human 
          prescription drugs.
201.57  Specific requirements on content and format of labeling for 
          human prescription drugs.
201.58  Requests for waiver of requirement for adequate and well-
          controlled studies to substantiate certain labeling 
          statements.
201.59  Effective date of Secs. 201.56, 201.57, 201.100(d)(3), and 
          201.100(e).

       Subpart C--Labeling Requirements for Over-the-Counter Drugs

201.60  Principal display panel.
201.61  Statement of identity.
201.62  Declaration of net quantity of contents.
201.63  Pregnancy/breast-feeding warning.
201.64  Sodium labeling.
201.66  Format and content requirements for over-the-counter (OTC) drug 
          product labeling.

         Subpart D--Exemptions From Adequate Directions for Use

201.100  Prescription drugs for human use.
201.105  Veterinary drugs.
201.115  New drugs or new animal drugs.
201.116  Drugs having commonly known directions.
201.117  Inactive ingredients.
201.119  In vitro diagnostic products.
201.120  Prescription chemicals and other prescription components.
201.122  Drugs for processing, repacking, or manufacturing.
201.125  Drugs for use in teaching, law enforcement, research, and 
          analysis.
201.127  Drugs; expiration of exemptions.
201.128  Meaning of ``intended uses''.
201.129  Drugs; exemption for radioactive drugs for research use.

                       Subpart E--Other Exemptions

201.150  Drugs; processing, labeling, or repacking.
201.161  Carbon dioxide and certain other gases.

[[Page 9]]

       Subpart F--Labeling Claims for Drugs in Drug Efficacy Study

201.200  Disclosure of drug efficacy study evaluations in labeling and 
          advertising.

  Subpart G--Specific Labeling Requirements for Specific Drug Products

201.300  Notice to manufacturers, packers, and distributors of glandular 
          preparations.
201.301  Notice to manufacturers, packers, and distributors of 
          estrogenic hormone preparations.
201.302  Notice to manufacturers, packers, and distributors of drugs for 
          internal use which contain mineral oil.
201.303  Labeling of drug preparations containing significant 
          proportions of wintergreen oil.
201.304  Tannic acid and barium enema preparations.
201.305  Isoproterenol inhalation preparations (pressurized aerosols, 
          nebulizers, powders) for human use; warnings.
201.306  Potassium salt preparations intended for oral ingestion by man.
201.307  Sodium phosphates; package size limitation, warnings, and 
          directions for over-the-counter sale.
201.308  Ipecac syrup; warnings and directions for use for over-the-
          counter sale.
201.309  Acetophenetidin (phenacetin)-containing preparations; necessary 
          warning statement.
201.310  Phenindione; labeling of drug preparations intended for use by 
          man.
201.311  [Reserved]
201.312  Magnesium sulfate heptahydrate; label declaration on drug 
          products.
201.313  Estradiol labeling.
201.314  Labeling of drug preparations containing salicylates.
201.315  Over-the-counter drugs for minor sore throats; suggested 
          warning.
201.316  Drugs with thyroid hormone activity for human use; required 
          warning.
201.317  Digitalis and related cardiotonic drugs for human use in oral 
          dosage forms; required warning.
201.319  Water-soluble gums, hydrophilic gums, and hydrophilic 
          mucilloids (including, but not limited to agar, alginic acid, 
          calcium polycarbophil, carboxymethylcellulose sodium, 
          carrageenan, chondrus, glucomannan ((B-1,4 linked) polymannose 
          acetate), guar gum, karaya gum, kelp, methylcellulose, 
          plantago seed (psyllium), polycarbophil tragacanth, and 
          xanthan gum) as active ingredients; required warnings and 
          directions.
201.320  Warning statements for drug products containing or manufactured 
          with chlorofluorocarbons or other ozone-depleting substances.
201.322  Over-the-counter drug products containing internal analgesic/
          antipyretic active ingredients; required alcohol warning.
201.323   Aluminum in large and small volume parenterals used in total 
          parenteral nutrition.

Appendix A to Part 201--Examples of Graphic Enhancements Used by FDA

    Authority: 21 U.S.C. 321, 331, 351, 352, 353, 355, 358, 360, 360b, 
360gg-360ss, 371, 374, 379e; 42 U.S.C. 216, 241, 262, 264.

    Source: 40 FR 13998, Mar. 27, 1975, unless otherwise noted.



                 Subpart A--General Labeling Provisions



Sec. 201.1  Drugs; name and place of business of manufacturer, packer, or distributor.

    (a) A drug or drug product (as defined in Sec. 320.1 of this 
chapter) in finished package form is misbranded under section 502 (a) 
and (b)(1) of the act if its label does not bear conspicuously the name 
and place of business of the manufacturer, packer, or distributor. This 
paragraph does not apply to any drug or drug product dispensed in 
accordance with section 503(b)(1) of the act.
    (b) As used in this section, and for purposes of section 502 (a) and 
(b)(1) of the act, the manufacturer of a drug product is the person who 
performs all of the following operations that are required to produce 
the product: (1) Mixing, (2) granulating, (3) milling, (4) molding, (5) 
lyophilizing, (6) tableting, (7) encapsulating, (8) coating, (9) 
sterilizing, and (10) filling sterile, aerosol, or gaseous drugs into 
dispensing containers.
    (c) If no person performs all of the applicable operations listed in 
paragraph (b) of this section, no person may be represented as 
manufacturer except as follows:
    (1) If the person performs more than one half of the applicable 
operations listed in paragraph (b) of this section and acknowledges the 
contribution of other persons who have performed the remaining 
applicable operations by stating on the product label that ``Certain 
manufacturing operations have been performed by other firms.''; or

[[Page 10]]

    (2) If the person performs at least one applicable operation listed 
in paragraph (b) of this section and identifies by appropriate 
designation all other persons who have performed the remaining 
applicable operations, e.g., ``Made by (Person A), Filled by (Person B), 
Sterilized by (Person C)''; or
    (3) If the person performs at least one applicable operation listed 
in paragraph (b) of this section and the person is listed along with all 
other persons who have performed the remaining applicable operations as 
``joint manufacturers.'' A list of joint manufacturers shall be 
qualified by the phrase ``Jointly Manufactured By ____________,'' and 
the names of all of the manufacturers shall be printed together in the 
same type size and style; or
    (4) If the person performs all applicable operations listed in 
paragraph (b) of this section except for those operations listed in 
paragraph (d) of this section. For purposes of this paragraph, person, 
when it identifies a corporation, includes a parent, subsidiary, or 
affiliate company where the related companies are under common ownership 
and control.
    (d) The Food and Drug Administration finds that it is the common 
practice in the drug industry to contract out the performance of certain 
manufacturing operations listed in paragraph (b) of this section. These 
operations include: (1) Soft-gelatin encapsulating, (2) aerosol filling, 
(3) sterilizing by irradiation, (4) lyophilizing, and (5) ethylene oxide 
sterilization.
    (e) A person performs an operation listed in paragraph (b) of this 
section only if the operation is performed, including the performance of 
the appropriate in-process quality control operations, except laboratory 
testing of samples taken during processing, as follows:
    (1) By individuals, a majority of whom are employees of the person 
and, throughout the performance of the operation, are subject to the 
person's direction and control;
    (2) On premises that are continuously owned or leased by the person 
and subject to the person's direction and control; and
    (3) On equipment that is continuously owned or leased by the person. 
As used in this paragraph, person, when it identifies a corporation, 
includes a parent, subsidiary, or affiliate company where the related 
companies are under common ownership and control.
    (f) The name of the person represented as manufacturer under 
paragraph (b) or (c) of this section must be the same as either (1) the 
name of the establishment (as defined in Sec. 207.3(b) of this chapter) 
under which that person is registered at the time the labeled product is 
produced or (2) the registered establishment name of a parent, 
subsidiary, or affiliate company where the related companies are under 
common ownership and control. In addition, the name shall meet the 
requirements of paragraph (g) of this section.
    (g) The requirement for declaration of the name of the manufacturer, 
packer, or distributor shall be deemed to be satisfied, in the case of a 
corporate person, only by the actual corporate name, except that the 
corporate name may be the name of a parent, subsidiary, or affiliate 
company where the related companies are under common ownership and 
control. The corporate name may be preceded or followed by the name of 
the particular division of the corporation. ``Company,'' 
``Incorporated,'' etc., may be abbreviated or omitted and ``The'' may be 
omitted. In the case of an individual, partnership, or association, the 
name under which the business is conducted shall be used.
    (h)(1) Except as provided in this section, no person other than the 
manufacturer, packer, or distributor may be identified on the label of a 
drug or drug product.
    (2) The appearance on a drug product label of a person's name 
without qualification is a representation that the named person is the 
sole manufacturer of the product. That representation is false and 
misleading, and the drug product is misbranded under section 502(a) of 
the act, if the person is not the manufacturer of the product in 
accordance with this section.
    (3) If the names of two or more persons appear on the label of a 
drug or drug product, the label may identify which of the persons is to 
be contacted for further information about the product.

[[Page 11]]

    (4) If a trademark appears on the drug or drug product label or 
appears as a mark directly on the drug product (e.g., tablet or 
capsule), the label may identify the holder or licensee of the 
trademark. The label may also state whether the person identified holds 
the trademark or is licensee of the trademark.
    (5) If the distributor is named on the label, the name shall be 
qualified by one of the following phrases: ``Manufactured for 
____________'', ``Distributed by ____________'', ``Manufactured by 
____________ for ____________'', ``Manufactured for __________by 
__________'', ``Distributor: ____________'', ``Marketed by 
____________''. The qualifying phrases may be abbreviated.
    (6) If the packer is identified on the label, the name shall be 
qualified by the phrase ``Packed by ____________'' or ``Packaged by 
____________''. The qualifying phrases may be abbreviated.
    (i) The statement of the place of business shall include the street 
address, city, State, and ZIP Code. For a foreign manufacturer, the 
statement of the place of business shall include the street address, 
city, country, and any applicable mailing code. The street address may 
be omitted if it is shown in a current city directory or telephone 
directory. The requirement for inclusion of the ZIP Code shall apply to 
consumer commodity labels developed or revised after July 1, 1969. In 
the case of nonconsumer packages, the ZIP Code shall appear either on 
the label or the labeling (including the invoice).
    (j) If a person manufactures, packs, or distributes a drug or drug 
product at a place other than the person's principal place of business, 
the label may state the principal place of business in lieu of the 
actual place where such drug or drug product was manufactured or packed 
or is to be distributed, unless such statement would be misleading.
    (k) Paragraphs (b), (c), (d), (e), and (f) of this section, do not 
apply to the labeling of drug components.
    (l) A drug product is misbranded under section 502(a) of the act if 
its labeling identifies a person as manufacturer, packer, or 
distributor, and that identification does not meet the requirements of 
this section.
    (m) This section does not apply to biological drug products that are 
subject to the requirements of section 351 of the Public Health Service 
Act, 42 U.S.C. 262.

[45 FR 25775, Apr. 15, 1980; 45 FR 72118, Oct. 31, 1980, as amended at 
48 FR 37620, Aug. 19, 1983]



Sec. 201.2  Drugs and devices; National Drug Code numbers.

    The National Drug Code (NDC) number is requested but not required to 
appear on all drug labels and in all drug labeling, including the label 
of any prescription drug container furnished to a consumer. If the NDC 
number is shown on a drug label, it shall be displayed as required in 
Sec. 207.35(b)(3) of this chapter.

[40 FR 52002, Nov. 7, 1975]



Sec. 201.5  Drugs; adequate directions for use.

    Adequate directions for use means directions under which the layman 
can use a drug safely and for the purposes for which it is intended. 
(Section 201.128 defines ``intended use.'') Directions for use may be 
inadequate because, among other reasons, of omission, in whole or in 
part, or incorrect specification of:
    (a) Statements of all conditions, purposes, or uses for which such 
drug is intended, including conditions, purposes, or uses for which it 
is prescribed, recommended, or suggested in its oral, written, printed, 
or graphic advertising, and conditions, purposes, or uses for which the 
drug is commonly used; except that such statements shall not refer to 
conditions, uses, or purposes for which the drug can be safely used only 
under the supervision of a practitioner licensed by law and for which it 
is advertised solely to such practitioner.
    (b) Quantity of dose, including usual quantities for each of the 
uses for which it is intended and usual quantities for persons of 
different ages and different physical conditions.
    (c) Frequency of administration or application.
    (d) Duration of administration or application.
    (e) Time of administration or application (in relation to time of 
meals,

[[Page 12]]

time of onset of symptoms, or other time factors).
    (f) Route or method of administration or application.
    (g) Preparation for use, i.e., shaking, dilution, adjustment of 
temperature, or, other manipulation or process.

[41 FR 6908, Feb. 13, 1976]



Sec. 201.6  Drugs; misleading statements.

    (a) Among representations in the labeling of a drug which render 
such drug misbranded is a false or misleading representation with 
respect to another drug or a device or a food or cosmetic.
    (b) The labeling of a drug which contains two or more ingredients 
may be misleading by reason, among other reasons, of the designation of 
such drug in such labeling by a name which includes or suggests the name 
of one or more but not all such ingredients, even though the names of 
all such ingredients are stated elsewhere in the labeling.

[41 FR 6908, Feb. 13, 1976]



Sec. 201.10  Drugs; statement of ingredients.

    (a) The ingredient information required by section 502(e) of the 
Federal Food, Drug, and Cosmetic Act shall appear together, without any 
intervening written, printed, or graphic matter, except the proprietary 
names of ingredients, which may be included with the listing of 
established names, and such statements as ``Warning--May be habit 
forming'' that are specifically required for certain ingredients by the 
act or regulations in this chapter.
    (b) The term ingredient applies to any substance in the drug, 
whether added to the formulation as a single substance or in admixture 
with other substances.
    (c) The labeling of a drug may be misleading by reason (among other 
reasons) of:
    (1) The order in which the names of the ingredients present in the 
drug appear in the labeling, or the relative prominence otherwise given 
such names.
    (2) Failure to reveal the proportion of, or other fact with respect 
to, an ingredient present in such drug, when such proportion or other 
fact is material in the light of the representation that such ingredient 
is present in such drug.
    (3) The employment of a fanciful proprietary name for a drug or 
ingredient in such a manner as to imply that the drug or ingredient has 
some unique effectiveness or composition when, in fact, the drug or 
ingredient is a common substance, the limitations of which are readily 
recognized when the drug or ingredient is listed by its established 
name.
    (4) The featuring in the labeling of inert or inactive ingredients 
in a manner that creates an impression of value greater than their true 
functional role in the formulation.
    (5) Designation of a drug or ingredient by a proprietary name that, 
because of similarity in spelling or pronunciation, may be confused with 
the proprietary name or the established name of a different drug or 
ingredient.
    (d)(1) If the drug is in tablet or capsule form or other unit dosage 
form, any statement of the quantity of an ingredient contained therein 
shall express the quantity of such ingredient in each such unit. If the 
drug is not in unit dosage form, any statement of the quantity of an 
ingredient contained therein shall express the amount of such ingredient 
in a specified unit of weight or measure of the drug, or the percentage 
of such ingredient in such drug. Such statements shall be in terms that 
are informative to licensed practitioners, in the case of a prescription 
drug, and to the layman, in the case of a nonprescription drug.
    (2) A statement of the percentage of an ingredient in a drug shall, 
if the term percent is used without qualification, mean percent weight-
in-weight, if the ingredient and the drug are both solids, or if the 
ingredient is a liquid and the drug is a solid; percent weight in volume 
at 68  deg.F. (20  deg.C.), if the ingredient is a solid and the drug is 
a liquid; and percent volume in volume at 68  deg.F. (20  deg.C.), if 
both the ingredient and the drug are liquids, except that alcohol shall 
be stated in terms of percent volume of absolute alcohol at 60  deg.F. 
(15.56  deg.C.).
    (e) A derivative or preparation of a substance named in section 
502(e) of the act is an article derived or prepared

[[Page 13]]

from such substance by any method, including actual or theoretical 
chemical action.
    (f) If an ingredient is a derivative or preparation of a substance 
specifically named in section 502(e) of the act and the established name 
of such ingredient does not indicate that it is a derivative or 
preparation of the parent substance named in section 502(e) of the act, 
the labeling shall, in conjunction with the listing of the established 
name of such ingredient, declare that such article is a derivative or 
preparation of such parent substance.
    (g)(1) If the label or labeling of a prescription drug bears a 
proprietary name or designation for the drug or any ingredient thereof, 
the established name, if such there be, corresponding to such 
proprietary name or designation shall accompany such proprietary name or 
designation each time it is featured on the label or in the labeling for 
the drug; but, except as provided in this subparagraph, the established 
name need not be used with the proprietary name or designation in the 
running text of the label or labeling. On any label or page of labeling 
in which the proprietary name or designation is not featured but is used 
in the running text, the established name shall be used at least once in 
the running text in association with such proprietary name or 
designation and in the same type size used in such running text: 
Provided, however, That if the proprietary name or designation is used 
in the running text in larger size type, the established name shall be 
used at least once in association with, and in type at least half as 
large as the type used for, the most prominent presentation of the 
proprietary name or designation in such running text. If any labeling 
includes a column with running text containing detailed information as 
to composition, prescribing, side effects, or contraindications and the 
proprietary name or designation is used in such column but is not 
featured above or below the column, the established name shall be used 
at least once in such column of running text in association with such 
proprietary name or designation and in the same type size used in such 
column of running text: Provided, however, That if the proprietary name 
or designation is used in such column of running text in larger size 
type, the established name shall be used at least once in association 
with, and in type at least half as large as the type used for, the most 
prominent presentation of the proprietary name or designation in such 
column of running text. Where the established name is required to 
accompany or to be used in association with the proprietary name or 
designation, the established name shall be placed in direct conjunction 
with the proprietary name or designation, and the relationship between 
the proprietary name or designation and the established name shall be 
made clear by use of a phrase such as ``brand of'' preceding the 
established name, by brackets surrounding the established name, or by 
other suitable means.
    (2) The established name shall be printed in letters that are at 
least half as large as the letters comprising the proprietary name or 
designation with which it is joined, and the established name shall have 
a prominence commensurate with the prominence with which such 
proprietary name or designation appears, taking into account all 
pertinent factors, including typography, layout, contrast, and other 
printing features.
    (h)(1) In the case of a prescription drug containing two or more 
active ingredients, if the label bears a proprietary name or designation 
for such mixture and there is no established name corresponding to such 
proprietary name or designation, the quantitative ingredient information 
required on the label by section 502(e) of the act shall be placed in 
direct conjunction with the most prominent display of the proprietary 
name or designation. The prominence of the quantitative ingredient 
information shall bear a reasonable relationship to the prominence of 
the proprietary name.
    (2) If the drug is packaged in a container too small to bear the 
quantitative ingredient information on the main display panel, the 
quantitative ingredient information required by section 502(e) of the 
act may appear elsewhere on the label, even though the proprietary name 
or designation appears on the main display panel of the

[[Page 14]]

label; but side- or back-panel placement shall in this case be so 
arranged and printed as to provide size and prominence of display 
reasonably related to the size and prominence of the front-panel 
display.
    (i) A drug packaged in a container too small or otherwise unable to 
accommodate a label with sufficient space to bear the information 
required for compliance with section 502(e)(1) (A)(ii) and (B) of the 
act shall be exempt from compliance with those clauses: Provided, That:
    (1) The label bears:
    (i) The proprietary name of the drug;
    (ii) The established name, if such there be, of the drug;
    (iii) An identifying lot or control number; and
    (iv) The name of the manufacturer, packer, or distributor of the 
drug; and
    (2) All the information required to appear on the label by the act 
and the regulations in this chapter appears on the carton or other outer 
container or wrapper if such carton, outer container, or wrapper has 
sufficient space to bear such information, or such complete label 
information appears on a leaflet with the package.



Sec. 201.15  Drugs; prominence of required label statements.

    (a) A word, statement, or other information required by or under 
authority of the act to appear on the label may lack that prominence and 
conspicuousness required by section 502(c) of the act by reason, among 
other reasons, of:
    (1) The failure of such word, statement, or information to appear on 
the part or panel of the label which is presented or displayed under 
customary conditions of purchase;
    (2) The failure of such word, statement, or information to appear on 
two or more parts or panels of the label, each of which has sufficient 
space therefor, and each of which is so designed as to render it likely 
to be, under customary conditions of purchase, the part or panel 
displayed;
    (3) The failure of the label to extend over the area of the 
container or package available for such extension, so as to provide 
sufficient label space for the prominent placing of such word, 
statement, or information;
    (4) Insufficiency of label space for the prominent placing of such 
word, statement, or information, resulting from the use of label space 
for any word, statement, design, or device which is not required by or 
under authority of the act to appear on the label;
    (5) Insufficiency of label space for the prominent placing of such 
word, statement, or information, resulting from the use of label space 
to give materially greater conspicuousness to any other word, statement, 
or information, or to any design or device; or
    (6) Smallness or style of type in which such word, statement, or 
information appears, insufficient background contrast, obscuring designs 
or vignettes, or crowding with other written, printed, or graphic 
matter.
    (b) No exemption depending on insufficiency of label space, as 
prescribed in regulations promulgated under section 502 (b) or (e) of 
the act, shall apply if such insufficiency is caused by:
    (1) The use of label space for any word, statement, design, or 
device which is not required by or under authority of the act to appear 
on the label;
    (2) The use of label space to give greater conspicuousness to any 
word, statement, or other information than is required by section 502(c) 
of the act; or
    (3) The use of label space for any representation in a foreign 
language.
    (c)(1) All words, statements, and other information required by or 
under authority of the act to appear on the label or labeling shall 
appear thereon in the English language: Provided, however, That in the 
case of articles distributed solely in the Commonwealth of Puerto Rico 
or in a Territory where the predominant language is one other than 
English, the predominant language may be substituted for English.
    (2) If the label contains any representation in a foreign language, 
all words, statements, and other information required by or under 
authority of the act to appear on the label shall appear thereon in the 
foreign language.
    (3) If the labeling contains any representation in a foreign 
language, all words, statements, and other information required by or 
under authority of

[[Page 15]]

the act to appear on the label or labeling shall appear on the labeling 
in the foreign language.

[41 FR 6908, Feb. 13, 1976]



Sec. 201.16  Drugs; Spanish-language version of certain required statements.

    An increasing number of medications restricted to prescription use 
only are being labeled solely in Spanish for distribution in the 
Commonwealth of Puerto Rico where Spanish is the predominant language. 
Such labeling is authorized under Sec. 201.15(c). Two required warnings, 
the wording of which is fixed by law in the English language, are 
presently being translated in various ways, from literal translation to 
loose interpretation. The statutory nature of these two statements 
requires that the translation must convey the meaning properly, in order 
to avoid confusion and dilution of the purposes of the warnings. The 
Commissioner of Food and Drugs hereby adopts the following Spanish-
language versions as the accepted equivalents of the English wording of 
the following:
    (a) Section 503(b)(4) of the Federal Food, Drug, and Cosmetic Act 
requires the statement ``Caution: Federal law prohibits dispensing 
without prescription.'' The Spanish version of this shall be: 
``Precaucion: La ley Federal prohibe su despacho sin prescripcion 
facultativa.''
    (b) Section 502(d) of the Federal Food, Drug, and Cosmetic Act 
requires the statement ``Warning--May be habit forming'' on habit-
forming drugs. The Spanish version of this shall be: ``Aviso--Puede 
formar habito o vicio.''

[41 FR 6908, Feb. 13, 1976]



Sec. 201.17  Drugs; location of expiration date.

    When an expiration date of a drug is required, e.g., expiration 
dating of drug products required by Sec. 211.137 of this chapter, it 
shall appear on the immediate container and also the outer package, if 
any, unless it is easily legible through such outer package. However, 
when single-dose containers are packed in individual cartons, the 
expiration date may properly appear on the individual carton instead of 
the immediate product container.

[43 FR 45076, Sept. 29, 1978]



Sec. 201.18  Drugs; significance of control numbers.

    The lot number on the label of a drug should be capable of yielding 
the complete manufacturing history of the package. An incorrect lot 
number may be regarded as causing the article to be misbranded.



Sec. 201.19  Drugs; use of term ``infant''.

    The regulations affecting special dietary foods (Sec. 105.3(e) of 
this chapter) define an infant as a child not more than 12 months old. 
Apart from this, the Food and Drug Administration has not established 
any definition of the term infant. Some question has arisen whether, for 
the purposes of drug labeling, an infant means a child up to 1 year of 
age or a child up to 2 years of age. Until the term is more precisely 
defined by legislation or formal regulation, where the exact meaning of 
the term is significant, manufacturers should qualify any reference to 
``infant'' to indicate whether it refers to a child who is not more than 
1 year of age, or a child not more than 2 years of age.

[40 FR 13998, Mar. 27, 1975, as amended at 42 FR 14091, Mar. 15, 1977; 
44 FR 16006, Mar. 16, 1979]



Sec. 201.20  Declaration of presence of FD&C Yellow No. 5 and/or FD&C Yellow No. 6 in certain drugs for human use.

    (a) The label for over-the-counter and prescription drug products 
intended for human use administered orally, nasally, rectally, or 
vaginally, or for use in the area of the eye, containing FD&C Yellow No. 
5 as a color additive using the names FD&C Yellow No. 5 and tartrazine. 
The labeling for over-the-counter and prescription drug products shall 
bear a statement such as ``Contains FD&C Yellow No. 5 (tartrazine) as a 
color additive'' or ``Contains color additives including FD&C Yellow No. 
5 (tartrazine)''. The labels of certain drug products subject to this 
labeling requirement that are also cosmetics, such as antibacterial 
mouthwashes and fluoride toothpastes,

[[Page 16]]

need not comply with this requirement provided they comply with the 
requirements of Sec. 701.3 of this chapter.
    (b) For prescription drugs for human use containing FD&C Yellow No. 
5 that are administered orally, nasally, vaginally, or rectally, or for 
use in the area of the eye, the labeling required by Sec. 201.100(d) 
shall bear the warning statement ``This product contains FD&C Yellow No. 
5 (tartrazine) which may cause allergic-type reactions (including 
bronchial asthma) in certain susceptible persons. Although the overall 
incidence of FD&C Yellow No. 5 (tartrazine) sensitivity in the general 
population is low, it is frequently seen in patients who also have 
aspirin hypersensitivity.'' This warning statement shall appear in the 
``Precautions'' section of the labeling.
    (c) The label for over-the-counter drug products intended for human 
use administered orally, nasally, rectally, or vaginally containing FD&C 
Yellow No. 6 shall specifically declare the presence of FD&C Yellow No. 
6 by listing the color additive using the name FD&C Yellow No. 6. The 
labeling for over-the-counter and prescription drug products containing 
FD&C Yellow No. 6 shall declare the presence of FD&C Yellow No. 6. The 
labels of certain drug products subject to this labeling requirement 
that are also cosmetics, such as antibacterial mouthwashes and fluoride 
toothpastes, need not comply with this requirement provided they comply 
with the requirements of Sec. 701.3 of this chapter.

[45 FR 60422, Sept. 12, 1980, as amended at 51 FR 41783, Nov. 19, 1986; 
52 FR 21509, June 8, 1987; 59 FR 60898, Nov. 29, 1994]

    Effective Date Note: At 53 FR 49138, Dec. 6, 1988, Sec. 201.20(c) 
was suspended pending further agency action.



Sec. 201.21  Declaration of presence of phenylalanine as a component of aspartame in over-the-counter and prescription drugs for human use.

    (a) Aspartame is the methylester of a dipeptide composed of two 
amino acids, phenylalanine and aspartic acid. When these two amino acids 
are so combined to form aspartame (1-methyl N-L--aspartyl-L-
phenylalanine), they produce an intensely sweet-tasting substance, 
approximately 180 times as sweet as sucrose. The Food and Drug 
Administration has determined that aspartame when used at a level no 
higher than reasonably required to perform its intended technical 
function is safe for use as an inactive ingredient in human drug 
products, provided persons with phenylketonuria, who must restrict 
carefully their phenylalanine intake, are alerted to the presence of 
phenylalanine in the drug product and the amount of the ingredient in 
each dosage unit.
    (b) The label and labeling of all over-the-counter human drug 
products containing aspartame as an inactive ingredient shall bear a 
statement to the following effect: Phenylketonurics: Contains 
Phenylalanine (__)mg Per (Dosage Unit).
    (c) The package labeling and other labeling providing professional 
use information concerning prescription drugs for human use containing 
aspartame as an inactive ingredient shall bear a statement to the 
following effect under the ``Precautions'' section of the labeling, as 
required in Sec. 201.57(f)(2): Phenylketonurics: Contains Phenylalanine 
(__)mg Per (Dosage Unit).
    (d) Holders of approved new drug applications who reformulate their 
drug products under the provisions of this section shall submit 
supplements under Sec. 314.70 of this chapter to provide for the new 
composition and the labeling changes.

(Approved by the Office of Management and Budget under control number 
0910-0242)

[52 FR 2111, Jan. 20, 1987; 52 FR 12152, April 15, 1987; 53 FR 4135, 
Feb. 12, 1988]



Sec. 201.22  Prescription drugs containing sulfites; required warning statements.

    (a) Sulfites are chemical substances that are added to certain drug 
products to inhibit the oxidation of the active drug ingredient. 
Oxidation of the active drug ingredient may result in instability and a 
loss of potency of the drug product. Examples of specific sulfites used 
to inhibit this oxidation process include sodium bisulfite, sodium 
metabisulfite, sodium sulfite, potassium bisulfite, and potassium 
metabisulfite. Recent studies have demonstrated that sulfites may cause

[[Page 17]]

allergic-type reactions in certain susceptible persons, especially 
asthmatics. The labeling for any prescription drug product to which 
sulfites have been added as an inactive ingredient, regardless of the 
amount added, must bear the warning specified in paragraph (b) or (c) of 
this section.
    (b) The labeling required by Secs. 201.57 and 201.100(d) for 
prescription drugs for human use containing a sulfite, except 
epinephrine for injection when intended for use in allergic or other 
emergency situations, shall bear the warning statement ``Contains 
(insert the name of the sulfite, e.g., sodium metabisulfite), a sulfite 
that may cause allergic-type reactions including anaphylactic symptoms 
and life-threatening or less severe asthmatic episodes in certain 
susceptible people. The overall prevalence of sulfite sensitivity in the 
general population is unknown and probably low. Sulfite sensitivity is 
seen more frequently in asthmatic than in nonasthmatic people.'' This 
statement shall appear in the ``Warnings'' section of the labeling.
    (c) The labeling required by Secs. 201.57 and 201.100(d) for 
sulfite-containing epinephrine for injection for use in allergic 
emergency situations shall bear the warning statement ``Epinephrine is 
the preferred treatment for serious allergic or other emergency 
situations even though this product contains (insert the name of the 
sulfite, e.g., sodium metabisulfite), a sulfite that may in other 
products cause allergic-type reactions including anaphylactic symptoms 
or life-threatening or less severe asthmatic episodes in certain 
susceptible persons. The alternatives to using epinephrine in a life-
threatening situation may not be satisfactory. The presence of a 
sulfite(s) in this product should not deter administration of the drug 
for treatment of serious allergic or other emergency situations.'' This 
statement shall appear in the ``Warnings'' section of the labeling.

[51 FR 43904, Dec. 5, 1986]



Sec. 201.23  Required pediatric studies.

    (a) A manufacturer of a marketed drug product, including a 
biological drug product, that is used in a substantial number of 
pediatric patients, or that provides a meaningful therapeutic benefit 
over existing treatments for pediatric patients, as defined in 
Secs. 314.55(c)(5) and 601.27(c)(5) of this chapter, but whose label 
does not provide adequate information to support its safe and effective 
use in pediatric populations for the approved indications may be 
required to submit an application containing data adequate to assess 
whether the drug product is safe and effective in pediatric populations. 
The application may be required to contain adequate evidence to support 
dosage and administration in some or all pediatric subpopulations, 
including neonates, infants, children, and adolescents, depending upon 
the known or appropriate use of the drug product in such subpopulations. 
The applicant may also be required to develop a pediatric formulation 
for a drug product that represents a meaningful therapeutic benefit over 
existing therapies for pediatric populations for whom a pediatric 
formulation is necessary, unless the manufacturer demonstrates that 
reasonable attempts to produce a pediatric formulation have failed.
    (b) The Food and Drug Administration (FDA) may by order, in the form 
of a letter, after notifying the manufacturer of its intent to require 
an assessment of pediatric safety and effectiveness of a pediatric 
formulation, and after offering an opportunity for a written response 
and a meeting, which may include an advisory committee meeting, require 
a manufacturer to submit an application containing the information or 
request for approval of a pediatric formulation described in paragraph 
(a) of this section within a time specified in the order, if FDA finds 
that:
    (1) The drug product is used in a substantial number of pediatric 
patients for the labeled indications and the absence of adequate 
labeling could pose significant risks to pediatric patients; or
    (2) There is reason to believe that the drug product would represent 
a meaningful therapeutic benefit over existing treatments for pediatric 
patients for one or more of the claimed indications, and the absence of 
adequate labeling could pose significant risks to pediatric patients.

[[Page 18]]

    (c)(1) An applicant may request a full waiver of the requirements of 
paragraph (a) of this section if the applicant certifies that:
    (i) Necessary studies are impossible or highly impractical because, 
e.g., the number of such patients is so small or geographically 
dispersed, or
    (ii) There is evidence strongly suggesting that the product would be 
ineffective or unsafe in all pediatric age groups.
    (2) An applicant may request a partial waiver of the requirements of 
paragraph (a) of this section with respect to a specified pediatric age 
group, if the applicant certifies that:
    (i) The product:
    (A) Does not represent a meaningful therapeutic benefit over 
existing therapies for pediatric patients in that age group, and
    (B) Is not likely to be used in a substantial number of patients in 
that age group, and
    (C) The absence of adequate labeling could not pose significant 
risks to pediatric patients; or
    (ii) Necessary studies are impossible or highly impractical because, 
e.g., the number of patients in that age group is so small or 
geographically dispersed, or
    (iii) There is evidence strongly suggesting that the product would 
be ineffective or unsafe in that age group, or
    (iv) The applicant can demonstrate that reasonable attempts to 
produce a pediatric formulation necessary for that age group have 
failed.
    (3) FDA shall grant a full or partial waiver, as appropriate, if the 
agency finds that there is a reasonable basis on which to conclude that 
one or more of the grounds for waiver specified in paragraphs (c)(2) or 
(c)(3) of this section have been met. If a waiver is granted on the 
ground that it is not possible to develop a pediatric formulation, the 
waiver will cover only those pediatric age groups requiring that 
formulation. If a waiver is granted because there is evidence that the 
product would be ineffective or unsafe in pediatric populations, this 
information will be included in the product's labeling.
    (d) If a manufacturer fails to submit a supplemental application 
containing the information or request for approval of a pediatric 
formulation described in paragraph (a) of this section within the time 
specified by FDA, the drug product may be considered misbranded or an 
unapproved new drug or unlicensed biologic.

[63 FR 66668, Dec. 2, 1998]



 Subpart B--Labeling Requirements for Prescription Drugs and/or Insulin



Sec. 201.50  Statement of identity.

    (a) The label of prescription and insulin-containing drugs in 
package form shall bear as one of its principal features a statement of 
the identity of the drug.
    (b) Such statement of identity shall be in terms of the established 
name of the drug. In the case of a prescription drug that is a mixture 
and that has no established name, the requirement for statement of 
identity shall be deemed to be satisfied by a listing of the 
quantitative ingredient information as prescribed by Sec. 201.10.
    (c) The statement of identity of a prescription drug shall also 
comply with the placement, size and prominence requirements of 
Sec. 201.10.

[40 FR 13998, Mar. 27, 1975, as amended at 63 FR 26698, May 13, 1998]



Sec. 201.51  Declaration of net quantity of contents.

    (a) The label of a prescription or insulin-containing drug in 
package form shall bear a declaration of the net quantity of contents. 
This shall be expressed in the terms of weight, measure, numerical 
count, or a combination of numerical count and weight or measure. The 
statement of quantity of drugs in tablet, capsule, ampule, or other unit 
dosage form shall be expressed in terms of numerical count; the 
statement of quantity for drugs in other dosage forms shall be in terms 
of weight if the drug is solid, semi-solid, or viscous, or in terms of 
fluid measure if the drug is liquid. When the drug quantity statement is 
in terms of the numerical count of the drug units, it shall be augmented 
to give the weight or measure of the drug units or the quantity of each 
active ingredient in each drug unit or, when quantity does

[[Page 19]]

not accurately reflect drug potency, a statement of the drug potency.
    (b) Statements of weight of the contents shall in the case of 
prescription drugs be expressed in terms of avoirdupois pound, ounce, 
and grain or of kilogram, gram, and subdivisions thereof. A statement of 
liquid measure of the contents shall in the case of prescription drugs 
be expressed in terms of the U.S. gallon of 231 cubic inches and quart, 
pint, fluid-ounce, and fluid-dram subdivisions thereof, or of the liter 
and milliliter, or cubic centimeter, and shall express the volume at 68 
deg.F. (20  deg.C.). A statement of the liquid measure of the contents 
in the case of insulin-containing drugs shall be expressed in terms of 
the liter and milliliter, or cubic centimeter, and shall express the 
volume at 68  deg.F. (20  deg.C.).
    (c) The declaration shall contain only such fractions as are 
generally used in expressing the quantity of the drug. A common fraction 
shall be reduced to its lowest terms; a decimal fraction shall not be 
carried out to more than three places, except in the case of a statement 
of the quantity of an active ingredient in a unit of a drug.
    (d) The declaration shall appear as a distinct item on the label 
and, in the case of large volume parenterals, may be embossed on the 
glass.
    (e) The declaration shall accurately reveal the quantity of drug in 
the package exclusive of wrappers and other material packed therewith.
    (f) A statement of the quantity of a prescription or insulin-
containing drug in terms of weight or measure applicable to such drug, 
under the provisions of paragraph (a) of this section, shall express 
with prominence and conspicuousness the number of the largest whole 
unit, as specified in paragraph (b) of this section, that are contained 
in the package. Any remainder shall be expressed in terms of common or 
decimal fractions of such unit or in terms of the next smaller whole 
unit and common or decimal fractions thereof.
    (g) The declaration of net quantity of contents shall express an 
accurate statement of the quantity of contents of the package. 
Reasonable variations caused by loss or gain of moisture during the 
course of good distribution practice or by unavoidable deviations in 
good manufacturing practice will be recognized. Variations from stated 
quantity of contents shall not be unreasonably large. In the case of a 
liquid drug in ampules or vials, intended for injection, the declaration 
shall be considered to express the minimum quantity and the variation 
above the stated measure shall comply with the excess volume prescribed 
by the National Formulary or the U.S. Pharmacopeia for filling of 
ampules. In the case of a solid drug in ampules or vials, the 
declaration shall be considered to express the accurate net weight. 
Variations shall comply with the limitations provided in the U.S. 
Pharmacopeia or the National Formulary.
    (h) A drug shall be exempt from compliance with the net quantity 
declaration required by this section if it is an ointment labeled 
``sample'', ``physician's sample'', or a substantially similar statement 
and the contents of the package do not exceed 8 grams.



Sec. 201.55  Statement of dosage.

    Section 201.100(b)(2) requires that labels for prescription drugs 
bear a statement of the recommended or usual dosage. Since the dosage 
for some prescription drugs varies within extremely wide limits, 
depending upon the conditions being treated, it may not be possible in 
all cases to present an informative or useful statement of the 
recommended or usual dosage in the space available on the label or 
carton of the package. It is the view of the Food and Drug 
Administration that when such a situation prevails, compliance with this 
requirement would be met by a statement such as ``See package insert for 
dosage information'', where the detailed information is contained in 
such insert. However, if an informative, realistic, recommended or usual 
dosage can readily be set forth on the label, it should appear thereon.



Sec. 201.56  General requirements on content and format of labeling for human prescription drugs.

    Prescription drug labeling described in Sec. 201.100(d) shall 
contain the information in the format required by Sec. 201.57 and shall 
meet the following general requirements:

[[Page 20]]

    (a) The labeling shall contain a summary of the essential scientific 
information needed for the safe and effective use of the drug.
    (b) The labeling shall be informative and accurate and neither 
promotional in tone nor false or misleading in any particular.
    (c) The labeling shall be based whenever possible on data derived 
from human experience. No implied claims or suggestions of drug use may 
be made if there is inadequate evidence of safety or a lack of 
substantial evidence of effectiveness. Conclusions based on animal data 
but necessary for safe and effective use of the drug in humans shall be 
identified as such and included with human data in the appropriate 
section of the labeling, headings for which are listed in paragraph (d) 
of this section.
    (d)(1) The labeling shall contain specific information required 
under Sec. 201.57 under the following section headings and in the 
following order:

Description.
Clinical Pharmacology.
Indications and Usage.
Contraindications.
Warnings.
Precautions.
Adverse Reactions.
Drug Abuse and Dependence.
Overdosage.
Dosage and Administration.
How Supplied.

    (2) The labeling may contain the following additional section 
headings if appropriate and if in compliance with Sec. 201.57 (l) and 
(m):

Animal Pharmacology and/or Animal Toxicology.
Clinical Studies.
References.

    (3) The labeling may omit any section or subsection of the labeling 
format if clearly inapplicable.
    (4) The labeling may contain a ``Product Title'' section preceding 
the ``Description'' section and containing only the information required 
by Sec. 201.57(a)(1)(i), (ii), (iii), and (iv) and Sec. 201.100(e). The 
information required by Sec. 201.57(a)(1)(i), (ii), (iii), and (iv) 
shall appear in the ``Description'' section of the labeling, whether or 
not it also appears in a ``Product Title.''
    (e) The labeling shall contain the date of the most recent revision 
of the labeling, identified as such, placed prominently immediately 
after the last section of the labeling.

[44 FR 37462, June 26, 1979]



Sec. 201.57  Specific requirements on content and format of labeling for human prescription drugs.

    Each section heading listed in Sec. 201.56(d), if not omitted under 
Sec. 201.56(d)(3), shall contain the following information in the 
following order:
    (a) Description. (1) Under this section heading, the labeling shall 
contain:
    (i) The proprietary name and the established name, if any, as 
defined in section 502(e)(2) of the act, of the drug;
    (ii) The type of dosage form and the route of administration to 
which the labeling applies;
    (iii) The same qualitative and/or quantitative ingredient 
information as required under Sec. 201.100(b) for labels;
    (iv) If the product is sterile, a statement of that fact;
    (v) The pharmacological or therapeutic class of the drug;
    (vi) The chemical name and structural formula of the drug;
    (vii) If the product is radioactive, a statement of the important 
nuclear physical characteristics, such as the principal radiation 
emission data, external radiation, and physical decay characteristics.
    (2) If appropriate, other important chemical or physical 
information, such as physical constants, or pH, shall be stated.
    (b) Clinical Pharmacology. (1) Under this section heading, the 
labeling shall contain a concise factual summary of the clinical 
pharmacology and actions of the drug in humans. The summary may include 
information based on in vitro and/or animal data if the information is 
essential to a description of the biochemical and/or physiological mode 
of action of the drug or is otherwise pertinent to human therapeutics. 
Pharmacokinetic information that is important to safe and effective use 
of the drug is required, if known, e.g., degree and rate of absorption, 
pathways of biotransformation, percentage of

[[Page 21]]

dose as unchanged drug and metabolites, rate or half-time of 
elimination, concentration in body fluids associated with therapeutic 
and/or toxic effects, degree of binding to plasma proteins, degree of 
uptake by a particular organ or in the fetus, and passage across the 
blood brain barrier. Inclusion of pharmacokinetic information is 
restricted to that which relates to clinical use of the drug. If the 
pharmacological mode of action of the drug is unknown or if important 
metabolic or pharmacokinetic data in humans are unavailable, the 
labeling shall contain a statement about the lack of information.
    (2) Data that demonstrate activity or effectiveness in in vitro or 
animal tests and that have not been shown by adequate and well-
controlled clinical studies to be pertinent to clinical use may be 
included under this section of the labeling only under the following 
circumstances:
    (i) In vitro data for anti-infective drugs may be included if the 
data are immediately preceded by the statement ``The following in vitro 
data are available but their clinical significance is unknown.''
    (ii) For other classes of drugs, in vitro and animal data that have 
not been shown by adequate and well-controlled clinical studies, as 
defined in Sec. 314.126(b) of this chapter, to be pertinent to clinical 
use may be used only if a waiver is granted under Sec. 201.58 or 
Sec. 314.126(b) of this chapter.
    (c) Indications and Usage. (1) Under this section heading, the 
labeling shall state that:
    (i) The drug is indicated in the treatment, prevention, or diagnosis 
of a recognized disease or condition, e.g., penicillin is indicated for 
the treatment of pneumonia due to susceptible pneumococci; and/or
    (ii) The drug is indicated for the treatment, prevention, or 
diagnosis of an important manifestation of a disease or condition, e.g., 
chlorothiazide is indicated for the treatment of edema in patients with 
congestive heart failure; and/or
    (iii) The drug is indicated for the relief of symptoms associated 
with a disease or syndrome, e.g., chlorpheniramine is indicated for the 
symptomatic relief of nasal congestion in patients with vasomotor 
rhinitis; and/or
    (iv) The drug, if used for a particular indication only in 
conjuction with a primary mode of therapy, e.g., diet, surgery, or some 
other drug, is an adjunct to the mode of therapy.
    (2) All indications shall be supported by substantial evidence of 
effectiveness based on adequate and well-controlled studies as defined 
in Sec. 314.126(b) of this chapter unless the requirement is waived 
under Sec. 201.58 or Sec. 314.126(b) of this chapter.
    (3) This section of the labeling shall also contain the following 
additional information:
    (i) If evidence is available to support the safety and effectiveness 
of the drug only in selected subgroups of the larger population with a 
disease, syndrome, or symptom under consideration, e.g., patients with 
mild disease or patients in a special age group, the labeling shall 
describe the available evidence and state the limitations of usefulness 
of the drug. The labeling shall also identify specific tests needed for 
selection or monitoring of the patients who need the drug, e.g., microbe 
susceptibility tests. Information on the approximate kind, degree, and 
duration of improvement to be anticipated shall be stated if available 
and shall be based on substantial evidence derived from adequate and 
well-controlled studies as defined in Sec. 314.126(b) of this chapter 
unless the requirement is waived under Sec. 201.58 or Sec. 314.126(b) of 
this chapter. If the information is relevant to the recommended 
intervals between doses, the usual duration of treatment, or any 
modification of dosage, it shall be stated in the ``Dosage and 
Administration'' section of the labeling and referenced in this section.
    (ii) If safety considerations are such that the drug should be 
reserved for certain situations, e.g., cases refractory to other drugs, 
this information shall be stated in this section.
    (iii) If there are specific conditions that should be met before the 
drug is used on a long-term basis, e.g., demonstration of responsiveness 
to the drug in a short-term trial, the labeling shall identify the 
conditions; or, if the indications for long-term use are different from 
those for short-term use,

[[Page 22]]

the labeling shall identify the specific indications for each use.
    (iv) If there is a common belief that the drug may be effective for 
a certain use or if there is a common use of the drug for a condition, 
but the preponderance of evidence related to the use or condition shows 
that the drug is ineffective, the Food and Drug Administration may 
require that the labeling state that there is a lack of evidence that 
the drug is effective for that use or condition.
    (v) Any statements comparing the safety or effectiveness, either 
greater or less, of the drug with other agents for the same indication 
shall be supported by adequate and well-controlled studies as defined in 
Sec. 314.126(b) of this chapter unless this requirement is waived under 
Sec. 201.58 or Sec. 314.126(b) of this chapter.
    (d) Contraindications. Under this section heading, the labeling 
shall describe those situations in which the drug should not be used 
because the risk of use clearly outweighs any possible benefit. These 
situations include administration of the drug to patients known to have 
a hypersensitivity to it; use of the drug in patients who, because of 
their particular age, sex, concomitant therapy, disease state, or other 
condition, have a substantial risk of being harmed by it; or continued 
use of the drug in the face of an unacceptably hazardous adverse 
reaction. Known hazards and not theoretical possibilities shall be 
listed, e.g., if hypersensitivity to the drug has not been demonstrated, 
it should not be listed as a contraindication. If no contraindications 
are known, this section of the labeling shall state ``None known.''
    (e) Warnings. Under this section heading, the labeling shall 
describe serious adverse reactions and potential safety hazards, 
limitations in use imposed by them, and steps that should be taken if 
they occur. The labeling shall be revised to include a warning as soon 
as there is reasonable evidence of an association of a serious hazard 
with a drug; a causal relationship need not have been proved. A specific 
warning relating to a use not provided for under the ``Indications and 
Usage'' section of the labeling may be required by the Food and Drug 
Administration if the drug is commonly prescribed for a disease or 
condition, and there is lack of substantial evidence of effectivenes for 
that disease or condition, and such usage is associated with serious 
risk or hazard. Special problems, particularly those that may lead to 
death or serious injury, may be required by the Food and Drug 
Administration to be placed in a prominently displayed box. The boxed 
warning ordinarily shall be based on clinical data, but serious animal 
toxicity may also be the basis of a boxed warning in the absence of 
clinical data. If a boxed warning is required, its location will be 
specified by the Food and Drug Administration. The frequency of these 
serious adverse reactions and, if known, the approximate mortality and 
morbidity rates for patients sustaining the reaction, which are 
important to safe and effective use of the drug, shall be expressed as 
provided under the ``Adverse Reactions'' section of the labeling.
    (f) Precautions. Under this section heading, the labeling shall 
contain the following subsections as appropriate for the drug:
    (1) General. This subsection of the labeling shall contain 
information regarding any special care to be exercised by the 
practitioner for safe and effective use of the drug, e.g., precautions 
not required under any other specific section or subsection of the 
labeling.
    (2) Information for patients. This subsection of the labeling shall 
contain information to be given to patients for safe and effective use 
of the drug, e.g., precautions concerning driving or the concomitant use 
of other substances that may have harmful additive effects. Any printed 
patient information or Medication Guide required under this chapter to 
be distributed to the patient shall be referred to under the 
``Precautions'' section of the labeling and the full text of such 
patient information or Medication Guide shall be reprinted at the end of 
the labeling. The print size requirements for the Medication Guide set 
forth in Sec. 208.20 of this chapter, however, do not apply to the 
Medication Guide that is reprinted in the professional labeling.

[[Page 23]]

    (3) Laboratory tests. This subsection of the labeling shall identify 
any laboratory tests that may be helpful in following the patient's 
response or in identifying possible adverse reactions. If appropriate, 
information shall be provided on such factors as the range of normal and 
abnormal values expected in the particular situation and the recommended 
frequency with which tests should be done before, during, and after 
therapy.
    (4)(i) Drug interactions. This subsection of the labeling shall 
contain specific practical guidance for the physician on preventing 
clinically significant drug/drug and drug/food interactions that may 
occur in vivo in patients taking the drug. Specific drugs or classes of 
drugs with which the drug to which the labeling applies may interact in 
vivo shall be identified, and the mechanism(s) of the interaction shall 
be briefly described. Information in this subsection of the labeling 
shall be limited to that pertaining to clinical use of the drug in 
patients. Drug interactions supported only by animal or in vitro 
experiments may not ordinarily be included, but animal or in vitro data 
may be used if shown to be clinically relevant. Drug incompatibilities, 
i.e., drug interactions that may occur when drugs are mixed in vitro, as 
in a solution for intravenous administration, shall be discussed under 
the ``Dosage and Administration'' section of the labeling rather than 
under this subsection of the labeling.
    (ii) Drug/laboratory test interactions. This subsection of the 
labeling shall contain practical guidance on known interference of the 
drug with laboratory tests.
    (5) Carcinogenesis, mutagenesis, impairment of fertility. This 
subsection of the labeling shall state whether long-term studies in 
animals have been performed to evaluate carcinogenic potential and, if 
so, the species and results. If reproduction studies or other data in 
animals reveal a problem or potential problem concerning mutagenesis or 
impairment of fertility in either males or females, the information 
shall be described. Any precautionary statement on these topics shall 
include practical, relevant advice to the physician on the significance 
of these animal findings. If there is evidence from human data that the 
drug may be carcinogenic or mutagenic or that it impairs fertility, this 
information shall be included under the ``Warnings'' section of the 
labeling. Also, under ``Precautions,'' the labeling shall state: ``See 
`Warnings' section for information on carcinogenesis, mutagenesis, and 
impairment of fertility.''
    (6) Pregnancy. This subsection of the labeling may be omitted only 
if the drug is not absorbed systemically and the drug is not known to 
have a potential for indirect harm to the fetus. For all other drugs, 
this subsection of the labeling shall contain the following information:
    (i) Teratogenic effects. Under this heading the labeling shall 
identify one of the following categories that applies to the drug, and 
the labeling shall bear the statement required under the category:
    (a) Pregnancy category A. If adequate and well-controlled studies in 
pregnant women have failed to demonstrate a risk to the fetus in the 
first trimester of pregnancy (and there is no evidence of a risk in 
later trimesters), the labeling shall state: ``Pregnancy Category A. 
Studies in pregnant women have not shown that (name of drug) increases 
the risk of fetal abnormalities if administered during the first 
(second, third, or all) trimester(s) of pregnancy. If this drug is used 
during pregnancy, the possibility of fetal harm appears remote. Because 
studies cannot rule out the possibility of harm, however, (name of drug) 
should be used during pregnancy only if clearly needed.'' The labeling 
shall also contain a description of the human studies. If animal 
reproduction studies are available and they fail to demonstrate a risk 
to the fetus, the labeling shall also state: ``Reproduction studies have 
been performed in (kinds of animal(s)) at doses up to (x) times the 
human dose and have revealed no evidence of impaired fertility or harm 
to the fetus due to (name of drug).'' The labeling shall also contain a 
description of available data on the effect of the drug on the later 
growth, development, and functional maturation of the child.

[[Page 24]]

    (b) Pregnancy category B. If animal reproduction studies have failed 
to demonstrate a risk to the fetus and there are no adequate and well-
controlled studies in pregnant women, the labeling shall state: 
``Pregnancy Category B. Reproduction studies have been performed in 
(kind(s) of animal(s)) at doses up to (x) times the human dose and have 
revealed no evidence of impaired fertility or harm to the fetus due to 
(name of drug). There are, however, no adequate and well-controlled 
studies in pregnant women. Because animal reproduction studies are not 
always predictive of human response, this drug should be used during 
pregnancy only if clearly needed.'' If animal reproduction studies have 
shown an adverse effect (other than decrease in fertility), but adequate 
and well-controlled studies in pregnant women have failed to demonstrate 
a risk to the fetus during the first trimester of pregnancy (and there 
is no evidence of a risk in later trimesters), the labeling shall state: 
``Pregnancy Category B. Reproduction studies in (kind(s) of animal(s)) 
have shown (describe findings) at (x) times the human dose. Studies in 
pregnant women, however, have not shown that (name of drug) increases 
the risk of abnormalities when administered during the first (second, 
third, or all) trimester(s) of pregnancy. Despite the animal findings, 
it would appear that the possibility of fetal harm is remote, if the 
drug is used during pregnancy. Nevertheless, because the studies in 
humans cannot rule out the possibility of harm, (name of drug) should be 
used during pregnancy only if clearly needed.'' The labeling shall also 
contain a description of the human studies and a description of 
available data on the effect of the drug on the later growth, 
development, and functional maturation of the child.
    (c) Pregnancy category C. If animal reproduction studies have shown 
an adverse effect on the fetus, if there are no adequate and well-
controlled studies in humans, and if the benefits from the use of the 
drug in pregnant women may be acceptable despite its potential risks, 
the labeling shall state: ``Pregnancy Category C. (Name of drug) has 
been shown to be teratogenic (or to have an embryocidal effect or other 
adverse effect) in (name(s) of species) when given in doses (x) times 
the human dose. There are no adequate and well-controlled studies in 
pregnant women. (Name of drug) should be used during pregnancy only if 
the potential benefit justifies the potential risk to the fetus.'' The 
labeling shall contain a description of the animal studies. If there are 
no animal reproduction studies and no adequate and well-controlled 
studies in humans, the labeling shall state: ``Pregnancy Category C. 
Animal reproduction studies have not been conducted with (name of drug). 
It is also not known whether (name of drug) can cause fetal harm when 
administered to a pregnant woman or can affect reproduction capacity. 
(Name of drug) should be given to a pregnant woman only if clearly 
needed.'' The labeling shall contain a description of any available data 
on the effect of the drug on the later growth, development, and 
functional maturation of the child.
    (d) Pregnancy category D. If there is positive evidence of human 
fetal risk based on adverse reaction data from investigational or 
marketing experience or studies in humans, but the potential benefits 
from the use of the drug in pregnant women may be acceptable despite its 
potential risks (for example, if the drug is needed in a life-
threatening situation or serious disease for which safer drugs cannot be 
used or are ineffective), the labeling shall state: ``Pregnancy Category 
D. See `Warnings' section.'' Under the ``Warnings'' section, the 
labeling states: ``(Name of drug) can cause fetal harm when administered 
to a pregnant woman. (Describe the human data and any pertinent animal 
data.) If this drug is used during pregnancy, or if the patient becomes 
pregnant while taking this drug, the patient should be apprised of the 
potential hazard to the fetus.''
    (e) Pregnancy category X. If studies in animals or humans have 
demonstrated fetal abnormalities or if there is positive evidence of 
fetal risk based on adverse reaction reports from investigational or 
marketing experience, or both, and the risk of the use of the drug in a 
pregnant woman clearly outweighs any possible benefit (for example, 
safer drugs or other forms of therapy are available), the labeling shall

[[Page 25]]

state: ``Pregnancy Category X. See `Contraindications' section.'' Under 
``Contraindications,'' the labeling shall state: ``(Name of drug) may 
(can) cause fetal harm when administered to a pregnant woman. (Describe 
the human data and any pertinant animal data.) (Name of drug) is 
contraindicated in women who are or may become pregnant. If this drug is 
used during pregnancy, or if the patient becomes pregnant while taking 
this drug, the patient should be apprised of the potential hazard to the 
fetus.''
    (ii) Nonteratogenic effects. Under this heading the labeling shall 
contain other information on the drug's effects on reproduction and the 
drug's use during pregnancy that is not required specifically by one of 
the pregnancy categories, if the information is relevant to the safe and 
effective use of the drug. Information required under this heading shall 
include nonteratogenic effects in the fetus or newborn infant (for 
example, withdrawal symptoms or hypoglycemia) that may occur because of 
a pregnant woman's chronic use of the drug for a preexisting condition 
or disease.
    (7) Labor and delivery. If the drug has a recognized use during 
labor or delivery (vaginal or abdominal delivery), whether or not the 
use is stated in the indications section of the labeling, this 
subsection of the labeling shall describe the available information 
about the effect of the drug on the mother and the fetus, on the 
duration of labor or delivery, on the possibility that forceps delivery 
or other intervention or resuscitation of the newborn will be necessary, 
and the effect of the drug on the later growth, development, and 
functional maturation of the child. If any information required under 
this subsection is unknown, this subsection of the labeling shall state 
that the information is unknown.
    (8) Nursing mothers. (i) If a drug is absorbed systemically, this 
subsection of the labeling shall contain, if known, information about 
excretion of the drug in human milk and effects on the nursing infant. 
Pertinent adverse effects observed in animal offspring shall be 
described.
    (ii) If a drug is absorbed systemically and is known to be excreted 
in human milk, this subsection of the labeling shall contain one of the 
following statements, as appropriate. If the drug is associated with 
serious adverse reactions or if the drug has a known tumorigenic 
potential, the labeling shall state: ``Because of the potential for 
serious adverse reactions in nursing infants from (name of drug) (or, 
``Because of the potential for tumorigenicity shown for (name of drug) 
in (animal or human) studies), 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.'' If the drug is not associated 
with serious adverse reactions and does not have a known tumorigenic 
potential, the labeling shall state: ``Caution should be exercised when 
(name of drug) is administered to a nursing woman.''
    (iii) If a drug is absorbed systemically and information on 
excretion in human milk is unknown, this subsection of the labeling 
shall contain one of the following statements, as appropriate. If the 
drug is associated with serious adverse reactions or has a known 
tumorigenic potential, the labeling shall state: ``It is not known 
whether this drug is excreted in human milk. Because many drugs are 
excreted in human milk and because of the potential for serious adverse 
reactions in nursing infants from (name of drug) (or, ``Because of the 
potential for tumorigenicity shown for (name of drug) in (animal or 
human) studies), 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.'' If the drug is not associated with serious 
adverse reactions and does not have a known tumorigenic potential, the 
labeling shall state: ``It is not known whether this drug is excreted in 
human milk. Because many drugs are excreted in human milk, caution 
should be exercised when (name of drug) is administered to a nursing 
woman.''
    (9) Pediatric use. (i) Pediatric population(s)/pediatric patient(s): 
For the purposes of paragraphs (f)(9)(ii) through (f)(9)(viii) of this 
setion, the terms pediatric population(s) and pediatric patient(s) are 
defined as the pediatric age group, from birth to 16 years,

[[Page 26]]

including age groups often called neonates, infants, children, and 
adolescents.
    (ii) If there is a specific pediatric indication (i.e., an 
indication different from those approved for adults) that is supported 
by adequate and well-controlled studies in the pediatric population, it 
shall be described under the ``Indications and Usage'' section of the 
labeling, and appropriate pediatric dosage information shall be given 
under the ``Dosage and Administration'' section of the labeling. The 
``Pediatric use'' subsection shall cite any limitations on the pediatric 
indication, need for specific monitoring, specific hazards associated 
with use of the drug in any subsets of the pediatric population (e.g., 
neonates), differences between pediatric and adult responses to the 
drug, and other information related to the safe and effective pediatric 
use of the drug. Data summarized in this subsection of the labeling 
should be discussed in more detail, if appropriate, under the ``Clinical 
Pharmacology'' or ``Clinical Studies'' section. As appropriate, this 
information shall also be contained in the ``Contraindications,'' 
``Warnings,'' and elsewhere in the ``Precautions'' sections.
    (iii) If there are specific statements on pediatric use of the drug 
for an indication also approved for adults that are based on adequate 
and well-controlled studies in the pediatric population, they shall be 
summarized in the ``Pediatric use'' subsection of the labeling and 
discussed in more detail, if appropriate, under the ``Clinical 
Pharmacology'' and ``Clinical Studies'' sections. Appropriate pediatric 
dosage shall be given under the ``Dosage and Administration'' section of 
the labeling. The ``Pediatric use'' subsection of the labeling shall 
also cite any limitations on the pediatric use statement, need for 
specific monitoring, specific hazards associated with use of the drug in 
any subsets of the pediatric population (e.g., neonates), differences 
between pediatric and adult responses to the drug, and other information 
related to the safe and effective pediatric use of the drug. As 
appropriate, this information shall also be contained in the 
``Contraindications,'' ``Warnings,'' and elsewhere in the 
``Precautions'' sections.
    (iv) FDA may approve a drug for pediatric use based on adequate and 
well-controlled studies in adults, with other information supporting 
pediatric use. In such cases, the agency will have concluded that the 
course of the disease and the effects of the drug, both beneficial and 
adverse, are sufficiently similar in the pediatric and adult populations 
to permit extrapolation from the adult efficacy data to pediatric 
patients. The additional information supporting pediatric use must 
ordinarily include data on the pharmacokinetics of the drug in the 
pediatric population for determination of appropriate dosage. Other 
information, such as data from pharmacodynamic studies of the drug in 
the pediatric population, data from other studies supporting the safety 
or effectiveness of the drug in pediatric patients, pertinent 
premarketing or postmarketing studies or experience, may be necessary to 
show that the drug can be used safely and effectively in pediatric 
patients. When a drug is approved for pediatric use based on adequate 
and well-controlled studies in adults with other information supporting 
pediatric use, the ``Pediatric use'' subsection of the labeling shall 
contain either the following statement, or a reasonable alternative: 
``The safety and effectiveness of (drug name) have been established in 
the age groups __ to __ (note any limitations, e.g., no data for 
pediatric patients under 2, or only applicable to certain indications 
approved in adults). Use of (drug name) in these age groups is supported 
by evidence from adequate and well-controlled studies of (drug name) in 
adults with additional data (insert wording that accurately describes 
the data submitted to support a finding of substantial evidence of 
effectiveness in the pediatric population).'' Data summarized in the 
preceding prescribed statement in this subsection of the labeling shall 
be discussed in more detail, if appropriate, under the ``Clinical 
Pharmacology'' or the ``Clinical Studies'' section. For example, 
pediatric pharmacokinetic or pharmacodynamic studies and dose-response 
information should

[[Page 27]]

be described in the ``Clinical Pharmacology'' section. Pediatric dosing 
instructions shall be included in the ``Dosage and Administration'' 
section of the labeling. Any differences between pediatric and adult 
responses, need for specific monitoring, dosing adjustments, and any 
other information related to safe and effective use of the drug in 
pediatric patients shall be cited briefly in the ``Pediatric use'' 
subsection and, as appropriate, in the ``Contraindications,'' 
``Warnings,'' ``Precautions,'' and ``Dosage and Administration'' 
sections.
    (v) If the requirements for a finding of substantial evidence to 
support a pediatric indication or a pediatric use statement have not 
been met for a particular pediatric population, the ``Pediatric use'' 
subsection of the labeling shall contain an appropriate statement such 
as ``Safety and effectiveness in pediatric patients below the age of 
(__) have not been established.'' If use of the drug in this pediatric 
population is associated with a specific hazard, the hazard shall be 
described in this subsection of the labeling, or, if appropriate, the 
hazard shall be stated in the ``Contraindications'' or ``Warnings'' 
section of the labeling and this subsection shall refer to it.
    (vi) If the requirements for a finding of substantial evidence to 
support a pediatric indication or a pediatric use statement have not 
been met for any pediatric population, this subsection of the labeling 
shall contain the following statement: ``Safety and effectiveness in 
pediatric patients have not been established.'' If use of the drug in 
premature or neonatal infants, or other pediatric subgroups, is 
associated with a specific hazard, the hazard shall be described in this 
subsection of the labeling, or, if appropriate, the hazard shall be 
stated in the ``Contraindications'' or ``Warnings'' section of the 
labeling and this subsection shall refer to it.
    (vii) If the sponsor believes that none of the statements described 
in paragraphs (f)(9)(ii) through (f)(9)(vi) of this section is 
appropriate or relevant to the labeling of a particular drug, the 
sponsor shall provide reasons for omission of the statements and may 
propose alternative statement(s). FDA may permit use of an alternative 
statement if FDA determines that no statement described in those 
paragraphs is appropriate or relevant to the drug's labeling and that 
the alternative statement is accurate and appropriate.
    (viii) If the drug product contains one or more inactive ingredients 
that present an increased risk of toxic effects to neonates or other 
pediatric subgroups, a special note of this risk shall be made, 
generally in the ``Contraindications,'' ``Warnings,'' or ``Precautions'' 
section.
    (10) Geriatric use. (i) A specific geriatric indication, if any, 
that is supported by adequate and well-controlled studies in the 
geriatric population shall be described under the ``Indications and 
Usage'' section of the labeling, and appropriate geriatric dosage shall 
be stated under the ``Dosage and Administration'' section of the 
labeling. The ``Geriatric use'' subsection shall cite any limitations on 
the geriatric indication, need for specific monitoring, specific hazards 
associated with the geriatric indication, and other information related 
to the safe and effective use of the drug in the geriatric population. 
Unless otherwise noted, information contained in the ``Geriatric use'' 
subsection of the labeling shall pertain to use of the drug in persons 
65 years of age and older. Data summarized in this subsection of the 
labeling shall be discussed in more detail, if appropriate, under 
``Clinical Pharmacology'' or the ``Clinical Studies'' section. As 
appropriate, this information shall also be contained in 
``Contraindications,'' ``Warnings,'' and elsewhere in ``Precautions.''
    (ii) Specific statements on geriatric use of the drug for an 
indication approved for adults generally, as distinguished from a 
specific geriatric indication, shall be contained in the ``Geriatric 
use'' subsection and shall reflect all information available to the 
sponsor that is relevant to the appropriate use of the drug in elderly 
patients. This information includes detailed results from controlled 
studies that are available to the sponsor and pertinent information from 
well-documented studies obtained from a literature search. Controlled 
studies include those that are part of the marketing application and 
other relevant studies available to the

[[Page 28]]

sponsor that have not been previously submitted in the investigational 
new drug application, new drug application, biological license 
application, or a supplement or amendment to one of these applications 
(e.g., postmarketing studies or adverse drug reaction reports). The 
``Geriatric use'' subsection shall contain the following statement(s) or 
reasonable alternative, as applicable, taking into account available 
information:
    (A) If clinical studies did not include sufficient numbers of 
subjects aged 65 and over to determine whether elderly subjects respond 
differently from younger subjects, and other reported clinical 
experience has not identified such differences, the ``Geriatric use'' 
subsection shall include the following statement:

    ``Clinical studies of (name of drug) 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 the elderly and 
younger patients. In general, dose selection for an elderly patient 
should be cautious, usually starting at the low end of the dosing range, 
reflecting the greater frequency of decreased hepatic, renal, or cardiac 
function, and of concomitant disease or other drug therapy.''

    (B) If clinical studies (including studies that are part of 
marketing applications and other relevant studies available to the 
sponsor that have not been submitted in the sponsor's applications) 
included enough elderly subjects to make it likely that differences in 
safety or effectiveness between elderly and younger subjects would have 
been detected, but no such differences (in safety or effectiveness) were 
observed, and other reported clinical experience has not identified such 
differences, the ``Geriatric use'' subsection shall contain the 
following statement:

    Of the total number of subjects in clinical studies of (name of 
drug), __ percent were 65 and over, while __ percent were 75 and over. 
(Alternatively, the labeling may state the total number of subjects 
included in the studies who were 65 and over and 75 and over.) No 
overall differences in safety or effectiveness were observed between 
these subjects and younger subjects, and other reported clinical 
experience has not identified differences in responses between the 
elderly and younger patients, but greater sensitivity of some older 
individuals cannot be ruled out.

    (C) If evidence from clinical studies and other reported clinical 
experience available to the sponsor indicates that use of the drug in 
elderly patients is associated with differences in safety or 
effectiveness, or requires specific monitoring or dosage adjustment, the 
``Geriatric use'' subsection of the labeling shall contain a brief 
description of observed differences or specific monitoring or dosage 
requirements and, as appropriate, shall refer to more detailed 
discussions in the ``Contraindications,'' ``Warnings,'' ``Dosage and 
Administration,'' or other sections of the labeling.
    (iii)(A) If specific pharmacokinetic or pharmacodynamic studies have 
been carried out in the elderly, they shall be described briefly in the 
``Geriatric use'' subsection of the labeling and in detail under the 
``Clinical Pharmacology'' section. The ``Clinical Pharmacology'' section 
and ``Drug interactions'' subsection of the ``Precautions'' section 
ordinarily contain information on drug-disease and drug-drug 
interactions that is particularly relevant to the elderly, who are more 
likely to have concomitant illness and to utilize concomitant drugs.
    (B) If a drug is known to be substantially excreted by the kidney, 
the ``Geriatric use'' subsection shall include the statement:

    ``This drug is known to be substantially excreted by the kidney, and 
the risk of toxic reactions to this drug may be greater in patients with 
impaired renal function. Because elderly patients are more likely to 
have decreased renal function, care should be taken in dose selection, 
and it may be useful to monitor renal function.''

    (iv) If use of the drug in the elderly appears to cause a specific 
hazard, the hazard shall be described in the ``Geriatric use'' 
subsection of the labeling, or, if appropriate, the hazard shall be 
stated in the ``Contraindications,'' ``Warnings,'' or ``Precautions'' 
section of the labeling, and the ``Geriatric use'' subsection shall 
refer to those sections.
    (v) Labeling under paragraphs (f)(10)(i) through (f)(10)(iii) of 
this section may include statements, if they would be useful in 
enhancing safe use

[[Page 29]]

of the drug, that reflect good clinical practice or past experience in a 
particular situation, e.g., for a sedating drug, it could be stated 
that:

    ``Sedating drugs may cause confusion and over-sedation in the 
elderly; elderly patients generally should be started on low doses of 
(name of drug) and observed closely.''

    (vi) If the sponsor believes that none of the requirements described 
in paragraphs (f)(10)(i) through (f)(10)(v) of this section is 
appropriate or relevant to the labeling of a particular drug, the 
sponsor shall provide reasons for omission of the statements and may 
propose an alternative statement. FDA may permit omission of the 
statements if FDA determines that no statement described in those 
paragraphs is appropriate or relevant to the drug's labeling. FDA may 
permit use of an alternative statement if the agency determines that 
such statement is accurate and appropriate.
    (g) Adverse Reactions. An adverse reaction is an undesirable effect, 
reasonably associated with the use of the drug, that may occur as part 
of the pharmacological action of the drug or may be unpredictable in its 
occurrence.
    (1) This section of the labeling shall list the adverse reactions 
that occur with the drug and with drugs in the same pharmacologically 
active and chemically related class, if applicable.
    (2) In this listing, adverse reactions may be categorized by organ 
system, by severity of the reaction, by frequency, or by toxicological 
mechanism, or by a combination of these, as appropriate. If frequency 
information from adequate clinical studies is available, the categories 
and the adverse reactions within each category shall be listed in 
decreasing order of frequency. An adverse reaction that is significantly 
more severe than the other reactions listed in a category, however, 
shall be listed before those reactions, regardless of its frequency. If 
frequency information from adequate clinical studies is not available, 
the categories and adverse reactions within each category shall be 
listed in decreasing order of severity. The approximate frequency of 
each adverse reaction shall be expressed in rough estimates or orders of 
magnitude essentially as follows: ``The most frequent adverse 
reaction(s) to (name of drug) is (are) (list reactions). This (these) 
occur(s) in about (e.g., one-third of patients; one in 30 patients; less 
than one-tenth of patients). Less frequent adverse reactions are (list 
reactions), which occur in approximately (e.g., one in 100 patients). 
Other adverse reactions, which occur rarely, in approximately (e.g., one 
in 1,000 patients), are (list reactions).'' Percent figures may not 
ordinarily be used unless they are documented by adequate and well-
controlled studies as defined in Sec. 314.126(b) of this chapter, they 
are shown to reflect general experience, and they do not falsely imply a 
greater degree of accuracy than actually exists.
    (3) The ``Warnings'' section of the labeling or, if appropriate, the 
``Contraindications'' section of the labeling shall identify any 
potentially fatal adverse reaction.
    (4) Any claim comparing the drug to which the labeling applies with 
other drugs in terms of frequency, severity, or character of adverse 
reactions shall be based on adequate and well-controlled studies as 
defined in Sec. 314.126(b) of this chapter unless this requirement is 
waived under Sec. 201.58 or Sec. 314.126(b) of this chapter.
    (h) Drug Abuse and Dependence. Under this section heading, the 
labeling shall contain the following subsections, as appropriate for the 
drug:
    (1) Controlled Substance. If the drug is controlled by the Drug 
Enforcement Administration, the schedule in which it is controlled shall 
be stated.
    (2) Abuse. This subsection of the labeling shall be based primarily 
on human data and human experience, but pertinent animal data may also 
be used. This subsection shall state the types of abuse that can occur 
with the drug and the adverse reactions pertinent to them. Particularly 
susceptible patient populations shall be identified.
    (3) Dependence. This subsection of the labeling shall describe 
characteristic effects resulting from both psychological and physical 
dependence that occur with the drug and shall identify the quantity of 
the drug over a period of time that may lead to tolerance or dependence, 
or both. Details shall be provided on the adverse effects of chronic 
abuse and the effects of abrupt

[[Page 30]]

withdrawal. Procedures necessary to diagnose the dependent state shall 
be provided, and the principles of treating the effects of abrupt 
withdrawal shall be described.
    (i) Overdosage. Under this section heading, the labeling shall 
describe the signs, symptoms, and laboratory findings of acute 
overdosage and the general principles of treatment. This section shall 
be based on human data, when available. If human data are unavailable, 
appropriate animal and in vitro data may be used. Specific information 
shall be provided about the following:
    (1) Signs, symptoms, and laboratory findings associated with an 
overdosage of the drug.
    (2) Complications that can occur with the drug (for example, organ 
toxicity or delayed acidosis).
    (3) Oral LD50 of the drug in animals; concentrations of 
the drug in biologic fluids associated with toxicity and/or death; 
physiologic variables influencing excretion of the drug, such as urine 
pH; and factors that influence the dose response relationship of the 
drug, such as tolerance. The pharmacokinetic data given in the 
``Clinical Pharmacology'' section also may be referenced here, if 
applicable to overdoses.
    (4) The amount of the drug in a single dose that is ordinarily 
associated with symptoms of overdosage and the amount of the drug in a 
single dose that is likely to be life-threatening.
    (5) Whether the drug is dialyzable.
    (6) Recommended general treatment procedures and specific measures 
for support of vital functions, such as proven antidotes, induced 
emesis, gastric lavage, and forced diuresis. Unqualified recommendations 
for which data are lacking with the specific drug or class of drugs, 
especially treatment using another drug (for example, central nervous 
system stimulants, respiratory stimulants) may not be stated unless 
specific data or scientific rationale exists to support safe and 
effective use.
    (j) Dosage and Administration. This section of the labeling shall 
state the recommended usual dose, the usual dosage range, and, if 
appropriate, an upper limit beyond which safety and effectiveness have 
not been established; dosages shall be stated for each indication when 
appropriate. This section shall also state the intervals recommended 
between doses, the optimal method of titrating dosage, the usual 
duration of treatment, and any modification of dosage needed in special 
patient populations, e.g., in children, in geriatric age groups, or in 
patients with renal or hepatic disease. Specific tables or monographs 
may be included to clarify dosage schedules. Radiation dosimetry 
information shall be stated for both the patient receiving a radioactive 
drug and the person administering it. This section shall also contain 
specific direction on dilution, preparation (including the strength of 
the final dosage solution, when prepared according to instructions, in 
terms of milligrams active ingredient per milliliter of reconstituted 
solution, unless another measure of the strength is more appropriate), 
and administration of the dosage form, if needed, e.g., the rate of 
administration of parenteral drug in milligrams per minute; storage 
conditions for stability of the drug or reconstituted drug, when 
important; essential information on drug incompatibilities if the drug 
is mixed in vitro with other drugs; and the following statement for 
parenterals: ``Parenteral drug products should be inspected visually for 
particulate matter and discoloration prior to administration, whenever 
solution and container permit.''
    (k) How Supplied. This section of the labeling shall contain 
information on the available dosage forms to which the labeling applies 
and for which the manufacturer or distributor is responsible. The 
information shall ordinarily include:
    (1) The strength of the dosage form, e.g., 10-milligram tablets, in 
metric system and, if the apothecary system is used, a statement of the 
strength is placed in parentheses after the metric designation;
    (2) The units in which the dosage form is ordinarily available for 
prescribing by practitioners, e.g., bottles of 100;
    (3) Appropriate information to facilitate identification of the 
dosage forms,

[[Page 31]]

such as shape, color, coating, scoring, and National Drug Code; and
    (4) Special handling and storage conditions.
    (l) Animal Pharmacology and/or Animal Toxicology. In most cases, the 
labeling need not include this section. Significant animal data 
necessary for safe and effective use of the drug in humans shall 
ordinarily be included in one or more of the other sections of the 
labeling, as appropriate. Commonly for a drug that has been marketed for 
a long time, and in rare cases for a new drug, chronic animal toxicity 
studies have not been performed or completed for a drug that is 
administered over prolonged periods or is implanted in the body. The 
unavailability of such data shall be stated in the appropriate section 
of the labeling for the drug. If the pertinent animal data cannot be 
appropriately incorporated into other sections of the labeling, this 
section may be used.
    (m) ``Clinical Studies'' and ``References''. These sections may 
appear in labeling in the place of a detailed discussion of a subject 
that is of limited interest but nonetheless important. A reference to a 
specific important clinical study may be made in any section of the 
format required under Secs. 201.56 and 201.57 if the study is essential 
to an understandable presentation of the available information. 
References may appear in sections of the labeling format, other than the 
``Clinical Studies'' or ``References'' section, in rare circumstances 
only. A clinical study or reference may be cited in prescription drug 
labeling only under the following conditions:
    (1) If the clinical study or reference is cited in the labeling in 
the place of a detailed discussion of data and information concerning an 
indication for use of the drug, the reference shall be based upon, or 
the clinical study shall constitute, an adequate and well-controlled 
clinical investigation under Sec. 314.126(b) of this chapter.
    (2) If the clinical study or reference is cited in the labeling in 
the place of a detailed discussion of data and information concerning a 
risk or risks from the use of the drug, the risk or risks shall also be 
identified or discussed in the appropriate section of the labeling for 
the drug.

[44 FR 37462, June 26, 1979, as amended at 55 FR 11576, Mar. 29, 1990; 
59 FR 64249, Dec. 13, 1994; 62 FR 45325, Aug. 27, 1997; 63 FR 66396, 
Dec. 1, 1998]



Sec. 201.58  Requests for waiver of requirement for adequate and well-controlled studies to substantiate certain labeling statements.

    A request under Sec. 201.57(b)(2)(ii), (c)(2), (c)(3)(i), (c)(3)(v), 
(f)(9), and (g)(4) for a waiver of the requirements of Sec. 314.126(b) 
of this chapter shall be submitted in writing as provided in 
Sec. 314.126(b) to the Director, Center for Drug Evaluation and 
Research, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 
20587, or, if applicable, the Director, Center for Biologics Evaluation 
and Research, 8800 Rockville Pike, Bethesda, MD 20892. The waiver shall 
be granted or denied in writing by such Director or the Director's 
designee.

[55 FR 11576, Mar. 29, 1990]



Sec. 201.59  Effective date of Secs. 201.56, 201.57, 201.100(d)(3), and 201.100(e).

    (a) On and after December 26, 1979, no person may initially 
introduce or initially deliver for introduction into interstate commerce 
any drug to which Secs. 201.56, 201.57, 201.100(d)(3) apply unless the 
drug's labeling complies with the requirements set forth in the 
regulations, with the following exceptions:
    (1) If the drug is a prescription drug that is not a biologic and 
not subject to section 505 of the act (21 U.S.C. 355), and was not 
subject to former section 507 of the act (21 U.S.C. 357, repealed 1997), 
Secs. 201.56, 201.57, and 201.100(d)(3) are effective on April 10, 1981.
    (2) If the drug is a prescription drug that on December 26, 1979 is 
(i) a licensed biologic, (ii) a new drug subject to an approved new drug 
application or abbreviated new drug application under section 505 of the 
act or (iii) an antibiotic drug subject to an approved antibiotic form, 
Secs. 201.56, 201.57, and 201.100(d)(3) are effective on the date listed 
below for the class of drugs to which the drug belongs. Dates are also 
listed below for the submission of supplemental applications, 
amendments, and license changes.

[[Page 32]]

    (3) If the drug is approved after December 26, 1979 but is a 
duplicate of a drug approved on or before that date (for example, a drug 
approved under an abbreviated new drug application or an antibiotic 
form), Secs. 201.56, 201.57, and 201.100(d)(3) are effective on the date 
listed below for the class of drugs to which the drug belongs. Dates are 
also listed below for the submission of supplemental applications, 
amendments, and license changes.

----------------------------------------------------------------------------------------------------------------
       Effective         Revised labeling due            Drug class                    Mail routing code
----------------------------------------------------------------------------------------------------------------
                                                    Biologics
----------------------------------------------------------------------------------------------------------------
Nov. 1, 1982..........  Nov. 1, 1980..........  Bacterial vaccines and        HFB-240
                                                 antigens with no U.S.
                                                 standard of potency.
    Do................  ......do..............  Skin test antigens..........  HFB-240
Nov. 1, 1982 \1\......  Nov. 1,1980 \2\.......  Bacteral vaccines and         HFB-240
                                                 toxoids with standards of
                                                 potency..
    Do................  ......do..............  Viral and rickettsial         HFB-240
                                                 vaccines.
    Do................  ......do..............  Allergenic extracts.........  HFB-240
    Do................  ......do..............  Blood and blood derivatives.  HFB-240
----------------------------------------------------------------------------------------------------------------
                                         New Drugs and Antibiotic Drugs
----------------------------------------------------------------------------------------------------------------
Nov. 1, 1982..........  Nov. 1, 1980..........  Antiarrhythmics.............  HFD-110
    Do................  ......do..............  Replenishers and regulators   HFD-110, HFD-510, and HFD-160
                                                 of electrolytes and water
                                                 balance.
    Do................  ......do..............  Anticonvulsants.............  HFD-120
    Do................  ......do..............  Adrenal corticosteroids.....  HFD-510 and HFD-150
    Do................  ......do..............  Aminoglycosides.............  HFD-520
    Do................  ......do..............  Scabicides..................      Do.
    Do................  ......do..............  Pediculicides...............      Do.
    Do................  ......do..............  General anesthetics.........  HFD-160
Dec. 1, 1982..........  Dec. 1, 1980..........  Antivirals..................  HFD-520
    Do................  ......do..............  Dermatologics...............      Do.
Jan. 1, 1983..........  Jan. 1, 1981..........  Glaucoma ophthalmics........  HFD-520
    Do................  ......do..............  Topical otics...............      Do.
Feb. 1, 1983..........  Feb. 1, 1981..........  Antispasmodics..............  HFD-110
    Do................  ......do..............  Anticholinergics............      Do.
    Do................  ......do..............  Diuretics...................      Do.
    Do................  ......do..............  Narcotic antagonists........  HFD-120
    Do................  ......do..............  Alcohol antagonists.........      Do.
    Do................  ......do..............  Antipsychotics/antimanics...      Do.
    Do................  ......do..............  Androgens...................  HFD-510
    Do................  ......do..............  Anabolic steroids...........      Do.
    Do................  ......do..............  Hyperlipidemia..............      Do.
    Do................  ......do..............  Anthelmintics...............  HFD-520
    Do................  ......do..............  Antigout....................  HFD-150
Mar. 1, 1983..........  Mar. 1, 1981..........  Vaginal antibiotics.........  HFD-520
Apr. 1, 1983..........  Apr. 1, 1981..........  Cephalosporins..............  HFD-520
May 1, 1983...........  May 1, 1981...........  General analgesics..........  HFD-120
    Do................  ......do..............  Anterior pituitary hormones.  HFD-510
    Do................  ......do..............  Hypothalamic hormones.......      Do.
    Do................  ......do..............  Progestins..................      Do.
    Do................  ......do..............  Mydriatic ophthalmics.......  HFD-520
    Do................  ......do..............  Cycloplegic ophthalmics.....      Do.
    Do................  ......do..............  Radiopharmaceuticals,         HFD-150
                                                 diagnostic.
    Do................  ......do..............  Radiopharmaceuticals,             Do.
                                                 therapeutic.
    Do................  ......do..............  Contrast agents diagnostic        Do.
                                                 radiopaque.
    Do................  ......do..............  Local anesthetics...........  HFD-160
    Do................  ......do..............  Antihistamines..............      Do.
June 1, 1983..........  June 1, 1981..........  Antifungals.................  HFD-520
July 1, 1983..........  July 1, 1981..........  Antidiarrheals..............  HFD-110
    Do................  ......do..............  Cardiac glycosides..........      Do.
    Do................  ......do..............  Sedatives...................  HFD-120
    Do................  ......do..............  Hypnotics...................      Do.
    Do................  ......do..............  Tetracyclines...............  HFD-520
Aug. 1, 1983..........  Aug. 1, 1981..........  Calcium metabolism..........  HFD-510
    Do................  ......do..............  Vitamins and minerals.......      Do.
    Do................  ......do..............  Antiinfective ophthalmics...  HFD-520
    Do................  ......do..............  Antiinflammatory ophthalmics      Do.
Sept. 1, 1983.........  Sept. 1, 1981.........  Antihypertensives...........  HFD-110
    Do................  ......do..............  Drugs indicated for           HFD-120
                                                 extrapyramidal movement
                                                 disorders.
    Do................  ......do..............  Antiprotozoals..............  HFD-520
Oct. 1, 1983..........  Oct. 1, 1981..........  Penicillins.................  HFD-520
Nov. 1, 1983..........  Nov. 1, 1981..........  Blood glucose regulators      HFD-510
                                                 (except sulfonylureas).
Oct. 9, 1984..........  July 10, 1984.........  Sulfonylurea blood glucose    HFN-130
                                                 regulators.

[[Page 33]]

 
Nov. 1, 1983..........  Nov. 1, 1981..........  Drugs indicated for           HFD-510 and HFD-160
                                                 parenteral nutrition.
    Do................  ......do..............  Drugs indicated for enteral       Do.
                                                 nutrition.
    Do................  ......do..............  Miscellaneous ophthalmics...  HFD-520
    Do................  ......do..............  Immunomodulators............  HFD-150
Dec. 1, 1983..........  Dec. 1, 1981..........  Anticoagulants..............  HFD-110
    Do................  ......do..............  Thrombolytics...............      Do.
    Do................  ......do..............  Drugs indicated for acid          Do.
                                                 peptic disorders.
    Do................  ......do..............  Antidepressants.............  HFD-120
    Do................  ......do..............  Drugs indicated for skeletal      Do.
                                                 muscle hyperactivity.
    Do................  ......do..............  Sulfonamides and related      HFD-520
                                                 sulfa compounds.
    Do................  ......do..............  Dental preparations.........  HFD-160
Jan. 1, 1984..........  Jan. 1, 1982..........  Miscellaneous antibacterials  HFD-520
Feb. 1, 1984..........  Feb. 1, 1982..........  Drugs indicated for           HFD-510
                                                 infertility.
    Do................  ......do..............  Thyroids....................      Do.
    Do................  ......do..............  Antithyroids................      Do.
    Do................  ......do..............  Polymyxins..................  HFD-520
    Do................  ......do..............  Antineoplastics.............  HFD-150
Mar. 1, 1984..........  Mar. 1, 1982..........  Urinary tract stimulants....  HFD-110
    Do................  ......do..............  Urinary tract relaxants.....      Do.
    Do................  ......do..............  Antimigraine................  HFD-120
                                                Antimycobacterials            HFD-520
                                                 (including antileprosy).
    Do................  ......do..............  Adjuncts to anethesia.......  HFD-160
Apr. 1, 1984..........  Apr. 1, 1982..........  Antianginals................  HFD-110
    Do................  ......do..............  Laxatives...................      Do.
    Do................  ......do..............  CNS stimulants..............  HFD-120
    Do................  ......do..............  Anorexiants.................      Do.
    Do................  ......do..............  Chloramphenicol and           HFD-520
                                                 derivatives.
May 1, 1984...........  May 1, 1982...........  Drugs indicated for vertigo/  HFD-120
                                                 motion sickness/vomiting.
    Do................  ......do..............  Antidiuretics...............  HFD-510
    Do................  ......do..............  Contraceptives..............      Do.
    Do................  ......do..............  Macrolides..................  HFD-520
    Do................  ......do..............  Lincosamides................      Do.
    Do................  ......do..............  Antiarthritics..............  HFD-150
    Do................  ......do..............  Antitussives................  HFD-160
    Do................  ......do..............  Expectorants................      Do.
    Do................  ......do..............  Inhalants...................      Do.
June 1, 1984..........  June 1, 1982..........  Urinary tract antiseptics...  HFD-520
July 1, 1984..........  July 1, 1982..........  Chelating agents/heavy metal  HFD-110
                                                 antagonists.
    Do................  ......do..............  All other gastrointestinal    HFD-110
                                                 drugs.
    Do................  ......do..............  Antianxiety.................  HFD-120
    Do................  ......do..............  Drugs indicated for           HFD-120
                                                 myasthenia gravis.
    Do................  ......do..............  All other antiinfective       HFD-520
                                                 drugs.
    Do................  ......do..............  Bronchodilators/              HFD-160
                                                 antiasthmatics.
Aug. 1, 1984..........  Aug. 1, 1982..........  Estrogens...................  HFD-510
    Do................  ......do..............  Uterine stimulants..........  HFD-510
    Do................  ......do..............  Uterine relaxants...........      Do.
Sept. 1, 1984.........  Sept. 1, 1982.........  Drugs indicated for           HFD-110
                                                 hypotension and shock.
Oct. 1, 1984..........  Oct. 1, 1982..........  All other cardiac drugs.....  HFD-110
    Do................  ......do..............  Nasal decongestants.........  HFD-160
Nov. 1, 1984..........  Nov. 1, 1982..........  All other prescription drugs
----------------------------------------------------------------------------------------------------------------
\1\ Except the effective date for all biological products reviewed generically by the advisory panel is 30
  months after a final order is published under 21 CFR 601.25(g).
\2\ Except the due date for all biological products reviewed generically by the advisory panel is 6 months after
  a final order is published under 21 CFR 601.25(g).

[45 FR 32552, May 16, 1980, as amended at 46 FR 7272, Jan. 23, 1981; 49 
FR 14331, Apr. 11, 1984; 50 FR 8995, Mar. 6, 1985; 55 FR 11576, Mar. 29, 
1990; 64 FR 400, Jan. 5, 1999]



       Subpart C--Labeling Requirements for Over-the-Counter Drugs

    Source: 41 FR 6908, Feb. 13, 1976, unless otherwise noted.



Sec. 201.60  Principal display panel.

    The term principal display panel, as it applies to over-the-counter 
drugs in package form and as used in this part, means the part of a 
label that is most likely to be displayed, presented, shown, or examined 
under customary conditions of display for retail sale.

[[Page 34]]

The principal display panel shall be large enough to accommodate all the 
mandatory label information required to be placed thereon by this part 
with clarity and conspicuousness and without obscuring designs, 
vignettes, or crowding. Where packages bear alternate principal display 
panels, information required to be placed on the principal display panel 
shall be duplicated on each principal display panel. For the purpose of 
obtaining uniform type size in declaring the quantity of contents for 
all packages of substantially the same size, the term area of the 
principal display panel means the area of the side or surface that bears 
the principal display panel, which area shall be:
    (a) In the case of a rectangular package where one entire side 
properly can be considered to be the principal display panel side, the 
product of the height times the width of that side;
    (b) In the case of a cylindrical or nearly cylindrical container, 40 
percent of the product of the height of the container times the 
circumference; and
    (c) In the case of any other shape of container, 40 percent of the 
total surface of the container: Provided, however, That where such 
container presents an obvious ``principal display panel'' such as the 
top of a triangular or circular package, the area shall consist of the 
entire top surface.

In determining the area of the principal display panel, exclude tops, 
bottoms, flanges at the tops and bottoms of cans, and shoulders and 
necks of bottles or jars. In the case of cylindrical or nearly 
cylindrical containers, information required by this part to appear on 
the principal display panel shall appear within that 40 percent of the 
circumference which is most likely to be displayed, presented, shown, or 
examined under customary conditions of display for retail sale.



Sec. 201.61  Statement of identity.

    (a) The principal display panel of an over-the-counter drug in 
package form shall bear as one of its principal features a statement of 
the identity of the commodity.
    (b) Such statement of identity shall be in terms of the established 
name of the drug, if any there be, followed by an accurate statement of 
the general pharmacological category(ies) of the drug or the principal 
intended action(s) of the drug. In the case of an over-the-counter drug 
that is a mixture and that has no established name, this requirement 
shall be deemed to be satisfied by a prominent and conspicuous statement 
of the general pharmacological action(s) of the mixture or of its 
principal intended action(s) in terms that are meaningful to the layman. 
Such statements shall be placed in direct conjunction with the most 
prominent display of the proprietary name or designation and shall 
employ terms descriptive of general pharmacological category(ies) or 
principal intended action(s); for example, ``antacid,'' ``analgesic,'' 
``decongestant,'' ``antihistaminic,'' etc. The indications for use shall 
be included in the directions for use of the drug, as required by 
section 502(f)(1) of the act and by the regulations in this part.
    (c) The statement of identity shall be presented in bold face type 
on the principal display panel, shall be in a size reasonably related to 
the most prominent printed matter on such panel, and shall be in lines 
generally parallel to the base on which the package rests as it is 
designed to be displayed.



Sec. 201.62  Declaration of net quantity of contents.

    (a) The label of an over-the-counter drug in package form shall bear 
a declaration of the net quantity of contents. This shall be expressed 
in the terms of weight, measure, numerical count, or a combination or 
numerical count and weight, measure, or size. The statement of quantity 
of drugs in tablet, capsule, ampule, or other unit form and the quantity 
of devices shall be expressed in terms of numerical count; the statement 
of quantity for drugs in other dosage forms shall be in terms of weight 
if the drug is solid, semisolid, or viscous, or in terms of fluid 
measure if the drug is liquid. The drug quantity statement shall be 
augmented when necessary to give accurate information as to the strength 
of such drug in the package; for example, to differentiate between 
several strengths of the same drug ``100 tablets, 5 grains each'' or 
``100 capsules, 125 milligrams each'' or

[[Page 35]]

``100 capsules, 250 milligrams each'': Provided, That:
    (1) In the case of a firmly established, general consumer usage and 
trade custom of declaring the quantity of a drug in terms of linear 
measure or measure of area, such respective term may be used. Such term 
shall be augmented when necessary for accuracy of information by a 
statement of the weight, measure, or size of the individual units or of 
the entire drug; for example, the net quantity of adhesive tape in 
package form shall be expressed in terms of linear measure augmented by 
a statement of its width.
    (2) Whenever the Commissioner determines for a specific packaged 
drug that an existing practice of declaring net quantity of contents by 
weight, measure, numerical count, or a combination of these does not 
facilitate value comparisons by consumers, he shall by regulation 
designate the appropriate term or terms to be used for such article.
    (b) Statements of weight of the contents shall be expressed in terms 
of avoirdupois pound and ounce. A statement of liquid measure of the 
contents shall be expressed in terms of the U.S. gallon of 231 cubic 
inches and quart, pint, and fluid-ounce subdivisions thereof, and shall 
express the volume at 68  deg.F (20  deg.C). See also paragraph (p) of 
this section.
    (c) The declaration may contain common or decimal fractions. A 
common fraction shall be in terms of halves, quarters, eights, 
sixteenths, or thirty-seconds; except that if there exists a firmly 
established, general consumer usage and trade custom of employing 
different common fractions in the net quantity declaration of a 
particular commodity, they may be employed. A common fraction shall be 
reduced to its lowest terms; a decimal fraction shall not be carried out 
to more than two places. A statement that includes small fractions of an 
ounce shall be deemed to permit smaller variations than one which does 
not include such fractions.
    (d) The declaration shall be located on the principal display panel 
of the label, and with respect to packages bearing alternate principal 
panels it shall be duplicated on each principal display panel.
    (e) The declaration shall appear as a distinct item on the principal 
display panel, shall be separated, by at least a space equal to the 
height of the lettering used in the declaration, from other printed 
label information appearing above or below the declaration and, by at 
least a space equal to twice the width of the letter ``N'' of the style 
of type used in the quantity of contents statement, from other printed 
label information appearing to the left or right of the declaration. It 
shall not include any term qualifying a unit of weight, measure, or 
count, such as ``giant pint'' and ``full quart'', that tends to 
exaggerate the amount of the drug in the container. It shall be placed 
on the principal display panel within the bottom 30 percent of the area 
of the label panel in lines generally parallel to the base on which the 
package rests as it is designed to be displayed: Provided, That:
    (1) On packages having a principal display panel of 5 square inches 
or less the requirement for placement within the bottom 30 percent of 
the area of the label panel shall not apply when the declaration of net 
quantity of contents meets the other requirements of this part; and
    (2) In the case of a drug that is marketed with both outer and inner 
retail containers bearing the mandatory label information required by 
this part and the inner container is not intended to be sold separately, 
the net quantity of contents placement requirement of this section 
applicable to such inner container is waived.
    (3) The principal display panel of a drug marketed on a display card 
to which the immediate container is affixed may be considered to be the 
display panel of the card, and the type size of the net quantity of 
contents statement is governed by the dimensions of the display card.
    (f) The declaration shall accurately reveal the quantity of drug or 
device in the package exclusive of wrappers and other material packed 
therewith: Provided, That in the case of drugs packed in containers 
designed to deliver the drug under pressure, the declaration

[[Page 36]]

shall state the net quantity of the contents that will be expelled when 
the instructions for use as shown on the container are followed. The 
propellant is included in the net quantity declaration.
    (g) The declaration shall appear in conspicuous and easily legible 
boldface print or type in distinct contrast (by typography, layout, 
color, embossing, or molding) to other matter on the package; except 
that a declaration of net quantity blown, embossed, or molded on a glass 
or plastic surface is permissible when all label information is so 
formed on the surface. Requirements of conspicuousness and legibility 
shall include the specifications that:
    (1) The ratio of height to width of the letter shall not exceed a 
differential of 3 units to 1 unit, i.e., no more than 3 times as high as 
it is wide.
    (2) Letter heights pertain to upper case or capital letters. When 
upper and lower case or all lower case letters are used, it is the lower 
case letter ``o'' or its equivalent that shall meet the minimum 
standards.
    (3) When fractions are used, each component numeral shall meet one-
half the minimum height standards.
    (h) The declaration shall be in letters and numerals in a type size 
established in relationship to the area of the principal display panel 
of the package and shall be uniform for all packages of substantially 
the same size by complying with the following type specifications:
    (1) Not less than one-sixteenth inch in height on packages the 
principal display panel of which has an area of 5 square inches or less.
    (2) Not less than one-eighth inch in height on packages the 
principal display panel of which has an area of more than five but not 
more than 25 square inches.
    (3) Not less than three-sixteenths inch in height on packages the 
principal display panel of which has an area of more than 25 but not 
more than 100 square inches.
    (4) Not less than one-fourth inch in height on packages the 
principal display panel of which has an area of more than 100 square 
inches, except not less than one-half inch in height if the area is more 
than 400 square inches.

Where the declaration is blown, embossed, or molded on a glass or 
plastic surface rather than by printing, typing, or coloring, the 
lettering sizes specified in paragraphs (h) (1) through (4) of this 
section shall be increased by one-sixteenth of an inch.
    (i) On packages containing less than 4 pounds or 1 gallon and 
labeled in terms of weight or fluid measure:
    (1) The declaration shall be expressed both in ounces, with 
identification by weight or by liquid measure and, if applicable (1 
pound or 1 pint or more) followed in parentheses by a declaration in 
pounds for weight units, with any remainder in terms of ounces or common 
or decimal fractions of the pound (see examples set forth in paragraphs 
(k) (1) and (2) of this section), or in the case of liquid measure, in 
the largest whole units (quarts, quarts and pints, or pints, as 
appropriate) with any remainder in terms of fluid ounces or common or 
decimal fractions of the pint or quart (see examples set forth in 
paragraphs (k) (3) and (4) of this section). If the net weight of the 
package is less than 1 ounce avoirdupois or the net fluid measure is 
less than 1 fluid ounce, the declaration shall be in terms of common or 
decimal fractions of the respective ounce and not in terms of drams.
    (2) The declaration may appear in more than one line. The term net 
weight shall be used when stating the net quantity of contents in terms 
of weight. Use of the terms net or net contents in terms of fluid 
measure or numerical count is optional. It is sufficient to distinguish 
avoirdupois ounce from fluid ounce through association of terms; for 
example, ``Net wt. 6 oz'' or ``6 oz net wt.,'' and ``6 fl oz'' or ``net 
contents 6 fl oz''.
    (j) On packages containing 4 pounds or 1 gallon or more and labeled 
in terms of weight or fluid measure, the declaration shall be expressed 
in pounds for weight units with any remainder in terms of ounces or 
common or decimal fractions of the pound; in the case of fluid measure, 
it shall be expressed in the largest whole unit (gallons, followed by 
common or decimal fractions of a gallon or by the next smaller whole 
unit or units (quarts or quarts and pints)) with any

[[Page 37]]

remainder in terms of fluid ounces or common or decimal fractions of the 
pint or quart; see paragraph (k)(5) of this section.
    (k) Examples:
    (1) A declaration of 1\1/2\ pounds weight shall be expressed as 
``Net wt. 24 oz (1 lb 8 oz),'' or ``Net wt. 24 oz (1\1/2\ lb)'' or ``Net 
wt. 24 oz (1.5 lb)''.
    (2) A declaration of three-fourths pound avoirdupois weight shall be 
expressed as ``Net wt. 12 oz''.
    (3) A declaration of 1 quart liquid measure shall be expressed as 
``Net contents 32 fl oz (1 qt)'' or ``32 fl oz (1 qt)''.
    (4) A declaration of 1\3/4\ quarts liquid measure shall be expressed 
as ``Net contents 56 fl oz (1 qt 1 pt 8 oz)'' or ``Net contents 56 fl oz 
(1 qt 1.5 pt),'' but not in terms of quart and ounce such as ``Net 56 fl 
oz (1 qt 24 oz).''
    (5) A declaration of 2\1/2\ gallons liquid measure shall be 
expressed as ``Net contents 2 gal 2 qt,'' ``Net contents 2.5 gallons,'' 
or ``Net contents 2\1/2\ gal'' but not as ``2 gal 4 pt''.
    (l) For quantities, the following abbreviations and none other may 
be employed. Periods and plural forms are optional:

Gallon gal
quart qt
pint pt
ounce oz
pound lb
grain gr
kilogram kg
gram g
milligram mg
microgram mcg
liter l
milliliter ml
cubic centimeter cc
yard yd
feet or foot ft
inch in
meter m
centimeter cm
millimeter mm
fluid fl
square sq
weight wt

    (m) On packages labeled in terms of linear measure, the declaration 
shall be expressed both in terms of inches and, if applicable (1 foot or 
more), the largest whole units (yards, yards and feet, feet). The 
declaration in terms of the largest whole units shall be in parentheses 
following the declaration in terms of inches and any remainder shall be 
in terms of inches or common or decimal fractions of the foot or yard; 
if applicable, as in the case of adhesive tape, the initial declaration 
in linear inches shall be preceded by a statement of the width. Examples 
of linear measure are ``86 inches (2 yd 1 ft 2 in),'' ``90 inches (2\1/
2\ yd),'' ``30 inches (2.5 ft),'' `` \3/4\ inch by 36 in (1 yd),'' etc.
    (n) On packages labeled in terms of area measure, the declaration 
shall be expressed both in terms of square inches and, if applicable (1 
square foot or more), the largest whole square unit (square yards, 
square yards and square feet, square feet). The declaration in terms of 
the largest whole units shall be in parentheses following the 
declaration in terms of square inches and any remainder shall be in 
terms of square inches or common or decimal fractions of the square foot 
or square yard; for example, ``158 sq inches (1 sq ft 14 sq in).''
    (o) Nothing in this section shall prohibit supplemental statements 
at locations other than the principal display panel(s) describing in 
nondeceptive terms the net quantity of contents, provided that such 
supplemental statements of net quantity of contents shall not include 
any term qualifying a unit of weight, measure, or count that tends to 
exaggerate the amount of the drug contained in the package; for example, 
``giant pint'' and ``full quart.'' Dual or combination declarations of 
net quantity of contents as provided for in paragraphs (a) and (i) of 
this section are not regarded as supplemental net quantity statements 
and shall be located on the principal display panel.
    (p) A separate statement of net quantity of contents in terms of the 
metric system of weight or measure is not regarded as a supplemental 
statement and an accurate statement of the net quantity of contents in 
terms of the metric system of weight or measure may also appear on the 
principal display panel or on other panels.
    (q) The declaration of net quantity of contents shall express an 
accurate statement of the quantity of contents of the package. 
Reasonable variations caused by loss or gain of moisture during the 
course of good distribution practice or by unavoidable deviations in 
good manufacturing practice will be recognized. Variations from stated 
quantity of contents shall not be unreasonably large.
    (r) A drug shall be exempt from compliance with the net quantity 
declaration required by this section if it is an

[[Page 38]]

ointment labeled ``sample,'' ``physician's sample,'' or a substantially 
similar statement and the contents of the package do not exceed 8 grams.



Sec. 201.63  Pregnancy/breast-feeding warning.

    (a) The labeling for all over-the-counter (OTC) drug products that 
are intended for systemic absorption, unless specifically exempted, 
shall contain a general warning under the heading ``Warning'' (or 
``Warnings'' if it appears with additional warning statements) as 
follows: ``If pregnant or breast-feeding, ask a health professional 
before use.'' [first four words of this statement in bold type] In 
addition to the written warning, a symbol that conveys the intent of the 
warning may be used in labeling.
    (b) Where a specific warning relating to use during pregnancy or 
while nursing has been established for a particular drug product in a 
new drug application (NDA) or for a product covered by an OTC drug final 
monograph in part 330 of this chapter, the specific warning shall be 
used in place of the warning in paragraph (a) of this section, unless 
otherwise stated in the NDA or in the final OTC drug monograph.
    (c) The following OTC drugs are exempt from the provisions of 
paragraph (a) of this section:
    (1) Drugs that are intended to benefit the fetus or nursing infant 
during the period of pregnancy or nursing.
    (2) Drugs that are labeled exclusively for pediatric use.
    (d) The Food and Drug Administration will grant an exemption from 
paragraph (a) of this section where appropriate upon petition under the 
provisions of Sec. 10.30 of this chapter. Decisions with respect to 
requests for exemptions shall be maintained in a permanent file for 
public review by the Dockets Management Branch (HFA-305), Food and Drug 
Administration, rm. 1-23, 12420 Parklawn Dr., Rockville, MD 20857.
    (e) The labeling of orally or rectally administered OTC aspirin and 
aspirin-containing drug products must bear a warning that immediately 
follows the general warning identified in paragraph (a) of this section. 
The warning shall be as follows:

    ``It is especially important not to use'' (select ``aspirin'' or 
``carbaspirin calcium,'' as appropriate) ``during the last 3 months of 
pregnancy unless definitely directed to do so by a doctor because it may 
cause problems in the unborn child or complications during delivery.''

[47 FR 54757, Dec. 3, 1982, as amended at 55 FR 27784, July 5, 1990; 59 
FR 14364, Mar. 28, 1994; 64 FR 13286, Mar. 17, 1999]



Sec. 201.64  Sodium labeling.

    (a) The labeling of over-the-counter (OTC) drug products intended 
for oral ingestion shall contain the sodium content per dosage unit 
(e.g., tablet, teaspoonful) if the sodium content of a single 
recommended dose of the product (which may be one or more dosage units) 
is 5 milligrams or more. OTC drug products intended for oral ingestion 
include gum and lozenge dosage forms, but do not include dentifrices, 
mouthwashes, or mouth rinses.
    (b) The sodium content shall be expressed in milligrams per dosage 
unit and shall include the total amount of sodium regardless of the 
source, i.e., from both active and inactive ingredients. The sodium 
content shall be rounded-off to the nearest whole number. The sodium 
content per dosage unit shall follow the heading ``Other information'' 
as stated in Sec. 201.66(c)(7).
    (c) The labeling of OTC drug products intended for oral ingestion 
shall contain the following warning under the heading ``Warning'' (or 
``Warnings'' if it appears with additional warning statements) if the 
amount of sodium present in the labeled maximum daily dose of the 
product is more than 140 milligrams: ``Do not use this product if you 
are on a sodium-restricted diet unless directed by a doctor.''
    (d) The term sodium free may be used in the labeling of OTC drug 
products intended for oral ingestion if the amount of sodium in the 
labeled maximum daily dose is 0 milligram. For example, a product 
containing 0.4 (rounded-off to zero (0)) milligram sodium per tablet 
with directions to take one tablet daily may use the term ``sodium 
free'' in its labeling. However, when the recommended dose provides for 
taking more than one dosage unit per

[[Page 39]]

day, e.g., take one or two tablets, or take two tablets, the same 
product containing 0.4 milligram sodium per tablet shall not use the 
term ``sodium free'' because the labeled maximum daily dose contains 0.8 
milligram sodium.
    (e) The term very low sodium may be used in the labeling of OTC drug 
products intended for oral ingestion if the amount of sodium in the 
labeled maximum daily dose is 35 milligrams or less.
    (f) The term low sodium may be used in the labeling of OTC drug 
products intended for oral ingestion if the amount of sodium in the 
labeled maximum daily dose is 140 milligrams or less.
    (g) The term salt is not synonymous with the term sodium and shall 
not be used interchangeably or substituted for the term sodium.
    (h) The terms sodium free, very low sodium, and low sodium shall be 
in print size and style no larger than the product's statement of 
identity and shall not be unduly prominent in print size or style 
compared to the statement of identity.
    (i) Any product subject to this paragraph that contains sodium 
bicarbonate, sodium phosphate, or sodium biphosphate as an active 
ingredient for oral ingestion and that is not labeled as required by 
this paragraph and that is initially introduced or initially delivered 
for introduction into interstate commerce after April 22, 1997, is 
misbranded under sections 201(n) and 502 (a) and (f) of the Federal 
Food, Drug, and Cosmetic Act (the act).

[61 FR 17806, Apr. 22, 1996, as amended at 62 FR 19925, Apr. 24, 1997; 
64 FR 13286, Mar. 17, 1999]

    Effective Date Note: At 62 FR 19925, Apr. 24, 1997, the effective 
date for Sec. 201.64 (a) through (h) was delayed until further notice.



Sec. 201.66  Format and content requirements for over-the-counter (OTC) drug product labeling.

    (a) Scope. This section sets forth the content and format 
requirements for the labeling of all OTC drug products. Where an OTC 
drug product is the subject of an applicable monograph or regulation 
that contains content and format requirements that conflict with this 
section, the content and format requirements in this section must be 
followed unless otherwise specifically provided in the applicable 
monograph or regulation.
    (b) Definitions. The following definitions apply to this section:
    (1) Act means the Federal Food, Drug, and Cosmetic Act (secs. 201 et 
seq. (21 U.S.C. 321 et seq.)).
    (2) Active ingredient means any component that is intended to 
furnish pharmacological activity or other direct effect in the 
diagnosis, cure, mitigation, treatment, or prevention of disease, or to 
affect the structure or any function of the body of humans. The term 
includes those components that may undergo chemical change in the 
manufacture of the drug product and be present in the drug product in a 
modified form intended to furnish the specified activity or effect.
    (3) Approved drug application means a new drug (NDA) or abbreviated 
new drug (ANDA) application approved under section 505 of the act (21 
U.S.C. 355).
    (4) Bullet means a geometric symbol that precedes each statement in 
a list of statements. For purposes of this section, the bullet style is 
limited to solid squares or solid circles, in the format set forth in 
paragraph (d)(4) of this section.
    (5) Established name of a drug or ingredient thereof means the 
applicable official name designated under section 508 of the act (21 
U.S.C. 358), or, if there is no designated official name and the drug or 
ingredient is recognized in an official compendium, the official title 
of the drug or ingredient in such compendium, or, if there is no 
designated official name and the drug or ingredient is not recognized in 
an official compendium, the common or usual name of the drug or 
ingredient.
    (6) FDA means the Food and Drug Administration.
    (7) Heading means the required statements in quotation marks listed 
in paragraphs (c)(2) through (c)(9) of this section, excluding 
subheadings (as defined in paragraph (a)(9) of this section).
    (8) Inactive ingredient means any component other than an active 
ingredient.

[[Page 40]]

    (9)  Subheading means the required statements in quotation marks 
listed in paragraphs (c)(5)(ii) through (c)(5)(vii) of this section.
    (10) Drug facts labeling means the title, headings, subheadings, and 
information required under or otherwise described in paragraph (c) of 
this section.
    (11) Title means the heading listed at the top of the required OTC 
drug product labeling, as set forth in paragraph (c)(1) of this section.
    (12) Total surface area available to bear labeling means all 
surfaces of the outside container of the retail package or, if there is 
no such outside container, all surfaces of the immediate container or 
container wrapper except for the flanges at the tops and bottoms of cans 
and the shoulders and necks of bottles and jars.
    (c) Content requirements. The outside container or wrapper of the 
retail package, or the immediate container label if there is no outside 
container or wrapper, shall contain the title, headings, subheadings, 
and information set forth in paragraphs (c)(1) through (c)(8) of this 
section, and may contain the information under the heading in paragraph 
(c)(9) of this section, in the order listed.
    (1) (Title) ``Drug Facts''. If the drug facts labeling appears on 
more than one panel, the title ``Drug Facts (continued)'' shall appear 
at the top of each subsequent panel containing such information.
    (2) ``Active ingredient'' or ``Active ingredients'' ``(in each 
[insert the dosage unit stated in the directions for use (e.g., tablet, 
5 mL teaspoonful) or in each gram as stated in Secs. 333.110 and 333.120 
of this chapter])'', followed by the established name of each active 
ingredient and the quantity of each active ingredient per dosage unit. 
Unless otherwise provided in an applicable OTC drug monograph or 
approved drug application, products marketed without discrete dosage 
units (e.g., topicals) shall state the proportion (rather than the 
quantity) of each active ingredient.
    (3) ``Purpose'' or ``Purposes'', followed by the general 
pharmacological category(ies) or the principal intended action(s) of the 
drug or, where the drug consists of more than one ingredient, the 
general pharmacological categories or the principal intended actions of 
each active ingredient. When an OTC drug monograph contains a statement 
of identity, the pharmacological action described in the statement of 
identity shall also be stated as the purpose of the active ingredient.
    (4) ``Use'' or ``Uses'', followed by the indication(s) for the 
specific drug product.
    (5) ``Warning'' or ``Warnings'', followed by one or more of the 
following, if applicable:
    (i) ``For external use only'' [in bold type] for topical drug 
products not intended for ingestion, or ``For'' (select one of the 
following, as appropriate: ``rectal'' or ``vaginal'') ``use only'' [in 
bold type].
    (ii) All applicable warnings listed in paragraphs (c)(5)(ii)(A) 
through (c)(5)(ii)(G) of this section with the appropriate subheadings 
highlighted in bold type:
    (A) Reye's syndrome warning for drug products containing salicylates 
set forth in Sec. 201.314(h)(1). This warning shall follow the 
subheading ``Reye's syndrome:''
    (B) Allergic reaction warnings set forth in any applicable OTC drug 
monograph or approved drug application for any product that requires a 
separate allergy warning. This warning shall follow the subheading 
``Allergy alert:''
    (C) Flammability warning, with appropriate flammability signal word 
(e.g., Secs. 358.150(c) and 358.550(c) of this chapter). This warning 
shall follow a subheading containing the appropriate flammability signal 
word described in an applicable OTC drug monograph or approved drug 
application.
    (D) Water soluble gums warning set forth in Sec. 201.319. This 
warning shall follow the subheading ``Choking:''
    (E) Alcohol warning set forth in Sec. 201.322. This warning shall 
follow the subheading ``Alcohol warning:''
    (F) Sore throat warning set forth in Sec. 201.315. This warning 
shall follow the subheading ``Sore throat warning:''
    (G) Warning for drug products containing sodium phosphates set forth 
in Sec. 201.307(b)(2)(i) or (b)(2)(ii). This warning shall follow the 
subheading ``Dosage warning:''

[[Page 41]]

    (iii) ``Do not use'' [in bold type], followed by all 
contraindications for use with the product. These contraindications are 
absolute and are intended for situations in which consumers should not 
use the product unless a prior diagnosis has been established by a 
doctor or for situations in which certain consumers should not use the 
product under any circumstances regardless of whether a doctor or health 
professional is consulted.
    (iv) ``Ask a doctor before use if you have'' [in bold type] or, for 
products labeled only for use in children under 12 years of age, ``Ask a 
doctor before use if the child has'' [in bold type], followed by all 
warnings for persons with certain preexisting conditions (excluding 
pregnancy) and all warnings for persons experiencing certain symptoms. 
The warnings under this heading are those intended only for situations 
in which consumers should not use the product until a doctor is 
consulted.
    (v) ``Ask a doctor or pharmacist before use if you are'' [in bold 
type] or, for products labeled only for use in children under 12 years 
of age, ``Ask a doctor or pharmacist before use if the child is'' [in 
bold type], followed by all drug-drug and drug-food interaction 
warnings.
    (vi) ``When using this product'' [in bold type], followed by the 
side effects that the consumer may experience, and the substances (e.g., 
alcohol) or activities (e.g., operating machinery, driving a car, 
warnings set forth in Sec. 369.21 of this chapter for drugs in 
dispensers pressurized by gaseous propellants) to avoid while using the 
product.
    (vii) ``Stop use and ask a doctor if'' [in bold type], followed by 
any signs of toxicity or other reactions that would necessitate 
immediately discontinuing use of the product.
    (viii) Any required warnings in an applicable OTC drug monograph, 
other OTC drug regulations, or approved drug application that do not fit 
within one of the categories listed in paragraphs (c)(5)(i) through 
(c)(5)(vii), (c)(5)(ix), and (c)(5)(x) of this section.
    (ix) The pregnancy/breast-feeding warning set forth in 
Sec. 201.63(a); the third trimester warning set forth in Sec. 201.63(e) 
for products containing aspirin or carbaspirin calcium; the third 
trimester warning set forth in approved drug applications for products 
containing ketoprofen, naproxen sodium, and ibuprofen (not intended 
exclusively for use in children).
    (x) The ``Keep out of reach of children'' warning and the accidental 
overdose/ingestion warning set forth in Sec. 330.1(g) of this chapter.
    (6) ``Directions'', followed by the directions for use described in 
an applicable OTC drug monograph or approved drug application.
    (7) ``Other information'', followed by additional information that 
is not included under paragraphs (c)(2) through (c)(6), (c)(8), and 
(c)(9) of this section, but which is required by or is made optional 
under an applicable OTC drug monograph, other OTC drug regulation, or is 
included in the labeling of an approved drug application.
    (i) Required information about certain ingredients in OTC drug 
products (e.g., sodium in Sec. 201.64(c)) shall appear as follows: 
``each (insert appropriate dosage unit) contains:'' [in bold type] 
(insert name(s) of ingredient(s) and the quantity of each ingredient). 
This information shall be the first statement under this heading.
    (ii) The phenylalanine/aspartame content required by Sec. 201.21(b), 
if applicable, shall appear as the next item of information.
    (iii) Additional information that is authorized to appear under this 
heading shall appear as the next item(s) of information. There is no 
required order for this subsequent information.
    (8) ``Inactive ingredients'', followed by a listing of the 
established name of each inactive ingredient. If the product is an OTC 
drug product that is not also a cosmetic product, then the inactive 
ingredients shall be listed in alphabetical order. If the product is an 
OTC drug product that is also a cosmetic product, then the inactive 
ingredients shall be listed as set forth in Sec. 701.3(a) or (f) of this 
chapter, the names of cosmetic ingredients shall be determined in 
accordance with Sec. 701.3(c) of this chapter, and the provisions in 
Sec. 701.3(e), (g), (h), (l), (m), (n), and (o) of this chapter and 
Sec. 720.8 of this chapter may also apply, as appropriate. If there is a 
difference in the labeling provisions in this Sec. 201.66 and 
Secs. 701.3 and 720.8 of this

[[Page 42]]

chapter, the labeling provisions in this Sec. 201.66 shall be used.
    (9) ``Questions?'' or ``Questions or comments?'', followed by the 
telephone number of a source to answer questions about the product. It 
is recommended that the days of the week and times of the day when a 
person is available to respond to questions also be included. A graphic 
of a telephone or telephone receiver may appear before the heading. The 
telephone number must appear in a minimum 6-point bold type.
    (d) Format requirements. The title, headings, subheadings, and 
information set forth in paragraphs (c)(1) through (c)(9) of this 
section shall be presented on OTC drug products in accordance with the 
following specifications. In the interest of uniformity of presentation, 
FDA strongly reccommends that the Drug Facts labeling be presented using 
the graphic specifications set forth in appendix A to part 201.
    (1) The title ``Drug Facts'' or ``Drug Facts (continued)'' shall use 
uppercase letters for the first letter of the words ``Drug'' and 
``Facts.'' All headings and subheadings in paragraphs (c)(2) through 
(c)(9) of this section shall use an uppercase letter for the first 
letter in the first word and lowercase letters for all other words. The 
title, headings, and subheadings in paragraphs (c)(1), (c)(2), and 
(c)(4) through (c)(9) of this section shall be left justified.
    (2) The letter height or type size for the title ``Drug Facts'' 
shall appear in a type size larger than the largest type size used in 
the Drug Facts labeling. The letter height or type size for the title 
``Drug Facts (continued)'' shall be no smaller than 8-point type. The 
letter height or type size for the headings in paragraphs (c)(2) through 
(c)(9) of this section shall be the larger of either 8-point or greater 
type, or 2-point sizes greater than the point size of the text. The 
letter height or type size for the subheadings and all other information 
described in paragraphs (c)(2) through (c)(9) of this section shall be 
no smaller than 6-point type.
    (3) The title, heading, subheadings, and information in paragraphs 
(c)(1) through (c)(9) of this section shall be legible and clearly 
presented, shall have at least 0.5-point leading (i.e., space between 
two lines of text), and shall not have letters that touch. The type 
style for the title, headings, subheadings, and all other required 
information described in paragraphs (c)(2) through (c)(9) of this 
section shall be any single, clear, easy-to-read type style, with no 
more than 39 characters per inch. The title and headings shall be in 
bold italic, and the subheadings shall be in bold type, except that the 
word ``(continued)'' in the title ``Drug Facts (continued)'' shall be 
regular type. The type shall be all black or one color printed on a 
white or other contrasting background, except that the title and the 
headings may be presented in a single, alternative, contrasting color 
unless otherwise provided in an approved drug application, OTC drug 
monograph (e.g., current requirements for bold print in Secs. 341.76 and 
341.80 of this chapter), or other OTC drug regulation (e.g., the 
requirement for a box and red letters in Sec. 201.308(c)(1)).
    (4) When there is more than one statement, each individual statement 
listed under the headings and subheadings in paragraphs (c)(4) through 
(c)(7) of this section shall be preceded by a solid square or solid 
circle bullet of 5-point type size. Bullets shall be presented in the 
same shape and color throughout the labeling. The first bulleted 
statement on each horizontal line of text shall be either left justified 
or separated from an appropriate heading or subheading by at least two 
square ``ems'' (i.e., two squares of the size of the letter ``M''). If 
more than one bulleted statement is placed on the same horizontal line, 
the end of one bulleted statement shall be separated from the beginning 
of the next bulleted statement by at least two square ``ems'' and the 
complete additional bulleted statement(s) shall not continue to the next 
line of text. Additional bulleted statements appearing on each 
subsequent horizontal line of text under a heading or subheading shall 
be vertically aligned with the bulleted statements appearing on the 
previous line.
    (5) The title, headings, subheadings, and information set forth in 
paragraphs (c)(1) through (c)(9) of this section may appear on more than 
one panel on the outside container of the

[[Page 43]]

retail package, or the immediate container label if there is no outside 
container or wrapper. The continuation of the required content and 
format onto multiple panels must retain the required order and flow of 
headings, subheadings, and information. A visual graphic (e.g., an 
arrow) shall be used to signal the continuation of the Drug Facts 
labeling to the next adjacent panel.
    (6) The heading and information required under paragraph (c)(2) of 
this section shall appear immediately adjacent and to the left of the 
heading and information required under paragraph (c)(3) of this section. 
The active ingredients and purposes shall be aligned under the 
appropriate headings such that the heading and information required 
under paragraph (c)(2) of this section shall be left justified and the 
heading and information required under paragraph (c)(3) of this section 
shall be right justified. If the OTC drug product contains more than one 
active ingredient, the active ingredients shall be listed in 
alphabetical order. If more than one active ingredient has the same 
purpose, the purpose need not be repeated for each active ingredient, 
provided the information is presented in a manner that readily 
associates each active ingredient with its purpose (i.e., through the 
use of brackets, dot leaders, or other graphical features). The 
information described in paragraphs (c)(4) and (c)(6) through (c)(9) of 
this section may start on the same line as the required headings. None 
of the information described in paragraph (c)(5) of this section shall 
appear on the same line as the ``Warning'' or ``Warnings'' heading.
    (7) Graphical images (e.g., the UPC symbol) and information not 
described in paragraphs (c)(1) through (c)(9) of this section shall not 
appear in or in any way interrupt the required title, headings, 
subheadings, and information in paragraphs (c)(1) through (c)(9) of this 
section. Hyphens shall not be used except to punctuate compound words.
    (8) The information described in paragraphs (c)(1) through (c)(9) of 
this section shall be set off in a box or similar enclosure by the use 
of a barline. A distinctive horizontal barline extending to each end of 
the ``Drug Facts'' box or similar enclosure shall provide separation 
between each of the headings listed in paragraphs (c)(2) through (c)(9) 
of this section. When a heading listed in paragraphs (c)(2) through 
(c)(9) of this section appears on a subsequent panel immediately after 
the ``Drug Facts (continued)'' title, a horizontal hairline shall follow 
the title and immediately precede the heading. A horizontal hairline 
extending within two spaces on either side of the ``Drug Facts'' box or 
similar enclosure shall immediately follow the title and shall 
immediately precede each of the subheadings set forth in paragraph 
(c)(5) of this section, except the subheadings in paragraphs 
(c)(5)(ii)(A) through (c)(5)(ii)(G) of this section.
    (9) The information set forth in paragraph (c)(6) of this section 
under the heading ``Directions'' shall appear in a table format when 
dosage directions are provided for three or more age groups or 
populations. The last line of the table may be the horizontal barline 
immediately preceding the heading of the next section of the labeling.
    (10) If the title, headings, subheadings, and information in 
paragraphs (c)(1) through (c)(9) of this section, printed in accordance 
with the specifications in paragraphs (d)(1) through (d)(9) of this 
section, and any other FDA required information for drug products, and, 
as appropriate, cosmetic products, other than information required to 
appear on a principle display panel, requires more than 60 percent of 
the total surface area available to bear labeling, then the Drug Facts 
labeling shall be printed in accordance with the specifications set 
forth in paragraphs (d)(10)(i) through (d)(10)(v) of this section. In 
determining whether more than 60 percent of the total surface area 
available to bear labeling is required, the indications for use listed 
under the ``Use(s)'' heading, as set forth in paragraph (c)(4) of this 
section, shall be limited to the minimum required uses reflected in the 
applicable monograph, as provided in Sec. 330.1(c)(2) of this chapter.
    (i) Paragraphs (d)(1), (d)(5), (d)(6), and (d)(7) of this section 
shall apply.
    (ii) Paragraph (d)(2) of this section shall apply except that the 
letter height or type size for the title ``Drug

[[Page 44]]

Facts (continued)'' shall be no smaller than 7-point type and the 
headings in paragraphs (c)(2) through (c)(9) of this section shall be 
the larger of either 7-point or greater type, or 1-point size greater 
than the point size of the text.
    (iii) Paragraph (d)(3) of this section shall apply except that less 
than 0.5-point leading may be used, provided the ascenders and 
descenders do not touch.
    (iv) Paragraph (d)(4) of this section shall apply except that if 
more than one bulleted statement is placed on the same horizontal line, 
the additional bulleted statements may continue to the next line of 
text, and except that the bullets under each heading or subheading need 
not be vertically aligned.
    (v) Paragraph (d)(8) of this section shall apply except that the box 
or similar enclosure required in paragraph (d)(8) of this section may be 
omitted if the Drug Facts labeling is set off from the rest of the 
labeling by use of color contrast.
    (11)(i) The following labeling outlines the various provisions in 
paragraphs (c) and (d) of this section:
[GRAPHIC] [TIFF OMITTED] TR17MR99.003

    (ii) The following sample label illustrates the provisions in 
paragraphs (c) and (d) of this section:

[[Page 45]]

[GRAPHIC] [TIFF OMITTED] TR17MR99.004

    (iii) The following sample label illustrates the provisions in 
paragraphs (c) and (d) of this section, including paragraph (d)(10) of 
this section, which permits modifications for small packages:

[[Page 46]]

[GRAPHIC] [TIFF OMITTED] TR17MR99.005

    (iv) The following sample label illustrates the provisions in 
paragraphs (c) and (d) of this section for a drug product marketed with 
cosmetic claims:

[[Page 47]]

[GRAPHIC] [TIFF OMITTED] TR17MR99.006

    (e) Exemptions and deferrals. FDA on its own initiative or in 
response to a written request from any manufacturer, packer, or 
distributor, may exempt or defer, based on the circumstances presented, 
one or more specific requirements set forth in this section on the basis 
that the requirement is inapplicable, impracticable, or contrary to 
public health or safety. Requests for exemptions shall be submitted in 
three copies in the form of an ``Application for Exemption'' to the Food 
and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 
20852. The request shall be clearly identified on the envelope as a 
``Request for Exemption from 21 CFR 201.66 (OTC Labeling Format)'' and 
shall be directed to Docket No. 98N-0337. A separate request shall be 
submitted for each OTC drug product. Sponsors of a product marketed 
under an approved drug application shall also submit a single copy of 
the exemption request to their application. Decisions on exemptions and 
deferrals will be maintained in a permanent file in this docket for 
public review. Exemption and deferral requests shall:
    (1) Document why a particular requirement is inapplicable, 
impracticable, or is contrary to public health or safety; and
    (2) Include a representation of the proposed labeling, including any 
outserts, panel extensions, or other graphical or packaging techniques 
intended to be used with the product.
    (f) Interchangeable terms and connecting terms. The terms listed in 
Sec. 330.1(i) of this chapter may be used

[[Page 48]]

interchangeably in the labeling of OTC drug products, provided such use 
does not alter the meaning of the labeling that has been established and 
identified in an applicable OTC drug monograph or by regulation. The 
terms listed in Sec. 330.1(j) of this chapter may be deleted from the 
labeling of OTC drug products when the labeling is revised to comply 
with this section, provided such deletion does not alter the meaning of 
the labeling that has been established and identified in an applicable 
OTC drug monograph or by regulation. The terms listed in Sec. 330.1(i) 
and (j) of this chapter shall not be used to change in any way the 
specific title, headings, and subheadings required under paragraphs 
(c)(1) through (c)(9) of this section.
    (g) Regulatory action. An OTC drug product that is not in compliance 
with the format and content requirements in this section is subject to 
regulatory action.

[64 FR 13286, Mar. 17, 1999, as amended at 65 FR 8, Jan. 3, 2000]



         Subpart D--Exemptions From Adequate Directions for Use



Sec. 201.100  Prescription drugs for human use.

    A drug subject to the requirements of section 503(b)(1) of the act 
shall be exempt from section 502(f)(1) if all the following conditions 
are met:
    (a) The drug is:
    (1)(i) In the possession of a person (or his agents or employees) 
regularly and lawfully engaged in the manufacture, transportation, 
storage, or wholesale distribution of prescription drugs; or
    (ii) In the possession of a retail, hospital, or clinic pharmacy, or 
a public health agency, regularly and lawfully engaged in dispensing 
prescription drugs; or
    (iii) In the possession of a practitioner licensed by law to 
administer or prescribe such drugs; and
    (2) It is to be dispensed in accordance with section 503(b)
    (b) The label of the drug bears:
    (1) The statement ``Caution: Federal law prohibits dispensing 
without prescription'' and
    (2) The recommended or usual dosage and
    (3) The route of administration, if it is not for oral use; and
    (4) The quantity or proportion of each active ingredient, as well as 
the information required by section 502 (d) and (e); and
    (5) If it is for other than oral use, the names of all inactive 
ingredients, except that:
    (i) Flavorings and perfumes may be designated as such without naming 
their components.
    (ii) Color additives may be designated as coloring without naming 
specific color components unless the naming of such components is 
required by a color additive regulation prescribed in subchapter A of 
this chapter.
    (iii) Trace amounts of harmless substances added solely for 
individual product identification need not be named. If it is intended 
for administration by parenteral injection, the quantity or proportion 
of all inactive ingredients, except that ingredients added to adjust the 
pH or to make the drug isotonic may be declared by name and a statement 
of their effect; and if the vehicle is water for injection it need not 
be named.
    (6) An identifying lot or control number from which it is possible 
to determine the complete manufacturing history of the package of the 
drug.
    (7) A statement directed to the pharmacist specifying the type of 
container to be used in dispensing the drug product to maintain its 
identity, strength, quality, and purity. Where there are standards and 
test procedures for determining that the container meets the 
requirements for specified types of containers as defined in an official 
compendium, such terms may be used. For example, ``Dispense in tight, 
light-resistant container as defined in the National Formulary''. Where 
standards and test procedures for determining the types of containers to 
be used in dispensing the drug product are not included in an official 
compendium, the specific container or types of containers known to be 
adequate to maintain the identity, strength, quality, and purity of the 
drug products shall be described. For example, ``Dispense

[[Page 49]]

in containers which (statement of specifications which clearly enable 
the dispensing pharmacist to select an adequate container)'': Provided, 
however, That in the case of containers too small or otherwise unable to 
accommodate a label with sufficient space to bear all such information, 
but which are packaged within an outer container from which they are 
removed for dispensing or use, the information required by paragraph (b) 
(2), (3), (5), and (7) of this section may be contained in other 
labeling on or within the package from which it is to be dispensed; the 
information referred to in paragraph (b)(1) of this section may be 
placed on such outer container only; and the information required by 
paragraph (b)(6) of this section may be on the crimp of the dispensing 
tube. The information required by this paragraph (b)(7) is not required 
for prescription drug products packaged in unit-dose, unit-of-use, on 
other packaging format in which the manufacturer's original package is 
designed and intended to be dispensed to patients without repackaging.
    (c)(1) Labeling on or within the package from which the drug is to 
be dispensed bears adequate information for its use, including 
indications, effects, dosages, routes, methods, and frequency and 
duration of administration, and any relevant hazards, contraindications, 
side effects, and precautions under which practitioners licensed by law 
to administer the drug can use the drug safely and for the purposes for 
which it is intended, including all purposes for which it is advertised 
or represented; and
    (2) If the article is subject to section 505 of the act, the 
labeling bearing such information is the labeling authorized by the 
approved new drug application or required as a condition for the 
certification or the exemption from certification requirements 
applicable to preparations of insulin or antibiotic drugs.
    (d) Any labeling, as defined in section 201(m) of the act, whether 
or not it is on or within a package from which the drug is to be 
dispensed, distributed by or on behalf of the manufacturer, packer, or 
distributor of the drug, that furnishes or purports to furnish 
information for use or which prescribes, recommends, or suggests a 
dosage for the use of the drug (other than dose information required by 
paragraph (b)(2) of this section and Sec. 201.105(b)(2) contains:
    (1) Adequate information for such use, including indications, 
effects, dosages, routes, methods, and frequency and duration of 
administration and any relevant warnings, hazards, contraindications, 
side effects, and precautions, under which practitioners licensed by law 
to administer the drug can use the drug safely and for the purposes for 
which it is intended, including all conditions for which it is 
advertised or represented; and if the article is subject to section 505 
of the act, the parts of the labeling providing such information are the 
same in language and emphasis as labeling approved or permitted, under 
the provisions of section 505, and any other parts of the labeling are 
consistent with and not contrary to such approved or permitted labeling; 
and
    (2) The same information concerning the ingredients of the drug as 
appears on the label and labeling on or within the package from which 
the drug is to be dispensed.
    (3) The information required, and in the format specified, by 
Secs. 201.56 and 201.57.
    (e) All labeling described in paragraph (d) of this section bears 
conspicuously the name and place of business of the manufacturer, 
packer, or distributor, as required for the label of the drug under 
Sec. 201.1.
    (f) Reminder labeling which calls attention to the name of the drug 
product but does not include indications or dosage recommendations for 
use of the drug product is exempted from the provisions of paragraph (d) 
of this section. This reminder labeling shall contain only the 
proprietary name of the drug product, if any; the established name of 
the drug product, if any; the established name of each active ingredient 
in the drug product; and, optionally, information relating to 
quantitative ingredient statements, dosage form, quantity of package 
contents, price, the name and address of the manufacturer, packer, or 
distributor or other written, printed, or graphic matter containing no 
representation or suggestion relating to the drug product. If

[[Page 50]]

the Commissioner finds that there is evidence of significant incidence 
of fatalities or serious injury associated with the use of a particular 
prescription drug, he may withdraw this exemption by so notifying the 
manufacturer, packer, or distributor of the drug by letter. Reminder 
labeling, other than price lists and catalogs solely intended to convey 
price information including, but not limited to, those subject to the 
requirements of Sec. 200.200 of this chapter, is not permitted for a 
prescription drug product whose labeling contains a boxed warning 
relating to a serious hazard associated with the use of the drug 
product. Reminder labeling which is intended to provide consumers with 
information concerning the price charged for a prescription for a 
particular drug product shall meet all of the conditions contained in 
Sec. 200.200 of this chapter. Reminder labeling, other than that subject 
to the requirements of Sec. 200.200 of this chapter, is not permitted 
for a drug for which an announcement has been published pursuant to a 
review of the labeling claims for the drug by the National Academy of 
Sciences/National Research Council (NAS/NRC), Drug Efficacy Study Group, 
and for which no claim has been evaluated as higher than ``possibly 
effective.'' If the Commissioner finds the circumstances are such that 
reminder labeling may be misleading to prescribers of drugs subject to 
NAS/NRC evaluation, such reminder labeling will not be allowed and the 
manufacturer, packer, or distributor will be notified either in the 
publication of the conclusions on the effectiveness of the drug or by 
letter.

[40 FR 13998, Mar. 27, 1975, as amended at 40 FR 58799, Dec. 18, 1975; 
42 FR 15674, Mar. 22, 1977; 43 FR 37989, Aug. 25, 1978; 44 FR 20659, 
Apr. 6, 1979; 44 FR 37467, June 26, 1979; 45 FR 25777, Apr. 15, 1980; 63 
FR 26698, May 13, 1998; 64 FR 400, Jan. 5, 1999]



Sec. 201.105  Veterinary drugs.

    A drug subject to the requirements of section 503(f)(1) of the act 
shall be exempt from section 502(f)(1) of the act if all the following 
conditions are met:
    (a) The drug is:
    (1)(i) In the possession of a person (or his agents or employees) 
regularly and lawfully engaged in the manufacture, transportation, 
storage, or wholesale distribution of drugs that are to be used only by 
or on the prescription or other order of a licensed veterinarian; or
    (ii) In the possession of a retail, hospital, or clinic pharmacy, or 
other person authorized under State law to dispense veterinary 
prescription drugs, who is regularly and lawfully engaged in dispensing 
drugs that are to be used only by or on the prescription or other order 
of a licensed veterinarian; or
    (iii) In the possession of a licensed veterinarian for use in the 
course of his professional practice; and
    (2) To be dispensed in accordance with section 503(f) of the act.
    (b) The label of the drug bears:
    (1) The statement ``Caution: Federal law restricts this drug to use 
by or on the order of a licensed veterinarian''; and
    (2) The recommended or usual dosage; and
    (3) The route of administration, if it is not for oral use; and
    (4) The quantity or proportion of each active ingredient as well as 
the information required by section 502(e) of the act; and
    (5) If it is for other than oral use, the names of all inactive 
ingredients, except that:
    (i) Flavorings and perfumes may be designated as such without naming 
their components.
    (ii) Color additives may be designated as coloring without naming 
specific color components unless the naming of such components is 
required by a color additive regulation prescribed in subchapter A of 
this chapter.
    (iii) Trace amounts of harmless substances added solely for 
individual product identification need not be named.

If it is intended for administration by parenteral injection, the 
quantity or proportion of all inactive ingredients, except that 
ingredients added to adjust the pH or to make the drug isotonic may be 
declared by name and a statement of their effect; and if the vehicle is 
water for injection, it need not be named.

[[Page 51]]

    (6) An identifying lot or control number from which it is possible 
to determine the complete manufacturing history of the package of the 
drug;

Provided, however, That in the case of containers too small or otherwise 
unable to accommodate a label with sufficient space to bear all such 
information, but which are packaged within an outer container from which 
they are removed for dispensing or use, the information required by 
paragraphs (b) (2), (3), and (5) of this section may be contained in 
other labeling on or within the package from which it is to be so 
dispensed, and the information referred to in paragraph (b)(1) of this 
section may be placed on such outer container only, and the information 
required by paragraph (b)(6) of this section may be on the crimp of the 
dispensing tube.
    (c)(1) Labeling on or within the package from which the drug is to 
be dispensed bears adequate information for its use, including 
indications, effects, dosages, routes, methods, and frequency and 
duration of administration, and any relevant hazards, contraindications, 
side effects, and precautions under which veterinarians licensed by law 
to administer the drug can use the drug safely and for the purposes for 
which it is intended, including all purposes for which it is advertised 
or represented; and
    (2) If the article is subject to section 512 of the act, the 
labeling bearing such information is the labeling authorized by the 
approved new animal drug application or required as a condition for the 
certification or the exemption from certification requirements 
applicable to preparations of antibiotic drugs: Provided, however, That 
the information required by paragraph (c)(1) of this section may be 
omitted from the dispensing package if, but only if, the article is a 
drug for which directions, hazards, warnings, and use information are 
commonly known to veterinarians licensed by law to administer the drug. 
Upon written request, stating reasonable grounds therefore, the 
Commissioner will offer an opinion on a proposal to omit such 
information from the dispensing package under this proviso.
    (d) Any labeling, as defined in section 201(m) of the act, whether 
or not it is on or within a package from which the drug is to be 
dispensed, distributed by or on behalf of the manufacturer, packer, or 
distributor of the drug, that furnishes or purports to furnish 
information for use or which prescribes, recommends, or suggests a 
dosage for the use of the drug (other than dose information required by 
paragraph (b)(2) of this section and Sec. 201.100(b)(2)) contains:
    (1) Adequate information for such use, including indications, 
effects, dosages, routes, methods, and frequency and duration of 
administration, and any relevant warnings, hazards, contraindications, 
side effects, and precautions, and including information relevant to 
compliance with the new animal drug provisions of the act, under which 
veterinarians licensed by law to administer the drug can use the drug 
safely and for the purposes for which it is intended, including all 
conditions for which it is advertised or represented; and if the article 
is subject to section 512 of the act, the parts of the labeling 
providing such information are the same in language and emphasis as 
labeling approved or permitted under the provisions of section 512, and 
any other parts of the labeling are consistent with and not contrary to 
such approved or permitted labeling; and
    (2) The same information concerning the ingredients of the drug as 
appears on the label and labeling on or within the package from which 
the drug is to be dispensed;


Provided, however, That the information required by paragraphs (d) (1) 
and (2) of this section is not required on the so-called reminder-piece 
labeling which calls attention to the name of the drug but does not 
include indications or dosage recommendations for use of the drug.
    (e) All labeling, except labels and cartons, bearing information for 
use of the drug also bears the date of the issuance or the date of the 
latest revision of such labeling.
    (f) A prescription drug intended for both human and veterinary use 
shall comply with paragraphs (e) and (f) of this section and 
Sec. 201.100.

[40 FR 13998, Mar. 27, 1975, as amended at 42 FR 15674, Mar. 22, 1977; 
57 FR 54300, Nov. 18, 1992]

[[Page 52]]



Sec. 201.115  New drugs or new animal drugs.

    A new drug shall be exempt from section 502(f)(1) of the act:
    (a) To the extent to which such exemption is claimed in an approved 
application with respect to such drug under section 505 or 512 of the 
act; or
    (b) If no application under section 505 of the act is approved with 
respect to such drug but it complies with section 505(i) or 512 of the 
act and regulations thereunder.

No exemption shall apply to any other drug which would be a new drug if 
its labeling bore representations for its intended uses.



Sec. 201.116  Drugs having commonly known directions.

    A drug shall be exempt from section 502(f)(1) of the act insofar as 
adequate directions for common uses thereof are known to the ordinary 
individual.

[41 FR 6910, Feb. 13, 1976]



Sec. 201.117  Inactive ingredients.

    A harmless drug that is ordinarily used as an inactive ingredient, 
such as a coloring, emulsifier, excipient, flavoring, lubricant, 
preservative, or solvent, in the preparation of other drugs shall be 
exempt from section 502(f)(1) of the act. This exemption shall not apply 
to any substance intended for a use which results in the preparation of 
a new drug, unless an approved new-drug application provides for such 
use.



Sec. 201.119  In vitro diagnostic products.

    (a) ``In vitro diagnostic products'' are those reagents, instruments 
and systems intended for use in the diagnosis of disease or in the 
determination of the state of health in order to cure, mitigate, treat, 
or prevent disease or its sequelae. Such products are intended for use 
in the collection, preparation and examination of specimens taken from 
the human body. These products are drugs or devices as defined in 
section 201(g) and 201(h), respectively, of the Federal Food, Drug, and 
Cosmetic Act (the act) or are a combination of drugs and devices, and 
may also be a biological product subject to section 351 of the Public 
Health Service Act.
    (b) A product intended for use in the diagnosis of disease and which 
is an in vitro diagnostic product as defined in paragraph (a) of this 
section shall be deemed to be in compliance with the requirements of 
this section and section 502(f)(1) of the act if it meets the 
requirements of Sec. 809.10 of this chapter.

[41 FR 6910, Feb. 13, 1976]



Sec. 201.120  Prescription chemicals and other prescription components.

    A drug prepared, packaged, and primarily sold as a prescription 
chemical or other component for use by registered pharmacists in 
compounding prescriptions or for dispensing in dosage unit form upon 
prescriptions shall be exempt from section 502(f)(1) of the act if all 
the following conditions are met:
    (a) The drug is an official liquid acid or official liquid alkali, 
or is not a liquid solution, emulsion, suspension, tablet, capsule, or 
other dosage unit form; and
    (b) The label of the drug bears:
    (1) The statement ``For prescription compounding''; and
    (2) If in substantially all dosage forms in which it may be 
dispensed it is subject to section 503(b)(1) of the act, the statement 
``Caution: Federal law prohibits dispensing without prescription''; or
    (3) If it is not subject to section 503(b)(1) of the act and is by 
custom among retail pharmacists sold in or from the interstate package 
for use by consumers, ``adequate directions for use'' in the conditions 
for which it is so sold.


Provided, however, That the information referred to in paragraph (b)(3) 
of this section may be contained in the labeling on or within the 
package from which it is to be dispensed.
    (c) This exemption shall not apply to any substance intended for use 
in compounding which results in a new drug, unless an approved new-drug 
application covers such use of the drug in compounding prescriptions.



Sec. 201.122  Drugs for processing, repacking, or manufacturing.

    A drug in a bulk package, except tablets, capsules, or other dosage 
unit

[[Page 53]]

forms, intended for processing, repacking, or use in the manufacture of 
another drug shall be exempt from section 502(f)(1) of the act if its 
label bears the statement ``Caution: For manufacturing, processing, or 
repacking''; and if in substantially all dosage forms in which it may be 
dispensed it is subject to section 503(b)(1) of the act, the statement 
``Caution: Federal law prohibits dispensing without prescription'', or 
if in substantially all dosage forms in which it may be dispensed it is 
subject to section 503(f)(1) of the act, the statement ``Caution: 
Federal law restricts this drug to use by or on the order of a licensed 
veterinarian''. This exemption and the exemption under Sec. 201.120 may 
be claimed for the same article. However, the exemption shall not apply 
to a substance intended for a use in manufacture, processing, or 
repacking which causes the finished article to be a new drug or new 
animal drug, unless:
    (a) An approved new drug application or new animal drug application 
covers the production and delivery of the drug substance to the 
application holder by persons named in the application, and, for a new 
drug substance, the export of it by such persons under Sec. 314.410 of 
this chapter; or
    (b) If no application is approved with respect to such new drug or 
new animal drug, the label statement ``Caution: For manufacturing, 
processing, or repacking'' is immediately supplemented by the words ``in 
the preparation of a new drug or new animal drug limited by Federal law 
to investigational use'', and the delivery is made for use only in the 
manufacture of such new drug or new animal drug limited to 
investigational use as provided in part 312 or Sec. 511.1 of this 
chapter; or
    (c) A new drug application or new animal drug application covering 
the use of the drug substance in the production and marketing of a 
finished drug product has been submitted but not yet approved or 
disapproved, the bulk drug is not exported, and the finished drug 
product is not further distributed after it is manufactured until after 
the new drug application or new animal drug application is approved.

[41 FR 6911, Feb. 13, 1976, as amended at 41 FR 15844, Apr. 15, 1976; 50 
FR 7492, Feb. 22, 1985; 55 FR 11576, Mar. 29, 1990; 57 FR 54301, Nov. 
18, 1992]



Sec. 201.125  Drugs for use in teaching, law enforcement, research, and analysis.

    A drug subject to Sec. 201.100 or Sec. 201.105, shall be exempt from 
section 502(f)(1) of the act if shipped or sold to, or in the possession 
of, persons regularly and lawfully engaged in instruction in pharmacy, 
chemistry, or medicine not involving clinical use, or engaged in law 
enforcement, or in research not involving clinical use, or in chemical 
analysis, or physical testing, and is to be used only for such 
instruction, law enforcement, research, analysis, or testing.

[41 FR 6911, Feb. 13, 1976]



Sec. 201.127  Drugs; expiration of exemptions.

    (a) If a shipment or delivery, or any part thereof, of a drug which 
is exempt under the regulations in this section is made to a person in 
whose possession the article is not exempt, or is made for any purpose 
other than those specified, such exemption shall expire, with respect to 
such shipment or delivery or part thereof, at the beginning of that 
shipment or delivery. The causing of an exemption to expire shall be 
considered an act which results in such drug being misbranded unless it 
is disposed of under circumstances in which it ceases to be a drug or 
device.
    (b) The exemptions conferred by Secs. 201.117, 201.119, 201.120, 
201.122, and 201.125 shall continue until the drugs are used for the 
purposes for which they are exempted, or until they are relabeled to 
comply with section 502(f)(1) of the act. If, however, the drug is 
converted, compounded, or manufactured into a dosage form limited to 
prescription dispensing, no exemption shall thereafter apply to the

[[Page 54]]

article unless the dosage form is labeled as required by section 503(b) 
and Secs. 201.100 or 201.105.

[41 FR 6911, Feb. 13, 1976]



Sec. 201.128  Meaning of ``intended uses''.

    The words intended uses or words of similar import in Secs. 201.5, 
201.115, 201.117, 201.119, 201.120, and 201.122 refer to the objective 
intent of the persons legally responsible for the labeling of drugs. The 
intent is determined by such persons' expressions or may be shown by the 
circumstances surrounding the distribution of the article. This 
objective intent may, for example, be shown by labeling claims, 
advertising matter, or oral or written statements by such persons or 
their representatives. It may be shown by the circumstances that the 
article is, with the knowledge of such persons or their representatives, 
offered and used for a purpose for which it is neither labeled nor 
advertised. The intended uses of an article may change after it has been 
introduced into interstate commerce by its manufacturer. If, for 
example, a packer, distributor, or seller intends an article for 
different uses than those intended by the person from whom he received 
the drug, such packer, distributor, or seller is required to supply 
adequate labeling in accordance with the new intended uses. But if a 
manufacturer knows, or has knowledge of facts that would give him 
notice, that a drug introduced into interstate commerce by him is to be 
used for conditions, purposes, or uses other than the ones for which he 
offers it, he is required to provide adequate labeling for such a drug 
which accords with such other uses to which the article is to be put.

[41 FR 6911, Feb. 13, 1976]



Sec. 201.129  Drugs; exemption for radioactive drugs for research use.

    A radioactive drug intended for administration to human research 
subjects during the course of a research project intended to obtain 
basic research information regarding metabolism (including kinetics, 
distribution, and localization) of a radioactively labeled drug or 
regarding human physiology, pathophysiology, or biochemistry (but not 
intended for immediate therapeutic, diagnostic, or similar purposes), 
under the conditions set forth in Sec. 361.1 of this chapter, shall be 
exempt from section 502(f)(1) of the act if the packaging, label, and 
labeling are in compliance with Sec. 361.1(f) of this chapter.

[41 FR 6911, Feb. 13, 1976]



                       Subpart E--Other Exemptions



Sec. 201.150  Drugs; processing, labeling, or repacking.

    (a) Except as provided by paragraphs (b) and (c) of this section, a 
shipment or other delivery of a drug which is, in accordance with the 
practice of the trade, to be processed, labeled, or repacked in 
substantial quantity at an establishment other than that where 
originally processed or packed, shall be exempt, during the time of 
introduction into and movement in interstate commerce and the time of 
holding in such establishment, from compliance with the labeling and 
packaging requirements of sections 501(b) and 502 (b), (d), (e), (f), 
and (g) of the act if:
    (1) The person who introduced such shipment or delivery into 
interstate commerce is the operator of the establishment where such drug 
is to be processed, labeled, or repacked; or
    (2) In case such person is not such operator, such shipment or 
delivery is made to such establishment under a written agreement, signed 
by and containing the post-office addresses of such person and such 
operator, and containing such specifications for the processing, 
labeling, or repacking, as the case may be, of such drug in such 
establishment as will insure, if such specifications are followed, that 
such drug will not be adulterated or misbranded within the meaning of 
the act upon completion of such processing, labeling, or repacking. Such 
person and such operator shall each keep a copy of such agreement until 
2 years after the final shipment or delivery of such drug from such 
establishment, and shall make such copies available for inspection at 
any reasonable hour to any officer or employee of the Department who 
requests them.

[[Page 55]]

    (b) An exemption of a shipment or other delivery of a drug under 
paragraph (a)(1) of this section shall, at the beginning of the act of 
removing such shipment or delivery, or any part thereof, from such 
establishment, become void ab initio if the drug comprising such 
shipment, delivery, or part is adulterated or misbranded within the 
meaning of the act when so removed.
    (c) An exemption of a shipment or other delivery of a drug under 
paragraph (a)(2) of this section shall become void ab initio with 
respect to the person who introduced such shipment or delivery into 
interstate commerce upon refusal by such person to make available for 
inspection a copy of the agreement, as required by such paragraph (a)(2) 
of this section.
    (d) An exemption of a shipment or other delivery of a drug under 
paragraph (a)(2) of this section shall expire:
    (1) At the beginning of the act of removing such shipment or 
delivery, or any part thereof, from such establishment if the drug 
comprising such shipment, delivery, or part is adulterated or misbranded 
within the meaning of the act when so removed; or
    (2) Upon refusal by the operator of the establishment where such 
drug is to be processed, labeled, or repacked, to make available for 
inspection a copy of the agreement, as required by such clause.

[41 FR 6911, Feb. 13, 1976, as amended at 64 FR 400, Jan. 5, 1999]



Sec. 201.161  Carbon dioxide and certain other gases.

    (a) Carbon dioxide, cyclopropane, ethylene, helium, and nitrous 
oxide gases intended for drug use are exempted from the requirements of 
Sec. 201.100(b) (2), (3), and (c)(1) provided the labeling bears, in 
addition to any other information required by the Federal Food, Drug, 
and Cosmetic Act, the following:
    (1) The warning statement ``Warning--Administration of (name of gas) 
may be hazardous or contraindicated. For use only by or under the 
supervision of a licensed practitioner who is experienced in the use and 
administration of (name of gas) and is familiar with the indications, 
effects, dosages, methods, and frequency and duration of administration, 
and with the hazards, contraindications, and side effects and the 
precautions to be taken''; and
    (2) Any needed directions concerning the conditions for storage and 
warnings against the inherent dangers in the handling of the specific 
compressed gas.
    (b) This labeling exemption does not apply to mixtures of any one or 
more of these gases with oxygen or with each other.
    (c) Regulatory action may be initiated with respect to any article 
shipped within the jurisdiction of the Act contrary to the provisions of 
this section after 60 days following publication of this section in the 
Federal Register.



       Subpart F--Labeling Claims for Drugs in Drug Efficacy Study



Sec. 201.200  Disclosure of drug efficacy study evaluations in labeling and advertising.

    (a)(1) The National Academy of Sciences--National Research Council, 
Drug Efficacy Study Group, has completed an exhaustive review of 
labeling claims made for drugs marketed under new-drug and antibiotic 
drug procedures between 1938 and 1962. The results are compiled in 
``Drug Efficacy Study, A Report to the Commissioner of Food and Drugs 
from the National Academy of Sciences (1969).'' As the report notes, 
this review has made ``an audit of the state of the art of drug usage 
that has been uniquely extensive in scope and uniquely intensive in 
time'' and is applicable to more than 80 percent of the currently 
marketed drugs. The report further notes that the quality of the 
evidence of efficacy, as well as the quality of the labeling claims, is 
poor. Labeling and other promotional claims have been evaluated as 
``effective,'' ``probably effective,'' ``possibly effective,'' 
``ineffective,'' ``ineffective as a fixed combination,'' and ``effective 
but,'' and a report for each drug in the study has been submitted to the 
Commissioner.
    (2) The Food and Drug Administration is processing the reports, 
seeking voluntary action on the part of the drug manufacturers and 
distributors in

[[Page 56]]

the elimination or modification of unsupported promotional claims, and 
initiating administrative actions as necessary to require product and 
labeling changes.
    (3) Delays have been encountered in bringing to the attention of the 
prescribers of prescription items the conclusions of the expert panels 
that reviewed the promotional claims.
    (b) The Commissioner of Food and Drugs concludes that:
    (1) The failure to disclose in the labeling of a drug and in other 
promotional material the conclusions of the Academy experts that a claim 
is ``ineffective,'' ``possibly effective,'' ``probably effective,'' or 
``ineffective as a fixed combination,'' while labeling and promotional 
material bearing any such claim are being used, is a failure to disclose 
facts that are material in light of the representations made and causes 
the drug to be misbranded.
    (2) The Academy classification of a drug as other than ``effective'' 
for a claim for which such drug is recommended establishes that there is 
a material weight of opinion among qualified experts contrary to the 
representation made or suggested in the labeling, and failure to reveal 
this fact causes such labeling to be misleading.
    (c) Therefore, after publication in the Federal Register of a Drug 
Efficacy Study Implementation notice on a prescription drug, unless 
exempted or otherwise provided for in the notice, all package labeling 
(other than the immediate container or carton label, unless such 
labeling contains information required by Sec. 201.100(c)(1) in lieu of 
a package insert), promotional labeling, and advertisements shall 
include, as part of the information for practitioners under which the 
drug can be safely and effectively used, an appropriate qualification of 
all claims evaluated as other than ``effective'' by a panel of the 
National Academy of Sciences--National Research Council, Drug Efficacy 
Study Group, if such claims continue to be included in either the 
labeling or advertisements. However, this qualifying information will be 
required in advertisements only if promotional material is included 
therein for claims evaluated as less than ``effective'' or if such 
claims are included in the indications section of the portion of the 
advertisement containing the information required in brief summary by 
Sec. 202.1(e)(1) of this chapter. When, however, the Food and Drug 
Administration classification of such claim is ``effective'' (for 
example, on the basis of revision of the language of the claim or 
submission or existence of adequate data), such qualification is not 
necessary. When the Food and Drug Administration classification of the 
claim, as stated in the implementation notice, differs from that of the 
Academy but is other than ``effective,'' the qualifying statement shall 
refer to this classification in lieu of the Academy's classification.
    (d) For new drugs and antibiotics, supplements to provide for 
revised labeling in accord with paragraph (c) of this section shall be 
submitted under the provisions of Sec. 314.70 and Sec. 514.8 of this 
chapter within 90 days after publication of the implementation notice in 
the Federal Register or by May 15, 1972, for those drugs for which 
notices have been published and such labeling shall be put into use as 
soon as possible but not later than the end of the time period allowed 
for submitting supplements to provide for revised labeling.
    (e) Qualifying information required in drug labeling by paragraph 
(c) of this section in order to advise prescribers of a drug of the 
findings made by a panel of the Academy in evaluating a claim as other 
than ``effective'' shall be at least of the same size and color and 
degree of prominence as other printing in the labeling and shall be 
presented in a prominent box using one of the following formats and 
procedures:
    (1) In drug labeling the box statement may entirely replace the 
indications section and be in the following format:

[[Page 57]]

   ------------------------------------------------------------------
                                Indications
         Based on a review of this drug by the National Academy of 
      Sciences--National Research Council and/or other 
      information, FDA has classified the indication(s) as 
      follows:
         Effective: (list or state in paragraph form).
         ``Probably'' effective: (list or state in paragraph 
      form).
         ``Possibly'' effective: (list or state in paragraph 
      form).
         Final classification of the less-than-effective 
      indications requires further investigation.

   ------------------------------------------------------------------
    (2) Or the indication(s) for which the drug has been found effective 
may appear outside the boxed statement and be followed immediately by 
the following boxed statement:

   ------------------------------------------------------------------
         Based on a review of this drug by the National Academy of 
      Sciences--National Research Council and/or other 
      information, FDA has classified the other indication(s) as 
      follows:
         ``Probably'' effective: (list or state in paragraph 
      form).
         ``Possibly'' effective: (list or state in paragraph 
      form).
         Final classification of the less-than-effective 
      indications requires further investigation.

   ------------------------------------------------------------------
    (3) In drug labeling (other than that which is required by 
Sec. 201.100(c)(1)) which may contain a promotional message, the 
promotional message shall be keyed to the boxed statement by the same 
means as those provided for advertisements in paragraph (f)(2) of this 
section.
    (f) Qualifying information required in prescription drug advertising 
by paragraph (c) of this section shall contain a prominent boxed 
statement of the advertised indication(s) and of the limitations of 
effectiveness using the same format, language, and emphasis as that 
required in labeling by paragraph (e) of this section.
    (1) The boxed statement shall appear in (or next to) the information 
required in brief summary by Sec. 202.1(e)(1) of this chapter and shall 
have prominence at least equal to that provided for other information 
presented in the brief summary and shall have type size, captions, 
color, and other physical characteristics comparable to the information 
required in the brief summary.
    (2) Less-than-effective indication(s) in the promotional message of 
an advertisement which is a single page or less shall be keyed to the 
boxed statement by asterisk, by an appropriate statement, or by other 
suitable means providing adequate emphasis on the boxed statement. On 
each page where less-than-effective indication(s) appear in a mutiple 
page advertisement, an asterisk shall be placed after the most prominent 
mention of the indi- cation(s); if the degree of prominence does not 
vary, an asterisk shall be placed after the first mention of the 
indication. The asterisk shall refer to a notation at the bottom of the 
page which shall state ``This drug has been evaluated as probably 
effective (or possibly effective whichever is appropriate) for this 
indication'' and ``See Brief Summary'' or ``See Prescribing 
Information,'' the latter legend to be used only if the advertisement 
carries the required information for professional use as set forth in 
Sec. 201.100(c)(1).
    (3) For less-than-effective indications which are included in the 
advertisement only as a part of the information required in brief 
summary, the disclosure information shall appear in this portion of the 
advertisement in the same manner as is specified for labeling in 
paragraph (e) of this section.
    (g) The Commissioner may find circumstances are such that, while the 
elimination of claims evaluated as other than effective will generally 
eliminate the need for disclosure about such claims, there will be 
instances in which the change in the prescribing or promotional profile 
of the drug is so substantial as to require a disclosure of the reason 
for the change so that the purchaser or prescriber is not misled by 
being left unaware through the sponsor's silence that a basic change has 
taken place. The Food and Drug Administration will identify these 
situations in direct correspondence with the drug promoters, after which 
the failure to make the disclosure will be regarded as misleading and 
appropriate action will be taken.

[40 FR 13998, Mar. 27, 1975, as amended at 55 FR 11576, Mar. 29, 1990]

[[Page 58]]



  Subpart G--Specific Labeling Requirements for Specific Drug Products



Sec. 201.300  Notice to manufacturers, packers, and distributors of glandular preparations.

    (a) Under date of December 4, 1941, in a notice to manufacturers of 
glandular preparations, the Food and Drug Administration expressed the 
opinion that preparations of inert glandular materials intended for 
medicinal use should, in view of the requirement of section 201(n) of 
the Federal Food, Drug, and Cosmetic Act (52 Stat. 1041; 21 U.S.C. 
321(n) ), be labeled with a statement of the material fact that there is 
no scientific evidence that the articles contain any therapeutic or 
physiologically active constituents. Numerous preparations of such inert 
glandular materials were subsequently marketed with disclaimers of the 
type suggested. The term inert glandular materials means preparations 
incapable of exerting an action or effect of some significant or 
measurable benefit in one way or another, i.e., in the diagnosis, cure, 
mitigation, treatment, or prevention of disease, or in affecting the 
structure or any function of the body.
    (b) Manufacturers have heretofore taken advantage of Sec. 201.100 
permitting omission of directions for use when the label bears the 
prescription legend. Section 201.100(c) requires that the labeling of 
the drug, which may include brochures readily available to licensed 
practitioners, bear information as to the use of the drug by 
practitioners licensed by law to administer it. Obviously, information 
adequate for the use of an inert glandular preparation is not available 
to practitioners licensed by law.
    (c) The Department of Health and Human Services is of the opinion 
that inert glandular materials may not be exempted from the requirements 
of section 502(f)(1) of the act that they bear adequate directions for 
use; and, accordingly, that their labeling must include among other 
things, representations as to the conditions for which such articles are 
intended to be used or as to the structure or function of the human body 
that they are intended to affect. Since any such representations 
offering these articles for use as drugs would be false or misleading, 
such articles will be considered to be misbranded if they are 
distributed for use as drugs.
    (d) The amended regulations provide also that in the case of drugs 
intended for parenteral administration there shall be no exemption from 
the requirement that their labelings bear adequate directions for use. 
Such inert glandular materials for parenteral use are therefore subject 
to the same comment as applies to those intended for oral 
administration.



Sec. 201.301  Notice to manufacturers, packers, and distributors of estrogenic hormone preparations.

    Some drug preparations fabricated wholly or in part from estradiol 
and labeled as to potency in terms of international units or in terms of 
international units of estrone activity have been marketed. The 
international unit of the estrus-producing hormone was established by 
the International Conference on the Standardization of Sex Hormones at 
London, England, on August 1, 1932. This unit was defined as ``the 
specific estrus-producing activity contained in 0.1 gamma (=0.0001 mg.) 
of the standard'' hydroxyketonic hormone found in urine (estrone). The 
International Conference declared that it did not recommend the 
determination of the activity of nonhydroxyketonic forms of estrogenic 
hormones in units of estrone because of the varying ratios between the 
activity of such nonhydroxyketonic estrogenic hormones and estrone, when 
measured by different methods on test animals. There is no international 
unit for measuring the activity of estradiol and no accepted 
relationship between its activity and that of estrone, either in test 
animals or in humans. The declaration of potency of estradiol in terms 
of international units or in terms of international units of estrone 
activity is therefore considered misleading, within the meaning of 21 
U.S.C. 352(a). The declaration of the estradiol content of an estrogenic 
hormone preparation in terms of weight is considered appropriate.

[[Page 59]]



Sec. 201.302  Notice to manufacturers, packers, and distributors of drugs for internal use which contain mineral oil.

    (a) In the past few years research studies have altered medical 
opinion as to the usefulness and harmfulness of mineral oil in the human 
body. These studies have indicated that when mineral oil is used orally 
near mealtime it interferes with absorption from the digestive tract of 
provitamin A and the fat-soluble vitamins A, D, and K, and consequently 
interferes with the utilization of calcium and phosphorus, with the 
result that the user is left liable to deficiency diseases. When so used 
in pregnancy it predisposes to hemorrhagic disease of the newborn.
    (b) There is accumulated evidence that the indiscriminate 
administration of mineral oil to infants may be followed by aspiration 
of the mineral oil and subsequent ``lipoid pneumonia.''
    (c) In view of these facts, the Department of Health and Human 
Services will regard as misbranded under the provisions of the Federal 
Food, Drug, and Cosmetic Act a drug for oral administration consisting 
in whole or in part of mineral oil, the labeling of which encourages its 
use in pregnancy or indicates or implies that such drug is for 
administration to infants.
    (d) It is also this Department's view that the act requires the 
labelings of such drugs to bear a warning against consumption other than 
at bedtime and against administration to infants. The following form of 
warning is suggested: ``Caution: To be taken only at bedtime. Do not use 
at any other time or administer to infants, except upon the advice of a 
physician.''
    (e) This statement of interpretation does not in any way exempt 
mineral oil or preparations containing mineral oil from complying in all 
other respects with the requirements of the Federal Food, Drug, and 
Cosmetic Act.



Sec. 201.303  Labeling of drug preparations containing significant proportions of wintergreen oil.

    (a) Because methyl salicylate (wintergreen oil) manifests no 
toxicity in the minute amounts in which it is used as a flavoring, it is 
mistakenly regarded by the public as harmless even when taken in 
substantially larger amounts. Actually, it is quite toxic when taken in 
quantities of a teaspoonful or more. Wintergreen oil and preparations 
containing it have caused a number of deaths through accidental misuse 
by both adults and children. Children are particularly attracted by the 
odor and are likely to swallow these products when left within reach.
    (b) To safeguard against fatalities from this cause, the Department 
of Health and Human Services will regard as misbranded under the 
provisions of the Federal Food, Drug, and Cosmetic Act any drug 
containing more than 5 percent methyl salicylate (wintergreen oil), the 
labeling of which fails to warn that use otherwise than as directed 
therein may be dangerous and that the article should be kept out of 
reach of children to prevent accidental poisoning.
    (c) This statement of interpretation in no way exempts methyl 
salicylate (wintergreen oil) or its preparations from complying in all 
other respects with the requirements of the Federal Food, Drug, and 
Cosmetic Act.



Sec. 201.304  Tannic acid and barium enema preparations.

    (a) It has become a widespread practice for tannic acid to be added 
to barium enemas to improve X-ray pictures. Tannic acid is capable of 
causing diminished liver function and severe liver necrosis when 
absorbed in sufficient amounts. The medical literature reports a number 
of deaths associated with the addition of tannic acid to barium enemas. 
There is a lack of scientific evidence to establish the conditions, if 
any, under which tannic acid is safe and effective for use in enemas. 
Tannic acid for rectal use to enhance X-ray visualization is regarded as 
a new drug within the meaning of section 201(p) of the Federal Food, 
Drug, and Cosmetic Act.
    (b) In view of the hazards involved when tannic acid is used in 
barium enemas, any shipments of tannic acid labeled to come within the 
exemptions under 502(f) of the Act containing such phrases as: 
``Caution: For manufacturing, processing, or repackaging,'' ``For 
prescription compounding,'' or ``Diagnostic reagent--For professional

[[Page 60]]

use only'' will be regarded by the Commissioner of Food and Drugs as 
misbranded within the meaning of section 502(f) of the Federal Food, 
Drug, and Cosmetic Act unless the label and the labeling bear 
conspicuously a warning to the effect: ``Warning-- Not for use in 
enemas.''
    (c) Any tannic acid intended for use by man and found within the 
jurisdiction of the Federal Food, Drug, and Cosmetic Act labeled 
contrary to this section after 60 days from the date of its publication 
in the Federal Register may be made the subject of regulatory 
proceedings.



Sec. 201.305  Isoproterenol inhalation preparations (pressurized aerosols, nebulizers, powders) for human use; warnings.

    (a) Accumulating reports have been received by the Food and Drug 
Administration and have appeared in the medical literature of severe 
paradoxical bronchoconstriction associated with repeated, excessive use 
of isoproterenol inhalation preparations in the treatment of bronchial 
asthma and other chronic bronchopulmonary disorders. The cause of this 
paradoxical reaction is unknown; it has been observed, however, that 
patients have not responded completely to other forms of therapy until 
use of the isoproterenol inhalation preparation was discontinued. In 
addition, sudden unexpected deaths have been associated with the 
excessive use of isoproterenol inhalation preparations. The mechanism of 
these deaths and their relationship, if any, to the cases of severe 
paradoxical bronchospasm are not clear. Cardiac arrest was noted in 
several of these cases of sudden death.
    (b) On the basis of the above information and after discussion with 
and concurrence of the Respiratory and Anesthetic Drugs Advisory 
Committee for Food and Drug Administration, the Commissioner of Food and 
Drugs concludes that in order for the labeling of such drugs to bear 
adequate information for their safe use, as required by Sec. 201.100, 
such labeling must include the following:

    Warning: Occasional patients have been reported to develop severe 
paradoxical airway resistance with repeated, excessive use of 
isoproterenol inhalation preparations. The cause of this refractory 
state is unknown. It is advisable that in such instances the use of this 
preparation be discontinued immediately and alternative therapy 
instituted, since in the reported cases the patients did not respond to 
other forms of therapy until the drug was withdrawn.
    Deaths have been reported following excessive use of isoproterenol 
inhalation preparations and the exact cause is unknown. Cardiac arrest 
was noted in several instances.

    (c)(1) The Commissioner also concludes that in view of the manner in 
which these preparations are self-administered for relief of attacks of 
bronchial asthma and other chronic bronchopulmonary disorders, it is 
necessary for the protection of users that warning information to 
patients be included as a part of the label and as part of any 
instructions to patients included in the package dispensed to the 
patient as follows:

    Warning: Do not exceed the dose prescribed by your physician. If 
difficulty in breathing persists, contact your physician immediately.

    (2) The warning on the label may be accomplished (i) by including it 
on the immediate container label with a statement directed to 
pharmacists not to remove the label or (ii) by including in the package 
a printed warning with instructions to pharmacists to place the warning 
on the container prior to dispensing.
    (d) The marketing of isoproterenol inhalation preparations may be 
continued if all the following conditions are met:
    (1) Within 30 days following the date of publication of this section 
in the Federal Register:
    (i) The label and labeling of such preparations shipped within the 
jurisdiction of the act are in accordance with paragraphs (b) and (c) of 
this section.
    (ii) The holder of an approved new-drug application for such 
preparation submits a supplement to his new-drug application to provide 
for appropriate labeling changes as described in paragraphs (b) and (c) 
of this section.
    (2) Within 90 days following the date of publication of this section 
in the Federal Register, the manufacturer,

[[Page 61]]

packer, or distributor of any drug containing isoproterenol intended for 
inhalation for which a new-drug approval is not in effect submits a new-
drug application containing satisfactory information of the kinds 
required by Sec. 314.50 of this chapter, including appropriate labeling 
as described in paragraphs (b) and (c) of this section.
    (3) The applicant submits additional information required for the 
approval of the application as may be specified in a written 
communication from the Food and Drug Administration.
    (e) After 270 days following expiration of said 90 days, regulatory 
proceedings based on section 505(a) of the Federal Food, Drug, and 
Cosmetic Act may be initiated with regard to any such drug shipped 
within the jurisdiction of the act for which an approved new-drug 
application is not in effect.

[40 FR 13998, Mar. 27, 1975, as amended at 55 FR 11576, Mar. 29, 1990]



Sec. 201.306  Potassium salt preparations intended for oral ingestion by man.

    (a) The Food and Drug Administration will initiate no regulatory 
action with respect to the continued marketing of coated tablets 
containing potassium chloride or other potassium salts which supply 100 
milligrams or more of potassium per tablet provided all the following 
conditions are met:
    (1) Within 30 days from the date of publication of this statement of 
policy in the Federal Register:
    (i) The labeling of the drug bears the prescription caution 
statement quoted in section 503(b)(4) of the Federal Food, Drug, and 
Cosmetic Act;
    (ii) The labeling on or within the package from which the drug is to 
be dispensed bears adequate information for its use by practitioners in 
accord with the ``full disclosure'' labeling requirements of 
Sec. 201.100 of this chapter, including the following warning statement:

    Warning--There have been several reports, published and unpublished, 
concerning nonspecific small-bowel lesions consisting of stenosis, with 
or without ulceration, associated with the administration of enteric-
coated thiazides with potassium salts. These lesions may occur with 
enteric-coated potassium tablets alone or when they are used with 
nonenteric-coated thiazides, or certain other oral diuretics. These 
small-bowel lesions have caused obstruction, hemorrhage, and 
perforation. Surgery was frequently required and deaths have occurred. 
Based on a large survey of physicians and hospitals, both United States 
and foreign, the incidence of these lesions is low, and a causal 
relationship in man has not been definitely established. Available 
information tends to implicate enteric-coated potassium salts, although 
lesions of this type also occur spontaneously. Therefore, coated 
potassium-containing formulations should be administered only when 
indicated, and should be discontinued immediately if abdominal pain, 
distention, nausea, vomiting, or gastrointestinal bleeding occur. Coated 
potassium tablets should be used only when adequate dietary 
supplementation is not practicable.


(Although the warning statement includes references to enteric-coated 
potassium salt preparations, it applies to any capsule or coated tablet 
of a potassium salt intended for oral ingestion without prior dilution 
with an adequate volume of liquid to preclude gastrointestinal injury.)
    (iii) Any other labeling or additional advertising for the drug 
conforms to the labeling described in paragraph (a)(1)(ii) of this 
section, in accordance with Secs. 202.1 and 201.100 of this chapter.
    (2) Within 90 days from the date of publication of this statement of 
policy in the Federal Register, the manufacturer, packer, or distributor 
of the drug shall submit a new-drug application containing satisfactory 
information of the kind required by Sec. 314.50 of this chapter, with 
appropriate labeling as described in this paragraph.
    (b) The Food and Drug Administration may initiate regulatory 
proceedings after 30 days from the date of publication of this section, 
with respect to the marketing of uncoated tablets containing potassium 
chloride or other potassium salts which supply 100 milligrams or more of 
potassium per tablet or with respect to liquid preparations containing 
potassium chloride or other potassium salts which supply 20 milligrams 
or more of potassium per milliliter, labeled or intended for human use, 
unless all the following conditions are met:
    (1) The labeling of the drug bears the prescription caution 
statement quoted in section 503(b)(4) of the Federal Food, Drug, and 
Cosmetic Act; and

[[Page 62]]

    (2) The labeling on or within the package from which the drug is to 
be dispensed bears adequate information for its use by practitioners in 
accord with the ``full disclosure'' labeling requirements of 
Sec. 201.100 of this chapter, including a recommendation that patients 
be directed to dissolve any such tablets in an appropriate amount of 
liquid and to dilute any such liquid preparations adequately to assure 
against gastrointestinal injury associated with the oral ingestion of 
concentrated potassium salt preparations.

[40 FR 13998, Mar. 27, 1975, as amended at 55 FR 11576, Mar. 29, 1990]



Sec. 201.307  Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    (a) Reports in the medical literature and data accumulated by the 
Food and Drug Administration indicate that multiple container sizes of 
sodium phosphates oral solution available in the marketplace have caused 
consumer confusion and appear to have been involved in several consumer 
deaths. Sodium phosphates oral solution has been marketed in 45-
milliliter (mL), 90-mL, and 240-mL container sizes. The 45-mL and 90-mL 
container sizes of sodium phosphates oral solution are often recommended 
and prescribed by physicians for bowel cleansing prior to surgery and 
diagnostic procedures of the colon. Sodium phosphates oral solution 
(adult dose 20 mL to 45 mL) is also used as an over-the-counter (OTC) 
laxative for the relief of occasional constipation. Accidental 
overdosing and deaths have occurred because the 240-mL container was 
mistakenly used instead of the 45-mL or 90-mL container. The Food and 
Drug Administration is limiting the amount of sodium phosphates oral 
solution to not more than 90 mL (3 ounces (oz)) per OTC container 
because of the serious health risks associated with the ingestion of 
larger than intended doses of this product. Further, because an overdose 
of either oral or rectal enema sodium phosphates can cause an 
electrolyte imbalance, additional warning and direction statements are 
required for the safe use of any OTC laxative drug product containing 
sodium phosphates.
    (b) Any OTC drug product for laxative or bowel cleansing use 
containing sodium phosphates as an active ingredient when marketed as 
described in paragraph (a) of this section is misbranded within the 
meaning of section 502 of the Federal Food, Drug, and Cosmetic Act 
unless packaged and labeled as follows:
    (1) Package size limitation for sodium phosphates oral solution: 
Container shall not contain more than 90 mL (3 oz).
    (2) Warnings. The following sentences shall appear in boldface type 
as the first statement under the heading ``Warnings.''
    (i) Oral dosage forms. ``Taking more than the recommended dose in 24 
hours can be harmful.''
    (ii) Rectal enema dosage forms. ``Using more than one enema in 24 
hours can be harmful.''
    (3) Directions--(i) The labeling of all orally or rectally 
administered OTC drug products containing sodium phosphates shall 
contain the following directions in boldface type immediately preceding 
the dosage information: ``Do not'' (``take'' or ``use'') ``more unless 
directed by a doctor. See Warnings.''
    (ii) For products containing dibasic sodium phosphate/monobasic 
sodium phosphate identified in Sec. 334.16(d) marketed as a solution. 
Adults and children 12 years of age and over: Oral dosage is dibasic 
sodium phosphate 3.42 to 7.56 grams (g) and monobasic sodium phosphate 
9.1 to 20.2 g (20 to 45 mL dibasic sodium phosphate/monobasic sodium 
phosphate oral solution) as a single daily dose. ``Do not take more than 
45 mL (9 teaspoonfuls or 3 tablespoonfuls) in a 24-hour period.'' 
Children 10 and 11 years of age: Oral dosage is dibasic sodium phosphate 
1.71 to 3.78 g and monobasic sodium phosphate 4.5 to 10.1 g (10 to 20 mL 
dibasic sodium phosphate/monobasic sodium phosphate oral solution) as a 
single daily dose. ``Do not take more than 20 mL (4 teaspoonfuls) in a 
24-hour period.'' Children 5 to 9 years of age: Oral dosage is dibasic 
sodium phosphate 0.86 to 1.89 g and monobasic sodium phosphate 2.2 to 
5.05 g (5 to 10 mL dibasic sodium phosphate/monobasic sodium phosphate 
oral solution) as a single daily dose.

[[Page 63]]

``Do not take more than 10 mL (2 teaspoonfuls) in a 24-hour period.'' 
Children under 5 years of age: ask a doctor.
    (c) After June 22, 1998, for package size limitation and September 
18, 1998, for labeling in accord with paragraph (b) of this section, any 
such OTC drug product initially introduced or initially delivered for 
introduction into interstate commerce, or any such drug product that is 
repackaged or relabeled after these dates regardless of the date the 
product was manufactured, initially introduced, or initially delivered 
for introduction into interstate commerce, that is not in compliance 
with this section is subject to regulatory action.

[63 FR 27843, May 21, 1998]



Sec. 201.308  Ipecac syrup; warnings and directions for use for over-the-counter sale.

    (a) It is estimated that each year about 500,000 accidental 
poisonings occur in the United States and result in approximately 1,500 
deaths, of which over 400 are children. In the emergency treatment of 
these poisonings, ipecac syrup is considered the emetic of choice. The 
immediate availability of this drug for use in such situations is 
critical, since rapid treatment may be the difference between life and 
death. The restriction of this drug to prescription sale limits its 
availability in emergencies. On the other hand, it is the consensus of 
informed medical opinion that ipecac syrup should be used only under 
medical supervision in the emergency treatment of poisonings. In view of 
these facts, the question of whether ipecac syrup labeled as an 
emergency treatment for use in poisonings should be available over the 
counter has been controversial.
    (b) In connection with its study of this problem, the Food and Drug 
Administration has obtained the views of medical authorities. It is the 
unanimous recommendation of the American Academy of Pediatrics, the 
American Association of Poison Control Centers, the American Medical 
Association, and the Medical Advisory Board of the Food and Drug 
Administration that ipecac syrup in 1 fluid ounce containers be 
permitted to be sold without prescription so that it will be readily 
available in the household for emergency treatment of poisonings, under 
medical supervision, and that the drug be appropriately packaged and 
labeled for this purpose.
    (c) In view of the above recommendations, the Commissioner of Food 
and Drugs has determined that it is in the interest of the public health 
for ipecac syrup to be available for sale without prescription, provided 
that it is packaged in a quantity of 1 fluid ounce (30 milliliters), and 
its label bears, in addition to other required label information, the 
following, in a prominent and conspicuous manner:
    (1) A statement conspicuously boxed and in red letters, to the 
effect: ``For emergency use to cause vomiting in poisoning. Before 
using, call physician, the Poison Control Center, or hospital emergency 
room immediately for advice.''
    (2) A warning to the effect: ``Warning--Keep out of reach of 
children. Do not use in unconscious persons. Ordinarily, this drug 
should not be used if strychnine, corrosives such as alkalies (lye) and 
strong acids, or petroleum distillates such as kerosine, gasoline, coal 
oil, fuel oil, paint thinner, or cleaning fluid have been ingested.''
    (3) Usual dosage: 1 tablespoon (15 milliliters) in persons over 1 
year of age.



Sec. 201.309  Acetophenetidin (phenacetin)-containing preparations; necessary warning statement.

    (a) In 1961, the Food and Drug Administration, pursuant to its 
statutory responsibility for the safety and effectiveness of drugs 
shipped in interstate commerce, began an active investigation of reports 
of possible toxic effects and renal damage due to misuse of the drug 
acetophenetidin. This study led to the decision that there was probable 
cause to conclude that misuse and prolonged use of the drug were in fact 
responsible for kidney lesions and disease. The Commissioner of Food and 
Drugs, in December 1963, appointed an ad hoc Advisory Committee of 
Inquiry on Possible Nephrotoxicity Associated With the Abuse of 
Acetophenetidin (Phenacetin)-Containing Preparations. This committee, 
composed of scientists

[[Page 64]]

in the fields of pharmacology and medicine, on April 23, 1964, submitted 
its findings and conclusions in the matter and recommended that all 
acetophenetidin (phenacetin)-containing preparations bear a warning as 
provided in section 502(f)(2) of the Federal Food, Drug, and Cosmetic 
Act.
    (b) On the basis of the studies made by the Food and Drug 
Administration and the report of the Advisory Committee, the 
Commissioner of Food and Drugs has concluded that it is necessary for 
the protection of users that the label and labeling of all 
acetophenetidin (phenacetin)-containing preparations bear a warning 
statement to the following effect: ``Warning--This medication may damage 
the kidneys when used in large amounts or for a long period of time. Do 
not take more than the recommended dosage, nor take regularly for longer 
than 10 days without consulting your physician.''



Sec. 201.310  Phenindione; labeling of drug preparations intended for use by man.

    (a) Reports in the medical literature and data accumulated by the 
Food and Drug Administration indicate that phenindione, a synthetic 
anticoagulant drug, has caused a number of cases of agranulocytosis 
(with two fatalities). There are also reports implicating the drug in 
cases of hepatitis and hypersensitivity reactions. In view of the 
potentially serious effects found to be associated with preparations of 
this drug intended for use by man, the Commissioner of Food and Drugs 
will regard such preparations as misbranded within the meaning of 
section 502(f) (1) and (2) of the Federal Food, Drug, and Cosmetic Act, 
unless the label and labeling on or within the package from which the 
drug is to be dispensed, and any other labeling furnishing or purporting 
to furnish information for use of the drug, bear a conspicuous warning 
statement to the following effect: ``Warning: Agranulocytosis and 
hepatitis have been associated with the use of phenindione. Patients 
should be instructed to report promptly prodromal symptoms such as 
marked fatigue, chill, fever, and sore throat. Periodic blood studies 
and liver function tests should be performed. Use of the drug should be 
discontinued if leukopenia occurs or if evidence of hypersensitivity, 
such as dermatitis or fever, appears.''
    (b) Regulatory action may be initiated with respect to preparations 
of phenindione intended for use by man found within the jurisdiction of 
the act on or after November 25, 1961, unless such preparations are 
labeled in accordance with paragraph (a) of this section.



Sec. 201.311  [Reserved]



Sec. 201.312  Magnesium sulfate heptahydrate; label declaration on drug products.

    Magnesium sulfate heptahydrate should be listed on the label of a 
drug product as epsom salt, which is its common or usual name.



Sec. 201.313  Estradiol labeling.

    The article presently recognized in The National Formulary under the 
heading ``Estradiol'' and which is said to be ``17-cis-beta estradiol'' 
is the same substance formerly recognized in the United States 
Pharmacopeia under the designation ``Alpha Estradiol.'' The substance 
should no longer be referred to in drug labeling as ``Alpha Estradiol.'' 
The Food and Drug Administration would not object to label references to 
the article as simply ``Estradiol''; nor would it object if the label of 
a preparation containing this substance referred to the presence of 
``Estradiol (formerly known as Alpha Estradiol).''



Sec. 201.314  Labeling of drug preparations containing salicylates.

    (a) The label of any oral drug preparation intended for sale without 
prescription and which contains any salicylate ingredient (including 
aspirin, salicylamide, other salicylates, and combinations) must 
conspicuously bear, on a clearly contrasting background, the warning 
statement: ``Keep out of reach of children [highlighted in bold type]. 
In case of overdose, get medical help or contact a Poison Control Center 
right away,'' or ``Keep out of reach of children [highlighted in bold 
type],'' except that if the article is an aspirin preparation, it shall 
bear the first of these

[[Page 65]]

warning statements. Such a warning statement is required for compliance 
with section 502(f)(2) of the Federal Food, Drug, and Cosmetic Act and 
is intended to guard against accidental poisonings. Safety closures that 
prevent access to the drug by young children are also recommended to 
guard against accidental poisonings.
    (b) Effervescent preparations and preparations containing para-
aminosalicylate as the only salicylate ingredient are exempted from this 
labeling requirement.
    (c) Aspirin tablets sold as such and containing no other active 
ingredients, except tablets which cannot be readily subdivided into a 
child's dose because of their coating or size, should always bear dosage 
directions for each age group down to 3 years of age, with a statement 
such as ``For children under 3 years of age, consult your physician.'' 
It is recommended that:
    (1) Aspirin tablets especially made for pediatric use be produced 
only in 1\1/4\-grain size to reduce the hazard of errors in dosage;
    (2) By June 1, 1967, manufacturers and distributors of 1\1/4\-grain 
size aspirin tablets discontinue the distribution of such tablets in 
retail containers containing more than 36 tablets, to reduce the hazard 
of accidental poisoning;
    (3) The flavoring of 5-grain aspirin tablets or other ``adult 
aspirin tablets'' be discontinued; and
    (4) Labeling giving undue emphasis to the pleasant flavor of 
flavored aspirin tablets be discontinued.
    (d) Salicylate preparations other than aspirin tablets sold as such 
may, at the option of the distributor, be labeled for use by adults 
only. If their labeling and advertising clearly offer them for 
administration to adults only.
    (e)(1) It is the obligation of the distributor who labels a 
salicylate preparation for administration to children to make certain 
that the article is suitable for such use and labeled with adequate 
directions for use in the age group for which it is offered, but in no 
case should such an article bear directions for use in children under 3 
years of age. If the directions provide for administration to children 
as young as 3 years of age, the label should bear the statement, ``For 
children under 3 years of age consult your physician.'' However, if the 
directions provide for administration to children only of an age greater 
than 3 years (for example, the dosage instructions provide for 
administration of the article to children only down to age 6), the label 
should bear a statement such as, ``For younger children consult your 
physician.''
    (2) A statement such as, ``For children under 3 years of age consult 
your physician'' or ``For younger children consult your physician'' is 
not required on the label of an article clearly offered for 
administration to adults only.
    (f) If the labeling or advertising of a salicylate preparation 
offers it for use in arthritis or rheumatism, the label and labeling 
should clearly state that the beneficial effects claimed are limited to: 
``For the temporary relief of minor aches and pains of arthritis and 
rheumatism.'' The qualifying phrase ``for the temporary relief of minor 
aches and pains'' should appear with the same degree of prominence and 
conspicuousness as the phrase ``arthritis and rheumatism''. The label 
and labeling should bear in juxtaposition with such directions for use 
conspicuous warning statements to the effect: ``Caution: If pain 
persists for more than 10 days, or redness is present, or in conditions 
affecting children under 12 years of age, consult a physician 
immediately.'' The salicylate dosage should not exceed 60 grains in a 
24-hour period or 10 grains in a 4-hour period. If the article contains 
other analgesics, the salicylate dosage should be appropriately reduced.
    (g)(1) The label of any drug containing more than 5 percent methyl 
salicylate (wintergreen oil) should bear a conspicuous warning such as: 
``Do not use otherwise than as directed.'' These drug products must also 
include the ``Keep out of reach of children'' warning and the accidental 
ingestion warning as required in Sec. 330.1(g) of this chapter.
    (2) If the preparation is a counterirritant or rubefacient, it 
should also bear a caution such as, ``Caution: Discontinue use if 
excessive irritation of the skin develops. Avoid getting into the eyes 
or on mucous membranes.'' (See also Sec. 201.303.)

[[Page 66]]

    (h)(1) The labeling of orally or rectally administered over-the-
counter aspirin and aspirin-containing drug products subject to this 
paragraph is required to prominently bear a warning. The warning shall 
be as follows: ``Children and teenagers should not use this medicine for 
chicken pox or flu symptoms before a doctor is consulted about Reye's 
syndrome, a rare but serious illness reported to be associated with 
aspirin.''
    (2) This warning statement shall appear on the immediate container 
labeling. In cases where the immediate container is not the retail 
package, the retail package also must bear the warning statement. In 
addition, the warning statement shall appear on any labeling that 
contains warnings and, in such cases, the warning statement shall be the 
first warning statement under the heading ``Warnings.''
    (3) Over-the-counter drug products subject to this paragraph and 
labeled solely for use by children (pediatric products) shall not 
recommend the product for use in treating flu or chicken pox.
    (4) Any product subject to this paragraph that is not labeled as 
required by this paragraph and that is initially introduced or initially 
delivered for introduction into interstate commerce after June 5, 1986, 
is misbranded under sections 201(n) and 502 (a) and (f) of the Federal 
Food, Drug, and Cosmetic Act.

[40 FR 13998, Mar. 27, 1985, as amended at 51 FR 8182, Mar. 7, 1986; 53 
FR 21637, June 9, 1988; 53 FR 24830, June 30, 1988; 64 FR 13291, Mar. 
17, 1999; 65 FR 8, Jan. 3, 2000]



Sec. 201.315  Over-the-counter drugs for minor sore throats; suggested warning.

    The Food and Drug Administration has studied the problem of the 
labeling of lozenges or troches containing a local anesthetic, chewing 
gum containing aspirin, various mouth washes and gargles and other 
articles sold over the counter for the relief of minor irritations of 
the mouth or throat. It will not object to the labeling of suitable 
articles of this type ``For the temporary relief of minor sore 
throats'', provided this is immediately followed in the labeling with a 
warning statement in prominent type essentially as follows: ``Warning--
Severe or persistent sore throat or sore throat accompanied by high 
fever, headache, nausea, and vomiting may be serious. Consult physician 
promptly. Do not use more than 2 days or administer to children under 3 
years of age unless directed by physician.''



Sec. 201.316  Drugs with thyroid hormone activity for human use; required warning.

    (a) Drugs with thyroid hormone activity have been promoted for, and 
continue to be dispensed and prescribed for, use in the treatment of 
obesity, although their safety and effectiveness for that use have never 
been established.
    (b) Drugs for human use with thyroid hormone activity are misbranded 
within the meaning of section 502 of the Federal Food, Drug, and 
Cosmetic Act unless their labeling bears the following boxed warning at 
the beginning of the ``Warnings'' section:

   ------------------------------------------------------------------
         Drugs with thyroid hormone activity, alone or together 
      with other therapeutic agents, have been used for the 
      treatment of obesity. In euthyroid patients, doses within 
      the range of daily hormonal requirements are ineffective for 
      weight reduction. Larger doses may produce serious or even 
      life-threatening manifestations of toxicity, particularly 
      when given in association with sympathomimetic amines such 
      as those used for their anorectic effects.

   ------------------------------------------------------------------

[43 FR 22009, May 23, 1978]



Sec. 201.317  Digitalis and related cardiotonic drugs for human use in oral dosage forms; required warning.

    (a) Digitalis and related cardiotonic drugs for human use in oral 
dosage forms have been promoted for, and continue to be dispensed and 
prescribed for, use in the treatment of obesity, although their safety 
and effectiveness for that use have never been established.
    (b) Digitalis and related cardiotonic drugs for human use in oral 
dosage forms are misbranded within the meaning of section 502 of the 
Federal Food,

[[Page 67]]

Drug, and Cosmetic Act unless their labeling bears the following boxed 
warning at the beginning of the ``Warnings'' section:

   ------------------------------------------------------------------
         Digitalis alone or with other drugs has been used in the 
      treatment of obesity. This use of digoxin or other digitalis 
      glycosides is unwarranted. Moreover, since they may cause 
      potentially fatal arrhythmias or other adverse effects, the 
      use of these drugs in the treatment of obesity is dangerous.

   ------------------------------------------------------------------
    (c) This section does not apply to digoxin products for oral use, 
which shall be labeled according to the requirements of Sec. 310.500 of 
this chapter.

[43 FR 22009, May 23, 1978]



Sec. 201.319  Water-soluble gums, hydrophilic gums, and hydrophilic mucilloids (including, but not limited to agar, alginic acid, calcium polycarbophil,
 
          carboxymethylcellulose sodium, carrageenan, chondrus, 
          glucomannan ((B-1,4 linked) polymannose acetate), guar gum, 
          karaya gum, kelp, methylcellulose, plantago seed (psyllium), 
          polycarbophil tragacanth, and xanthan gum) as active 
          ingredients; required warnings and directions.

    (a) Reports in the medical literature and data accumulated by the 
Food and Drug Administration indicate that esophageal obstruction and 
asphyxiation have been associated with the ingestion of water-soluble 
gums, hydrophilic gums, and hydrophilic mucilloids including, but not 
limited to, agar, alginic acid, calcium polycarbophil, 
carboxymethylcellulose sodium, carrageenan, chondrus, glucomannan ((B-
1,4 linked) polymannose acetate), guar gum, karaya gum, kelp, 
methylcellulose, plantago seed (psyllium), polycarbophil, tragacanth, 
and xanthan gum. Esophageal obstruction and asphyxiation due to orally-
administered drug products containing water-soluble gums, hydrophilic 
gums, and hydrophylic mucilloids as active ingredients are significant 
health risks when these products are taken without adequate fluid or 
when they are used by individuals with esophageal narrowing or 
dysfunction, or with difficulty in swallowing. Additional labeling is 
needed for the safe and effective use of any OTC drug product for human 
use containing a water-soluble gum, hydrophilic gum, or hydrophilic 
mucilloid as an active ingredient when marketed in a dry or incompletely 
hydrated form to include, but not limited to, the following dosage 
forms: capsules, granules, powders, tablets, and wafers.
    (b) Any drug products for human use containing a water-soluble gum, 
hydrophilic gum, or hydrophilic mucilloid as an active ingredient in an 
oral dosage form when marketed in a dry or incompletely hydrated form as 
described in paragraph (a) of this section are misbranded within the 
meaning of section 502 of the Federal Food, Drug, and Cosmetic Act 
unless their labeling bears the following warnings (under the subheading 
``Choking'') and directions:
    ```Choking' [highlighted in bold type]: Taking this product without 
adequate fluid may cause it to swell and block your throat or esophagus 
and may cause choking. Do not take this product if you have difficulty 
in swallowing. If you experience chest pain, vomiting, or difficulty in 
swallowing or breathing after taking this product, seek immediate 
medical attention;'' and
    ```Directions' [highlighted in bold type]:'' (Select one of the 
following, as appropriate: ``Take'' or ``Mix'') ``this product (child or 
adult dose) with at least 8 ounces (a full glass) of water or other 
fluid. Taking this product without enough liquid may cause choking. See 
choking warning.''

    (c) After February 28, 1994, any such OTC drug product initially 
introduced or initially delivered for introduction into interstate 
commerce, or any such drug product that is repackaged or relabeled after 
this date regardless of the date the product was manufactured, initially 
introduced, or initially delivered for introduction into interstate 
commerce, that is not in compliance with this section is subject to 
regulatory action.

[58 FR 45201, Aug. 26, 1993, as amended at 64 FR 13292, Mar. 17, 1999]

[[Page 68]]



Sec. 201.320  Warning statements for drug products containing or manufactured with chlorofluorocarbons or other ozone-depleting substances.

    (a)(1) All drug products containing or manufactured with 
chlorofluorocarbons, halons, carbon tetrachloride, methyl chloride, or 
any other class I substance designated by the Environmental Protection 
Agency (EPA) shall, except as provided in paragraph (b) or (c) of this 
section, bear the following warning statement:

    Warning: Contains [or Manufactured with, if applicable] [insert name 
of substance], a substance which harms public health and the environment 
by destroying ozone in the upper atmosphere.

    (2) The warning statement shall be clearly legible and conspicuous 
on the product, its immediate container, its outer packaging, or other 
labeling in accordance with the requirements of 40 CFR part 82 and 
appear with such prominence and conspicuousness as to render it likely 
to be read and understood by consumers under normal conditions of 
purchase.
    (b)(1) For prescription drug products for human use, the following 
alternative warning statement may be used:

    Note: The indented statement below is required by the Federal 
government's Clean Air Act for all products containing or manufactured 
with chlorofluorocarbons (CFC's) [or name of other class I substance, if 
applicable]:

    This product contains [or is manufactured with, if applicable] 
[insert name of substance], a substance which harms the environment by 
destroying ozone in the upper atmosphere.
    Your physician has determined that this product is likely to help 
your personal health. USE THIS PRODUCT AS DIRECTED, UNLESS INSTRUCTED TO 
DO OTHERWISE BY YOUR PHYSICIAN. If you have any questions about 
alternatives, consult with your physician.

    (2) The warning statement shall be clearly legible and conspicuous 
on the product, its immediate container, its outer packaging, or other 
labeling in accordance with the requirements of 40 CFR part 82 and 
appear with such prominence and conspicuousness as to render it likely 
to be read and understood by consumers under normal conditions of 
purchase.
    (3) If the warning statement in paragraph (b)(1) of this section is 
used, the following warning statement must be placed on the package 
labeling intended to be read by the physician (physician package insert) 
after the ``How supplied'' section, which describes special handling and 
storage conditions on the physician labeling:

    Note: The indented statement below is required by the Federal 
government's Clean Air Act for all products containing or manufactured 
with chlorofluorocarbons (CFC's) [or name of other class I substance, if 
applicable]:

    Warning: Contains [or Manufactured with, if applicable] [insert name 
of substance], a substance which harms public health and the environment 
by destroying ozone in the upper atmosphere.
    A notice similar to the above WARNING has been placed in the 
information for the patient [or patient information leaflet, if 
applicable] of this product under the Environmental Protection Agency's 
(EPA's) regulations. The patient's warning states that the patient 
should consult his or her physician if there are questions about 
alternatives.

    (c)(1) For over-the-counter drug products for human use, the 
following alternative warning statement may be used:

    Note: The indented statement below is required by the Federal 
government's Clean Air Act for all products containing or manufactured 
with chlorofluorocarbons (CFC's) [or other class I substance, if 
applicable]:

    Warning: Contains [or Manufactured with, if applicable] [insert name 
of substance], a substance which harms public health and environment by 
destroying ozone in the upper atmosphere.
    CONSULT WITH YOUR PHYSICIAN OR HEALTH PROFESSIONAL IF YOU HAVE ANY 
QUESTION ABOUT THE USE OF THIS PRODUCT.

    (2) The warning statement shall be clearly legible and conspicuous 
on the product, its immediate container, its outer packaging, or other 
labeling in accordance with the requirements of 40 CFR part 82 and 
appear with such prominence and conspicuousness as to render it likely 
to be read and understood by consumers under normal conditions of 
purchase.
    (d) This section does not replace or relieve a person from any 
requirements imposed under 40 CFR part 82.

[61 FR 20100, May 3, 1996]

[[Page 69]]



Sec. 201.322  Over-the-counter drug products containing internal analgesic/antipyretic active ingredients; required alcohol warning.

    (a) People who regularly consume large quantities of alcohol (three 
or more drinks every day) have an increased risk of adverse effects 
(possible liver damage or gastrointestinal bleeding). OTC drug products 
containing internal analgesic/antipyretic active ingredients may cause 
similar adverse effects. FDA concludes that the labeling of OTC drug 
products containing internal analgesic/antipyretic active ingredients 
should advise consumers with a history of heavy alcohol use to consult a 
physician. Accordingly, any OTC drug product, labeled for adult use, 
containing any internal analgesic/antipyretic active ingredients 
(including, but not limited to, acetaminophen, aspirin, carbaspirin 
calcium, choline salicylate, ibuprofen, ketoprofen, magnesium 
salicylate, naproxen sodium, and sodium salicylate) alone or in 
combination shall bear an alcohol warning statement in its labeling as 
follows:
    (1) Acetaminophen. ``Alcohol Warning'' [heading in boldface type]: 
``If you consume 3 or more alcoholic drinks every day, ask your doctor 
whether you should take acetaminophen or other pain relievers/fever 
reducers. Acetaminophen may cause liver damage.''
    (2) Nonsteroidal anti-inflammatory analgesic/antipyretic active 
ingredients--including but not limited to aspirin, carbaspirin calcium, 
choline salicylate, ibuprofen, ketoprofen, magnesium salicylate, 
naproxen sodium, and sodium salicylate. ``Alcohol Warning'' [heading in 
boldface type]: ``If you consume 3 or more alcoholic drinks every day, 
ask your doctor whether you should take [insert one nonsteroidal anti-
inflammatory analgesic/antipyretic active ingredient] or other pain 
relievers/fever reducers. [Insert one nonsteroidal anti-inflammatory 
analgesic/antipyretic active ingredient] may cause stomach bleeding.''
    (3) Combinations of acetaminophen with nonsteroidal anti-
inflammatory analgesic/antipyretic active ingredients--including but not 
limited to aspirin, carbaspirin calcium, choline salicylate, ibuprofen, 
ketoprofen, magnesium salicylate, naproxen sodium, and sodium 
salicylate. ``Alcohol Warning'' [heading in boldface type]: ``If you 
consume 3 or more alcoholic drinks every day, ask your doctor whether 
you should take [insert acetaminophen and one nonsteroidal anti-
inflammatory analgesic/antipyretic active ingredient--including, but not 
limited to aspirin, carbaspirin calcium, choline salicylate, magnesium 
salicylate, or sodium salicylate] or other pain relievers/fever 
reducers. [Acetaminophen and (insert one nonsteroidal anti-inflammatory 
analgesic/antipyretic ingredient--including, but not limited to aspirin, 
carbaspirin calcium, choline salicylate, magnesium salicylate, or sodium 
salicylate] may cause liver damage and stomach bleeding.''
    (b)  Requirements to supplement approved application. Holders of 
approved applications for OTC drug products that contain internal 
analgesic/antipyretic active ingredients that are subject to the 
requirements of paragraph (a) of this section must submit supplements 
under Sec. 314.70(c) of this chapter to include the required warning in 
the product's labeling. Such labeling may be put into use without 
advance approval of FDA provided it includes the exact information 
included in paragraph (a) of this section.
    (c) Any drug product subject to this section that is not labeled as 
required and that is initially introduced or initially delivered for 
introduction into interstate commerce after April 23, 1999, is 
misbranded under section 502 of the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 352) and is subject to regulatory action.

[63 FR 56801, Oct. 23, 1998]



Sec. 201.323  Aluminum in large and small volume parenterals used in total parenteral nutrition.

    (a) The aluminum content of large volume parenteral (LVP) drug 
products used in total parenteral nutrition (TPN) therapy must not 
exceed 25 micrograms per liter (g/L).
    (b) The package insert of LVP's used in TPN therapy must state that 
the drug product contains no more than 25 g/L of aluminum. This 
information must be contained in the ``Precautions'' section of the 
labeling of all

[[Page 70]]

large volume parenterals used in TPN therapy.
    (c) The maximum level of aluminum present at expiry must be stated 
on the immediate container label of all small volume parenteral (SVP) 
drug products and pharmacy bulk packages (PBP's) used in the preparation 
of TPN solutions. The aluminum content must be stated as follows: 
``Contains no more than __ g/L of aluminum.'' The immediate 
container label of all SVP's and PBP's that are lyophilized powders used 
in the preparation of TPN solutions must contain the following 
statement: ``When reconstituted in accordance with the package insert 
instructions, the concentration of aluminum will be no more than __ 
g/L.'' This maximum level of aluminum must be stated as the 
highest of:
    (1) The highest level for the batches produced during the last 3 
years;
    (2) The highest level for the latest five batches, or
    (3) The maximum historical level, but only until completion of 
production of the first five batches after January 26, 2001.
    (d) The package insert for all LVP's, all SVP's, and PBP's used in 
TPN must contain a warning statement. This warning must be contained in 
the ``Warnings'' section of the labeling. The warning must state:

    WARNING: This product contains aluminum that may be toxic. Aluminum 
may reach toxic levels with prolonged parenteral administration if 
kidney function is impaired. Premature neonates are particularly at risk 
because their kidneys are immature, and they require large amounts of 
calcium and phosphate solutions, which contain aluminum.
    Research indicates that patients with impaired kidney function, 
including premature neonates, who receive parenteral levels of aluminum 
at greater than 4 to 5 g/kg/day accumulate aluminum at levels 
associated with central nervous system and bone toxicity. Tissue loading 
may occur at even lower rates of administration.

    (e) Applicants and manufacturers must use validated assay methods to 
determine the aluminum content in parenteral drug products. The assay 
methods must comply with current good manufacturing practice 
requirements. Applicants must submit to the Food and Drug Administration 
validation of the method used and release data for several batches. 
Manufacturers of parenteral drug products not subject to an approved 
application must make assay methodology available to FDA during 
inspections. Holders of pending applications must submit an amendment 
under Sec. 314.60 or Sec. 314.96 of this chapter.

[65 FR 4110, Jan. 26, 2000]

    Effective Date Note: At 65 FR 4110, Jan. 26, 2000, Sec. 201.323 was 
added, effective Jan. 26, 2001.

  Appendix A to Part 201--Examples of Graphic Enhancements Used by FDA

               I. Section 201.66 Standard Labeling Format

                               A. Overall

    1. The ``Drug Facts'' labeling is set off in a box or similar 
enclosure by the use of a barline with all black type printed on a 
white, color contrasting background.

                          B. Typeface and size

    1. ``Drug Facts'' is set in 14 point Helvetica Bold Italic, left 
justified.
    2. ``Drug Facts (continued)'' is set in 8 point Helvetica Bold 
Italic for the words ``Drug Facts'' and 8 point Helvetica Regular for 
the word ``(continued)'' and is left justified.
    3. The headings (e.g., ``Directions'') are set in 8 point Helvetica 
Bold Italic, left justified.
    4. The subheadings (e.g., ``Ask a doctor or pharmacist before use if 
you are'') are set in 6 point Helvetica Bold, left justified.
    5. The information is set in 6 point Helvetica Regular with 6.5 
point leading, left justified.
    6. The heading ``Purpose'' is right justified.
    7. The bullet is a 5-point solid square.
    8. Two em spacing separates bullets when more than one bullet is on 
the same line.
    9. A table format is used for 3 or more dosage directions.
    10. A graphic appears at the bottom of the first panel leading the 
reader to the next panel.

                        C. Barlines and hairlines

    1. A 2.5-point horizontal barline extends to each end of the ``Drug 
Facts'' box (or similar enclosure), providing separation between each of 
the headings.
    2. A 0.5-point horizontal hairline extends within 2 spaces on either 
side of the ``Drug Facts'' box (or similar enclosure), immediately 
following the title and immediately preceding the subheadings.
    3. A 0.5-point horizontal hairline follows the title, immediately 
preceding the heading, when a heading appears on a subsequent

[[Page 71]]

panel immediately after the ``Drug Facts (continued)'' title.

                           D. Box or Enclosure

    1. All information is enclosed by a 2.5-point barline.

               II. Section 201.66 Modified Labeling Format

                               A. Overall

    1. The ``Drug Facts'' labeling is presented in all black type 
printed on a white color contrasting background.

                          B. Typeface and size

    1. ``Drug Facts'' is set in 9 point Helvetica Bold Italic, left 
justified.
    2. The headings (e.g., ``Directions'') are set in 8 point Helvetica 
Bold Italic, left justified.
    3. The subheadings (e.g., ``Ask a doctor or pharmacist before use if 
you are'') are set in 6 point Helvetica Bold, left justified.
    4. The information is set in 6 point Helvetica Regular with 6.5 
point leading, left justified.
    5. The heading ``Purpose'' is right justified.
    6. The bullet is a 5-point solid square.
    7. Bulleted information may start on same line as headings (except 
for the ``Warnings'' heading) and subheadings, with 2 em spacing 
separating bullets, and need not be vertically aligned.

                        C. Barlines and hairlines

    1. A 2.5-point horizontal barline extends to each end of the ``Drug 
Facts'' box (or similar enclosure), providing separation between each of 
the headings.
    2. A 0.5-point horizontal hairline extends within 2 spaces on either 
side of the ``Drug Facts'' box (or similar enclosure), immediately 
following the title and immediately preceding the subheadings.

                           D. Box or Enclosure

    1. All information is set off by color contrast. No barline is used.

  III. Examples of Sec. 201.66 Standard Labeling and Modified Labeling 
                                 Formats

               A. Section 201.66 Standard Labeling Format
[GRAPHIC] [TIFF OMITTED] TR17MR99.007


[[Page 72]]



               B. Section 201.66 Modified Labeling Format
[GRAPHIC] [TIFF OMITTED] TR17MR99.008



PART 202--PRESCRIPTION DRUG ADVERTISING--Table of Contents




    Authority:  21 U.S.C. 321, 331, 352, 355, 360b, 371.



Sec. 202.1  Prescription-drug advertisements.

    (a)(1) The ingredient information required by section 502(n) of the 
Federal Food, Drug, and Cosmetic Act shall appear together, without any 
intervening written, printed, or graphic matter, except the proprietary 
names of ingredients, which may be included with the listing of 
established names.
    (2) The order of listing of ingredients in the advertisement shall 
be the same as the order of listing of ingredients on the label of the 
product, and the information presented in the advertisement concerning 
the quantity of each such ingredient shall be the same as the 
corresponding information on the label of the product.
    (3) The advertisement shall not employ a fanciful proprietary name 
for the drug or any ingredient in such a manner as to imply that the 
drug or ingredient has some unique effectiveness or composition, when, 
in fact, the drug or ingredient is a common substance, the limitations 
of which are readily recognized when the drug or ingredient is listed by 
its established name.
    (4) The advertisement shall not feature inert or inactive 
ingredients in a manner that creates an impression of value greater than 
their true functional role in the formulation.
    (5) The advertisement shall not designate a drug or ingredient by a 
proprietary name that, because of similarity in spelling or 
pronunciation, may be confused with the proprietary name or the 
established name of a different drug or ingredient.
    (b)(1) If an advertisement for a prescription drug bears a 
proprietary name or designation for the drug or any ingredient thereof, 
the established name, if such there be, corresponding to such 
proprietary name or designation shall accompany such proprietary name or 
designation each time it is featured in the advertisement for the drug; 
but, except as provided below in this subparagraph, the established name 
need not be used with the proprietary name or designation in the running 
text of the advertisement. On any page of an advertisement in which the 
proprietary name or designation is not featured but is used in the 
running text, the established name shall be used at least once in the 
running text in association with such proprietary name or designation 
and in the same type size used in the running text: Provided, however, 
That if the proprietary

[[Page 73]]

name or designation is used in the running text in larger size type, the 
established name shall be used at least once in association with, and in 
type at least half as large as the type used for, the most prominent 
presentation of the proprietary name or designation in such running 
text. If any advertisement includes a column with running text 
containing detailed information as to composition, prescribing, side 
effects, or contraindications and the proprietary name or designation is 
used in such column but is not featured above or below the column, the 
established name shall be used at least once in such column of running 
text in association with such proprietary name or designation and in the 
same type size used in such column of running text: Provided, however, 
That if the proprietary name or designation is used in such column of 
running text in larger size type, the established name shall be used at 
least once in association with, and in type at least half as large as 
the type used for, the most prominent presentation of the proprietary 
name or designation in such column of running text. Where the 
established name is required to accompany or to be used in association 
with the proprietary name or designation, the established name shall be 
placed in direct conjunction with the proprietary name or designation, 
and the relationship between the proprietary name or designation and the 
established name shall be made clear by use of a phrase such as ``brand 
of'' preceding the established name, by brackets surrounding the 
established name, or by other suitable means.
    (2) The established name shall be printed in letters that are at 
least half as large as the letters comprising the proprietary name or 
designation with which it is joined, and the established name shall have 
a prominence commensurate with the prominence with which such 
proprietary name or designation appears, taking into account all 
pertinent factors, including typography, layout, contrast, and other 
printing features.
    (c) In the case of a prescription drug containing two or more active 
ingredients, if the advertisement bears a proprietary name or 
designation for such mixture and there is no established name 
corresponding to such proprietary name or designation, the quantitative 
ingredient information required in the advertisement by section 502(n) 
of the act shall be placed in direct conjunction with the most prominent 
display of the proprietary name or designation. The prominence of the 
quantitative ingredient information shall bear a reasonable relationship 
to the prominence of the proprietary name.
    (d)(1) If the advertisement employs one proprietary name or 
designation to refer to a combination of active ingredients present in 
more than one preparation (the individual preparations differing from 
each other as to quantities of active ingredients and/or the form of the 
finished preparation) and there is no established name corresponding to 
such proprietary name or designation, a listing showing the established 
names of the active ingredients shall be placed in direct conjunction 
with the most prominent display of such proprietary name or designation. 
The prominence of this listing of active ingredients shall bear a 
reasonable relationship to the prominence of the proprietary name and 
the relationship between such proprietary name or designation, and the 
listing of active ingredients shall be made clear by use of such phrase 
as ``brand of'', preceding the listing of active ingredients.
    (2) The advertisement shall prominently display the name of at least 
one specific dosage form and shall have the quantitative ingredient 
information required by section 502(n) of the act in direct conjunction 
with such display. If other dosage forms are listed in the 
advertisement, the quantitative ingredient information for such dosage 
forms shall appear in direct conjunction and in equal prominence with 
the most prominent listing of the names of such dosage forms.
    (e) True statement of information in brief summary relating to side 
effects, contraindications, and effectiveness:
    (1) When required. All advertisements for any prescription drug 
(``prescription drug'' as used in this section means drugs defined in 
section 503(b)(1) of the act and Sec. 201.105, applicable to drugs for 
use by man and veterinary

[[Page 74]]

drugs, respectively), except advertisements described in paragraph 
(e)(2) of this section, shall present a true statement of information in 
brief summary relating to side effects, contraindications (when used in 
this section ``side effects, contraindications'' include side effects, 
warnings, precautions, and contraindications and include any such 
information under such headings as cautions, special considerations, 
important notes, etc.) and effectiveness. Advertisements broadcast 
through media such as radio, television, or telephone communications 
systems shall include information relating to the major side effects and 
contraindications of the advertised drugs in the audio or audio and 
visual parts of the presentation and unless adequate provision is made 
for dissemination of the approved or permitted package labeling in 
connection with the broadcast presentation shall contain a brief summary 
of all necessary information related to side effects and 
contraindications.
    (2) Exempt advertisements. The following advertisements are exempt 
from the requirements of paragraph (e)(1) of this section under the 
conditions specified:
    (i) Reminder advertisements. Reminder advertisements are those which 
call attention to the name of the drug product but do not include 
indications or dosage recommendations for use of the drug product. These 
reminder advertisements shall contain only the proprietary name of the 
drug product, if any; the established name of the drug product, if any; 
the established name of each active ingredient in the drug product; and, 
optionally, information relating to quantitative ingredient statements, 
dosage form, quantity of package contents, price, the name and address 
of the manufacturer, packer, or distributor or other written, printed, 
or graphic matter containing no representation or suggestion relating to 
the advertised drug product. If the Commissioner finds that there is 
evidence of significant incidence of fatalities or serious injury 
associated with the use of a particular prescription drug, he may 
withdraw this exemption by so notifying the manufacturer, packer, or 
distributor of the drug by letter. Reminder advertisements, other than 
those solely intended to convey price information including, but not 
limited to, those subject to the requirements of Sec. 200.200 of this 
chapter, are not permitted for a prescription drug product whose 
labeling contains a boxed warning relating to a serious hazard 
associated with the use of the drug product. Reminder advertisements 
which are intended to provide consumers with information concerning the 
price charged for a prescription for a drug product are exempt from the 
requirements of this section if they meet all of the conditions 
contained in Sec. 200.200 of this chapter. Reminder advertisements, 
other than those subject to the requirements of Sec. 200.200 of this 
chapter, are not permitted for a drug for which an announcement has been 
published pursuant to a review on the labeling claims for the drug by 
the National Academy of Sciences/National Research Council (NAS/NRC), 
Drug Efficacy Study Group, and for which no claim has been evaluated as 
higher than ``possibly effective.'' If the Commissioner finds the 
circumstances are such that a reminder advertisement may be misleading 
to prescribers of drugs subject to NAS/NRC evaluation, such 
advertisements will not be allowed and the manufacturer, packer, or 
distributor will be notified either in the publication of the 
conclusions on the effectiveness of the drug or by letter.
    (ii) Advertisements of bulk-sale drugs. Advertisements of bulk-sale 
drugs that promote sale of the drug in bulk packages in accordance with 
the practice of the trade solely to be processed, manufactured, labeled, 
or repackaged in substantial quantities and that contain no claims for 
the therapeutic safety or effectiveness of the drug.
    (iii) Advertisements of prescription-compounding drugs. 
Advertisements of prescription-compounding drugs that promote sale of a 
drug for use as a prescription chemical or other compound for use by 
registered pharmacists in compounding prescriptions if the drug 
otherwise complies with the conditions for the labeling exemption 
contained in Sec. 201.120 and the advertisement contains no claims for 
the therapeutic safety or effectiveness of the drug.

[[Page 75]]

    (3) Scope of information to be included; applicability to the entire 
advertisement. (i) The requirement of a true statement of information 
relating to side effects, contraindications, and effectiveness applies 
to the entire advertisement. Untrue or misleading information in any 
part of the advertisement will not be corrected by the inclusion in 
another distinct part of the advertisement of a brief statement 
containing true information relating to side effects, contraindications, 
and effectiveness of the drug. If any part or theme of the advertisement 
would make the advertisement false or misleading by reason of the 
omission of appropriate qualification or pertinent information, that 
part or theme shall include the appropriate qualification or pertinent 
information, which may be concise if it is supplemented by a prominent 
reference on each page to the presence and location elsewhere in the 
advertisement of a more complete discussion of such qualification or 
information.
    (ii) The information relating to effectiveness is not required to 
include information relating to all purposes for which the drug is 
intended but may optionally be limited to a true statement of the 
effectiveness of the drug for the selected purpose(s) for which the drug 
is recommended or suggested in the advertisement. The information 
relating to effectiveness shall include specific indications for use of 
the drug for purposes claimed in the advertisement; for example, when an 
advertisement contains a broad claim that a drug is an antibacterial 
agent, the advertisement shall name a type or types of infections and 
microorganisms for which the drug is effective clinically as 
specifically as required, approved, or permitted in the drug package 
labeling.
    (iii) The information relating to side effects and contraindications 
shall disclose each specific side effect and contraindication (which 
include side effects, warnings, precautions, and contraindications and 
include any such information under such headings as cautions, special 
considerations, important notes, etc.; see paragraph (e)(1) of this 
section) contained in required, approved, or permitted labeling for the 
advertised drug dosage form(s): Provided, however,
    (a) The side effects and contraindications disclosed may be limited 
to those pertinent to the indications for which the drug is recommended 
or suggested in the advertisement to the extent that such limited 
disclosure has previously been approved or permitted in drug labeling 
conforming to the provisions of Secs. 201.100 or 201.105; and
    (b) The use of a single term for a group of side effects and 
contraindications (for example, ``blood dyscrasias'' for disclosure of 
``leukopenia,'' ``agranulocytosis,'' and ``neutropenia'') is permitted 
only to the extent that the use of such a single term in place of 
disclosure of each specific side effect and contraindication has been 
previously approved or permitted in drug labeling conforming to the 
provisions of Secs. 201.100 or 201.105.
    (4) Substance of information to be included in brief summary. (i)(a) 
An advertisement for a prescription drug covered by a new-drug 
application approved pursuant to section 505 of the act after October 
10, 1962 or section 512 of the act after August 1, 1969, or any approved 
supplement thereto, shall not recommend or suggest any use that is not 
in the labeling accepted in such approved new-drug application or 
supplement. The advertisement shall present information from labeling 
required, approved, or permitted in a new-drug application relating to 
each specific side effect and contraindication in such labeling that 
relates to the uses of the advertised drug dosage form(s) or shall 
otherwise conform to the provisions of paragraph (e)(3)(iii) of this 
section.
    (b) If a prescription drug was covered by a new-drug application or 
a supplement thereto that became effective prior to October 10, 1962, an 
advertisement may recommend or suggest:
    (1) Uses contained in the labeling accepted in such new-drug 
application and any effective, approved, or permitted supplement 
thereto.
    (2) Additional uses contained in labeling in commercial use on 
October 9, 1962, to the extent that such uses did not cause the drug to 
be an unapproved ``new drug'' as ``new drug'' was defined in section 
201(p) of the act as then in force, and to the extent that such uses

[[Page 76]]

would be permitted were the drug subject to paragraph (e)(4)(iii) of 
this section.
    (3) Additional uses contained in labeling in current commercial use 
to the extent that such uses do not cause the drug to be an unapproved 
``new drug'' as defined in section 201(p) of the act as amended or a 
``new animal drug'' as defined in section 201(v) of the act as amended.

The advertisement shall present information from labeling required, 
approved, or permitted in a new-drug application relating to each 
specific side effect and contraindication in such labeling that relates 
to the uses of the advertised drug dosage form(s) or shall otherwise 
conform to the provisions of paragraph (e)(3)(iii) of this section.
    (ii) In the case of an advertisement for a prescription drug other 
than a drug the labeling of which causes it to be an unapproved ``new 
drug'' and other than drugs covered by paragraph (e)(4)(i) of this 
section, an advertisement may recommend and suggest the drug only for 
those uses contained in the labeling thereof:
    (a) For which the drug is generally recognized as safe and effective 
among experts qualified by scientific training and experience to 
evaluate the safety and effectiveness of such drugs; or
    (b) For which there exists substantial evidence of safety and 
effectiveness, consisting of adequate and well-controlled 
investigations, including clinical investigations (as used in this 
section ``clinical investigations,'' ``clinical experience,'' and 
``clinical significance'' mean in the case of drugs intended for 
administration to man, investigations, experience, or significance in 
humans, and in the case of drugs intended for administration to other 
animals, investigations, experience, or significance in the specie or 
species for which the drug is advertised), by experts qualified by 
scientific training and experience to evaluate the safety and 
effectiveness of the drug involved, on the basis of which it can fairly 
and responsibly be concluded by such experts that the drug is safe and 
effective for such uses; or
    (c) For which there exists substantial clinical experience (as used 
in this section this means substantial clinical experience adequately 
documented in medical literature or by other data (to be supplied to the 
Food and Drug Administration, if requested)), on the basis of which it 
can fairly and responsibly be concluded by qualified experts that the 
drug is safe and effective for such uses; or
    (d) For which safety is supported under any of the preceding clauses 
in paragraphs (e)(4)(iii) (a), (b), and (c) of this section and 
effectiveness is supported under any other of such clauses.

The advertisement shall present information relating to each specific 
side effect and contraindication that is required, approved, or 
permitted in the package labeling by Secs. 201.100 or 201.105 of this 
chapter of the drug dosage form(s) or shall otherwise conform to the 
provisions of paragraph (e)(3)(iii) of this section.
    (5) ``True statement'' of information. An advertisement does not 
satisfy the requirement that it present a ``true statement'' of 
information in brief summary relating to side effects, 
contraindications, and effectiveness if:
    (i) It is false or misleading with respect to side effects, 
contraindications, or effectiveness; or
    (ii) It fails to present a fair balance between information relating 
to side effects and contraindications and information relating to 
effectiveness of the drug in that the information relating to 
effectiveness is presented in greater scope, depth, or detail than is 
required by section 502(n) of the act and this information is not fairly 
balanced by a presentation of a summary of true information relating to 
side effects and contraindications of the drug; Provided, however, That 
no advertisement shall be considered to be in violation of this section 
if the presentation of true information relating to side effects and 
contraindications is comparable in depth and detail with the claims for 
effectiveness or safety.
    (iii) It fails to reveal facts material in the light of its 
representations or material with respect to consequences that may result 
from the use of the drug as recommended or suggested in the 
advertisement.

[[Page 77]]

    (6) Advertisements that are false, lacking in fair balance, or 
otherwise misleading. An advertisement for a prescription drug is false, 
lacking in fair balance, or otherwise misleading, or otherwise violative 
of section 502(n) of the act, among other reasons, if it:
    (i) Contains a representation or suggestion, not approved or 
permitted for use in the labeling, that a drug is better, more 
effective, useful in a broader range of conditions or patients (as used 
in this section patients means humans and in the case of veterinary 
drugs, other animals), safer, has fewer, or less incidence of, or less 
serious side effects or contraindications than has been demonstrated by 
substantial evidence or substantial clinical experience (as described in 
paragraphs (e)(4)(ii) (b) and (c) of this section) whether or not such 
representations are made by comparison with other drugs or treatments, 
and whether or not such a representation or suggestion is made directly 
or through use of published or unpublished literature, quotations, or 
other references.
    (ii) Contains a drug comparison that represents or suggests that a 
drug is safer or more effective than another drug in some particular 
when it has not been demonstrated to be safer or more effective in such 
particular by substantial evidence or substantial clinical experience.
    (iii) Contains favorable information or opinions about a drug 
previously regarded as valid but which have been rendered invalid by 
contrary and more credible recent information, or contains literature 
references or quotations that are significantly more favorable to the 
drug than has been demonstrated by substantial evidence or substantial 
clinical experience.
    (iv) Contains a representation or suggestion that a drug is safer 
than it has been demonstrated to be by substantial evidence or 
substantial clinical experience, by selective presentation of 
information from published articles or other references that report no 
side effects or minimal side effects with the drug or otherwise selects 
information from any source in a way that makes a drug appear to be 
safer than has been demonstrated.
    (v) Presents information from a study in a way that implies that the 
study represents larger or more general experience with the drug than it 
actually does.
    (vi) Contains references to literature or studies that misrepresent 
the effectiveness of a drug by failure to disclose that claimed results 
may be due to concomitant therapy, or by failure to disclose the 
credible information available concerning the extent to which claimed 
results may be due to placebo effect (information concerning placebo 
effect is not required unless the advertisement promotes the drug for 
use by man).
    (vii) Contains favorable data or conclusions from nonclinical 
studies of a drug, such as in laboratory animals or in vitro, in a way 
that suggests they have clinical significance when in fact no such 
clinical significance has been demonstrated.
    (viii) Uses a statement by a recognized authority that is apparently 
favorable about a drug but fails to refer to concurrent or more recent 
unfavorable data or statements from the same authority on the same 
subject or subjects.
    (ix) Uses a quote or paraphrase out of context to convey a false or 
misleading idea.
    (x) Uses literature, quotations, or references that purport to 
support an advertising claim but in fact do not support the claim or 
have relevance to the claim.
    (xi) Uses literature, quotations, or references for the purpose of 
recommending or suggesting conditions of drug use that are not approved 
or permitted in the drug package labeling.
    (xii) Offers a combination of drugs for the treatment of patients 
suffering from a condition amenable to treatment by any of the 
components rather than limiting the indications for use to patients for 
whom concomitant therapy as provided by the fixed combination drug is 
indicated, unless such condition is included in the uses permitted under 
paragraph (e)(4) of this section.
    (xiii) Uses a study on normal individuals without disclosing that 
the subjects were normal, unless the drug is intended for use on normal 
individuals.

[[Page 78]]

    (xiv) Uses ``statistics'' on numbers of patients, or counts of 
favorable results or side effects, derived from pooling data from 
various insignificant or dissimilar studies in a way that suggests 
either that such ``statistics'' are valid if they are not or that they 
are derived from large or significant studies supporting favorable 
conclusions when such is not the case.
    (xv) Uses erroneously a statistical finding of ``no significant 
difference'' to claim clinical equivalence or to deny or conceal the 
potential existence of a real clinical difference.
    (xvi) Uses statements or representations that a drug differs from or 
does not contain a named drug or category of drugs, or that it has a 
greater potency per unit of weight, in a way that suggests falsely or 
misleadingly or without substantial evidence or substantial clinical 
experience that the advertised drug is safer or more effective than such 
other drug or drugs.
    (xvii) Uses data favorable to a drug derived from patients treated 
with dosages different from those recommended in approved or permitted 
labeling if the drug advertised is subject to section 505 of the act, 
or, in the case of other drugs, if the dosages employed were different 
from those recommended in the labeling and generally recognized as safe 
and effective. This provision is not intended to prevent citation of 
reports of studies that include some patients treated with dosages 
different from those authorized, if the results in such patients are not 
used.
    (xviii) Uses headline, subheadline, or pictorial or other graphic 
matter in a way that is misleading.
    (xix) Represents or suggests that drug dosages properly recommended 
for use in the treatment of certain classes of patients or disease 
conditions are safe and effective for the treatment of other classes of 
patients or disease conditions when such is not the case.
    (xx) Presents required information relating to side effects or 
contraindications by means of a general term for a group in place of 
disclosing each specific side effect and contraindication (for example 
employs the term blood dyscrasias instead of ``leukopenia,'' 
``agranulocytosis,'' ``neutropenia,'' etc.) unless the use of such 
general term conforms to the provisions of paragraph (e)(3)(iii) of this 
section.

Provided, however, That any provision of this paragraph shall be waived 
with respect to a specified advertisement as set forth in a written 
communication from the Food and Drug Administration on a petition for 
such a waiver from a person who would be adversely affected by the 
enforcement of such provision on the basis of a showing that the 
advertisement is not false, lacking in fair balance, or otherwise 
misleading, or otherwise violative of section 502(n) of the act. A 
petition for such a waiver shall set forth clearly and concisely the 
petitioner's interest in the advertisement, the specific provision of 
this paragraph from which a waiver is sought, a complete copy of the 
advertisement, and a showing that the advertisement is not false, 
lacking in fair balance, or otherwise misleading, or otherwise violative 
of section 502(n) of the act.
    (7) Advertisements that may be false, lacking in fair balance, or 
otherwise misleading. An advertisement may be false, lacking in fair 
balance, or otherwise misleading or otherwise violative of section 
502(n) of the act if it:
    (i) Contains favorable information or conclusions from a study that 
is inadequate in design, scope, or conduct to furnish significant 
support for such information or conclusions.
    (ii) Uses the concept of ``statistical significance'' to support a 
claim that has not been demonstrated to have clinical significance or 
validity, or fails to reveal the range of variations around the quoted 
average results.
    (iii) Uses statistical analyses and techniques on a retrospective 
basis to discover and cite findings not soundly supported by the study, 
or to suggest scientific validity and rigor for data from studies the 
design or protocol of which are not amenable to formal statistical 
evaluations.
    (iv) Uses tables or graphs to distort or misrepresent the 
relationships, trends, differences, or changes among the variables or 
products studied; for example, by failing to label abscissa and ordinate 
so that the graph creates a misleading impression.

[[Page 79]]

    (v) Uses reports or statements represented to be statistical 
analyses, interpretations, or evaluations that are inconsistent with or 
violate the established principles of statistical theory, methodology, 
applied practice, and inference, or that are derived from clinical 
studies the design, data, or conduct of which substantially invalidate 
the application of statistical analyses, interpretations, or 
evaluations.
    (vi) Contains claims concerning the mechanism or site of drug action 
that are not generally regarded as established by scientific evidence by 
experts qualified by scientific training and experience without 
disclosing that the claims are not established and the limitations of 
the supporting evidence.
    (vii) Fails to provide sufficient emphasis for the information 
relating to side effects and contraindications, when such information is 
contained in a distinct part of an advertisement, because of repetition 
or other emphasis in that part of the advertisement of claims for 
effectiveness or safety of the drug.
    (viii) Fails to present information relating to side effects and 
contraindications with a prominence and readability reasonably 
comparable with the presentation of information relating to 
effectiveness of the drug, taking into account all implementing factors 
such as typography, layout, contrast, headlines, paragraphing, white 
space, and any other techniques apt to achieve emphasis.
    (ix) Fails to provide adequate emphasis (for example, by the use of 
color scheme, borders, headlines, or copy that extends across the 
gutter) for the fact that two facing pages are part of the same 
advertisement when one page contains information relating to side 
effects and contraindications.
    (x) In an advertisement promoting use of the drug in a selected 
class of patients (for example, geriatric patients or depressed 
patients), fails to present with adequate emphasis the significant side 
effects and contraindications or the significant dosage considerations, 
when dosage recommendations are included in an advertisement, especially 
applicable to that selected class of patients.
    (xi) Fails to present on a page facing another page (or on another 
full page) of an advertisement on more than one page, information 
relating to side effects and contraindications when such information is 
in a distinct part of the advertisement.
    (xii) Fails to include on each page or spread of an advertisement 
the information relating to side effects and contraindications or a 
prominent reference to its presence and location when it is presented as 
a distinct part of an advertisement.
    (xiii) Contains information from published or unpublished reports or 
opinions falsely or misleadingly represented or suggested to be 
authentic or authoritative.
    (f)-(i) [Reserved]
    (j)(1) No advertisement concerning a particular prescription drug 
may be disseminated without prior approval by the Food and Drug 
Administration if:
    (i) The sponsor or the Food and Drug Administration has received 
information that has not been widely publicized in medical literature 
that the use of the drug may cause fatalities or serious damage;
    (ii) The Commissioner (or in his absence the officer acting as 
Commissioner), after evaluating the reliability of such information, has 
notified the sponsor that the information must be a part of the 
advertisements for the drug; and
    (iii) The sponsor has failed within a reasonable time as specified 
in such notification to present to the Food and Drug Administration a 
program, adequate in light of the nature of the information, for 
assuring that such information will be publicized promptly and 
adequately to the medical profession in subsequent advertisements.

If the Commissioner finds that the program presented is not being 
followed, he will notify the sponsor that prior approval of all 
advertisements for the particular drug will be required. Nothing in this 
paragraph is to be construed as limiting the Commissioner's or the 
Secretary's rights, as authorized by law, to issue publicity, to suspend 
any new-drug application, to decertify any antibiotic, or to recommend 
any regulatory action.

[[Page 80]]

    (2) Within a reasonable time after information concerning the 
possibility that a drug may cause fatalities or serious damage has been 
widely publicized in medical literature, the Food and Drug 
Administration shall notify the sponsor of the drug by mail that prior 
approval of advertisements for the drug is no longer necessary.
    (3) Dissemination of an advertisement not in compliance with this 
paragraph shall be deemed to be an act that causes the drug to be 
misbranded under section 502(n) of the act.
    (4) Any advertisement may be submitted to the Food and Drug 
Administration prior to publication for comment. If the advertiser is 
notified that the submitted advertisement is not in violation and, at 
some subsequent time, the Food and Drug Administration changes its 
opinion, the advertiser will be so notified and will be given a 
reasonable time for correction before any regulatory action is taken 
under this section. Notification to the advertiser that a proposed 
advertisement is or is not considered to be in violation shall be in 
written form.
    (5) The sponsor shall have an opportunity for a regulatory hearing 
before the Food and Drug Administration pursuant to part 16 of this 
chapter with respect to any determination that prior approval is 
required for advertisements concerning a particular prescription drug, 
or that a particular advertisement is not approvable.
    (k) An advertisement issued or caused to be issued by the 
manufacturer, packer, or distributor of the drug promoted by the 
advertisement and which is not in compliance with section 502(n) of the 
act and the applicable regulations thereunder shall cause stocks of such 
drug in possession of the person responsible for issuing or causing the 
issuance of the advertisement, and stocks of the drug distributed by 
such person and still in the channels of commerce, to be misbranded 
under section 502(n) of the act.
    (l)(1) Advertisements subject to section 502(n) of the act include 
advertisements in published journals, magazines, other periodicals, and 
newspapers, and advertisements broadcast through media such as radio, 
television, and telephone communication systems.
    (2) Brochures, booklets, mailing pieces, detailing pieces, file 
cards, bulletins, calendars, price lists, catalogs, house organs, 
letters, motion picture films, film strips, lantern slides, sound 
recordings, exhibits, literature, and reprints and similar pieces of 
printed, audio, or visual matter descriptive of a drug and references 
published (for example, the ``Physicians Desk Reference'') for use by 
medical practitioners, pharmacists, or nurses, containing drug 
information supplied by the manufacturer, packer, or distributor of the 
drug and which are disseminated by or on behalf of its manufacturer, 
packer, or distributor are hereby determined to be labeling as defined 
in section 201(m) of the act.

[40 FR 14016, Mar. 27, 1975, as amended at 40 FR 58799, Dec. 18, 1975; 
41 FR 48266, Nov. 2, 1976; 42 FR 15674, Mar. 22, 1977; 60 FR 38480, July 
27, 1995; 64 FR 400, Jan. 5, 1999]

    Effective Date Note 1: At 44 FR 37467, June 26, 1979, 
Sec. 202.1(e)(6) (ii) and (vii) were revised. At 44 FR 74817, Dec. 18, 
1979, paragraphs (e)(6) (ii) and (vii) were stayed indefinitely. For the 
convenience of the user, paragraphs (e)(6) (ii) and (vii), published at 
44 FR 37467, are set forth below:

Sec. 202.1  Prescription-drug advertisements.

                                * * * * *

    (e) * * *
    (6) * * *
    (ii) Represents or suggests that a prescription drug is safer or 
more effective than another drug in some particular when the difference 
has not been demonstrated by substantial evidence. An advertisement for 
a prescription drug may not, either directly or by implication, e.g., by 
use of comparative test data or reference to published reports, 
represent that the drug is safer or more effective than another drug, 
nor may an advertisement contain a quantitative statement of safety or 
effectiveness (a) unless the representation has been approved as part of 
the labeling in a new drug application or biologic license, or (b) if 
the drug is not a new drug or biologic, unless the representation of 
safety or effectiveness is supported by substantial evidence derived 
from adequate and well-controlled studies as defined in 
Sec. 314.111(a)(5)(ii) of this chapter, or unless the

[[Page 81]]

requirement for adequate and well-controlled studies is waived as 
provided in Sec. 314.111(a)(5)(ii) of this chapter.

                                * * * * *

    (vii) Suggests, on the basis of favorable data or conclusions from 
nonclinical studies of a prescription drug, such as studies in 
laboratory animals or in vitro, that the studies have clinical 
significance, if clinical significance has not been demonstrated. Data 
that demonstrate activity or effectiveness for a prescription drug in 
animal or in vitro tests and have not been shown by adequate and well-
controlled clinical studies to pertain to clinical use may be used in 
advertising except that (a), in the case of anti-infective drugs, in 
vitro data may be included in the advertisement, if data are immediately 
preceded by the statement ``The following in vitro data are available 
but their clinical significance is unknown'' and (b), in the case of 
other drug classes, in vitro and animal data that have not been shown to 
pertain to clinical use by adequate and well-controlled clinical studies 
as defined in Sec. 314.111(a)(5)(ii) of this chapter may not be used 
unless the requirement for adequate and well-controlled studies is 
waived as provided in Sec. 314.111(a)(5)(ii) of this chapter.

                                * * * * *

    Effective Date Note 2: At 64 FR 400, Jan. 5, 1999, Sec. 202.1 was 
amended by removing the phrase ``or antibiotic'' from indefinitely 
stayed paragraph (e)(6)(ii)(a); and by removing the phrase ``or a 
certified or released antibiotic,'' from indefinitely stayed paragraph 
(e)(6)(ii)(b), effective May 20, 1999.



PART 203--PRESCRIPTION DRUG MARKETING--Table of Contents




                      Subpart A--General Provisions

Sec.
203.1  Scope.
203.2  Purpose.
203.3  Definitions.

                        Subpart B--Reimportation

203.10  Restrictions on reimportation.
203.11  Applications for reimportation to provide emergency medical 
          care.
203.12  An appeal from an adverse decision by the district office.

                      Subpart C--Sales Restrictions

203.20  Sales restrictions.
203.22  Exclusions.
203.23  Returns.

                           Subpart D--Samples

203.30  Sample distribution by mail or common carrier.
203.31  Sample distribution by means other than mail or common carrier 
          (direct delivery by a representative or detailer).
203.32  Drug sample storage and handling requirements.
203.33  Drug sample forms.
203.34  Policies and procedures; administrative systems.
203.35  Standing requests.
203.36  Fulfillment houses, shipping and mailing services, comarketing 
          agreements, and third-party recordkeeping.
203.37  Investigation and notification requirements.
203.38  Sample lot or control numbers; labeling of sample units.
203.39  Donation of drug samples to charitable institutions.

                    Subpart E--Wholesale Distribution

203.50  Requirements for wholesale distribution of prescription drugs.

       Subpart F--Request and Receipt Forms, Reports, and Records

203.60  Request and receipt forms, reports, and records.

                           Subpart G--Rewards

203.70  Application for a reward.

    Authority: 21 U.S.C. 331, 333, 351, 352, 353, 360, 371, 374, 381.

    Source: 64 FR 67756, Dec. 3, 1999, unless otherwise noted.

    Effective Date Note: At 64 FR 67756, Dec. 3, 1999, part 203 was 
added, effective Dec. 4, 2000.



                      Subpart A--General Provisions



Sec. 203.1  Scope.

    This part sets forth procedures and requirements pertaining to the 
reimportation and wholesale distribution of prescription drugs, 
including both bulk drug substances and finished dosage forms; the sale, 
purchase, or trade of (or the offer to sell, purchase, or trade) 
prescription drugs, including bulk drug substances, that were purchased 
by hospitals or health care entities, or donated to charitable 
organizations; and the distribution of prescription drug samples. Blood 
and blood components intended for transfusion are excluded from the 
restrictions in

[[Page 82]]

and the requirements of the Prescription Drug Marketing Act of 1987 and 
the Prescription Drug Amendments of 1992.



Sec. 203.2  Purpose.

    The purpose of this part is to implement the Prescription Drug 
Marketing Act of 1987 and the Prescription Drug Amendments of 1992, 
except for those sections relating to State licensing of wholesale 
distributors (see part 205 of this chapter), to protect the public 
health, and to protect the public against drug diversion by establishing 
procedures, requirements, and minimum standards for the distribution of 
prescription drugs and prescription drug samples.



Sec. 203.3  Definitions.

    (a) The act means the Federal Food, Drug, and Cosmetic Act, as 
amended (21 U.S.C. 301 et seq.).
    (b) Authorized distributor of record means a distributor with whom a 
manufacturer has established an ongoing relationship to distribute such 
manufacturer's products.
    (c) Blood means whole blood collected from a single donor and 
processed either for transfusion or further manufacturing.
    (d) Blood component means that part of a single-donor unit of blood 
separated by physical or mechanical means.
    (e) Bulk drug substance means any substance that is represented for 
use in a drug and that, when used in the manufacturing, processing, or 
packaging of a drug, becomes an active ingredient or a finished dosage 
form of the drug, but the term does not include intermediates used in 
the synthesis of such substances.
    (f) Charitable institution or charitable organization means a 
nonprofit hospital, health care entity, organization, institution, 
foundation, association, or corporation that has been granted an 
exemption under section 501(c)(3) of the Internal Revenue Code of 1954, 
as amended.
    (g)  Common control means the power to direct or cause the direction 
of the management and policies of a person or an organization, whether 
by ownership of stock, voting rights, by contract, or otherwise.
    (h)  Distribute means to sell, offer to sell, deliver, or offer to 
deliver a drug to a recipient, except that the term ``distribute'' does 
not include:
    (1) Delivering or offering to deliver a drug by a common carrier in 
the usual course of business as a common carrier; or
    (2) Providing of a drug sample to a patient by:
    (i) A practitioner licensed to prescribe such drug;
    (ii) A health care professional acting at the direction and under 
the supervision of such a practitioner; or
    (iii) The pharmacy of a hospital or of another health care entity 
that is acting at the direction of such a practitioner and that received 
such sample in accordance with the act and regulations.
    (i)  Drug sample means a unit of a prescription drug that is not 
intended to be sold and is intended to promote the sale of the drug.
    (j) Drug coupon means a form that may be redeemed, at no cost or at 
reduced cost, for a drug that is prescribed in accordance with section 
503(b) of the act.
    (k) Electronic record means any combination of text, graphics, data, 
audio, pictorial, or other information representation in digital form 
that is created, modified, maintained, archived, retrieved, or 
distributed by a computer system.
    (l) Electronic signature means any computer data compilation of any 
symbol or series of symbols executed, adopted, or authorized by an 
individual to be the legally binding equivalent of the individual's 
handwritten signature.
    (m) Emergency medical reasons include, but are not limited to, 
transfers of a prescription drug between health care entities or from a 
health care entity to a retail pharmacy to alleviate a temporary 
shortage of a prescription drug arising from delays in or interruption 
of regular distribution schedules; sales to nearby emergency medical 
services, i.e., ambulance companies and fire fighting organizations in 
the same State or same marketing or service area, or nearby licensed 
practitioners, of drugs for use in the treatment of acutely ill or 
injured persons; provision of minimal emergency supplies of

[[Page 83]]

drugs to nearby nursing homes for use in emergencies or during hours of 
the day when necessary drugs cannot be obtained; and transfers of 
prescription drugs by a retail pharmacy to another retail pharmacy to 
alleviate a temporary shortage; but do not include regular and 
systematic sales to licensed practitioners of prescription drugs that 
will be used for routine office procedures.
    (n) FDA means the U.S. Food and Drug Administration.
    (o)  Group purchasing organization means any entity established, 
maintained, and operated for the purchase of prescription drugs for 
distribution exclusively to its members with such membership consisting 
solely of hospitals and health care entities bound by written contract 
with the entity.
    (p)  Handwritten signature means the scripted name or legal mark of 
an individual handwritten by that individual and executed or adopted 
with the present intention to authenticate a writing in a permanent 
form. The act of signing with a writing or marking instrument such as a 
pen or stylus is preserved. The scripted name or legal mark, while 
conventionally applied to paper, may also be applied to other devices 
that capture the name or mark.
    (q) Health care entity means any person that provides diagnostic, 
medical, surgical, or dental treatment, or chronic or rehabilitative 
care, but does not include any retail pharmacy or any wholesale 
distributor. A person cannot simultaneously be a ``health care entity'' 
and a retail pharmacy or wholesale distributor.
    (r) Licensed practitioner means any person licensed or authorized by 
State law to prescribe drugs.
    (s) Manufacturer means any person who is a manufacturer as defined 
by Sec. 201.1 of this chapter.
    (t)  Nonprofit affiliate means any not-for-profit organization that 
is either associated with or a subsidiary of a charitable organization 
as defined in section 501(c)(3) of the Internal Revenue Code of 1954.
    (u) Ongoing relationship means an association that exists when a 
manufacturer and a distributor enter into a written agreement under 
which the distributor is authorized to distribute the manufacturer's 
products for a period of time or for a number of shipments. If the 
distributor is not authorized to distribute a manufacturer's entire 
product line, the agreement must identify the specific drug products 
that the distributor is authorized to distribute.
    (v)  PDA means the Prescription Drug Amendments of 1992.
    (w) PDMA means the Prescription Drug Marketing Act of 1987.
    (x) Person includes any individual, partnership, corporation, or 
association.
    (y) Prescription drug means any drug (including any biological 
product, except for blood and blood components intended for transfusion 
or biological products that are also medical devices) required by 
Federal law (including Federal regulation) to be dispensed only by a 
prescription, including finished dosage forms and bulk drug substances 
subject to section 503(b) of the act.
    (z)  Representative means an employee or agent of a drug 
manufacturer or distributor who promotes the sale of prescription drugs 
to licensed practitioners and who may solicit or receive written 
requests for the delivery of drug samples. A detailer is a 
representative.
    (aa) Sample unit means a packet, card, blister pack, bottle, 
container, or other single package comprised of one or more dosage units 
of a prescription drug sample, intended by the manufacturer or 
distributor to be provided by a licensed practitioner to a patient in an 
unbroken or unopened condition.
    (bb) Unauthorized distributor means a distributor who does not have 
an ongoing relationship with a manufacturer to sell or distribute its 
products.
    (cc)  Wholesale distribution means distribution of prescription 
drugs to persons other than a consumer or patient, but does not include:
    (1) Intracompany sales;
    (2) The purchase or other acquisition by a hospital or other health 
care entity that is a member of a group purchasing organization of a 
drug for its own use from the group purchasing organization or from 
other hospitals or health care entities that are members of such 
organizations;
    (3) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or

[[Page 84]]

trade a drug by a charitable organization to a nonprofit affiliate of 
the organization to the extent otherwise permitted by law;
    (4) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug among hospitals or other health care entities 
that are under common control;
    (5) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug for emergency medical reasons;
    (6) The sale, purchase, or trade of a drug, an offer to sell, 
purchase, or trade a drug, or the dispensing of a drug under a 
prescription executed in accordance with section 503(b) of the act;
    (7) The distribution of drug samples by manufacturers' and 
authorized distributors' representatives;
    (8) The sale, purchase, or trade of blood or blood components 
intended for transfusion;
    (9) Drug returns, when conducted by a hospital, health care entity, 
or charitable institution in accordance with Sec. 203.23; or
    (10) The sale of minimal quantities of drugs by retail pharmacies to 
licensed practitioners for office use.
    (dd)  Wholesale distributor means any person engaged in wholesale 
distribution of prescription drugs, including, but not limited to, 
manufacturers; repackers; own-label distributors; private-label 
distributors; jobbers; brokers; warehouses, including manufacturers' and 
distributors' warehouses, chain drug warehouses, and wholesale drug 
warehouses; independent wholesale drug traders; and retail pharmacies 
that conduct wholesale distributions.



                        Subpart B--Reimportation



Sec. 203.10  Restrictions on reimportation.

    No prescription drug or drug composed wholly or partly of insulin 
that was manufactured in a State and exported from the United States may 
be reimported by anyone other than its manufacturer, except that FDA may 
grant permission to a person other than the manufacturer to reimport a 
prescription drug or insulin-containing drug if it determines that such 
reimportation is required for emergency medical care.



Sec. 203.11  Applications for reimportation to provide emergency medical care.

    (a) Applications for reimportation for emergency medical care shall 
be submitted to the director of the FDA District Office in the district 
where reimportation is sought (addresses found in Sec. 5.115 of this 
chapter).
    (b) Applications for reimportation to provide emergency medical care 
shall be reviewed and approved or disapproved by each district office.



Sec. 203.12  An appeal from an adverse decision by the district office.

    An appeal from an adverse decision by the district office involving 
insulin-containing drugs or prescription human drugs, other than 
biological products, may be made to the Office of Compliance (HFD-300), 
Center for Drug Evaluation and Research, Food and Drug Administration, 
7520 Standish Pl., Rockville, MD 20855. An appeal from an adverse 
decision by the district office involving prescription human biological 
products may be made to the Office of Compliance and Biologics Quality 
(HFM-600), Center for Biologics Evaluation and Research, Food and Drug 
Administration, 1401 Rockville Pike, Rockville, MD 20852.



                      Subpart C--Sales Restrictions



Sec. 203.20  Sales restrictions.

    Except as provided in Sec. 203.22 or Sec. 203.23, no person may 
sell, purchase, or trade, or offer to sell, purchase, or trade any 
prescription drug that was:
    (a) Purchased by a public or private hospital or other health care 
entity; or
    (b) Donated or supplied at a reduced price to a charitable 
organization.



Sec. 203.22  Exclusions.

    Section 203.20 does not apply to:
    (a) The purchase or other acquisition of a drug for its own use by a 
hospital or other health care entity that is a member of a group 
purchasing organization from the group purchasing organization or from 
other hospitals or health care entities that are members of the 
organization.

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    (b) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug by a charitable organization to a nonprofit 
affiliate of the organization to the extent otherwise permitted by law.
    (c) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug among hospitals or other health care entities 
that are under common control.
    (d) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug for emergency medical reasons.
    (e) The sale, purchase, or trade of a drug, an offer to sell, 
purchase, or trade a drug, or the dispensing of a drug under a valid 
prescription.
    (f) The sale, purchase, or trade of a drug or the offer to sell, 
purchase, or trade a drug by hospitals or health care entities owned or 
operated by Federal, State, or local governmental units to other 
hospitals or health care entities owned or operated by Federal, State, 
or local governmental units.
    (g) The sale, purchase, or trade of, or the offer to sell, purchase, 
or trade blood or blood components intended for transfusion.



Sec. 203.23  Returns.

    The return of a prescription drug purchased by a hospital or health 
care entity or acquired at a reduced price by or donated to a charitable 
institution is exempt from the prohibitions in Sec. 203.20, provided 
that:
    (a) The hospital, health care entity, or charitable institution 
documents the return by filling out a credit memo specifying:
    (1) The name and address of the hospital, health care entity, or 
charitable institution;
    (2) The name and address of the manufacturer or wholesale 
distributor from which it was acquired;
    (3) The product name and lot or control number;
    (4) The quantity returned; and
    (5) The date of the return.
    (b) The hospital, health care entity, or charitable institution 
forwards a copy of each credit memo to the manufacturer and retains a 
copy of each credit memo for its records;
    (c) Any drugs returned to a manufacturer or wholesale distributor 
are kept under proper conditions for storage, handling, and shipping, 
and written documentation showing that proper conditions were maintained 
is provided to the manufacturer or wholesale distributor to which the 
drugs are returned.



                           Subpart D--Samples



Sec. 203.30  Sample distribution by mail or common carrier.

    (a)  Requirements for drug sample distribution by mail or common 
carrier. A manufacturer or authorized distributor of record may 
distribute a drug sample to a practitioner licensed to prescribe the 
drug that is to be sampled or, at the written request of a licensed 
practitioner, to the pharmacy of a hospital or other health care entity, 
by mail or common carrier, provided that:
    (1) The licensed practitioner executes and submits a written request 
to the manufacturer or authorized distributor of record, as set forth in 
paragraph (b) of this section, before the delivery of the drug sample;
    (2) The manufacturer or authorized distributor of record verifies 
with the appropriate State authority that the practitioner requesting 
the drug sample is licensed or authorized under State law to prescribe 
the drug product;
    (3) The recipient executes a written receipt, as set forth in 
paragraph (c) of this section, when the drug sample is delivered; and
    (4) The receipt is returned to the manufacturer or distributor from 
which the drug sample was received.
    (b)  Contents of the written request form for delivery of samples by 
mail or common carrier. (1) A written request for a drug sample to be 
delivered by mail or common carrier to a licensed practitioner is 
required to contain the following:
    (i) The name, address, professional title, and signature of the 
practitioner making the request;
    (ii) The practitioner's State license or authorization number or, 
where a scheduled drug product is requested, the practitioner's Drug 
Enforcement Administration number.

[[Page 86]]

    (iii) The proprietary or established name and the strength of the 
drug sample requested;
    (iv) The quantity requested;
    (v) The name of the manufacturer and the authorized distributor of 
record, if the drug sample is requested from an authorized distributor 
of record; and
    (vi) The date of the request.
    (2) A written request for a drug sample to be delivered by mail or 
common carrier to the pharmacy of a hospital or other health care entity 
is required to contain, in addition to all of the information in 
paragraph (b)(l) of this section, the name and address of the pharmacy 
of the hospital or other health care entity to which the drug sample is 
to be delivered.
    (c)  Contents of the receipt to be completed upon delivery of a drug 
sample. The receipt is to be on a form designated by the manufacturer or 
distributor, and is required to contain the following:
    (1) If the drug sample is delivered to the licensed practitioner who 
requested it, the receipt is required to contain the name, address, 
professional title, and signature of the practitioner or the 
practitioner's designee who acknowledges delivery of the drug sample; 
the proprietary or established name and strength of the drug sample and 
the quantity of the drug sample delivered; and the date of the delivery.
    (2) If the drug sample is delivered to the pharmacy of a hospital or 
other health care entity at the request of a licensed practitioner, the 
receipt is required to contain the name and address of the requesting 
licensed practitioner; the name and address of the hospital or health 
care entity pharmacy designated to receive the drug sample; the name, 
address, professional title, and signature of the person acknowledging 
delivery of the drug sample; the proprietary or established name and 
strength of the drug sample; the quantity of the drug sample delivered; 
and the date of the delivery.



Sec. 203.31  Sample distribution by means other than mail or common carrier (direct delivery by a representative or detailer).

    (a)  Requirements for drug sample distribution by means other than 
mail or common carrier. A manufacturer or authorized distributor of 
record may distribute by means other than mail or common carrier, by a 
representative or detailer, a drug sample to a practitioner licensed to 
prescribe the drug to be sampled or, at the written request of such a 
licensed practitioner, to the pharmacy of a hospital or other health 
care entity, provided that:
    (1) The manufacturer or authorized distributor of record receives 
from the licensed practitioner a written request signed by the licensed 
practitioner before the delivery of the drug sample;
    (2) The manufacturer or authorized distributor of record verifies 
with the appropriate State authority that the practitioner requesting 
the drug sample is licensed or authorized under State law to prescribe 
the drug product;
    (3) A receipt is signed by the recipient, as set forth in paragraph 
(c) of this section, when the drug sample is delivered;
    (4) The receipt is returned to the manufacturer or distributor; and
    (5) The requirements of paragraphs (d) through (e) of this section 
are met.
    (b)  Contents of the written request forms for delivery of samples 
by a representative. (1) A written request for delivery of a drug sample 
by a representative to a licensed practitioner is required to contain 
the following:
    (i) The name, address, professional title, and signature of the 
practitioner making the request;
    (ii) The practitioner's State license or authorization number, or, 
where a scheduled drug product is requested, the practitioner's Drug 
Enforcement Administration number;
    (iii) The proprietary or established name and the strength of the 
drug sample requested;
    (iv) The quantity requested;
    (v) The name of the manufacturer and the authorized distributor of

[[Page 87]]

record, if the drug sample is requested from an authorized distributor 
of record; and
    (vi) The date of the request.
    (2) A written request for delivery of a drug sample by a 
representative to the pharmacy of a hospital or other health care entity 
is required to contain, in addition to all of the information in 
paragraph (b) of this section, the name and address of the pharmacy of 
the hospital or other health care entity to which the drug sample is to 
be delivered.
    (c)  Contents of the receipt to be completed upon delivery of a drug 
sample. The receipt is to be on a form designated by the manufacturer or 
distributor, and is required to contain the following:
    (1) If the drug sample is received at the address of the licensed 
practitioner who requested it, the receipt is required to contain the 
name, address, professional title, and signature of the practitioner or 
the practitioner's designee who acknowledges delivery of the drug 
sample; the proprietary or established name and strength of the drug 
sample; the quantity of the drug sample delivered; and the date of the 
delivery.
    (2) If the drug sample is received by the pharmacy of a hospital or 
other health care entity at the request of a licensed practitioner, the 
receipt is required to contain the name and address of the requesting 
licensed practitioner; the name and address of the hospital or health 
care entity pharmacy designated to receive the drug sample; the name, 
address, professional title, and signature of the person acknowledging 
delivery of the drug sample; the proprietary or established name and 
strength of the drug sample; the quantity of the drug sample delivered; 
and the date of the delivery.
    (d)  Inventory and reconciliation of drug samples of manufacturers' 
and distributors' representatives. Each drug manufacturer or authorized 
distributor of record that distributes drug samples by means of 
representatives shall conduct, at least annually, a complete and 
accurate physical inventory of all drug samples. All drug samples in the 
possession or control of each manufacturer's and distributor's 
representatives are required to be inventoried and the results of the 
inventory are required to be recorded in an inventory record, as 
specified in paragraph (d)(1) of this section. In addition, 
manufacturers and distributors shall reconcile the results of the 
physical inventory with the most recently completed prior physical 
inventory and create a report documenting the reconciliation process, as 
specified in paragraph (d)(2) of this section.
    (1) The inventory record is required to identify all drug samples in 
a representative's stock by the proprietary or established name, dosage 
strength, and number of units.
    (2) The reconciliation report is required to include:
    (i) The inventory record for the most recently completed prior 
inventory;
    (ii) A record of each drug sample shipment received since the most 
recently completed prior inventory, including the sender and date of the 
shipment, and the proprietary or established name, dosage strength, and 
number of sample units received;
    (iii) A record of drug sample distributions since the most recently 
completed inventory showing the name and address of each recipient of 
each sample unit shipped, the date of the shipment, and the proprietary 
or established name, dosage strength, and number of sample units 
shipped. For the purposes of this paragraph and paragraph (d)(2)(v) of 
this section, ``distributions'' includes distributions to health care 
practitioners or designated hospital or health care entity pharmacies, 
transfers or exchanges with other firm representatives, returns to the 
manufacturer or authorized distributor, destruction of drug samples by a 
sales representative, and other types of drug sample dispositions. The 
specific type of distribution must be specified in the record;
    (iv) A record of drug sample thefts or significant losses reported 
by the representative since the most recently completed prior inventory, 
including the approximate date of the occurrence and the proprietary or 
established name, dosage strength, and number of sample units stolen or 
lost; and
    (v) A record summarizing the information required by paragraphs 
(d)(2)(ii)

[[Page 88]]

through (d)(2)(iv) of this section. The record must show, for each type 
of sample unit (i.e., sample units having the same established or 
proprietary name and dosage strength), the total number of sample units 
received, distributed, lost, or stolen since the most recently completed 
prior inventory. For example, a typical entry in this record may read 
``50 units risperidone (1 mg) returned to manufacturer'' or simply 
``Risperidone (1 mg)/50/returned to manufacturer.''
    (3) Each drug manufacturer or authorized distributor of record shall 
take appropriate internal control measures to guard against error and 
possible fraud in the conduct of the physical inventory and 
reconciliation, and in the preparation of the inventory record and 
reconciliation report.
    (4) A manufacturer or authorized distributor of record shall 
carefully evaluate any apparent discrepancy or significant loss revealed 
through the inventory and reconciliation process and shall fully 
investigate any such discrepancy or significant loss that cannot be 
justified.
    (e) Lists of manufacturers' and distributors' representatives. Each 
drug manufacturer or authorized distributor of record who distributes 
drug samples by means of representatives shall maintain a list of the 
names and addresses of its representatives who distribute drug samples 
and of the sites where drug samples are stored.



Sec. 203.32  Drug sample storage and handling requirements.

    (a) Storage and handling conditions. Manufacturers, authorized 
distributors of record, and their representatives shall store and handle 
all drug samples under conditions that will maintain their stability, 
integrity, and effectiveness and ensure that the drug samples are free 
of contamination, deterioration, and adulteration.
    (b)  Compliance with compendial and labeling requirements. 
Manufacturers, authorized distributors of record, and their 
representatives can generally comply with this section by following the 
compendial and labeling requirements for storage and handling of a 
particular prescription drug in handling samples of that drug.



Sec. 203.33  Drug sample forms.

    A sample request or receipt form may be delivered by mail, common 
carrier, or private courier or may be transmitted photographically or 
electronically (i.e., by telephoto, wirephoto, radiophoto, facsimile 
transmission (FAX), xerography, or electronic data transfer) or by any 
other system, provided that the method for transmission meets the 
security requirements set forth in Sec. 203.60(c).



Sec. 203.34  Policies and procedures; administrative systems.

    Each manufacturer or authorized distributor of record that 
distributes drug samples shall establish, maintain, and adhere to 
written policies and procedures describing its administrative systems 
for the following:
    (a) Distributing drug samples by mail or common carrier, including 
methodology for reconciliation of requests and receipts;
    (b) Distributing drug samples by means other than mail or common 
carrier including the methodology for:
    (1) Reconciling requests and receipts, identifying patterns of 
nonresponse, and the manufacturer's or distributor's response when such 
patterns are found;
    (2) Conducting the annual physical inventory and preparation of the 
reconciliation report;
    (3) Implementing a sample distribution security and audit system, 
including conducting random and for-cause audits of sales 
representatives by personnel independent of the sales force; and
    (4) Storage of drug samples by representatives;
    (c) Identifying any significant loss of drug samples and notifying 
FDA of the loss; and
    (d) Monitoring any loss or theft of drug samples.



Sec. 203.35  Standing requests.

    Manufacturers or authorized distributors of record shall not 
distribute drug samples on the basis of open-ended or standing requests, 
but shall require separate written requests for each drug sample or 
group of samples. An arrangement by which a licensed practitioner 
requests in writing that a

[[Page 89]]

specified number of drug samples be delivered over a period of not more 
than 6 months, with the actual delivery dates for parts of the order to 
be set by subsequent oral communication or electronic transmission, is 
not considered to be a standing request.



Sec. 203.36  Fulfillment houses, shipping and mailing services, comarketing agreements, and third-party recordkeeping.

    (a)  Responsibility for creating and maintaining forms, reports, and 
records. Any manufacturer or authorized distributor of record that uses 
a fulfillment house, shipping or mailing service, or other third party, 
or engages in a comarketing agreement with another manufacturer or 
distributor to distribute drug samples or to meet any of the 
requirements of PDMA, PDA, or this part, remains responsible for 
creating and maintaining all requests, receipts, forms, reports, and 
records required under PDMA, PDA, and this part.
    (b) Responsibility for producing requested forms, reports, or 
records. A manufacturer or authorized distributor of record that 
contracts with a third party to maintain some or all of its records 
shall produce requested forms, reports, records, or other required 
documents within 2 business days of a request by an authorized 
representative of FDA or another Federal, State, or local regulatory or 
law enforcement official.



Sec. 203.37  Investigation and notification requirements.

    (a)  Investigation of falsification of drug sample records. A 
manufacturer or authorized distributor of record that has reason to 
believe that any person has falsified drug sample requests, receipts, or 
records, or is diverting drug samples, shall:
    (1) Notify FDA, by telephone or in writing, within 5 working days;
    (2) Immediately initiate an investigation; and
    (3) Provide FDA with a complete written report, including the reason 
for and the results of the investigation, not later than 30 days after 
the date of the initial notification in paragraph (a)(1) of this 
section.
    (b)  Significant loss or known theft of drug samples. A manufacturer 
or authorized distributor of record that distributes drug samples or a 
charitable institution that receives donated drug samples from a 
licensed practitioner shall:
    (1) Notify FDA, by telephone or in writing, within 5 working days of 
becoming aware of a significant loss or known theft;
    (2) Immediately initiate an investigation into the significant loss 
or known theft; and
    (3) Provide FDA with a complete written report, including the reason 
for and the results of the investigation, not later than 30 days after 
the date of the initial notification in paragraph (b)(1) of this 
section.
    (c)  Conviction of a representative. (1) A manufacturer or 
authorized distributor of record that distributes drug samples shall 
notify FDA, by telephone or in writing, within 30 days of becoming aware 
of the conviction of one or more of its representatives for a violation 
of section 503(c)(1) of the act or any State law involving the sale, 
purchase, or trade of a drug sample or the offer to sell, purchase, or 
trade a drug sample.
    (2) A manufacturer or authorized distributor of record shall provide 
FDA with a complete written report not later than 30 days after the date 
of the initial notification.
    (d)  Selection of individual responsible for drug sample 
information. A manufacturer or authorized distributor of record that 
distributes drug samples shall inform FDA in writing within 30 days of 
selecting the individual responsible for responding to a request for 
information about drug samples of that individual's name, business 
address, and telephone number.
    (e)  Whom to notify at FDA. Notifications and reports concerning 
prescription human drugs shall be made to the Division of Prescription 
Drug Compliance and Surveillance (HFD-330), Office of Compliance, Center 
for Drug Evaluation and Research, Food and Drug Administration, 7520 
Standish Pl., Rockville, MD 20855. Notifications and reports concerning 
prescription human biological products shall be made to the Division of 
Inspections and Surveillance (HFM-650), Office of Compliance,

[[Page 90]]

Center for Biologics Evaluation and Research, Food and Drug 
Administration, 1401 Rockville Pike, Rockville, MD 20852.



Sec. 203.38  Sample lot or control numbers; labeling of sample units.

    (a)  Lot or control number required on drug sample labeling and 
sample unit label. The manufacturer or authorized distributor of record 
of a drug sample shall include on the label of the sample unit and on 
the outside container or packaging of the sample unit, if any, an 
identifying lot or control number that will permit the tracking of the 
distribution of each drug sample unit.
    (b)  Records containing lot or control numbers required for all drug 
samples distributed. A manufacturer or authorized distributor of record 
shall maintain for all samples distributed records of drug sample 
distribution containing lot or control numbers that are sufficient to 
permit the tracking of sample units to the point of the licensed 
practitioner.
    (c)  Labels of sample units. Each sample unit shall bear a label 
that clearly denotes its status as a drug sample, e.g., ``sample,'' 
``not for sale,'' ``professional courtesy package.''
    (1) A drug that is labeled as a drug sample is deemed to be a drug 
sample within the meaning of the act.
    (2) A drug product dosage unit that bears an imprint identifying the 
dosage form as a drug sample is deemed to be a drug sample within the 
meaning of the act.
    (3) Notwithstanding paragraphs (c)(1) and (c)(2) of this section, 
any article that is a drug sample as defined in section 503(c)(1) of the 
act and Sec. 203.3(i) that fails to bear the label required in this 
paragraph (c) is a drug sample.



Sec. 203.39  Donation of drug samples to charitable institutions.

     A charitable institution may receive a drug sample donated by a 
licensed practitioner or another charitable institution for dispensing 
to a patient of the charitable institution, or donate a drug sample to 
another charitable institution for dispensing to its patients, provided 
that the following requirements are met:
    (a) A drug sample donated by a licensed practitioner or donating 
charitable institution shall be received by a charitable institution in 
its original, unopened packaging with its labeling intact.
    (b) Delivery of a donated drug sample to a recipient charitable 
institution shall be completed by mail or common carrier, collection by 
an authorized agent or employee of the recipient charitable institution, 
or personal delivery by a licensed practitioner or an agent or employee 
of the donating charitable institution. Donated drug samples shall be 
placed by the donor in a sealed carton for delivery to or collection by 
the recipient charitable institution.
    (c) A donated drug sample shall not be dispensed to a patient or be 
distributed to another charitable institution until it has been examined 
by a licensed practitioner or registered pharmacist at the recipient 
charitable institution to confirm that the donation record accurately 
describes the drug sample delivered and that no drug sample is 
adulterated or misbranded for any reason, including, but not limited to, 
the following:
    (1) The drug sample is out of date;
    (2) The labeling has become mutilated, obscured, or detached from 
the drug sample packaging;
    (3) The drug sample shows evidence of having been stored or shipped 
under conditions that might adversely affect its stability, integrity, 
or effectiveness;
    (4) The drug sample is for a prescription drug product that has been 
recalled or is no longer marketed; or
    (5) The drug sample is otherwise possibly contaminated, 
deteriorated, or adulterated.
    (d) The recipient charitable institution shall dispose of any drug 
sample found to be unsuitable by destroying it or by returning it to the 
manufacturer. The charitable institution shall maintain complete records 
of the disposition of all destroyed or returned drug samples.
    (e) The recipient charitable institution shall prepare at the time 
of collection or delivery of a drug sample a complete and accurate 
donation record, a copy of which shall be retained by the recipient 
charitable institution for at least 3 years, containing the following 
information:

[[Page 91]]

    (1) The name, address, and telephone number of the licensed 
practitioner (or donating charitable institution);
    (2) The manufacturer, brand name, quantity, and lot or control 
number of the drug sample donated; and
    (3) The date of the donation.
    (f) Each recipient charitable institution shall maintain complete 
and accurate records of donation, receipt, inspection, inventory, 
dispensing, redistribution, destruction, and returns sufficient for 
complete accountability and auditing of drug sample stocks.
    (g) Each recipient charitable institution shall conduct, at least 
annually, an inventory of prescription drug sample stocks and shall 
prepare a report reconciling the results of each inventory with the most 
recent prior inventory. Drug sample inventory discrepancies and 
reconciliation problems shall be investigated by the charitable 
institution and reported to FDA.
    (h) A recipient charitable institution shall store drug samples 
under conditions that will maintain the sample's stability, integrity, 
and effectiveness, and will ensure that the drug samples will be free of 
contamination, deterioration, and adulteration.
    (i) A charitable institution shall notify FDA within 5 working days 
of becoming aware of a significant loss or known theft of prescription 
drug samples.



                    Subpart E--Wholesale Distribution



Sec. 203.50  Requirements for wholesale distribution of prescription drugs.

    (a)  Identifying statement for sales by unauthorized distributors. 
Before the completion of any wholesale distribution by a wholesale 
distributor of a prescription drug for which the seller is not an 
authorized distributor of record to another wholesale distributor or 
retail pharmacy, the seller shall provide to the purchaser a statement 
identifying each prior sale, purchase, or trade of such drug. This 
identifying statement shall include:
    (1) The proprietary and established name of the drug;
    (2) Dosage;
    (3) Container size;
    (4) Number of containers;
    (5) The drug's lot or control number(s);
    (6) The business name and address of all parties to each prior 
transaction involving the drug, starting with the manufacturer; and
    (7) The date of each previous transaction.
    (b) The drug origin statement is subject to the record retention 
requirements of Sec. 203.60 and must be retained by all wholesale 
distributors involved in the distribution of the drug product, whether 
authorized or unauthorized, for 3 years.
    (c) Identifying statement not required when additional manufacturing 
processes are completed. A manufacturer that subjects a drug to any 
additional manufacturing processes to produce a different drug is not 
required to provide to a purchaser a statement identifying the previous 
sales of the component drug or drugs.
    (d) List of authorized distributors of record. Each manufacturer 
shall maintain at the corporate offices a current written list of all 
authorized distributors of record.
    (1) Each manufacturer's list of authorized distributors of record 
shall specify whether each distributor listed thereon is authorized to 
distribute the manufacturer's full product line or only particular, 
specified products.
    (2) Each manufacturer shall update its list of authorized 
distributors of record on a continuing basis.
    (3) Each manufacturer shall make its list of authorized distributors 
of record available on request to the public for inspection or copying. 
A manufacturer may impose reasonable copying charges for such requests 
from members of the public.



       Subpart F--Request and Receipt Forms, Reports, and Records



Sec. 203.60  Request and receipt forms, reports, and records.

    (a)  Use of electronic records, electronic signatures, and 
handwritten signatures executed to electronic records. (1) Provided the 
requirements of part 11 of this chapter are met, electronic records, 
electronic signatures, and handwritten signatures executed to electronic 
records may be used as an

[[Page 92]]

alternative to paper records and handwritten signatures executed on 
paper to meet any of the record and signature requirements of PDMA, PDA, 
or this part.
    (2) Combinations of paper records and electronic records, electronic 
records and handwritten signatures executed on paper, or paper records 
and electronic signatures or handwritten signatures executed to 
electronic records, may be used to meet any of the record and signature 
requirements of PDMA, PDA, or this part, provided that:
    (i) The requirements of part 11 of this chapter are met for the 
electronic records, electronic signatures, or handwritten signatures 
executed to electronic records; and
    (ii) A reasonably secure link between the paper-based and electronic 
components exists such that the combined records and signatures are 
trustworthy and reliable, and to ensure that the signer cannot readily 
repudiate the signed records as not genuine.
    (3) For the purposes of this paragraph (a), the phrase ``record and 
signature requirements of PDMA, PDA, or this part'' includes drug sample 
request and receipt forms, reports, records, and other documents, and 
their associated signatures required by PDMA, PDA, and this part.
    (b) Maintenance of request and receipt forms, reports, records, and 
other documents created on paper. Request and receipt forms, reports, 
records, and other documents created on paper may be maintained on paper 
or by photographic imaging (i.e., photocopies or microfiche), provided 
that the security and authentication requirements described in paragraph 
(c) of this section are followed. Where a required document is created 
on paper and electronically scanned into a computer, the resulting 
record is an electronic record that must meet the requirements of part 
11 of this chapter.
    (c) Security and authentication requirements for request and receipt 
forms, reports, records, and other documents created on paper. A request 
or receipt form, report, record, or other document, and any signature 
appearing thereon, that is created on paper and that is maintained by 
photographic imaging, or transmitted electronically (i.e., by facsimile) 
shall be maintained or transmitted in a form that provides reasonable 
assurance of being:
    (1) Resistant to tampering, revision, modification, fraud, 
unauthorized use, or alteration;
    (2) Preserved in accessible and retrievable fashion; and
    (3) Available to permit copying for purposes of review, analysis, 
verification, authentication, and reproduction by the person who 
executed the form or created the record, by the manufacturer or 
distributor, and by authorized personnel of FDA and other regulatory and 
law enforcement agencies.
    (d) Retention of request and receipt forms, reports, lists, records, 
and other documents. Any person required to create or maintain reports, 
lists, or other records under PDMA, PDA, or this part, including records 
relating to the distribution of drug samples, shall retain them for at 
least 3 years after the date of their creation.
    (e) Availability of request and receipt forms, reports, lists, and 
records. Any person required to create or maintain request and receipt 
forms, reports, lists, or other records under PDMA, PDA, or this part 
shall make them available, upon request, in a form that permits copying 
or other means of duplication, to FDA or other Federal, State, or local 
regulatory and law enforcement officials for review and reproduction. 
The records shall be made available within 2 business days of a request.



                           Subpart G--Rewards



Sec. 203.70  Application for a reward.

    (a) Reward for providing information leading to the institution of a 
criminal proceeding against, and conviction of, a person for the sale, 
purchase, or trade of a drug sample. A person who provides information 
leading to the institution of a criminal proceeding against, and 
conviction of, a person for the sale, purchase, or trade of a drug 
sample, or the offer to sell, purchase, or trade a drug sample, in 
violation of section 503(c)(1) of the act, is entitled to one-half the 
criminal fine imposed and collected for such violation, but not more 
than $125,000.

[[Page 93]]

    (b)  Procedure for making application for a reward for providing 
information leading to the institution of a criminal proceeding against, 
and conviction of, a person for the sale, purchase, or trade of a drug 
sample. A person who provides information leading to the institution of 
a criminal proceeding against, and conviction of, a person for the sale, 
purchase, or trade of a drug sample, or the offer to sell, purchase, or 
trade a drug sample, in violation of section 503(c)(1) of the act, may 
apply for a reward by making written application to:
     (1) Director, Office of Compliance (HFD-300), Center for Drug 
Evaluation and Research, Food and Drug Administration, 7500 Standish 
Pl., Rockville, MD 20855; or
    (2) Director, Office of Compliance and Biologics Quality (HFM-600), 
Center for Biologics Evaluation and Research, Food and Drug 
Administration, 1401 Rockville Pike, Rockville, MD 20852, as 
appropriate.



PART 205--GUIDELINES FOR STATE LICENSING OF WHOLESALE PRESCRIPTION DRUG DISTRIBUTORS--Table of Contents




Sec.
205.1  Scope.
205.2  Purpose.
205.3  Definitions.
205.4  Wholesale drug distributor licensing requirement.
205.5  Minimum required information for licensure.
205.6  Minimum qualifications.
205.7  Personnel.
205.8  Violations and penalties.
205.50  Minimum requirements for the storage and handling of 
          prescription drugs and for the establishment and maintenance 
          of prescription drug distribution records.

    Authority: 21 U.S.C. 351, 352, 353, 371, 374.

    Source: 55 FR 38023, Sept. 14, 1990, unless otherwise noted.



Sec. 205.1  Scope.

    This part applies to any person, partnership, corporation, or 
business firm in a State engaging in the wholesale distribution of human 
prescription drugs in interstate commerce.



Sec. 205.2  Purpose.

    The purpose of this part is to implement the Prescription Drug 
Marketing Act of 1987 by providing minimum standards, terms, and 
conditions for the licensing by State licensing authorities of persons 
who engage in wholesale distributions in interstate commerce of 
prescription drugs.



Sec. 205.3  Definitions.

    (a) Blood means whole blood collected from a single donor and 
processed either for transfusion or further manufacturing.
    (b) Blood component means that part of blood separated by physical 
or mechanical means.
    (c) Drug sample means a unit of a prescription drug that is not 
intended to be sold and is intended to promote the sale of the drug.
    (d) Manufacturer means anyone who is engaged in manufacturing, 
preparing, propagating, compounding, processing, packaging, repackaging, 
or labeling of a prescription drug.
    (e) Prescription drug means any human drug required by Federal law 
or regulation to be dispensed only by a prescription, including finished 
dosage forms and active ingredients subject to section 503(b) of the 
Federal Food, Drug, and Cosmetic Act.
    (f) Wholesale distribution and wholesale distribution means 
distribution of prescription drugs to persons other than a consumer or 
patient, but does not include:
    (1) Intracompany sales;
    (2) The purchase or other acquisition by a hospital or other health 
care entity that is a member of a group purchasing organization of a 
drug for its own use from the group purchasing organization or from 
other hospitals or health care entities that are members of such 
organizations;
    (3) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug by a charitable organization described in 
section 501(c)(3) of the Internal Revenue Code of 1954 to a nonprofit 
affiliate of the organization to the extent otherwise permitted by law;
    (4) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug among hospitals or other health care entities 
that are under common control; for purposes of this section, common 
control means the power to direct or cause the direction

[[Page 94]]

of the management and policies of a person or an organization, whether 
by ownership of stock, voting rights, by contract, or otherwise;
    (5) The sale, purchase, or trade of a drug or an offer to sell, 
purchase, or trade a drug for emergency medical reasons; for purposes of 
this section, emergency medical reasons includes transfers of 
prescription drugs by a retail pharmacy to another retail pharmacy to 
alleviate a temporary shortage;
    (6) The sale, purchase, or trade of a drug, an offer to sell, 
purchase, or trade a drug, or the dispensing of a drug pursuant to a 
prescription;
    (7) The distribution of drug samples by manufacturers' 
representatives or distributors' representatives; or
    (8) The sale, purchase, or trade of blood and blood components 
intended for transfusion.
    (9) Drug returns, when conducted by a hospital, health care entity, 
or charitable institution in accordance with Sec. 203.23 of this 
chapter; or
    (10) The sale of minimal quantities of drugs by retail pharmacies to 
licensed practitioners for office use.
    (g) Wholesale distributor means any one engaged in wholesale 
distribution of prescription drugs, including, but not limited to, 
manufacturers; repackers; own-label distributors; private-label 
distributors; jobbers; brokers; warehouses, including manufacturers' and 
distributors' warehouses, chain drug warehouses, and wholesale drug 
warehouses; independent wholesale drug traders; and retail pharmacies 
that conduct wholesale distributions.
    (h) Health care entity means any person that provides diagnostic, 
medical, surgical, or dental treatment, or chronic or rehabilitative 
care, but does not include any retail pharmacy or any wholesale 
distributor. A person cannot simultaneously be a ``health care entity'' 
and a retail pharmacy or wholesale distributor.

[55 FR 38023, Sept. 14, 1990, as amended at 64 FR 67762, Dec. 3, 1999]

    Effective Date Note: At 64 FR 67762, Dec. 3, 1999, Sec. 205.3 was 
amended by adding paragraphs (f)(9), (f)(10), and (h), effective Dec. 4, 
2000.



Sec. 205.4  Wholesale drug distributor licensing requirement.

    Every wholesale distributor in a State who engages in wholesale 
distributions of prescription drugs in interstate commerce must be 
licensed by the State licensing authority in accordance with this part 
before engaging in wholesale distributions of prescription drugs in 
interstate commerce.



Sec. 205.5  Minimum required information for licensure.

    (a) The State licensing authority shall require the following 
minimum information from each wholesale drug distributor as part of the 
license described in Sec. 205.4 and as part of any renewal of such 
license:
    (1) The name, full business address, and telephone number of the 
licensee;
    (2) All trade or business names used by the licensee;
    (3) Addresses, telephone numbers, and the names of contact persons 
for all facilities used by the licensee for the storage, handling, and 
distribution of prescription drugs;
    (4) The type of ownership or operation (i.e., partnership, 
corporation, or sole proprietorship); and
    (5) The name(s) of the owner and/or operator of the licensee, 
including:
    (i) If a person, the name of the person;
    (ii) If a partnership, the name of each partner, and the name of the 
partnership;
    (iii) If a corporation, the name and title of each corporate officer 
and director, the corporate names, and the name of the State of 
incorporation; and
    (iv) If a sole proprietorship, the full name of the sole proprietor 
and the name of the business entity.
    (b) The State licensing authority may provide for a single license 
for a business entity operating more than one facility within that 
State, or for a parent entity with divisions, subsidiaries, and/or 
affiliate companies within that State when operations are conducted at 
more than one location and there exists joint ownership and control 
among all the entities.
    (c) Changes in any information in paragraph (a) of this section 
shall be

[[Page 95]]

submitted to the State licensing authority as required by such 
authority.

(Approved by the Office of Management and Budget under control number 
0910-0251)



Sec. 205.6  Minimum qualifications.

    (a) The State licensing authority shall consider, at a minimum, the 
following factors in reviewing the qualifications of persons who engage 
in wholesale distribution of prescription drugs within the State:
    (1) Any convictions of the applicant under any Federal, State, or 
local laws relating to drug samples, wholesale or retail drug 
distribution, or distribution of controlled substances;
    (2) Any felony convictions of the applicant under Federal, State, or 
local laws;
    (3) The applicant's past experience in the manufacture or 
distribution of prescription drugs, including controlled substances;
    (4) The furnishing by the applicant of false or fraudulent material 
in any application made in connection with drug manufacturing or 
distribution;
    (5) Suspension or revocation by Federal, State, or local government 
of any license currently or previously held by the applicant for the 
manufacture or distribution of any drugs, including controlled 
substances;
    (6) Compliance with licensing requirements under previously granted 
licenses, if any;
    (7) Compliance with requirements to maintain and/or make available 
to the State licensing authority or to Federal, State, or local law 
enforcement officials those records required under this section; and
    (8) Any other factors or qualifications the State licensing 
authority considers relevant to and consistent with the public health 
and safety.
    (b) The State licensing authority shall have the right to deny a 
license to an applicant if it determines that the granting of such a 
license would not be in the public interest.



Sec. 205.7  Personnel.

    The State licensing authority shall require that personnel employed 
in wholesale distribution have appropriate education and/or experience 
to assume responsibility for positions related to compliance with State 
licensing requirements.



Sec. 205.8  Violations and penalties.

    (a) State licensing laws shall provide for the suspension or 
revocation of licenses upon conviction of violations of Federal, State, 
or local drug laws or regulations, and may provide for fines, 
imprisonment, or civil penalties.
    (b) State licensing laws shall provide for suspension or revocation 
of licenses, where appropriate, for violations of its provisions.



Sec. 205.50  Minimum requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution 
          records.

    The State licensing law shall include the following minimum 
requirements for the storage and handling of prescription drugs, and for 
the establishment and maintenance of prescription drug distribution 
records by wholesale drug distributors and their officers, agents, 
representatives, and employees:
    (a) Facilities. All facilities at which prescription drugs are 
stored, warehoused, handled, held, offered, marketed, or displayed 
shall:
    (1) Be of suitable size and construction to facilitate cleaning, 
maintenance, and proper operations;
    (2) Have storage areas designed to provide adequate lighting, 
ventilation, temperature, sanitation, humidity, space, equipment, and 
security conditions;
    (3) Have a quarantine area for storage of prescription drugs that 
are outdated, damaged, deteriorated, misbranded, or adulterated, or that 
are in immediate or sealed, secondary containers that have been opened;
    (4) Be maintained in a clean and orderly condition; and
    (5) Be free from infestation by insects, rodents, birds, or vermin 
of any kind.
    (b) Security. (1) All facilities used for wholesale drug 
distribution shall be secure from unauthorized entry.
    (i) Access from outside the premises shall be kept to a minimum and 
be well-controlled.
    (ii) The outside perimeter of the premises shall be well-lighted.

[[Page 96]]

    (iii) Entry into areas where prescription drugs are held shall be 
limited to authorized personnel.
    (2) All facilities shall be equipped with an alarm system to detect 
entry after hours.
    (3) All facilities shall be equipped with a security system that 
will provide suitable protection against theft and diversion. When 
appropriate, the security system shall provide protection against theft 
or diversion that is facilitated or hidden by tampering with computers 
or electronic records.
    (c) Storage. All prescription drugs shall be stored at appropriate 
temperatures and under appropriate conditions in accordance with 
requirements, if any, in the labeling of such drugs, or with 
requirements in the current edition of an official compendium, such as 
the United States Pharmacopeia/National Formulary (USP/NF).
    (1) If no storage requirements are established for a prescription 
drug, the drug may be held at ``controlled'' room temperature, as 
defined in an official compendium, to help ensure that its identity, 
strength, quality, and purity are not adversely affected.
    (2) Appropriate manual, electromechanical, or electronic temperature 
and humidity recording equipment, devices, and/or logs shall be utilized 
to document proper storage of prescription drugs.
    (3) The recordkeeping requirements in paragraph (f) of this section 
shall be followed for all stored drugs.
    (d) Examination of materials. (1) Upon receipt, each outside 
shipping container shall be visually examined for identity and to 
prevent the acceptance of contaminated prescription drugs or 
prescription drugs that are otherwise unfit for distribution. This 
examination shall be adequate to reveal container damage that would 
suggest possible contamination or other damage to the contents.
    (2) Each outgoing shipment shall be carefully inspected for identity 
of the prescription drug products and to ensure that there is no 
delivery of prescription drugs that have been damaged in storage or held 
under improper conditions.
    (3) The recordkeeping requirements in paragraph (f) of this section 
shall be followed for all incoming and outgoing prescription drugs.
    (e) Returned, damaged, and outdated prescription drugs. (1) 
Prescription drugs that are outdated, damaged, deteriorated, misbranded, 
or adulterated shall be quarantined and physically separated from other 
prescription drugs until they are destroyed or returned to their 
supplier.
    (2) Any prescription drugs whose immediate or sealed outer or sealed 
secondary containers have been opened or used shall be identified as 
such, and shall be quarantined and physically separated from other 
prescription drugs until they are either destroyed or returned to the 
supplier.
    (3) If the conditions under which a prescription drug has been 
returned cast doubt on the drug's safety, identity, strength, quality, 
or purity, then the drug shall be destroyed, or returned to the 
supplier, unless examination, testing, or other investigation proves 
that the drug meets appropriate standards of safety, identity, strength, 
quality, and purity. In determining whether the conditions under which a 
drug has been returned cast doubt on the drug's safety, identity, 
strength, quality, or purity, the wholesale drug distributor shall 
consider, among other things, the conditions under which the drug has 
been held, stored, or shipped before or during its return and the 
condition of the drug and its container, carton, or labeling, as a 
result of storage or shipping.
    (4) The recordkeeping requirements in paragraph (f) of this section 
shall be followed for all outdated, damaged, deteriorated, misbranded, 
or adulterated prescription drugs.
    (f) Recordkeeping. (1) Wholesale drug distributors shall establish 
and maintain inventories and records of all transactions regarding the 
receipt and distribution or other disposition of prescription drugs. 
These records shall include the following information:
    (i) The source of the drugs, including the name and principal 
address of the seller or transferor, and the address of the location 
from which the drugs were shipped;
    (ii) The identity and quantity of the drugs received and distributed 
or disposed of; and

[[Page 97]]

    (iii) The dates of receipt and distribution or other disposition of 
the drugs.
    (2) Inventories and records shall be made available for inspection 
and photocopying by authorized Federal, State, or local law enforcement 
agency officials for a period of 3 years after the date of their 
creation.
    (3) Records described in this section that are kept at the 
inspection site or that can be immediately retrieved by computer or 
other electronic means shall be readily available for authorized 
inspection during the retention period. Records kept at a central 
location apart from the inspection site and not electronically 
retrievable shall be made available for inspection within 2 working days 
of a request by an authorized official of a Federal, State, or local law 
enforcement agency.
    (g) Written policies and procedures. Wholesale drug distributors 
shall establish, maintain, and adhere to written policies and 
procedures, which shall be followed for the receipt, security, storage, 
inventory, and distribution of prescription drugs, including policies 
and procedures for identifying, recording, and reporting losses or 
thefts, and for correcting all errors and inaccuracies in inventories. 
Wholesale drug distributors shall include in their written policies and 
procedures the following:
    (1) A procedure whereby the oldest approved stock of a prescription 
drug product is distributed first. The procedure may permit deviation 
from this requirement, if such deviation is temporary and appropriate.
    (2) A procedure to be followed for handling recalls and withdrawals 
of prescription drugs. Such procedure shall be adequate to deal with 
recalls and withdrawals due to:
    (i) Any action initiated at the request of the Food and Drug 
Administration or other Federal, State, or local law enforcement or 
other government agency, including the State licensing agency;
    (ii) Any voluntary action by the manufacturer to remove defective or 
potentially defective drugs from the market; or
    (iii) Any action undertaken to promote public health and safety by 
replacing of existing merchandise with an improved product or new 
package design.
    (3) A procedure to ensure that wholesale drug distributors prepare 
for, protect against, and handle any crisis that affects security or 
operation of any facility in the event of strike, fire, flood, or other 
natural disaster, or other situations of local, State, or national 
emergency.
    (4) A procedure to ensure that any outdated prescription drugs shall 
be segregated from other drugs and either returned to the manufacturer 
or destroyed. This procedure shall provide for written documentation of 
the disposition of outdated prescription drugs. This documentation shall 
be maintained for 2 years after disposition of the outdated drugs.
    (h) Responsible persons. Wholesale drug distributors shall establish 
and maintain lists of officers, directors, managers, and other persons 
in charge of wholesale drug distribution, storage, and handling, 
including a description of their duties and a summary of their 
qualifications.
    (i) Compliance with Federal, State, and local law. Wholesale drug 
distributors shall operate in compliance with applicable Federal, State, 
and local laws and regulations.
    (1) Wholesale drug distributors shall permit the State licensing 
authority and authorized Federal, State, and local law enforcement 
officials to enter and inspect their premises and delivery vehicles, and 
to audit their records and written operating procedures, at reasonable 
times and in a reasonable manner, to the extent authorized by law.
    (2) Wholesale drug distributors that deal in controlled substances 
shall register with the appropriate State controlled substance authority 
and with the Drug Enforcement Administration (DEA), and shall comply 
with all applicable State, local, and DEA regulations.
    (j) Salvaging and reprocessing. Wholesale drug distributors shall be 
subject to the provisions of any applicable Federal, State, or local 
laws or regulations

[[Page 98]]

that relate to prescription drug product salvaging or reprocessing, 
including parts 207, 210, and 211 of this chapter.

(Approved by the Office of Management and Budget under control number 
0910-0251)

[55 FR 38023, Sept. 14, 1990, as amended at 64 FR 67763, Dec. 3, 1999]

    Effective Date Note: At 64 FR 67763, Dec. 3, 1999, Sec. 205.50 was 
amended by revising paragraph (f)(2), effective Dec. 4, 2000. For the 
convenience of the user, the superseded text is set forth as follows:

Sec. 205.50  Minimum requirements for the storage and handling of 
          prescription drugs and for the establishment and maintenance 
          of prescription drug distribution records.

                                * * * * *

    (f) * * *
    (2) Inventories and records shall be made available for inspection 
and photocopying by authorized Federal, State, or local law enforcement 
agency officials for a period of 2 years following disposition of the 
drugs.

                                * * * * *



PART 206--IMPRINTING OF SOLID ORAL DOSAGE FORM DRUG PRODUCTS FOR HUMAN USE--Table of Contents




Sec.
206.1  Scope.
206.3  Definitions.
206.7  Exemptions.
206.10  Code imprint required.

    Authority: 21 U.S.C. 321, 331, 351, 352, 355, 371; 42 U.S.C. 262.

    Source: 58 FR 47958, Sept. 13, 1993, unless otherwise noted.



Sec. 206.1  Scope.

    This part applies to all solid oral dosage form human drug products, 
including prescription drug products, over-the-counter drug products, 
biological drug products, and homeopathic drug products, unless 
otherwise exempted under Sec. 206.7.



Sec. 206.3  Definitions.

    The following definitions apply to this part:
    The act means the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
301 et seq.).
    Debossed means imprinted with a mark below the dosage form surface.
    Drug product means a finished dosage form, e.g., a tablet or capsule 
that contains a drug substance, generally, but not necessarily, in 
association with one or more other ingredients.
    Embossed means imprinted with a mark raised above the dosage form 
surface.
    Engraved means imprinted with a code that is cut into the dosage 
form surface after it has been completed.
    Imprinted means marked with an identification code by means of 
embossing, debossing, engraving, or printing with ink.
    Manufacturer means the manufacturer as described in Secs. 201.1 and 
600.3(t) of this chapter.
    Solid oral dosage form means capsules, tablets, or similar drug 
products intended for oral use.



Sec. 206.7  Exemptions.

    (a) The following classes of drug products are exempt from 
requirements of this part:
    (1) Drug products intended for use in a clinical investigation under 
section 505(i) of the act, but not including drugs distributed under a 
treatment IND under part 312 of this chapter or distributed as part of a 
nonconcurrently controlled study. Placebos intended for use in a 
clinical investigation are exempt from the requirements of this part if 
they are designed to copy the active drug products used in that 
investigation.
    (2) Drugs, other than reference listed drugs, intended for use in 
bioequivalence studies.
    (3) Drugs that are extemporaneously compounded by a licensed 
pharmacist, upon receipt of a valid prescription for an individual 
patient from a practitioner licensed by law to prescribe or administer 
drugs, to be used solely by the patient for whom they are prescribed.
    (4) Radiopharmaceutical drug products.
    (b) Exemption of drugs because of size or unique physical 
characteristics:
    (1) For a drug subject to premarket approval, FDA may provide an 
exemption from the requirements of Sec. 206.10 upon a showing that the 
product's size,

[[Page 99]]

shape, texture, or other physical characteristics make imprinting 
technologically infeasible or impossible.
    (i) Exemption requests for products with approved applications shall 
be made in writing to the appropriate review division in the Center for 
Drug Evaluation and Research (CDER) or the Center for Biologics 
Evaluation and Research (CBER), Food and Drug Administration, 5600 
Fishers Lane, Rockville, MD 20857. If FDA denies the request, the holder 
of the approved application will have 1 year after the date of an agency 
denial to imprint the drug product.
    (ii) Exemption requests for products that have not yet received 
approval shall be made in writing to the appropriate review division in 
CDER or CBER.
    (2) Any product not subject to premarket approval is exempt from the 
requirement of Sec. 206.10 if, based on the product's size, shape, 
texture, or other physical characteristics, the manufacturer or 
distributor of the product is prepared to demonstrate that imprinting 
the dosage form is technologically infeasible or impossible.
    (c) For drugs that are administered solely in controlled health care 
settings and not provided to patients for self-administration, sponsors 
may submit requests for exemptions from the requirements of this rule. 
Controlled settings include physicians' offices and other health care 
facilities. Exemption requests should be submitted in writing to the 
appropriate review division in CDER or CBER.



Sec. 206.10  Code imprint required.

    (a) Unless exempted under Sec. 206.7, no drug product in solid oral 
dosage form may be introduced or delivered for introduction into 
interstate commerce unless it is clearly marked or imprinted with a code 
imprint that, in conjunction with the product's size, shape, and color, 
permits the unique identification of the drug product and the 
manufacturer or distributor of the product. Identification of the drug 
product requires identification of its active ingredients and its dosage 
strength. Inclusion of a letter or number in the imprint, while not 
required, is encouraged as a more effective means of identification than 
a symbol or logo by itself. Homeopathic drug products are required only 
to bear an imprint that identifies the manufacturer and their 
homeopathic nature.
    (b) A holder of an approved application who has, under Sec. 314.70 
(b)(2)(xi) or (b)(2)(xii) of this chapter, supplemented its application 
to provide for a new imprint is not required to bring its product into 
compliance with this section during the pendency of the agency's review. 
Once the review is complete, the drug product is subject to the 
requirements of the rule.
    (c) A solid oral dosage form drug product that does not meet the 
requirement for imprinting in paragraph (a) of this section and is not 
exempt from the requirement may be considered adulterated and misbranded 
and may be an unapproved new drug.
    (d) For purposes of this section, code imprint means any single 
letter or number or any combination of letters and numbers, including, 
e.g., words, company name, and National Drug Code, or a mark, symbol, 
logo, or monogram, or a combination of letters, numbers, and marks or 
symbols, assigned by a drug firm to a specific drug product.

[58 FR 47958, Sept. 13, 1993, as amended at 60 FR 19846, Apr. 21, 1995]



PART 207--REGISTRATION OF PRODUCERS OF DRUGS AND LISTING OF DRUGS IN COMMERCIAL DISTRIBUTION--Table of Contents




                           Subpart A--General

Sec.
207.3  Definitions.
207.7  Establishment registration and product listing for human blood 
          and blood products and for medical devices.

                          Subpart B--Exemptions

207.10  Exemptions for domestic establishments.

         Subpart C--Procedures for Domestic Drug Establishments

207.20  Who must register and submit a drug list.
207.21  Times for registration and drug listing.
207.22  How and where to register and list drugs.

[[Page 100]]

207.25  Information required in registration and drug listing.
207.26  Amendments to registration.
207.30  Updating drug listing information.
207.31  Additional drug listing information.
207.35  Notification of registrant; drug establishment registration 
          number and drug listing number.
207.37  Inspection of registrations and drug listings.
207.39  Misbranding by reference to registration or to registration 
          number.

          Subpart D--Procedure for Foreign Drug Establishments

207.40  Drug listing requirements for foreign drug establishments.

    Authority: 21 U.S.C. 331, 351, 352, 355, 360, 360b, 371, 374; 42 
U.S.C. 262.

    Source: 45 FR 38043, June 6, 1980, unless otherwise noted.



                           Subpart A--General



Sec. 207.3  Definitions.

    (a) The following definitions apply to this part:
    (1) Act means the Federal Food, Drug, and Cosmetic Act approved June 
25, 1938 (52 Stat. 1040 et seq., as amended (21 U.S.C. 301-392)), except 
as otherwise provided.
    (2) Advertising and labeling include the promotional material 
described in Sec. 202.1(l) (1) and (2) respectively.
    (3) Any material change includes but is not limited to any change in 
the name of the drug, any change in the identity or quantity of the 
active ingredient(s), any change in the identity or quantity of the 
inactive ingredient(s) where quantitative listing of all ingredients is 
required by Sec. 207.31(a)(2), any significant change in the labeling of 
a prescription drug, and any significant change in the label or package 
insert of an over-the-counter drug. Changes that are not significant 
include changes in arrangement or printing or changes of an editorial 
nature.
    (4) Bulk drug substance means any substance that is represented for 
use in a drug and that, when used in the manufacturing, processing, or 
packaging of a drug, becomes an active ingredient or a finished dosage 
form of the drug, but the term does not include intermediates used in 
the synthesis of such substances.
    (5) Commercial distribution means any distribution of a human drug 
except for investigational use under part 312 of this chapter, and any 
distribution of an animal drug or an animal feed bearing or containing 
an animal drug for noninvestigational uses, but the term does not 
include internal or interplant transfer of a bulk drug substance between 
registered domestic establishments within the same parent, subsidiary, 
and/or affiliate company.
    (6) Drug product salvaging means the act of segregating drug 
products that may have been subjected to improper storage conditions, 
such as extremes in temperature, humidity, smoke, fumes, pressure, age, 
or radiation, for the purpose of returning some or all of the products 
to the marketplace.
    (7) Establishment means a place of business under one management at 
one general physical location. The term includes, among others, 
independent laboratories that engage in control activities for a 
registered drug establishment (e.g., consulting laboratories), 
manufacturers of medicated feeds and of vitamin products that are drugs 
in accordance with section 201(g) of the act, human blood donor centers, 
and animal facilities used for the production or control testing of 
licensed biologicals, and establishments engaged in drug product 
salvaging.
    (8) Manufacturing or processing means the manufacture, preparation, 
propagation, compounding, or processing of a drug or drugs as used in 
section 510 of the act and is the making by chemical, physical, 
biological, or other procedures of any articles that meet the definition 
of drugs in section 201(g) of the act. The term includes manipulation, 
sampling, testing, or control procedures applied to the final product or 
to any part of the process. The term also includes repackaging or 
otherwise changing the container, wrapper, or labeling of any drug 
package to further the distribution of the drug from the original place 
of manufacture to the person who makes final delivery or sale to the 
ultimate consumer.
    (9) Representative sampling of advertisements means typical 
advertising material (excluding labeling as determined in Sec. 202.1(l) 
(1) and (2)) that gives a balanced picture of the promotional

[[Page 101]]

claims used for the drug, e.g., if more than one medical journal 
advertisement is used but the promotional content is essentially 
identical, only one need be submitted.
    (10) Representative sampling of any other labeling means typical 
labeling material (excluding labels and package inserts) that gives a 
balanced picture of the promotional claims used for the drug, e.g., if 
more than one brochure is used but the promotional content is 
essentially identical, only one need be submitted.
    (b) The definitions and interpretations of terms in sections 201, 
502(e), and 510 of the act apply to the use of terms in this part.

[45 FR 38043, June 6, 1980, as amended at 55 FR 11576, Mar. 29, 1990]



Sec. 207.7  Establishment registration and product listing for human blood and blood products and for medical devices.

    (a) Owners and operators of human blood and blood product 
establishments shall register and list their products with the Division 
of Product Certification, Office of Biological Product Review (HFB-240), 
Center for Biologics Evaluation and Research, 8800 Rockville Pike, 
Bethesda, MD 20892, on Form FDA-2830 (Blood Establishment Registration 
and Product Listing), in acordance with part 607. Such owners and 
operators who also manufature or process other drug products at the same 
establishment shall, in addition, register and list all such other drug 
products with the Drug Listing Branch in accordance with this part.
    (b) [Reserved]
    (c) Owners and operators of establishments engaged in manufacture or 
processing of medical devices shall register and list their products 
with the Center for Devices and Radiological Health, FDA, on Form FDA-
2891 (Initial Registration of Device Establishments), FDA-2891a 
(Registration of Device Establishment), and FDA-2892 (Medical Device 
Listing), in accordance with part 807.
    (d) Owners and operators of establishments engaged in the 
manufacture or processing at the same establishment of both drug 
products and medical devices shall (1) register with the Drug Listing 
Branch (HFD-334), Center for Drug Evaluation and Research, FDA, and list 
their drug products in accordance with this part, and (2) register with 
the Center for Devices and Radiological Health and list their medical 
devices in accordance with part 807.

[45 FR 38043, June 6, 1980, as amended at 50 FR 8995, Mar. 6, 1985; 55 
FR 11576, Mar. 29, 1990]



                          Subpart B--Exemptions



Sec. 207.10  Exemptions for domestic establishments.

    The following classes of persons are exempt from registration and 
drug listing in accordance with this part under section 510(g) (1), (2), 
and (3) of the act, or because FDA has found, under section 510(g)(4), 
that their registration is not necessary for the protection of the 
public health.
    (a) Pharmacies that operate under applicable local laws regulating 
dispensing of prescription drugs and that do not manufacture or process 
drugs for sale other than in the regular course of the practice of the 
profession of pharmacy, including dispensing and selling drugs at 
retail. The supplying of prescription drugs by these pharmacies to a 
practitioner licensed to administer these drugs for his or her use in 
the course of professional practice or to other pharmacies to meet 
temporary inventory shortages are not acts that require pharmacies to 
register.
    (b) Hospitals, clinics, and public health agencies that maintain 
establishments in conformance with any applicable local laws regulating 
the practices of pharmacy or medicine and that regularly engage in 
dispensing prescription drugs, other than human blood or blood products, 
upon prescription of practitioners licensed by law to administer these 
drugs to patients under their professional care.
    (c) Practitioners who are licensed by law to prescribe or administer 
drugs and who manufacture or process drugs solely for use in their 
professional practice.
    (d) Persons who manufacture or process drugs not for sale but solely 
for use in research, teaching, or chemical analysis.

[[Page 102]]

    (e) Manufacturers of harmless inactive ingredients that are 
excipients, colorings, flavorings, emulsifiers, lubricants, 
preservatives, or solvents that become components of drugs, and who 
otherwise would not be required to register under this part.
    (f) Persons who only manufacture the following:
    (1) Type B or Type C medicated feed using Category I, Type A 
medicated articles or Category I, Type B or Type C medicated feeds, and/
or;
    (2) Type B or Type C medicated feed using Category II, Type B or 
Type C medicated feeds.
    (3) Persons who manufacture free-choice feeds, as defined in 
Sec. 510.455 of this chapter, or medicated liquid feeds, as defined in 
Sec. 558.5 of this chapter, where a medicated feed mill license is 
required are not exempt.
    (g) Any manufacturer of a virus, serum, toxin, or analogous product 
intended for treatment of domestic animals who holds an unsuspended and 
unrevoked license issued by the Secretary of Agriculture under the 
animal virus-serum-toxin law of March 4, 1913 (37 Stat. 832 (21 U.S.C. 
151 et seq.)), provided that this exemption from registration applies 
only to the manufacture or processing of that animal virus, serum, 
toxin, or analogous product.
    (h) Carriers, in their receipt, carriage, holding, or delivery of 
drugs in the usual course of business as carriers.

[45 FR 38043, June 6, 1980, as amended at 51 FR 7389, Mar. 3, 1986; 64 
FR 63203, Nov. 19, 1999]



         Subpart C--Procedures for Domestic Drug Establishments



Sec. 207.20  Who must register and submit a drug list.

    (a) Owners or operators of all drug establishments, not exempt under 
section 510(g) of the act or subpart D of this part 207, that engage in 
the manufacture, preparation, propagation, compounding, or processing of 
a drug or drugs are required to register and to submit a list of every 
drug in commercial distribution (except that listing information may be 
submitted by the parent, subsidiary, and/or affiliate company for all 
establishments when operations are conducted at more than one 
establishment and there exists joint ownership and control among all the 
establishments). Such owners or operators are required to register and 
to submit a list of every drug in commercial distribution (except that 
listing information may be submitted by the parent, subsidiary, and/or 
affiliate company for all establishments when operations are conducted 
at more than one establishment and there exists joint ownership and 
control among all the establishments), whether or not the output of such 
establishment or any particular drug so listed enters interstate 
commerce, except that drug listing is not required at this time for the 
manufacturing, preparation, propagation, compounding, or processing of 
an animal feed (including a Type B and Type C medicated feed) bearing or 
containing an animal drug, nor is drug listing required for 
establishments engaged in drug product salvaging. No owner or operator 
may register an establishment, if any part of the establishment is 
registered by any other owner or operator.
    (b) Owners or operators of establishments not otherwise required to 
register under section 510 of the act that distribute under their own 
label or trade name a drug manufactured or processed by a registered 
establishment may elect to submit listing information directly to FDA 
and to obtain a Labeler Code. A distributor who submits drug listing 
information shall include the registration number of the drug 
establishment that manufactured, prepared, propagated, compounded, or 
processed each drug listed. All distributors who submit drug listing 
information to FDA assume full responsibility for compliance with all of 
the requirements of this part. Each such distributor at the time of 
submitting or updating drug listing information as required under 
Sec. 207.30 shall certify to the registered establishment that the 
submission has been made by providing a signed copy of Form FDA-2656 
(Registration of Drug Establishment) to the registered establishment 
that manufactures or processes the drug. Each such distributor shall 
submit the original of Form FDA-2656 showing this certification to FDA, 
and shall accompany the certification with a list showing

[[Page 103]]

the National Drug Code number that the distributor has assigned to each 
drug product. If a distributor does not elect to submit drug listing 
information directly to FDA and to obtain a Labeler Code, the registered 
establishment shall submit the drug listing information. Distributors or 
registered establishments shall use Form FDA-2658 (Registered 
Establishments' Report of Private Label Distributors) to submit drug 
listing information or to request a Labeler Code, or both.
    (c) Before beginning manufacture or processing of a drug subject to 
one of the following applications, an owner or operator of an 
establishment is required to register before the agency approves it: A 
new drug application, a new animal drug application, a medicated feed 
mill license application, or a biologics license application.
    (d) No registration fee is required.
    (e) Registration and listing do not constitute an admission, or 
agreement, or determination that a product is a drug as defined in 
section 201(g) of the act.

[45 FR 38043, June 6, 1980, as amended at 45 FR 32293, May 16, 1980; 52 
FR 2682, Jan. 26, 1987; 55 FR 11576, Mar. 29, 1990; 64 FR 400, Jan. 5, 
1999; 64 FR 56448, Oct. 20, 1999; 64 FR 63203, Nov. 19, 1999]



Sec. 207.21  Times for registration and drug listing.

    (a) The owner or operator of an establishment entering into the 
manufacture or processing of a drug or drugs shall register the 
establishment within 5 days after the beginning of the operation and 
shall submit a list of every drug in commercial distribution at that 
time. If the owner or operator of the establishment has not previously 
entered into such an operation, the owner or operator shall register 
within 5 days after submitting a new drug application, new animal drug 
application, medicated feed mill license application, or a biologics 
license application. Owners or operators of all establishments engaged 
in the drug activities described in Sec. 207.3(a)(8) shall register 
annually within 30 days after receiving registration forms from FDA. FDA 
will mail Forms FDA-2656 (Registration of Drug Establishment) to 
registered establishments according to a schedule based on the first 
letter of the name of the establishment's parent company as stated on 
the firm's registration form. If no parent company name is given on that 
form, the schedule is based on the first letter of the establishment's 
name. In scheduling the mailing of forms based on the first letter of 
the company name, FDA will not consider the word ``the'' when it appears 
as the first word in the name of the parent company or establishment.
    The schedule is as follows:

------------------------------------------------------------------------
       First letter of company name           Date FDA will mail forms
------------------------------------------------------------------------
A or B...................................  January
C, D, or E...............................  February
F, G, or H...............................  March
I, J, K, L. or M.........................  April
N, O, P, Q, or R.........................  May
S or T...................................  June
U, V, W, X, Y, or Z......................  July
------------------------------------------------------------------------

    (b) Owners and operators of all registered establishments shall 
update their drug listing information every June and December.

[45 FR 38043, June 6, 1980, as amended at 55 FR 11576, Mar. 29, 1990; 64 
FR 400, Jan. 5, 1999; 64 FR 56448, Oct. 20, 1999; 64 FR 63203, Nov. 19, 
1999]



Sec. 207.22  How and where to register and list drugs.

    (a) An establishment shall register the first time on Form FDA-2656 
(Registration of Drug Establishment), obtainable on request from the 
Drug Listing Branch (HFD-334), Center for Drug Evaluation and Research, 
Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, or 
from FDA district offices. An establishment whose drug registration for 
that year was validated under Sec. 207.35 shall make subsequent annual 
registration on Form FDA-2656 as described in Sec. 207.21(a) by mailing 
the completed form to the above address within 30 days after receipt 
from FDA.
    (b) The first list of drugs and later June and December updatings 
shall be on Form FDA-2657 (Drug Product Listing), obtainable upon 
request as described in paragraph (a) of this section. An establishment 
may submit, in lieu of Form FDA-2657, tapes for computer inputs 
containing the information specified in Form FDA-2657 if formats 
proposed for this use were reviewed and

[[Page 104]]

approved by the Drug Listing Branch (HFD-334), Center for Drug 
Evaluation and Research, FDA.

[45 FR 38043, June 6, 1980, as amended at 50 FR 8995, Mar. 6, 1985; 55 
FR 11576, Mar. 29, 1990]



Sec. 207.25  Information required in registration and drug listing.

    (a) Form FDA-2656 (Registration of Drug Establishment) provides for 
furnishing or confirming information required by the act. This 
information includes, for each establishment, the name and full address 
of the drug establishment; all trade names used by the establishment; 
the kind of ownership or operation (that is, individually owned, 
partnership or corporation); and the name of the owner or operator of 
the establishment. The term name of the owner or operator includes in 
the case of a partnership the name of each partner, and in the case of a 
corporation the name and title of each corporate officer and director 
and the name of the State of incorporation.
    (b) Form FDA-2657 (Drug Product Listing) provides that information 
required by the act be furnished as follows:
    (1) A list of drugs, including bulk drug substances and Type A 
articles for use in the manufacture of animal feeds as well as finished 
dosage forms, by established name and by proprietary name, that are 
being manufactured or processed for commercial distribution and that 
have not been included in any list previously submitted to FDA on Form 
FDA-2657 or in conjunction with the FDA voluntary inventory on Form FDA-
2422 (Survey Report of Marketed Drugs), or Form FDA-2250 (National Drug 
Code Directory Input).
    (2) For each drug listed that the registrant regards as subject to 
section 505 or 512 of the act, the new drug application number, 
abbreviated new drug application number, or new animal drug application 
number and a copy of all current labeling, except that only one 
representative container or carton label need be submitted where 
differences exist only in the quantity of contents statement.
    (3) For each drug listed that the registrant regards as subject to 
section 351 of the Public Health Service Act, the license number of the 
manufacturer.
    (4) For each human prescription drug listed that the registrant 
regards as not subject to section 505 of the act or 351 of the Public 
Health Service Act, and that is not manufactured by a registered blood 
bank, a copy of all current labeling (except that only one 
representative container or carton label need be submitted where 
differences exist only in the quantity of contents statement) and a 
representative sampling of advertisements.
    (5) For each human over-the-counter drug listed, or each animal drug 
listed, that the registrant regards as not subject to section 505 or 512 
of the act or 351 of the Public Health Service Act, a copy of the label 
(except that only one representative container or carton label need be 
submitted where differences exist only in the quantity of contents 
statement), the package insert, and a representative sampling of any 
other labeling.
    (6) For each prescription or over-the-counter drug so listed that 
the registrant regards as not subject to section 505 or 512 of the act 
or 351 of the Public Health Service Act, and that is not manufactured by 
a registered blood bank, a quantitative listing of the active 
ingredient(s). Unless the quantitative listing is expressed as a 
percentage in the offical compendium or the ingredient is a 
nonantibiotic ingredient in a Type A medicated article for use in the 
manufacture of animal feeds, the quantity of an ingredient shall be 
expressed in terms of the amount, not the percent, of that ingredient in 
each dosage unit or, if the drug is not in unit dosage form, the amount 
of the ingredient in a specific unit of weight or measure of the drug. 
For a drug formulation that is a Type A medicated article subject to 
Sec. 207.35(b)(2)(iii), the registrant may limit the quantitative 
listing of ingredients to each variation of level of active drug 
ingredient.
    (7) For each drug listed, the registration number of every drug 
establishment within the parent company at which it is manufactured or 
processed.
    (8) For each drug listed, the National Drug Code (NDC) number. If 
FDA has not assigned an NDC Labeler Code, the registrant shall include a 
Product Code

[[Page 105]]

and Package Code and FDA will assign a Labeler Code as described in 
Sec. 207.35(b)(2)(i).
    (c) For each drug product listed that is subject to the imprinting 
requirements of part 206 of this chapter, including products that are 
exempted under Sec. 206.7(b), drug companies must submit a document that 
provides the name of the product, its active ingredient(s), dosage 
strength, National Drug Code number, the name of its manufacturer or 
distributor, its size, shape, color, and code imprint (if any), and any 
other characteristic that identifies the product as unique.

[45 FR 38043, June 6, 1980, as amended at 52 FR 2682, Jan. 26, 1987; 55 
FR 11577, Mar. 29, 1990; 58 FR 47959, Sept. 13, 1993; 63 FR 26698, May 
13, 1998; 64 FR 400, Jan. 5, 1999]



Sec. 207.26  Amendments to registration.

    Changes in individual ownership, corporate or partnership structure 
location or drug-handling activity, shall be submitted by Form FDA-2656 
(Registration of Drug Establishment) as amendment to registration within 
5 days of such changes. A change in a registered establishment's firm 
name within 6 months of the registration of the establishment is 
required to be supported by a signed statement of the establishment's 
owner or operator that the change is not made for the purpose of 
changing the name of the manufacturer of a drug product under Sec. 201.1 
of this chapter. Changes in the names of officers and directors of the 
corporations do not require such amendment but must be shown at time of 
annual registration.

[45 FR 25777, Apr. 15, 1980, as amended at 55 FR 11577, Mar. 29, 1990]



Sec. 207.30  Updating drug listing information.

    (a) After submitting the initial drug listing information, every 
person who is required to list drugs under Sec. 207.20 shall submit on 
Form FDA-2657 (Drug Product Listing) during each subsequent June and 
December, or at the discretion of the registrant when the change occurs, 
the following information:
    (1) A list of each drug introduced by the registrant for commerical 
distribution which has not been included in any list previously 
submitted. The registrant shall provide all of the information required 
by Sec. 207.25(b) for each such drug.
    (2) A list of each drug formerly listed in accordance with 
Sec. 207.25(b) for which commercial distribution has been discontinued, 
including for each drug so listed the National Drug Code (NDC) number, 
the identity by established name and by proprietary name, and date of 
discontinuance. It is requested but not required that the reason for 
discontinuance of distribution be included with this information.
    (3) A list of each drug for which a notice of discontinuance was 
submitted under paragraph (a)(2) of this section and for which 
commercial distribution has been resumed, including for each drug so 
listed the NDC number, the identity by established name and by 
proprietary name, the date of resumption, and any other information 
required by Sec. 207.25(b) not previously submitted.
    (4) Any material change in any information previously submitted.
    (b) When no changes have occurred since the previously submitted 
list, no report is required.



Sec. 207.31  Additional drug listing information.

    (a) In addition to the information routinely required by 
Secs. 207.25 and 207.30, FDA may require submission of the following 
information by letter or by Federal Register notice:
    (1) For a particular prescription drug so listed that the registrant 
regards as not subject to section 505 of the act, upon request by FDA 
for good cause, a copy of all advertisements.
    (2) For a particular drug product so listed that the registrant 
regards as not subject to section 505 or 512 of the act, upon a finding 
by FDA that it is necessary to carry out the purposes of the act, a 
quantitative listing of all ingredients.
    (3) For a particular drug product, upon request by FDA, a brief 
statement of the basis for the registrant's belief that the drug product 
is not subject to section 505 or 512 of the act.
    (4) For each registrant, upon a finding by FDA that it is necessary 
to carry out the purposes of the act, a list

[[Page 106]]

of each listed drug product containing a particular ingredient.
    (b) It is requested but not required that a qualitative listing of 
the inactive ingredients be submitted for all listed drugs in the format 
prescribed in Form FDA-2657 (Drug Product Listing).
    (c) It is requested but not required that a quantitative listing of 
the active ingredients be submitted for all drugs listed that are 
subject to section 505 or 512 of the act or section 351 of the Public 
Health Service Act.

[45 FR 38043, June 6, 1980, as amended at 63 FR 26698, May 13, 1998; 64 
FR 400, Jan. 5, 1999]



Sec. 207.35  Notification of registrant; drug establishment registration number and drug listing number.

    (a) FDA will provide to the registrant a validated copy of Form FDA-
2656 (Registration of Drug Establishment) as evidence of registration. 
This validated copy will be sent to the mailing address shown on the 
form. FDA will assign a permanent registration number to each drug 
establishment registered in accordance with these regulations.
    (b) Using the National Drug Code (NDC) numbering system, FDA assigns 
a drug listing number to each drug or class of drugs listed as follows:
    (1) If a drug is already listed in the National Drug Code System or 
in the National Health Related Items Code System, the number is the same 
as that assigned under those codes. FDA adds a lead zero to the first 
three characters of the code, which identifies the manufacturer or 
distributor, to expand the ``Labeler Code'' segment to four characters. 
The National Drug Code, Product Code, and Package Code configurations 
used to describe these drugs, or any drugs added to the product line, 
remain the same, i.e., a four-character Product Code and a two-character 
Package Code. A manufacturer or distributor may either retain 
alphanumeric characters that are already used in the Product Code and 
Package Code segments of the National Drug Code or convert these 
alphanumeric characters to all numeric digits. The manufacturer or 
distributor shall inform FDA of a decision to convert the alphanumeric 
characters to all numeric digits.
    (2) If a registered establishment or distributor has not previously 
participated in the National Drug Code System or in the National Health 
Related Items Code System, FDA uses the National Drug Code numbering 
system in assigning a number, as follows (only numerals are used):
    (i) The first 5 numeric characters of the 10-character code identify 
the manufacturer or distributor and are known as the Labeler Code. FDA 
will expand the Labeler Code from five to six numeric characters when 
the available five-character code combinations are exhausted. FDA will 
assign Labeler Code numbers and provide them to the registrant along 
with the validated copy of Form FDA-2656. Any registered firm that does 
not have an assigned Labeler Code will be assigned one when registration 
and listing information are submitted.
    (ii) The last 5 numeric characters of the 10-character code identify 
the drug and the trade package size and type. The segment that 
identifies the drug formulation is known as the Product Code and the 
segment that identifies the trade package size and type is known as the 
Package Code. The manufacturer or distributor will assign the Product 
Code and the Package Code before drug listing and include these codes in 
Form FDA-2657 (Drug Product Listing). The manufacturer or distributor 
may use either of two methods in assigning the Product and Package 
Codes: a 3-2 Product-Package Code configuration (e.g., 542-12) or a 4-1 
Product-Package Code configuration (e.g., 5421-2). A manufacturer or 
distributor with a given Labeler Code shall use only one such Product-
Package Code configuration and shall use this same configuration in 
assigning the Product-Package Codes for all drugs included in the drug 
listing. The manufacturer or distributor shall report to FDA the 
Product-Package Code configuration used in assigning these codes.
    (iii) If the drug formulation is a Type A medicated article intended 
for use in the manufacture of an animal feed, FDA assigns a separate 
Product Code only for each variation of level of active drug ingredient.
    (3) FDA requests but does not require that the NDC number appear on 
all

[[Page 107]]

drug labels and in other drug labeling, including the label of any 
prescription drug container furnished to a consumer. If the NDC number 
is shown on a drug label, it shall be placed as follows:
    (i) The NDC number shall appear prominently in the top third of the 
principal display panel of the label on the immediate container and of 
any outside container or wrapper. Instead of appearing in the top third 
of the label, the NDC number may appear as part of and contiguous to any 
bar-code symbol for any drug product if two conditions are met. First, 
the symbol appears prominently on the immediate container and on any 
outside container or wrapper and in a conspicuous location; this 
condition is not satisfied by the appearance of the symbol only on the 
natural bottom of a container or wrapper. Second, the bar-code symbol is 
compatible with the NDC, i.e., the symbol provides a format capable of 
encoding the numeric characters of an NDC Number. The term principal 
display panel, as used in this paragraph, means that part of a label 
most likely to be displayed, presented, shown, or examined under 
customary conditions of display to the consumer (for over-the-counter 
drug products) or to the dispenser (for prescription drug products).
    (ii) The NDC number shall be preceded by the prefix ``NDC'' or ``N'' 
when it is used on a label or in labeling. The prefix used for a drug 
product shall be used consistently on the label of the immediate 
container, outside container, or wrapper, if any, and on other labeling 
for that drug product.
    (iii) The Product-Package Code configuration shall be indicated and 
the segments of the number shall be separated by a dash, e.g., NDC 
15643-542-12 or N 15643-542-12.
    (iv) All 10 characters shall appear and the leading zeros in any 
segment of the NDC number shall be shown, except that leading zeros may 
be omitted from any segment of the NDC number when the NDC number is 
used for product identification by direct imprinting on dosage forms or 
in the case of containers too small or otherwise unable to accommodate a 
label with sufficent space to bear both required and optional labeling 
information.
    (v) The placing of the assigned NDC number on a label or in other 
labeling does not require the submission of a supplemental new drug 
application, supplemental new animal drug application.
    (4)(i) If any change occurs in those product characteristics that 
clearly distinguish one drug product version from another, the 
registrant shall assign a new NDC number to the new product version and 
submit that information to FDA. Such a change includes, but is not 
limited to, a change in active ingredient(s); strength or concentration 
of active ingredient(s); dosage form; route of administration, if it 
also includes a change in product formulation; product name; and a 
change in marketing status from prescription to over-the-counter or 
over-the-counter to prescription. If, by notice in the Federal Register, 
FDA requires a change in drug product characteristics and determines the 
change will require assignment of a new product code to the reformulated 
product, FDA will announce its determination in the Federal Register 
publication that requires the change, setting forth its reasoning and 
justification for its determination. If a change only in the trade 
package is involved, the registrant may revise the trade package code 
without the assignment of a new product code segment, but shall inform 
FDA of the new code for the trade package and the characteristics of the 
new trade package.
    (ii) When a registrant has discontinued a drug product, its product 
code may be reassigned to another drug product 5 years after the 
expiration date of the discontinued product, or, if there is no 
expiration date, 5 years after the last shipment of the discontinued 
product into commercial distribution. Reuse of product codes may occur, 
under the specified conditions, regardless of the NDC, Product Code, and 
Package Code configuration used.
    (c) Although registration and drug listing are required to engage in 
the drug activities described in Sec.  207.20, validation of 
registration and the assignment of a drug listing number do not, in 
themselves, establish that the

[[Page 108]]

holder of the registration is legally qualified to deal in such drugs.

[45 FR 38043, June 6, 1980, as amended at 48 FR 54007, Nov. 30, 1983; 52 
FR 2682, Jan. 26, 1987; 55 FR 11577, Mar. 29, 1990; 64 FR 400, Jan. 5, 
1999]



Sec. 207.37  Inspection of registrations and drug listings.

    (a) A copy of the Form FDA-2656 (Registration of Drug Establishment) 
filed by the registrant will be available for inspection in accordance 
with section 510(f) of the act, at the Drug Listing Branch (HFD-334), 
Center for Drug Evaluation and Research, Food and Drug Administration, 
5600 Fishers Lane, Rockville, MD 20857. In addition, there will be 
available for inspection at each of the FDA district offices the same 
information concerning firms within the geographical area of each 
district office. Upon request and receipt of a self-addressed stamped 
envelope, the Drug Listing Branch, Center for Drug Evaluation and 
Research or appropriate FDA district office will verify registration 
number or provide the location of a registered establishment.
    (1) The following types of information submitted under the drug 
listing requirements will be available for public disclosure when 
compiled:
    (i) A list of all drug products.
    (ii) A list of all drug products arranged by labeled indications or 
pharmacological category.
    (iii) A list of all drug products arranged by manufacturer.
    (iv) A list of a drug product's active ingredients.
    (v) A list of drug products newly marketed or for which marketing is 
resumed.
    (vi) A list of drug products discontinued.
    (vii) Labeling.
    (viii) Advertising.
    (ix) Information that has become a matter of public knowledge.
    (x) A list of drug products containing a particular active 
ingredient.
    (xi) A list of all code imprints.
    (2) The following types of information submitted in accordance with 
the drug listing requirements will not be available for public 
disclosure (except that any of the information will be available for 
public disclosure if it has become a matter of public knowledge or if 
FDA finds that confidentiality would be inconsistent with protection of 
the public health):
    (i) Any information submitted as the basis upon which it has been 
determined that a particular drug product is not subject to section 505 
or 512 of the act.
    (ii) A list of a drug product's inactive ingredients.
    (iii) A list of drugs containing a particular inactive ingredient.
    (b) Requests for information about registrations and drug listings 
of an establishment should be directed to Drug Listing Branch (HFD-334), 
Center for Drug Evaluation and Research, Food and Drug Administration, 
5600 Fishers Lane, Rockville, MD 20857 or, with respect to the 
information described in paragraph (a) of this section, to the FDA 
district office responsible for the geographical area in which the 
establishment is located.

[45 FR 38043, June 6, 1980, as amended at 50 FR 8996, Mar. 6, 1985; 55 
FR 11577, Mar. 29, 1990; 58 FR 47959, Sept. 13, 1993; 63 FR 26698, May 
13, 1998; 64 FR 400, Jan. 5, 1999]



Sec. 207.39  Misbranding by reference to registration or to registration number.

    Registration of a drug establishment or drug wholesaler, or 
assignment of a registration number, or assignment of a NDC number does 
not in any way denote approval of the firm or its products. Any 
representation that creates an impression of official approval because 
of registration or possession of registration number or NDC number is 
misleading and constitutes misbranding.



          Subpart D--Procedure for Foreign Drug Establishments



Sec. 207.40  Drug listing requirements for foreign drug establishments.

    (a) Every foreign drug establishment whose drugs are imported or 
offered for import into the United States shall comply with the drug 
listing requirements in subpart C of this part, unless exempt under 
subpart B of this part, whether or not it is also registered.

[[Page 109]]

    (b) No drug, unless it is listed as required in subpart C of this 
part, may be imported from a foreign drug establishment into the United 
States except a drug imported or offered for import under the 
investigational use provisions of part 312 of this chapter. Foreign drug 
establishments shall submit the drug listing information in the English 
language.
    (c) Every foreign drug establishment shall submit, as part of drug 
listing, the name and address of the establishment and the name of the 
individual responsible for submitting drug listing information. The 
establishment shall report to FDA any changes in this information at the 
intervals specified in Sec. 207.30(a) for updating drug listing 
information.

[45 FR 38043, June 6, 1980, as amended at 55 FR 11577, Mar. 29, 1990]



PART 208--MEDICATION GUIDES FOR PRESCRIPTION DRUG PRODUCTS--Table of Contents




                      Subpart A--General Provisions

Sec.
208.1  Scope and purpose.
208.3  Definitions.

         Subpart B--General Requirements for a Medication Guide

208.20  Content and format of a Medication Guide.
208.24  Distributing and dispensing a Medication Guide.
208.26  Exemptions and deferrals.

    Authority: 21 U.S.C. 321, 331, 351, 352, 353, 355, 356, 357, 360, 
371, 374; 42 U.S.C. 262.

    Source: 63 FR 66396, Dec. 1, 1998, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 208.1  Scope and purpose.

    (a) This part sets forth requirements for patient labeling for human 
prescription drug products, including biological products, that the Food 
and Drug Administration (FDA) determines pose a serious and significant 
public health concern requiring distribution of FDA-approved patient 
information. It applies primarily to human prescription drug products 
used on an outpatient basis without direct supervision by a health 
professional. This part shall apply to new prescriptions and refill 
prescriptions.
    (b) The purpose of patient labeling for human prescription drug 
products required under this part is to provide information when the FDA 
determines in writing that it is necessary to patients' safe and 
effective use of drug products.
    (c) Patient labeling will be required if the FDA determines that one 
or more of the following circumstances exists:
    (1) The drug product is one for which patient labeling could help 
prevent serious adverse effects.
    (2) The drug product is one that has serious risk(s) (relative to 
benefits) of which patients should be made aware because information 
concerning the risk(s) could affect patients' decision to use, or to 
continue to use, the product.
    (3) The drug product is important to health and patient adherence to 
directions for use is crucial to the drug's effectiveness.



Sec. 208.3  Definitions.

    For the purposes of this part, the following definitions shall 
apply:
    (a) Authorized dispenser means an individual licensed, registered, 
or otherwise permitted by the jurisdiction in which the individual 
practices to provide drug products on prescription in the course of 
professional practice.
    (b) Dispense to patients means the act of delivering a prescription 
drug product to a patient or an agent of the patient either:
    (1) By a licensed practitioner or an agent of a licensed 
practitioner, either directly or indirectly, for self-administration by 
the patient, or the patient's agent, or outside the licensed 
practitioner's direct supervision; or
    (2) By an authorized dispenser or an agent of an authorized 
dispenser under a lawful prescription of a licensed practitioner.
    (c) Distribute means the act of delivering, other than by 
dispensing, a drug product to any person.
    (d) Distributor means a person who distributes a drug product.

[[Page 110]]

    (e) Drug product means a finished dosage form, e.g., tablet, 
capsule, or solution, that contains an active drug ingredient, 
generally, but not necessarily, in association with inactive 
ingredients. For purposes of this part, drug product also means 
biological product within the meaning of section 351(a) of the Public 
Health Service Act.
    (f) Licensed practitioner means an individual licensed, registered, 
or otherwise permitted by the jurisdiction in which the individual 
practices to prescribe drug products in the course of professional 
practice.
    (g) Manufacturer means for a drug product that is not also a 
biological product, both the manufacturer as described in Sec. 201.1 and 
the applicant as described in Sec. 314.3(b) of this chapter, and for a 
drug product that is also a biological product, the manufacturer as 
described in Sec. 600.3(t) of this chapter.
    (h) Medication Guide means FDA-approved patient labeling conforming 
to the specifications set forth in this part and other applicable 
regulations.
    (i) Packer means a person who packages a drug product.
    (j) Patient means any individual with respect to whom a drug product 
is intended to be, or has been, used.
    (k) Serious risk or serious adverse effect means an adverse drug 
experience, or the risk of such an experience, as that term is defined 
in Secs. 310.305, 312.32, 314.80, and 600.80 of this chapter.



         Subpart B--General Requirements for a Medication Guide



Sec. 208.20  Content and format of a Medication Guide.

    (a) A Medication Guide shall meet all of the following conditions:
    (1) The Medication Guide shall be written in English, in 
nontechnical, understandable language, and shall not be promotional in 
tone or content.
    (2) The Medication Guide shall be scientifically accurate and shall 
be based on, and shall not conflict with, the approved professional 
labeling for the drug product under Sec. 201.57 of this chapter, but the 
language of the Medication Guide need not be identical to the sections 
of approved labeling to which it corresponds.
    (3) The Medication Guide shall be specific and comprehensive.
    (4) The letter height or type size shall be no smaller than 10 
points (1 point = 0.0138 inches) for all sections of the Medication 
Guide, except the manufacturer's name and address and the revision date.
    (5) The Medication Guide shall be legible and clearly presented. 
Where appropriate, the Medication Guide shall also use boxes, bold or 
underlined print, or other highlighting techniques to emphasize specific 
portions of the text.
    (6) The words ``Medication Guide'' shall appear prominently at the 
top of the first page of a Medication Guide. The verbatim statement 
``This Medication Guide has been approved by the U.S. Food and Drug 
Administration'' shall appear at the bottom of a Medication Guide.
    (7) The brand and established or proper name of the drug product 
shall appear immediately below the words ``Medication Guide.'' The 
established or proper name shall be no less than one-half the height of 
the brand name.
    (b) A Medication Guide shall contain those of the following headings 
relevant to the drug product and to the need for the Medication Guide in 
the specified order. Each heading shall contain the specific information 
as follows:
    (1) The brand name (e.g., the trademark or proprietary name), if 
any, and established or proper name. Those products not having an 
established or proper name shall be designated by their active 
ingredients. The Medication Guide shall include the phonetic spelling of 
either the brand name or the established name, whichever is used 
throughout the Medication Guide.
    (2) The heading, ``What is the most important information I should 
know about (name of drug)?'' followed by a statement describing the 
particular serious and significant public health concern that has 
created the need for the Medication Guide. The statement should describe 
specifically what the patient should do or consider because of that 
concern, such as, weighing particular risks against the benefits of the 
drug, avoiding particular behaviors

[[Page 111]]

(e.g., activities, drugs), observing certain events (e.g., symptoms, 
signs) that could prevent or mitigate a serious adverse effect, or 
engaging in particular behaviors (e.g., adhering to the dosing regimen).
    (3) The heading, ``What is (name of drug)?'' followed by a section 
that identifies a drug product's indications for use. The Medication 
Guide may not identify an indication unless the indication is identified 
in the indications and usage section of the professional labeling for 
the product required under Sec. 201.57 of this chapter. In appropriate 
circumstances, this section may also explain the nature of the disease 
or condition the drug product is intended to treat, as well as the 
benefit(s) of treating the condition.
    (4) The heading, ``Who should not take (name of drug)?'' followed by 
information on circumstances under which the drug product should not be 
used for its labeled indication (its contraindications). The Medication 
Guide shall contain directions regarding what to do if any of the 
contraindications apply to a patient, such as contacting the licensed 
practitioner or discontinuing use of the drug product.
    (5) The heading, ``How should I take (name of drug)?'' followed by 
information on the proper use of the drug product, such as:
    (i) A statement stressing the importance of adhering to the dosing 
instructions, if this is particularly important;
    (ii) A statement describing any special instructions on how to 
administer the drug product, if they are important to the drug's safety 
or effectiveness;
    (iii) A statement of what patients should do in case of overdose of 
the drug product; and
    (iv) A statement of what patients should do if they miss taking a 
scheduled dose(s) of the drug product, where there are data to support 
the advice, and where the wrong behavior could cause harm or lack of 
effect.
    (6) The heading ``What should I avoid while taking (name of drug)?'' 
followed by a statement or statements of specific, important precautions 
patients should take to ensure proper use of the drug, including:
    (i) A statement that identifies activities (such as driving or 
sunbathing), and drugs, foods, or other substances (such as tobacco or 
alcohol) that patients should avoid when using the medication;
    (ii) A statement of the risks to mothers and fetuses from the use of 
the drug during pregnancy, if specific, important risks are known;
    (iii) A statement of the risks of the drug product to nursing 
infants, if specific, important risks are known;
    (iv) A statement about pediatric risks, if the drug product has 
specific hazards associated with its use in pediatric patients;
    (v) A statement about geriatric risks, if the drug product has 
specific hazards associated with its use in geriatric patients; and
    (vi) A statement of special precautions, if any, that apply to the 
safe and effective use of the drug product in other identifiable patient 
populations.
    (7) The heading, ``What are the possible or reasonably likely side 
effects of (name of drug)?'' followed by:
    (i) A statement of the adverse reactions reasonably likely to be 
caused by the drug product that are serious or occur frequently.
    (ii) A statement of the risk, if there is one, of patients' 
developing dependence on the drug product.
    (8) General information about the safe and effective use of 
prescription drug products, including:
    (i) The verbatim statement that ``Medicines are sometimes prescribed 
for purposes other than those listed in a Medication Guide'' followed by 
a statement that patients should ask health professionals about any 
concerns, and a reference to the availability of professional labeling;
    (ii) A statement that the drug product should not be used for a 
condition other than that for which it is prescribed, or given to other 
persons;
    (iii) The name and place of business of the manufacturer, packer, or 
distributor of a drug product that is not also a biological product, or 
the name and place of business of the manufacturer or distributor of a 
drug product that is also a biological product, and in any case the name 
and place of business of the dispenser of the product may also be 
included; and

[[Page 112]]

    (iv) The date, identified as such, of the most recent revision of 
the Medication Guide placed immediately after the last section.
    (9) Additional headings and subheadings may be interspersed 
throughout the Medication Guide, if appropriate.



Sec. 208.24  Distributing and dispensing a Medication Guide.

    (a) The manufacturer of a drug product for which a Medication Guide 
is required under this part shall obtain FDA approval of the Medication 
Guide before the Medication Guide may be distributed.
    (b) Each manufacturer who ships a container of drug product for 
which a Medication Guide is required under this part is responsible for 
ensuring that Medication Guides are available for distribution to 
patients by either:
    (1) Providing Medication Guides in sufficient numbers to 
distributors, packers, or authorized dispensers to permit the authorized 
dispenser to provide a Medication Guide to each patient receiving a 
prescription for the drug product; or
    (2) Providing the means to produce Medication Guides in sufficient 
numbers to distributors, packers, or authorized dispensers to permit the 
authorized dispenser to provide a Medication Guide to each patient 
receiving a prescription for the drug product.
    (c) Each distributor or packer that receives Medication Guides, or 
the means to produce Medication Guides, from a manufacturer under 
paragraph (b) of this section shall provide those Medication Guides, or 
the means to produce Medication Guides, to each authorized dispenser to 
whom it ships a container of drug product.
    (d) The label of each container or package, where the container 
label is too small, of drug product for which a Medication Guide is 
required under this part shall instruct the authorized dispenser to 
provide a Medication Guide to each patient to whom the drug product is 
dispensed, and shall state how the Medication Guide is provided. These 
statements shall appear on the label in a prominent and conspicuous 
manner.
    (e) Each authorized dispenser of a prescription drug product for 
which a Medication Guide is required under this part shall, when the 
product is dispensed to a patient (or to a patient's agent), provide a 
Medication Guide directly to each patient (or to the patient's agent) 
unless an exemption applies under Sec. 208.26.
    (f) An authorized dispenser or wholesaler is not subject to section 
510 of the Federal Food, Drug, and Cosmetic Act, which requires the 
registration of producers of drugs and the listing of drugs in 
commercial distribution, solely because of an act performed by the 
authorized dispenser or wholesaler under this part.



Sec. 208.26  Exemptions and deferrals.

    (a) FDA on its own initiative, or in response to a written request 
from an applicant, may exempt or defer any Medication Guide content or 
format requirement, except those requirements in Sec. 208.20 (a)(2) and 
(a)(6), on the basis that the requirement is inapplicable, unnecessary, 
or contrary to patients' best interests. Requests from applicants should 
be submitted to the director of the FDA division responsible for 
reviewing the marketing application for the drug product, or for a 
biological product, to the application division in the office with 
product responsibility.
    (b) If the licensed practitioner who prescribes a drug product 
subject to this part determines that it is not in a particular patient's 
best interest to receive a Medication Guide because of significant 
concerns about the effect of a Medication Guide, the licensed 
practitioner may direct that the Medication Guide not be provided to the 
particular patient. However, the authorized dispenser of a prescription 
drug product subject to this part shall provide a Medication Guide to 
any patient who requests information when the drug product is dispensed 
regardless of any such direction by the licensed practitioner.

[[Page 113]]



PART 210--CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL--Table of Contents




Sec.
210.1  Status of current good manufacturing practice regulations.
210.2  Applicability of current good manufacturing practice regulations.
210.3  Definitions.

    Authority: 21 U.S.C. 321, 351, 352, 355, 360b, 371, 374.

    Source: 43 FR 45076, Sept, 29, 1978, unless otherwise noted.



Sec. 210.1  Status of current good manufacturing practice regulations.

    (a) The regulations set forth in this part and in parts 211 through 
226 of this chapter contain the minimum current good manufacturing 
practice for methods to be used in, and the facilities or controls to be 
used for, the manufacture, processing, packing, or holding of a drug to 
assure that such drug meets the requirements of the act as to safety, 
and has the identity and strength and meets the quality and purity 
characteristics that it purports or is represented to possess.
    (b) The failure to comply with any regulation set forth in this part 
and in parts 211 through 226 of this chapter in the manufacture, 
processing, packing, or holding of a drug shall render such drug to be 
adulterated under section 501(a)(2)(B) of the act and such drug, as well 
as the person who is responsible for the failure to comply, shall be 
subject to regulatory action.



Sec. 210.2  Applicability of current good manufacturing practice regulations.

    (a) The regulations in this part and in parts 211 through 226 of 
this chapter as they may pertain to a drug and in parts 600 through 680 
of this chapter as they may pertain to a biological product for human 
use, shall be considered to supplement, not supersede, each other, 
unless the regulations explicitly provide otherwise. In the event that 
it is impossible to comply with all applicable regulations in these 
parts, the regulations specifically applicable to the drug in question 
shall supersede the more general.
    (b) If a person engages in only some operations subject to the 
regulations in this part and in parts 211 through 226 and parts 600 
through 680 of this chapter, and not in others, that person need only 
comply with those regulations applicable to the operations in which he 
or she is engaged.



 Sec. 210.3  Definitions.

    (a) The definitions and interpretations contained in section 201 of 
the act shall be applicable to such terms when used in this part and in 
parts 211 through 226 of this chapter.
    (b) The following definitions of terms apply to this part and to 
parts 211 through 226 of this chapter.
    (1) Act means the Federal Food, Drug, and Cosmetic Act, as amended 
(21 U.S.C. 301 et seq.).
    (2) Batch means a specific quantity of a drug or other material that 
is intended to have uniform character and quality, within specified 
limits, and is produced according to a single manufacturing order during 
the same cycle of manufacture.
    (3) Component means any ingredient intended for use in the 
manufacture of a drug product, including those that may not appear in 
such drug product.
    (4) Drug product means a finished dosage form, for example, tablet, 
capsule, solution, etc., that contains an active drug ingredient 
generally, but not necessarily, in association with inactive 
ingredients. The term also includes a finished dosage form that does not 
contain an active ingredient but is intended to be used as a placebo.
    (5) Fiber means any particulate contaminant with a length at least 
three times greater than its width.
    (6) Non-fiber-releasing filter means any filter, which after any 
appropriate pretreatment such as washing or flushing, will not release 
fibers into the component or drug product that is being filtered. All 
filters composed of asbestos are deemed to be fiber-releasing filters.
    (7) Active ingredient means any component that is intended to 
furnish pharmacological activity or other direct effect in the 
diagnosis, cure, mitigation, treatment, or prevention of disease, or to 
affect the structure or any function of the body of man or other

[[Page 114]]

animals. The term includes those components that may undergo chemical 
change in the manufacture of the drug product and be present in the drug 
product in a modified form intended to furnish the specified activity or 
effect.
    (8) Inactive ingredient means any component other than an active 
ingredient.
    (9) In-process material means any material fabricated, compounded, 
blended, or derived by chemical reaction that is produced for, and used 
in, the preparation of the drug product.
    (10) Lot means a batch, or a specific identified portion of a batch, 
having uniform character and quality within specified limits; or, in the 
case of a drug product produced by continuous process, it is a specific 
identified amount produced in a unit of time or quantity in a manner 
that assures its having uniform character and quality within specified 
limits.
    (11) Lot number, control number, or batch number means any 
distinctive combination of letters, numbers, or symbols, or any 
combination of them, from which the complete history of the manufacture, 
processing, packing, holding, and distribution of a batch or lot of drug 
product or other material can be determined.
    (12) Manufacture, processing, packing, or holding of a drug product 
includes packaging and labeling operations, testing, and quality control 
of drug products.
    (13) The term medicated feed means any Type B or Type C medicated 
feed as defined in Sec. 558.3 of this chapter. The feed contains one or 
more drugs as defined in section 201(g) of the act. The manufacture of 
medicated feeds is subject to the requirements of part 225 of this 
chapter.
    (14) The term medicated premix means a Type A medicated article as 
defined in Sec. 558.3 of this chapter. The article contains one or more 
drugs as defined in section 201(g) of the act. The manufacture of 
medicated premixes is subject to the requirements of part 226 of this 
chapter.
    (15) Quality control unit means any person or organizational element 
designated by the firm to be responsible for the duties relating to 
quality control.
    (16) Strength means:
    (i) The concentration of the drug substance (for example, weight/
weight, weight/volume, or unit dose/volume basis), and/or
    (ii) The potency, that is, the therapeutic activity of the drug 
product as indicated by appropriate laboratory tests or by adequately 
developed and controlled clinical data (expressed, for example, in terms 
of units by reference to a standard).
    (17) Theoretical yield means the quantity that would be produced at 
any appropriate phase of manufacture, processing, or packing of a 
particular drug product, based upon the quantity of components to be 
used, in the absence of any loss or error in actual production.
    (18) Actual yield means the quantity that is actually produced at 
any appropriate phase of manufacture, processing, or packing of a 
particular drug product.
    (19) Percentage of theoretical yield means the ratio of the actual 
yield (at any appropriate phase of manufacture, processing, or packing 
of a particular drug product) to the theoretical yield (at the same 
phase), stated as a percentage.
    (20) Acceptance criteria means the product specifications and 
acceptance/rejection criteria, such as acceptable quality level and 
unacceptable quality level, with an associated sampling plan, that are 
necessary for making a decision to accept or reject a lot or batch (or 
any other convenient subgroups of manufactured units).
    (21) Representative sample means a sample that consists of a number 
of units that are drawn based on rational criteria such as random 
sampling and intended to assure that the sample accurately portrays the 
material being sampled.
    (22) Gang-printed labeling means labeling derived from a sheet of 
material on which more than one item of labeling is printed.

[43 FR 45076, Sept. 29, 1978, as amended at 51 FR 7389, Mar. 3, 1986; 58 
FR 41353, Aug. 3, 1993]

[[Page 115]]



PART 211--CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS--Table of Contents




                      Subpart A--General Provisions

Sec.
211.1  Scope.
211.3  Definitions.

                  Subpart B--Organization and Personnel

211.22  Responsibilities of quality control unit.
211.25  Personnel qualifications.
211.28  Personnel responsibilities.
211.34  Consultants.

                   Subpart C--Buildings and Facilities

211.42  Design and construction features.
211.44  Lighting.
211.46  Ventilation, air filtration, air heating and cooling.
211.48  Plumbing.
211.50  Sewage and refuse.
211.52  Washing and toilet facilities.
211.56  Sanitation.
211.58  Maintenance.

                          Subpart D--Equipment

211.63  Equipment design, size, and location.
211.65  Equipment construction.
211.67  Equipment cleaning and maintenance.
211.68  Automatic, mechanical, and electronic equipment.
211.72  Filters.

    Subpart E--Control of Components and Drug Product Containers and 
                                Closures

211.80  General requirements.
211.82  Receipt and storage of untested components, drug product 
          containers, and closures.
211.84  Testing and approval or rejection of components, drug product 
          containers, and closures.
211.86  Use of approved components, drug product containers, and 
          closures.
211.87  Retesting of approved components, drug product containers, and 
          closures.
211.89  Rejected components, drug product containers, and closures.
211.94  Drug product containers and closures.

               Subpart F--Production and Process Controls

211.100  Written procedures; deviations.
211.101  Charge-in of components.
211.103  Calculation of yield.
211.105  Equipment identification.
211.110  Sampling and testing of in-process materials and drug products.
211.111  Time limitations on production.
211.113  Control of microbiological contamination.
211.115  Reproccessing.

                Subpart G--Packaging and Labeling Control

211.122  Materials examination and usage criteria.
211.125  Labeling issuance.
211.130  Packaging and labeling operations.
211.132  Tamper-evident packaging requirements for over-the-counter 
          (OTC) human drug products.
211.134  Drug product inspection.
211.137  Expiration dating.

                   Subpart H--Holding and Distribution

211.142  Warehousing procedures.
211.150  Distribution procedures.

                     Subpart I--Laboratory Controls

211.160  General requirements.
211.165  Testing and release for distribution.
211.166  Stability testing.
211.167  Special testing requirements.
211.170  Reserve samples.
211.173  Laboratory animals.
211.176  Penicillin contamination.

                     Subpart J--Records and Reports

211.180  General requirements.
211.182  Equipment cleaning and use log.
211.184  Component, drug product container, closure, and labeling 
          records.
211.186  Master production and control records.
211.188  Batch production and control records.
211.192  Production record review.
211.194  Laboratory records.
211.196  Distribution records.
211.198  Complaint files.

             Subpart K--Returned and Salvaged Drug Products

211.204  Returned drug products.
211.208  Drug product salvaging.

    Authority: 21 U.S.C. 321, 351, 352, 355, 360b, 371, 374.

    Source: 43 FR 45077, Sept. 29, 1978, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 211.1  Scope.

    (a) The regulations in this part contain the minimum current good 
manufacturing practice for preparation of

[[Page 116]]

drug products for administration to humans or animals.
    (b) The current good manufacturing practice regulations in this 
chapter, as they pertain to drug products, and in parts 600 through 680 
of this chapter, as they pertain to biological products for human use, 
shall be considered to supplement, not supersede, the regulations in 
this part unless the regulations explicitly provide otherwise. In the 
event it is impossible to comply with applicable regulations both in 
this part and in other parts of this chapter or in parts 600 through 680 
of this chapter, the regulation specifically applicable to the drug 
product in question shall supersede the regulation in this part.
    (c) Pending consideration of a proposed exemption, published in the 
Federal Register of September 29, 1978, the requirements in this part 
shall not be enforced for OTC drug products if the products and all 
their ingredients are ordinarily marketed and consumed as human foods, 
and which products may also fall within the legal definition of drugs by 
virtue of their intended use. Therefore, until further notice, 
regulations under part 110 of this chapter, and where applicable, parts 
113 to 129 of this chapter, shall be applied in determining whether 
these OTC drug products that are also foods are manufactured, processed, 
packed, or held under current good manufacturing practice.

[43 FR 45077, Sept. 29, 1978, as amended at 62 FR 66522, Dec. 19, 1997]



Sec. 211.3  Definitions.

    The definitions set forth in Sec. 210.3 of this chapter apply in 
this part.



                  Subpart B--Organization and Personnel



Sec. 211.22  Responsibilities of quality control unit.

    (a) There shall be a quality control unit that shall have the 
responsibility and authority to approve or reject all components, drug 
product containers, closures, in-process materials, packaging material, 
labeling, and drug products, and the authority to review production 
records to assure that no errors have occurred or, if errors have 
occurred, that they have been fully investigated. The quality control 
unit shall be responsible for approving or rejecting drug products 
manufactured, processed, packed, or held under contract by another 
company.
    (b) Adequate laboratory facilities for the testing and approval (or 
rejection) of components, drug product containers, closures, packaging 
materials, in-process materials, and drug products shall be available to 
the quality control unit.
    (c) The quality control unit shall have the responsibility for 
approving or rejecting all procedures or specifications impacting on the 
identity, strength, quality, and purity of the drug product.
    (d) The responsibilities and procedures applicable to the quality 
control unit shall be in writing; such written procedures shall be 
followed.



Sec. 211.25  Personnel qualifications.

    (a) Each person engaged in the manufacture, processing, packing, or 
holding of a drug product shall have education, training, and 
experience, or any combination thereof, to enable that person to perform 
the assigned functions. Training shall be in the particular operations 
that the employee performs and in current good manufacturing practice 
(including the current good manufacturing practice regulations in this 
chapter and written procedures required by these regulations) as they 
relate to the employee's functions. Training in current good 
manufacturing practice shall be conducted by qualified individuals on a 
continuing basis and with sufficient frequency to assure that employees 
remain familiar with CGMP requirements applicable to them.
    (b) Each person responsible for supervising the manufacture, 
processing, packing, or holding of a drug product shall have the 
education, training, and experience, or any combination thereof, to 
perform assigned functions in such a manner as to provide assurance that 
the drug product has the safety, identity, strength, quality, and purity 
that it purports or is represented to possess.
    (c) There shall be an adequate number of qualified personnel to 
perform

[[Page 117]]

and supervise the manufacture, processing, packing, or holding of each 
drug product.



Sec. 211.28  Personnel responsibilities.

    (a) Personnel engaged in the manufacture, processing, packing, or 
holding of a drug product shall wear clean clothing appropriate for the 
duties they perform. Protective apparel, such as head, face, hand, and 
arm coverings, shall be worn as necessary to protect drug products from 
contamination.
    (b) Personnel shall practice good sanitation and health habits.
    (c) Only personnel authorized by supervisory personnel shall enter 
those areas of the buildings and facilities designated as limited-access 
areas.
    (d) Any person shown at any time (either by medical examination or 
supervisory observation) to have an apparent illness or open lesions 
that may adversely affect the safety or quality of drug products shall 
be excluded from direct contact with components, drug product 
containers, closures, in-process materials, and drug products until the 
condition is corrected or determined by competent medical personnel not 
to jeopardize the safety or quality of drug products. All personnel 
shall be instructed to report to supervisory personnel any health 
conditions that may have an adverse effect on drug products.



Sec. 211.34  Consultants.

    Consultants advising on the manufacture, processing, packing, or 
holding of drug products shall have sufficient education, training, and 
experience, or any combination thereof, to advise on the subject for 
which they are retained. Records shall be maintained stating the name, 
address, and qualifications of any consultants and the type of service 
they provide.



                   Subpart C--Buildings and Facilities



Sec. 211.42  Design and construction features.

    (a) Any building or buildings used in the manufacture, processing, 
packing, or holding of a drug product shall be of suitable size, 
construction and location to facilitate cleaning, maintenance, and 
proper operations.
    (b) Any such building shall have adequate space for the orderly 
placement of equipment and materials to prevent mixups between different 
components, drug product containers, closures, labeling, in-process 
materials, or drug products, and to prevent contamination. The flow of 
components, drug product containers, closures, labeling, in-process 
materials, and drug products through the building or buildings shall be 
designed to prevent contamination.
    (c) Operations shall be performed within specifically defined areas 
of adequate size. There shall be separate or defined areas or such other 
control systems for the firm's operations as are necessary to prevent 
contamination or mixups during the course of the following procedures:
    (1) Receipt, identification, storage, and withholding from use of 
components, drug product containers, closures, and labeling, pending the 
appropriate sampling, testing, or examination by the quality control 
unit before release for manufacturing or packaging;
    (2) Holding rejected components, drug product containers, closures, 
and labeling before disposition;
    (3) Storage of released components, drug product containers, 
closures, and labeling;
    (4) Storage of in-process materials;
    (5) Manufacturing and processing operations;
    (6) Packaging and labeling operations;
    (7) Quarantine storage before release of drug products;
    (8) Storage of drug products after release;
    (9) Control and laboratory operations;
    (10) Aseptic processing, which includes as appropriate:
    (i) Floors, walls, and ceilings of smooth, hard surfaces that are 
easily cleanable;
    (ii) Temperature and humidity controls;
    (iii) An air supply filtered through high-efficiency particulate air 
filters under positive pressure, regardless of whether flow is laminar 
or nonlaminar;
    (iv) A system for monitoring environmental conditions;

[[Page 118]]

    (v) A system for cleaning and disinfecting the room and equipment to 
produce aseptic conditions;
    (vi) A system for maintaining any equipment used to control the 
aseptic conditions.
    (d) Operations relating to the manufacture, processing, and packing 
of penicillin shall be performed in facilities separate from those used 
for other drug products for human use.

[43 FR 45077, Sept. 29, 1978, as amended at 60 FR 4091, Jan. 20, 1995]



Sec. 211.44  Lighting.

    Adequate lighting shall be provided in all areas.



Sec. 211.46  Ventilation, air filtration, air heating and cooling.

    (a) Adequate ventilation shall be provided.
    (b) Equipment for adequate control over air pressure, micro-
organisms, dust, humidity, and temperature shall be provided when 
appropriate for the manufacture, processing, packing, or holding of a 
drug product.
    (c) Air filtration systems, including prefilters and particulate 
matter air filters, shall be used when appropriate on air supplies to 
production areas. If air is recirculated to production areas, measures 
shall be taken to control recirculation of dust from production. In 
areas where air contamination occurs during production, there shall be 
adequate exhaust systems or other systems adequate to control 
contaminants.
    (d) Air-handling systems for the manufacture, processing, and 
packing of penicillin shall be completely separate from those for other 
drug products for human use.



Sec. 211.48  Plumbing.

    (a) Potable water shall be supplied under continuous positive 
pressure in a plumbing system free of defects that could contribute 
contamination to any drug product. Potable water shall meet the 
standards prescribed in the Environmental Protection Agency's Primary 
Drinking Water Regulations set forth in 40 CFR part 141. Water not 
meeting such standards shall not be permitted in the potable water 
system.
    (b) Drains shall be of adequate size and, where connected directly 
to a sewer, shall be provided with an air break or other mechanical 
device to prevent back-siphonage.

[43 FR 45077, Sept. 29, 1978, as amended at 48 FR 11426, Mar. 18, 1983]



Sec. 211.50  Sewage and refuse.

    Sewage, trash, and other refuse in and from the building and 
immediate premises shall be disposed of in a safe and sanitary manner.



Sec. 211.52  Washing and toilet facilities.

    Adequate washing facilities shall be provided, including hot and 
cold water, soap or detergent, air driers or single-service towels, and 
clean toilet facilities easily accesible to working areas.



Sec. 211.56  Sanitation.

    (a) Any building used in the manufacture, processing, packing, or 
holding of a drug product shall be maintained in a clean and sanitary 
condition, Any such building shall be free of infestation by rodents, 
birds, insects, and other vermin (other than laboratory animals). Trash 
and organic waste matter shall be held and disposed of in a timely and 
sanitary manner.
    (b) There shall be written procedures assigning responsibility for 
sanitation and describing in sufficient detail the cleaning schedules, 
methods, equipment, and materials to be used in cleaning the buildings 
and facilities; such written procedures shall be followed.
    (c) There shall be written procedures for use of suitable 
rodenticides, insecticides, fungicides, fumigating agents, and cleaning 
and sanitizing agents. Such written procedures shall be designed to 
prevent the contamination of equipment, components, drug product 
containers, closures, packaging, labeling materials, or drug products 
and shall be followed. Rodenticides, insecticides, and fungicides shall 
not be used unless registered and used in accordance with the Federal 
Insecticide, Fungicide, and Rodenticide Act (7 U.S.C. 135).
    (d) Sanitation procedures shall apply to work performed by 
contractors or temporary employees as well as work

[[Page 119]]

performed by full-time employees during the ordinary course of 
operations.



Sec. 211.58  Maintenance.

    Any building used in the manufacture, processing, packing, or 
holding of a drug product shall be maintained in a good state of repair.



                          Subpart D--Equipment



Sec. 211.63  Equipment design, size, and location.

    Equipment used in the manufacture, processing, packing, or holding 
of a drug product shall be of appropriate design, adequate size, and 
suitably located to facilitate operations for its intended use and for 
its cleaning and maintenance.



Sec. 211.65  Equipment construction.

    (a) Equipment shall be constructed so that surfaces that contact 
components, in-process materials, or drug products shall not be 
reactive, additive, or absorptive so as to alter the safety, identity, 
strength, quality, or purity of the drug product beyond the official or 
other established requirements.
    (b) Any substances required for operation, such as lubricants or 
coolants, shall not come into contact with components, drug product 
containers, closures, in-process materials, or drug products so as to 
alter the safety, identity, strength, quality, or purity of the drug 
product beyond the official or other established requirements.



Sec. 211.67  Equipment cleaning and maintenance.

    (a) Equipment and utensils shall be cleaned, maintained, and 
sanitized at appropriate intervals to prevent malfunctions or 
contamination that would alter the safety, identity, strength, quality, 
or purity of the drug product beyond the official or other established 
requirements.
    (b) Written procedures shall be established and followed for 
cleaning and maintenance of equipment, including utensils, used in the 
manufacture, processing, packing, or holding of a drug product. These 
procedures shall include, but are not necessarily limited to, the 
following:
    (1) Assignment of responsibility for cleaning and maintaining 
equipment;
    (2) Maintenance and cleaning schedules, including, where 
appropriate, sanitizing schedules;
    (3) A description in sufficient detail of the methods, equipment, 
and materials used in cleaning and maintenance operations, and the 
methods of disassembling and reassembling equipment as necessary to 
assure proper cleaning and maintenance;
    (4) Removal or obliteration of previous batch identification;
    (5) Protection of clean equipment from contamination prior to use;
    (6) Inspection of equipment for cleanliness immediately before use.
    (c) Records shall be kept of maintenance, cleaning, sanitizing, and 
inspection as specified in Secs. 211.180 and 211.182.



Sec. 211.68  Automatic, mechanical, and electronic equipment.

    (a) Automatic, mechanical, or electronic equipment or other types of 
equipment, including computers, or related systems that will perform a 
function satisfactorily, may be used in the manufacture, processing, 
packing, and holding of a drug product. If such equipment is so used, it 
shall be routinely calibrated, inspected, or checked according to a 
written program designed to assure proper performance. Written records 
of those calibration checks and inspections shall be maintained.
    (b) Appropriate controls shall be exercised over computer or related 
systems to assure that changes in master production and control records 
or other records are instituted only by authorized personnel. Input to 
and output from the computer or related system of formulas or other 
records or data shall be checked for accuracy. The degree and frequency 
of input/output verification shall be based on the complexity and 
reliability of the computer or related system. A backup file of data 
entered into the computer or related system shall be maintained except 
where certain data, such as calculations performed in connection with 
laboratory analysis, are eliminated by computerization or other 
automated processes. In such instances a written

[[Page 120]]

record of the program shall be maintained along with appropriate 
validation data. Hard copy or alternative systems, such as duplicates, 
tapes, or microfilm, designed to assure that backup data are exact and 
complete and that it is secure from alteration, inadvertent erasures, or 
loss shall be maintained.

[43 FR 45077, Sept. 29, 1978, as amended at 60 FR 4091, Jan. 20, 1995]



Sec. 211.72  Filters.

    Filters for liquid filtration used in the manufacture, processing, 
or packing of injectable drug products intended for human use shall not 
release fibers into such products. Fiber-releasing filters may not be 
used in the manufacture, processing, or packing of these injectable drug 
products unless it is not possible to manufacture such drug products 
without the use of such filters. If use of a fiber-releasing filter is 
necessary, an additional non-fiber-releasing filter of 0.22 micron 
maximum mean porosity (0.45 micron if the manufacturing conditions so 
dictate) shall subsequently be used to reduce the content of particles 
in the injectable drug product. Use of an asbestos-containing filter, 
with or without subsequent use of a specific non-fiber-releasing filter, 
is permissible only upon submission of proof to the appropriate bureau 
of the Food and Drug Administration that use of a non-fiber-releasing 
filter will, or is likely to, compromise the safety or effectiveness of 
the injectable drug product.



    Subpart E--Control of Components and Drug Product Containers and 
                                Closures



Sec. 211.80  General requirements.

    (a) There shall be written procedures describing in sufficient 
detail the receipt, identification, storage, handling, sampling, 
testing, and approval or rejection of components and drug product 
containers and closures; such written procedures shall be followed.
    (b) Components and drug product containers and closures shall at all 
times be handled and stored in a manner to prevent contamination.
    (c) Bagged or boxed components of drug product containers, or 
closures shall be stored off the floor and suitably spaced to permit 
cleaning and inspection.
    (d) Each container or grouping of containers for components or drug 
product containers, or closures shall be identified with a distinctive 
code for each lot in each shipment received. This code shall be used in 
recording the disposition of each lot. Each lot shall be appropriately 
identified as to its status (i.e., quarantined, approved, or rejected).



Sec. 211.82  Receipt and storage of untested components, drug product containers, and closures.

    (a) Upon receipt and before acceptance, each container or grouping 
of containers of components, drug product containers, and closures shall 
be examined visually for appropriate labeling as to contents, container 
damage or broken seals, and contamination.
    (b) Components, drug product containers, and closures shall be 
stored under quarantine until they have been tested or examined, as 
appropriate, and released. Storage within the area shall conform to the 
requirements of Sec. 211.80.



Sec. 211.84  Testing and approval or rejection of components, drug product containers, and closures.

    (a) Each lot of components, drug product containers, and closures 
shall be withheld from use until the lot has been sampled, tested, or 
examined, as appropriate, and released for use by the quality control 
unit.
    (b) Representative samples of each shipment of each lot shall be 
collected for testing or examination. The number of containers to be 
sampled, and the amount of material to be taken from each container, 
shall be based upon appropriate criteria such as statistical criteria 
for component variability, confidence levels, and degree of precision 
desired, the past quality history of the supplier, and the quantity 
needed for analysis and reserve where required by Sec. 211.170.
    (c) Samples shall be collected in accordance with the following 
procedures:

[[Page 121]]

    (1) The containers of components selected shall be cleaned where 
necessary, by appropriate means.
    (2) The containers shall be opened, sampled, and resealed in a 
manner designed to prevent contamination of their contents and 
contamination of other components, drug product containers, or closures.
    (3) Sterile equipment and aseptic sampling techniques shall be used 
when necessary.
    (4) If it is necessary to sample a component from the top, middle, 
and bottom of its container, such sample subdivisions shall not be 
composited for testing.
    (5) Sample containers shall be identified so that the following 
information can be determined: name of the material sampled, the lot 
number, the container from which the sample was taken, the date on which 
the sample was taken, and the name of the person who collected the 
sample.
    (6) Containers from which samples have been taken shall be marked to 
show that samples have been removed from them.
    (d) Samples shall be examined and tested as follows:
    (1) At least one test shall be conducted to verify the identity of 
each component of a drug product. Specific identity tests, if they 
exist, shall be used.
    (2) Each component shall be tested for conformity with all 
appropriate written specifications for purity, strength, and quality. In 
lieu of such testing by the manufacturer, a report of analysis may be 
accepted from the supplier of a component, provided that at least one 
specific identity test is conducted on such component by the 
manufacturer, and provided that the manufacturer establishes the 
reliability of the supplier's analyses through appropriate validation of 
the supplier's test results at appropriate intervals.
    (3) Containers and closures shall be tested for conformance with all 
appropriate written procedures. In lieu of such testing by the 
manufacturer, a certificate of testing may be accepted from the 
supplier, provided that at least a visual identification is conducted on 
such containers/closures by the manufacturer and provided that the 
manufacturer establishes the reliability of the supplier's test results 
through appropriate validation of the supplier's test results at 
appropriate intervals.
    (4) When appropriate, components shall be microscopically examined.
    (5) Each lot of a component, drug product container, or closure that 
is liable to contamination with filth, insect infestation, or other 
extraneous adulterant shall be examined against established 
specifications for such contamination.
    (6) Each lot of a component, drug product container, or closure that 
is liable to microbiological contamination that is objectionable in view 
of its intended use shall be subjected to microbiological tests before 
use.
    (e) Any lot of components, drug product containers, or closures that 
meets the appropriate written specifications of identity, strength, 
quality, and purity and related tests under paragraph (d) of this 
section may be approved and released for use. Any lot of such material 
that does not meet such specifications shall be rejected.

[43 FR 45077, Sept. 29, 1978, as amended at 63 FR 14356, Mar. 25, 1998]



Sec. 211.86  Use of approved components, drug product containers, and closures.

    Components, drug product containers, and closures approved for use 
shall be rotated so that the oldest approved stock is used first. 
Deviation from this requirement is permitted if such deviation is 
temporary and appropriate.



Sec. 211.87  Retesting of approved components, drug product containers, and closures.

    Components, drug product containers, and closures shall be retested 
or reexamined, as appropriate, for identity, strength, quality, and 
purity and approved or rejected by the quality control unit in 
accordance with Sec. 211.84 as necessary, e.g., after storage for long 
periods or after exposure to air, heat or other conditions that might 
adversely affect the component, drug product container, or closure.

[[Page 122]]



Sec. 211.89  Rejected components, drug product containers, and closures.

    Rejected components, drug product containers, and closures shall be 
identified and controlled under a quarantine system designed to prevent 
their use in manufacturing or processing operations for which they are 
unsuitable.



Sec. 211.94  Drug product containers and closures.

    (a) Drug product containers and closures shall not be reactive, 
additive, or absorptive so as to alter the safety, identity, strength, 
quality, or purity of the drug beyond the official or established 
requirements.
    (b) Container closure systems shall provide adequate protection 
against foreseeable external factors in storage and use that can cause 
deterioration or contamination of the drug product.
    (c) Drug product containers and closures shall be clean and, where 
indicated by the nature of the drug, sterilized and processed to remove 
pyrogenic properties to assure that they are suitable for their intended 
use.
    (d) Standards or specifications, methods of testing, and, where 
indicated, methods of cleaning, sterilizing, and processing to remove 
pyrogenic properties shall be written and followed for drug product 
containers and closures.



               Subpart F--Production and Process Controls



Sec. 211.100  Written procedures; deviations.

    (a) There shall be written procedures for production and process 
control designed to assure that the drug products have the identity, 
strength, quality, and purity they purport or are represented to 
possess. Such procedures shall include all requirements in this subpart. 
These written procedures, including any changes, shall be drafted, 
reviewed, and approved by the appropriate organizational units and 
reviewed and approved by the quality control unit.
    (b) Written production and process control procedures shall be 
followed in the execution of the various production and process control 
functions and shall be documented at the time of performance. Any 
deviation from the written procedures shall be recorded and justified.



Sec. 211.101  Charge-in of components.

    Written production and control procedures shall include the 
following, which are designed to assure that the drug products produced 
have the identity, strength, quality, and purity they purport or are 
represented to possess:
    (a) The batch shall be formulated with the intent to provide not 
less than 100 percent of the labeled or established amount of active 
ingredient.
    (b) Components for drug product manufacturing shall be weighed, 
measured, or subdivided as appropriate. If a component is removed from 
the original container to another, the new container shall be identified 
with the following information:
    (1) Component name or item code;
    (2) Receiving or control number;
    (3) Weight or measure in new container;
    (4) Batch for which component was dispensed, including its product 
name, strength, and lot number.
    (c) Weighing, measuring, or subdividing operations for components 
shall be adequately supervised. Each container of component dispensed to 
manufacturing shall be examined by a second person to assure that:
    (1) The component was released by the quality control unit;
    (2) The weight or measure is correct as stated in the batch 
production records;
    (3) The containers are properly identified.
    (d) Each component shall be added to the batch by one person and 
verified by a second person.



Sec. 211.103  Calculation of yield.

    Actual yields and percentages of theoretical yield shall be 
determined at the conclusion of each appropriate phase of manufacturing, 
processing, packaging, or holding of the drug product. Such calculations 
shall be performed by one person and independently verified by a second 
person.

[[Page 123]]



Sec. 211.105  Equipment identification.

    (a) All compounding and storage containers, processing lines, and 
major equipment used during the production of a batch of a drug product 
shall be properly identified at all times to indicate their contents 
and, when necessary, the phase of processing of the batch.
    (b) Major equipment shall be identified by a distinctive 
identification number or code that shall be recorded in the batch 
production record to show the specific equipment used in the manufacture 
of each batch of a drug product. In cases where only one of a particular 
type of equipment exists in a manufacturing facility, the name of the 
equipment may be used in lieu of a distinctive identification number or 
code.



Sec. 211.110  Sampling and testing of in-process materials and drug products.

    (a) To assure batch uniformity and integrity of drug products, 
written procedures shall be established and followed that describe the 
in-process controls, and tests, or examinations to be conducted on 
appropriate samples of in-process materials of each batch. Such control 
procedures shall be established to monitor the output and to validate 
the performance of those manufacturing processes that may be responsible 
for causing variability in the characteristics of in-process material 
and the drug product. Such control procedures shall include, but are not 
limited to, the following, where appropriate:
    (1) Tablet or capsule weight variation;
    (2) Disintegration time;
    (3) Adequacy of mixing to assure uniformity and homogeneity;
    (4) Dissolution time and rate;
    (5) Clarity, completeness, or pH of solutions.
    (b) Valid in-process specifications for such characteristics shall 
be consistent with drug product final specifications and shall be 
derived from previous acceptable process average and process variability 
estimates where possible and determined by the application of suitable 
statistical procedures where appropriate. Examination and testing of 
samples shall assure that the drug product and in-process material 
conform to specifications.
    (c) In-process materials shall be tested for identity, strength, 
quality, and purity as appropriate, and approved or rejected by the 
quality control unit, during the production process, e.g., at 
commencement or completion of significant phases or after storage for 
long periods.
    (d) Rejected in-process materials shall be identified and controlled 
under a quarantine system designed to prevent their use in manufacturing 
or processing operations for which they are unsuitable.



Sec. 211.111  Time limitations on production.

    When appropriate, time limits for the completion of each phase of 
production shall be established to assure the quality of the drug 
product. Deviation from established time limits may be acceptable if 
such deviation does not compromise the quality of the drug product. Such 
deviation shall be justified and documented.



Sec. 211.113  Control of microbiological contamination.

    (a) Appropriate written procedures, designed to prevent 
objectionable microorganisms in drug products not required to be 
sterile, shall be established and followed.
    (b) Appropriate written procedures, designed to prevent 
microbiological contamination of drug products purporting to be sterile, 
shall be established and followed. Such procedures shall include 
validation of any sterilization process.



Sec. 211.115  Reprocessing.

    (a) Written procedures shall be established and followed prescribing 
a system for reprocessing batches that do not conform to standards or 
specifications and the steps to be taken to insure that the reprocessed 
batches will conform with all established standards, specifications, and 
characteristics.
    (b) Reprocessing shall not be performed without the review and 
approval of the quality control unit.

[[Page 124]]



                Subpart G--Packaging and Labeling Control



Sec. 211.122  Materials examination and usage criteria.

    (a) There shall be written procedures describing in sufficient 
detail the receipt, identification, storage, handling, sampling, 
examination, and/or testing of labeling and packaging materials; such 
written procedures shall be followed. Labeling and packaging materials 
shall be representatively sampled, and examined or tested upon receipt 
and before use in packaging or labeling of a drug product.
    (b) Any labeling or packaging materials meeting appropriate written 
specifications may be approved and released for use. Any labeling or 
packaging materials that do not meet such specifications shall be 
rejected to prevent their use in operations for which they are 
unsuitable.
    (c) Records shall be maintained for each shipment received of each 
different labeling and packaging material indicating receipt, 
examination or testing, and whether accepted or rejected.
    (d) Labels and other labeling materials for each different drug 
product, strength, dosage form, or quantity of contents shall be stored 
separately with suitable identification. Access to the storage area 
shall be limited to authorized personnel.
    (e) Obsolete and outdated labels, labeling, and other packaging 
materials shall be destroyed.
    (f) Use of gang-printed labeling for different drug products, or 
different strengths or net contents of the same drug product, is 
prohibited unless the labeling from gang-printed sheets is adequately 
differentiated by size, shape, or color.
    (g) If cut labeling is used, packaging and labeling operations shall 
include one of the following special control procedures:
    (1) Dedication of labeling and packaging lines to each different 
strength of each different drug product;
    (2) Use of appropriate electronic or electromechanical equipment to 
conduct a 100-percent examination for correct labeling during or after 
completion of finishing operations; or
    (3) Use of visual inspection to conduct a 100-percent examination 
for correct labeling during or after completion of finishing operations 
for hand-applied labeling. Such examination shall be performed by one 
person and independently verified by a second person.
    (h) Printing devices on, or associated with, manufacturing lines 
used to imprint labeling upon the drug product unit label or case shall 
be monitored to assure that all imprinting conforms to the print 
specified in the batch production record.

[43 FR 45077, Sept. 29, 1978, as amended at 58 FR 41353, Aug. 3, 1993]



Sec. 211.125  Labeling issuance.

    (a) Strict control shall be exercised over labeling issued for use 
in drug product labeling operations.
    (b) Labeling materials issued for a batch shall be carefully 
examined for identity and conformity to the labeling specified in the 
master or batch production records.
    (c) Procedures shall be used to reconcile the quantities of labeling 
issued, used, and returned, and shall require evaluation of 
discrepancies found between the quantity of drug product finished and 
the quantity of labeling issued when such discrepancies are outside 
narrow preset limits based on historical operating data. Such 
discrepancies shall be investigated in accordance with Sec. 211.192. 
Labeling reconciliation is waived for cut or roll labeling if a 100-
percent examination for correct labeling is performed in accordance with 
Sec. 211.122(g)(2).
    (d) All excess labeling bearing lot or control numbers shall be 
destroyed.
    (e) Returned labeling shall be maintained and stored in a manner to 
prevent mixups and provide proper identification.
    (f) Procedures shall be written describing in sufficient detail the 
control procedures employed for the issuance of labeling; such written 
procedures shall be followed.

[43 FR 45077, Sept. 29, 1978, as amended at 58 FR 41354, Aug. 3, 1993]

[[Page 125]]



Sec. 211.130  Packaging and labeling operations.

    There shall be written procedures designed to assure that correct 
labels, labeling, and packaging materials are used for drug products; 
such written procedures shall be followed. These procedures shall 
incorporate the following features:
    (a) Prevention of mixups and cross-contamination by physical or 
spatial separation from operations on other drug products.
    (b) Identification and handling of filled drug product containers 
that are set aside and held in unlabeled condition for future labeling 
operations to preclude mislabeling of individual containers, lots, or 
portions of lots. Identification need not be applied to each individual 
container but shall be sufficient to determine name, strength, quantity 
of contents, and lot or control number of each container.
    (c) Identification of the drug product with a lot or control number 
that permits determination of the history of the manufacture and control 
of the batch.
    (d) Examination of packaging and labeling materials for suitability 
and correctness before packaging operations, and documentation of such 
examination in the batch production record.
    (e) Inspection of the packaging and labeling facilities immediately 
before use to assure that all drug products have been removed from 
previous operations. Inspection shall also be made to assure that 
packaging and labeling materials not suitable for subsequent operations 
have been removed. Results of inspection shall be documented in the 
batch production records.

[43 FR 45077, Sept. 29, 1978, as amended at 58 FR 41354, Aug. 3, 1993]



Sec. 211.132  Tamper-evident packaging requirements for over-the-counter (OTC) human drug products.

    (a) General. The Food and Drug Administration has the authority 
under the Federal Food, Drug, and Cosmetic Act (the act) to establish a 
uniform national requirement for tamper-evident packaging of OTC drug 
products that will improve the security of OTC drug packaging and help 
assure the safety and effectiveness of OTC drug products. An OTC drug 
product (except a dermatological, dentifrice, insulin, or lozenge 
product) for retail sale that is not packaged in a tamper-resistant 
package or that is not properly labeled under this section is 
adulterated under section 501 of the act or misbranded under section 502 
of the act, or both.
    (b) Requirements for tamper-evident package. (1) Each manufacturer 
and packer who packages an OTC drug product (except a dermatological, 
dentifrice, insulin, or lozenge product) for retail sale shall package 
the product in a tamper-evident package, if this product is accessible 
to the public while held for sale. A tamper-evident package is one 
having one or more indicators or barriers to entry which, if breached or 
missing, can reasonably be expected to provide visible evidence to 
consumers that tampering has occurred. To reduce the likelihood of 
successful tampering and to increase the likelihood that consumers will 
discover if a product has been tampered with, the package is required to 
be distinctive by design or by the use of one or more indicators or 
barriers to entry that employ an identifying characteristic (e.g., a 
pattern, name, registered trademark, logo, or picture). For purposes of 
this section, the term ``distinctive by design'' means the packaging 
cannot be duplicated with commonly available materials or through 
commonly available processes. A tamper-evident package may involve an 
immediate-container and closure system or secondary-container or carton 
system or any combination of systems intended to provide a visual 
indication of package integrity. The tamper-evident feature shall be 
designed to and shall remain intact when handled in a reasonable manner 
during manufacture, distribution, and retail display.
    (2) In addition to the tamper-evident packaging feature described in 
paragraph (b)(1) of this section, any two-piece, hard gelatin capsule 
covered by this section must be sealed using an acceptable tamper-
evident technology.
    (c) Labeling. (1) In order to alert consumers to the specific 
tamper-evident feature(s) used, each retail package of an OTC drug 
product covered by this

[[Page 126]]

section (except ammonia inhalant in crushable glass ampules, containers 
of compressed medical oxygen, or aerosol products that depend upon the 
power of a liquefied or compressed gas to expel the contents from the 
container) is required to bear a statement that:
    (i) Identifies all tamper-evident feature(s) and any capsule sealing 
technologies used to comply with paragraph (b) of this section;
    (ii) Is prominently placed on the package; and
    (iii) Is so placed that it will be unaffected if the tamper-evident 
feature of the package is breached or missing.
    (2) If the tamper-evident feature chosen to meet the requirements in 
paragraph (b) of this section uses an identifying characteristic, that 
characteristic is required to be referred to in the labeling statement. 
For example, the labeling statement on a bottle with a shrink band could 
say ``For your protection, this bottle has an imprinted seal around the 
neck.''
    (d) Request for exemptions from packaging and labeling requirements. 
A manufacturer or packer may request an exemption from the packaging and 
labeling requirements of this section. A request for an exemption is 
required to be submitted in the form of a citizen petition under 
Sec. 10.30 of this chapter and should be clearly identified on the 
envelope as a ``Request for Exemption from the Tamper-Evident Packaging 
Rule.'' The petition is required to contain the following:
    (1) The name of the drug product or, if the petition seeks an 
exemption for a drug class, the name of the drug class, and a list of 
products within that class.
    (2) The reasons that the drug product's compliance with the tamper-
evident packaging or labeling requirements of this section is 
unnecessary or cannot be achieved.
    (3) A description of alternative steps that are available, or that 
the petitioner has already taken, to reduce the likelihood that the 
product or drug class will be the subject of malicious adulteration.
    (4) Other information justifying an exemption.
    (e) OTC drug products subject to approved new drug applications. 
Holders of approved new drug applications for OTC drug products are 
required under Sec. 314.70 of this chapter to provide the agency with 
notification of changes in packaging and labeling to comply with the 
requirements of this section. Changes in packaging and labeling required 
by this regulation may be made before FDA approval, as provided under 
Sec. 314.70(c) of this chapter. Manufacturing changes by which capsules 
are to be sealed require prior FDA approval under Sec. 314.70(b) of this 
chapter.
    (f) Poison Prevention Packaging Act of 1970. This section does not 
affect any requirements for ``special packaging'' as defined under 
Sec. 310.3(l) of this chapter and required under the Poison Prevention 
Packaging Act of 1970.

(Approved by the Office of Management and Budget under OMB control 
number 0910-0149)

[54 FR 5228, Feb. 2, 1989, as amended at 63 FR 59470, Nov. 4, 1998]



Sec. 211.134  Drug product inspection.

    (a) Packaged and labeled products shall be examined during finishing 
operations to provide assurance that containers and packages in the lot 
have the correct label.
    (b) A representative sample of units shall be collected at the 
completion of finishing operations and shall be visually examined for 
correct labeling.
    (c) Results of these examinations shall be recorded in the batch 
production or control records.



Sec. 211.137  Expiration dating.

    (a) To assure that a drug product meets applicable standards of 
identity, strength, quality, and purity at the time of use, it shall 
bear an expiration date determined by appropriate stability testing 
described in Sec. 211.166.
    (b) Expiration dates shall be related to any storage conditions 
stated on the labeling, as determined by stability studies described in 
Sec. 211.166.
    (c) If the drug product is to be reconstituted at the time of 
dispensing, its labeling shall bear expiration information for both the 
reconstituted and unreconstituted drug products.
    (d) Expiration dates shall appear on labeling in accordance with the 
requirements of Sec. 201.17 of this chapter.

[[Page 127]]

    (e) Homeopathic drug products shall be exempt from the requirements 
of this section.
    (f) Allergenic extracts that are labeled ``No U.S. Standard of 
Potency'' are exempt from the requirements of this section.
    (g) New drug products for investigational use are exempt from the 
requirements of this section, provided that they meet appropriate 
standards or specifications as demonstrated by stability studies during 
their use in clinical investigations. Where new drug products for 
investigational use are to be reconstituted at the time of dispensing, 
their labeling shall bear expiration information for the reconstituted 
drug product.
    (h) Pending consideration of a proposed exemption, published in the 
Federal Register of September 29, 1978, the requirements in this section 
shall not be enforced for human OTC drug products if their labeling does 
not bear dosage limitations and they are stable for at least 3 years as 
supported by appropriate stability data.

[43 FR 45077, Sept. 29, 1978, as amended at 46 FR 56412, Nov. 17, 1981; 
60 FR 4091, Jan. 20, 1995]



                   Subpart H--Holding and Distribution



Sec. 211.142  Warehousing procedures.

    Written procedures describing the warehousing of drug products shall 
be established and followed. They shall include:
    (a) Quarantine of drug products before release by the quality 
control unit.
    (b) Storage of drug products under appropriate conditions of 
temperature, humidity, and light so that the identity, strength, 
quality, and purity of the drug products are not affected.



Sec. 211.150  Distribution procedures.

    Written procedures shall be established, and followed, describing 
the distribution of drug products. They shall include:
    (a) A procedure whereby the oldest approved stock of a drug product 
is distributed first. Deviation from this requirement is permitted if 
such deviation is temporary and appropriate.
    (b) A system by which the distribution of each lot of drug product 
can be readily determined to facilitate its recall if necessary.



                     Subpart I--Laboratory Controls



Sec. 211.160  General requirements.

    (a) The establishment of any specifications, standards, sampling 
plans, test procedures, or other laboratory control mechanisms required 
by this subpart, including any change in such specifications, standards, 
sampling plans, test procedures, or other laboratory control mechanisms, 
shall be drafted by the appropriate organizational unit and reviewed and 
approved by the quality control unit. The requirements in this subpart 
shall be followed and shall be documented at the time of performance. 
Any deviation from the written specifications, standards, sampling 
plans, test procedures, or other laboratory control mechanisms shall be 
recorded and justified.
    (b) Laboratory controls shall include the establishment of 
scientifically sound and appropriate specifications, standards, sampling 
plans, and test procedures designed to assure that components, drug 
product containers, closures, in-process materials, labeling, and drug 
products conform to appropriate standards of identity, strength, 
quality, and purity. Laboratory controls shall include:
    (1) Determination of conformance to appropriate written 
specifications for the acceptance of each lot within each shipment of 
components, drug product containers, closures, and labeling used in the 
manufacture, processing, packing, or holding of drug products. The 
specifications shall include a description of the sampling and testing 
procedures used. Samples shall be representative and adequately 
identified. Such procedures shall also require appropriate retesting of 
any component, drug product container, or closure that is subject to 
deterioration.
    (2) Determination of conformance to written specifications and a 
description of sampling and testing procedures for in-process materials. 
Such samples

[[Page 128]]

shall be representative and properly identified.
    (3) Determination of conformance to written descriptions of sampling 
procedures and appropriate specifications for drug products. Such 
samples shall be representative and properly identified.
    (4) The calibration of instruments, apparatus, gauges, and recording 
devices at suitable intervals in accordance with an established written 
program containing specific directions, schedules, limits for accuracy 
and precision, and provisions for remedial action in the event accuracy 
and/or precision limits are not met. Instruments, apparatus, gauges, and 
recording devices not meeting established specifications shall not be 
used.



Sec. 211.165  Testing and release for distribution.

    (a) For each batch of drug product, there shall be appropriate 
laboratory determination of satisfactory conformance to final 
specifications for the drug product, including the identity and strength 
of each active ingredient, prior to release. Where sterility and/or 
pyrogen testing are conducted on specific batches of shortlived 
radiopharmaceuticals, such batches may be released prior to completion 
of sterility and/or pyrogen testing, provided such testing is completed 
as soon as possible.
    (b) There shall be appropriate laboratory testing, as necessary, of 
each batch of drug product required to be free of objectionable 
microorganisms.
    (c) Any sampling and testing plans shall be described in written 
procedures that shall include the method of sampling and the number of 
units per batch to be tested; such written procedure shall be followed.
    (d) Acceptance criteria for the sampling and testing conducted by 
the quality control unit shall be adequate to assure that batches of 
drug products meet each appropriate specification and appropriate 
statistical quality control criteria as a condition for their approval 
and release. The statistical quality control criteria shall include 
appropriate acceptance levels and/or appropriate rejection levels.
    (e) The accuracy, sensitivity, specificity, and reproducibility of 
test methods employed by the firm shall be established and documented. 
Such validation and documentation may be accomplished in accordance with 
Sec. 211.194(a)(2).
    (f) Drug products failing to meet established standards or 
specifications and any other relevant quality control criteria shall be 
rejected. Reprocessing may be performed. Prior to acceptance and use, 
reprocessed material must meet appropriate standards, specifications, 
and any other relevant critieria.



Sec. 211.166  Stability testing.

    (a) There shall be a written testing program designed to assess the 
stability characteristics of drug products. The results of such 
stability testing shall be used in determining appropriate storage 
conditions and expiration dates. The written program shall be followed 
and shall include:
    (1) Sample size and test intervals based on statistical criteria for 
each attribute examined to assure valid estimates of stability;
    (2) Storage conditions for samples retained for testing;
    (3) Reliable, meaningful, and specific test methods;
    (4) Testing of the drug product in the same container-closure system 
as that in which the drug product is marketed;
    (5) Testing of drug products for reconstitution at the time of 
dispensing (as directed in the labeling) as well as after they are 
reconstituted.
    (b) An adequate number of batches of each drug product shall be 
tested to determine an appropriate expiration date and a record of such 
data shall be maintained. Accelerated studies, combined with basic 
stability information on the components, drug products, and container-
closure system, may be used to support tentative expiration dates 
provided full shelf life studies are not available and are being 
conducted. Where data from accelerated studies are used to project a 
tentative expiration date that is beyond a date supported by actual 
shelf life studies, there must be stability studies conducted, including 
drug product testing at appropriate intervals, until the tentative 
expiration date is verified or the

[[Page 129]]

appropriate expiration date determined.
    (c) For homeopathic drug products, the requirements of this section 
are as follows:
    (1) There shall be a written assessment of stability based at least 
on testing or examination of the drug product for compatibility of the 
ingredients, and based on marketing experience with the drug product to 
indicate that there is no degradation of the product for the normal or 
expected period of use.
    (2) Evaluation of stability shall be based on the same container-
closure system in which the drug product is being marketed.
    (d) Allergenic extracts that are labeled ``No U.S. Standard of 
Potency'' are exempt from the requirements of this section.

[43 FR 45077, Sept. 29, 1978, as amended at 46 FR 56412, Nov. 17, 1981]



Sec. 211.167  Special testing requirements.

    (a) For each batch of drug product purporting to be sterile and/or 
pyrogen-free, there shall be appropriate laboratory testing to determine 
conformance to such requirements. The test procedures shall be in 
writing and shall be followed.
    (b) For each batch of ophthalmic ointment, there shall be 
appropriate testing to determine conformance to specifications regarding 
the presence of foreign particles and harsh or abrasive substances. The 
test procedures shall be in writing and shall be followed.
    (c) For each batch of controlled-release dosage form, there shall be 
appropriate laboratory testing to determine conformance to the 
specifications for the rate of release of each active ingredient. The 
test procedures shall be in writing and shall be followed.



Sec. 211.170  Reserve samples.

    (a) An appropriately identified reserve sample that is 
representative of each lot in each shipment of each active ingredient 
shall be retained. The reserve sample consists of at least twice the 
quantity necessary for all tests required to determine whether the 
active ingredient meets its established specifications, except for 
sterility and pyrogen testing. The retention time is as follows:
    (1) For an active ingredient in a drug product other than those 
described in paragraphs (a) (2) and (3) of this section, the reserve 
sample shall be retained for 1 year after the expiration date of the 
last lot of the drug product containing the active ingredient.
    (2) For an active ingredient in a radioactive drug product, except 
for nonradioactive reagent kits, the reserve sample shall be retained 
for:
    (i) Three months after the expiration date of the last lot of the 
drug product containing the active ingredient if the expiration dating 
period of the drug product is 30 days or less; or
    (ii) Six months after the expiration date of the last lot of the 
drug product containing the active ingredient if the expiration dating 
period of the drug product is more than 30 days.
    (3) For an active ingredient in an OTC drug product that is exempt 
from bearing an expiration date under Sec. 211.137, the reserve sample 
shall be retained for 3 years after distribution of the last lot of the 
drug product containing the active ingredient.
    (b) An appropriately identified reserve sample that is 
representative of each lot or batch of drug product shall be retained 
and stored under conditions consistent with product labeling. The 
reserve sample shall be stored in the same immediate container-closure 
system in which the drug product is marketed or in one that has 
essentially the same characteristics. The reserve sample consists of at 
least twice the quantity necessary to perform all the required tests, 
except those for sterility and pyrogens. Except for those for drug 
products described in paragraph (b)(2) of this section, reserve samples 
from representative sample lots or batches selected by acceptable 
statistical procedures shall be examined visually at least once a year 
for evidence of deterioration unless visual examination would affect the 
integrity of the reserve sample. Any evidence of reserve sample 
deterioration shall be investigated in accordance with Sec. 211.192. The 
results of the examination shall be recorded and maintained with other 
stability data on the drug product. Reserve samples of compressed 
medical

[[Page 130]]

gases need not be retained. The retention time is as follows:
    (1) For a drug product other than those described in paragraphs (b) 
(2) and (3) of this section, the reserve sample shall be retained for 1 
year after the expiration date of the drug product.
    (2) For a radioactive drug product, except for nonradioactive 
reagent kits, the reserve sample shall be retained for:
    (i) Three months after the expiration date of the drug product if 
the expiration dating period of the drug product is 30 days or less; or
    (ii) Six months after the expiration date of the drug product if the 
expiration dating period of the drug product is more than 30 days.
    (3) For an OTC drug product that is exempt for bearing an expiration 
date under Sec. 211.137, the reserve sample must be retained for 3 years 
after the lot or batch of drug product is distributed.

[48 FR 13025, Mar. 29, 1983, as amended at 60 FR 4091, Jan. 20, 1995]



Sec. 211.173  Laboratory animals.

    Animals used in testing components, in-process materials, or drug 
products for compliance with established specifications shall be 
maintained and controlled in a manner that assures their suitability for 
their intended use. They shall be identified, and adequate records shall 
be maintained showing the history of their use.



Sec. 211.176  Penicillin contamination.

    If a reasonable possibility exists that a non-penicillin drug 
product has been exposed to cross-contamination with penicillin, the 
non-penicillin drug product shall be tested for the presence of 
penicillin. Such drug product shall not be marketed if detectable levels 
are found when tested according to procedures specified in `Procedures 
for Detecting and Measuring Penicillin Contamination in Drugs,' which is 
incorporated by reference. Copies are available from the Division of 
Research and Testing (HFD-470), Center for Drug Evaluation and Research, 
Food and Drug Administration, 200 C St. SW., Washington, DC 20204, or 
available for inspection at the Office of the Federal Register, 800 
North Capitol Street, NW., suite 700, Washington, DC 20408.

[43 FR 45077, Sept. 29, 1978, as amended at 47 FR 9396, Mar. 5, 1982; 50 
FR 8996, Mar. 6, 1985; 55 FR 11577, Mar. 29, 1990]



                     Subpart J--Records and Reports



Sec. 211.180  General requirements.

    (a) Any production, control, or distribution record that is required 
to be maintained in compliance with this part and is specifically 
associated with a batch of a drug product shall be retained for at least 
1 year after the expiration date of the batch or, in the case of certain 
OTC drug products lacking expiration dating because they meet the 
criteria for exemption under Sec. 211.137, 3 years after distribution of 
the batch.
    (b) Records shall be maintained for all components, drug product 
containers, closures, and labeling for at least 1 year after the 
expiration date or, in the case of certain OTC drug products lacking 
expiration dating because they meet the criteria for exemption under 
Sec. 211.137, 3 years after distribution of the last lot of drug product 
incorporating the component or using the container, closure, or 
labeling.
    (c) All records required under this part, or copies of such records, 
shall be readily available for authorized inspection during the 
retention period at the establishment where the activities described in 
such records occurred. These records or copies thereof shall be subject 
to photocopying or other means of reproduction as part of such 
inspection. Records that can be immediately retrieved from another 
location by computer or other electronic means shall be considered as 
meeting the requirements of this paragraph.
    (d) Records required under this part may be retained either as 
original records or as true copies such as photocopies, microfilm, 
microfiche, or other accurate reproductions of the original records. 
Where reduction techniques, such as microfilming, are used, suitable 
reader and photocopying equipment shall be readily available.
    (e) Written records required by this part shall be maintained so 
that data therein can be used for evaluating, at least annually, the 
quality standards of

[[Page 131]]

each drug product to determine the need for changes in drug product 
specifications or manufacturing or control procedures. Written 
procedures shall be established and followed for such evaluations and 
shall include provisions for:
    (1) A review of a representative number of batches, whether approved 
or rejected, and, where applicable, records associated with the batch.
    (2) A review of complaints, recalls, returned or salvaged drug 
products, and investigations conducted under Sec. 211.192 for each drug 
product.
    (f) Procedures shall be established to assure that the responsible 
officials of the firm, if they are not personally involved in or 
immediately aware of such actions, are notified in writing of any 
investigations conducted under Secs. 211.198, 211.204, or 211.208 of 
these regulations, any recalls, reports of inspectional observations 
issued by the Food and Drug Administration, or any regulatory actions 
relating to good manufacturing practices brought by the Food and Drug 
Administration.

[43 FR 45077, Sept. 29, 1978, as amended at 60 FR 4091, Jan. 20, 1995]



Sec. 211.182  Equipment cleaning and use log.

    A written record of major equipment cleaning, maintenance (except 
routine maintenance such as lubrication and adjustments), and use shall 
be included in individual equipment logs that show the date, time, 
product, and lot number of each batch processed. If equipment is 
dedicated to manufacture of one product, then individual equipment logs 
are not required, provided that lots or batches of such product follow 
in numerical order and are manufactured in numerical sequence. In cases 
where dedicated equipment is employed, the records of cleaning, 
maintenance, and use shall be part of the batch record. The persons 
performing and double-checking the cleaning and maintenance shall date 
and sign or initial the log indicating that the work was performed. 
Entries in the log shall be in chronological order.



Sec. 211.184  Component, drug product container, closure, and labeling records.

    These records shall include the following:
    (a) The identity and quantity of each shipment of each lot of 
components, drug product containers, closures, and labeling; the name of 
the supplier; the supplier's lot number(s) if known; the receiving code 
as specified in Sec. 211.80; and the date of receipt. The name and 
location of the prime manufacturer, if different from the supplier, 
shall be listed if known.
    (b) The results of any test or examination performed (including 
those performed as required by Sec. 211.82(a), Sec. 211.84(d), or 
Sec. 211.122(a)) and the conclusions derived therefrom.
    (c) An individual inventory record of each component, drug product 
container, and closure and, for each component, a reconciliation of the 
use of each lot of such component. The inventory record shall contain 
sufficient information to allow determination of any batch or lot of 
drug product associated with the use of each component, drug product 
container, and closure.
    (d) Documentation of the examination and review of labels and 
labeling for conformity with established specifications in accord with 
Secs. 211.122(c) and 211.130(c).
    (e) The disposition of rejected components, drug product containers, 
closure, and labeling.



Sec. 211.186  Master production and control records.

    (a) To assure uniformity from batch to batch, master production and 
control records for each drug product, including each batch size 
thereof, shall be prepared, dated, and signed (full signature, 
handwritten) by one person and independently checked, dated, and signed 
by a second person. The preparation of master production and control 
records shall be described in a written procedure and such written 
procedure shall be followed.
    (b) Master production and control records shall include:
    (1) The name and strength of the product and a description of the 
dosage form;

[[Page 132]]

    (2) The name and weight or measure of each active ingredient per 
dosage unit or per unit of weight or measure of the drug product, and a 
statement of the total weight or measure of any dosage unit;
    (3) A complete list of components designated by names or codes 
sufficiently specific to indicate any special quality characteristic;
    (4) An accurate statement of the weight or measure of each 
component, using the same weight system (metric, avoirdupois, or 
apothecary) for each component. Reasonable variations may be permitted, 
however, in the amount of components necessary for the preparation in 
the dosage form, provided they are justified in the master production 
and control records;
    (5) A statement concerning any calculated excess of component;
    (6) A statement of theoretical weight or measure at appropriate 
phases of processing;
    (7) A statement of theoretical yield, including the maximum and 
minimum percentages of theoretical yield beyond which investigation 
according to Sec. 211.192 is required;
    (8) A description of the drug product containers, closures, and 
packaging materials, including a specimen or copy of each label and all 
other labeling signed and dated by the person or persons responsible for 
approval of such labeling;
    (9) Complete manufacturing and control instructions, sampling and 
testing procedures, specifications, special notations, and precautions 
to be followed.



Sec. 211.188  Batch production and control records.

    Batch production and control records shall be prepared for each 
batch of drug product produced and shall include complete information 
relating to the production and control of each batch. These records 
shall include:
    (a) An accurate reproduction of the appropriate master production or 
control record, checked for accuracy, dated, and signed;
    (b) Documentation that each significant step in the manufacture, 
processing, packing, or holding of the batch was accomplished, 
including:
    (1) Dates;
    (2) Identity of individual major equipment and lines used;
    (3) Specific identification of each batch of component or in-process 
material used;
    (4) Weights and measures of components used in the course of 
processing;
    (5) In-process and laboratory control results;
    (6) Inspection of the packaging and labeling area before and after 
use;
    (7) A statement of the actual yield and a statement of the 
percentage of theoretical yield at appropriate phases of processing;
    (8) Complete labeling control records, including specimens or copies 
of all labeling used;
    (9) Description of drug product containers and closures;
    (10) Any sampling performed;
    (11) Identification of the persons performing and directly 
supervising or checking each significant step in the operation;
    (12) Any investigation made according to Sec. 211.192.
    (13) Results of examinations made in accordance with Sec. 211.134.



Sec. 211.192  Production record review.

    All drug product production and control records, including those for 
packaging and labeling, shall be reviewed and approved by the quality 
control unit to determine compliance with all established, approved 
written procedures before a batch is released or distributed. Any 
unexplained discrepancy (including a percentage of theoretical yield 
exceeding the maximum or minimum percentages established in master 
production and control records) or the failure of a batch or any of its 
components to meet any of its specifications shall be thoroughly 
investigated, whether or not the batch has already been distributed. The 
investigation shall extend to other batches of the same drug product and 
other drug products that may have been associated with the specific 
failure or discrepancy. A written record of the investigation shall be 
made and shall include the conclusions and followup.



Sec. 211.194  Laboratory records.

    (a) Laboratory records shall include complete data derived from all 
tests

[[Page 133]]

necessary to assure compliance with established specifications and 
standards, including examinations and assays, as follows:
    (1) A description of the sample received for testing with 
identification of source (that is, location from where sample was 
obtained), quantity, lot number or other distinctive code, date sample 
was taken, and date sample was received for testing.
    (2) A statement of each method used in the testing of the sample. 
The statement shall indicate the location of data that establish that 
the methods used in the testing of the sample meet proper standards of 
accuracy and reliability as applied to the product tested. (If the 
method employed is in the current revision of the United States 
Pharmacopeia, National Formulary, Association of Official Analytical 
Chemists, Book of Methods,\2\ or in other recognized standard 
references, or is detailed in an approved new drug application and the 
referenced method is not modified, a statement indicating the method and 
reference will suffice). The suitability of all testing methods used 
shall be verified under actual conditions of use.
---------------------------------------------------------------------------

    \2\ Copies may be obtained from: Association of Official Analytical 
Chemists, 2200 Wilson Blvd., Suite 400, Arlington, VA 22201-3301.
---------------------------------------------------------------------------

    (3) A statement of the weight or measure of sample used for each 
test, where appropriate.
    (4) A complete record of all data secured in the course of each 
test, including all graphs, charts, and spectra from laboratory 
instrumentation, properly identified to show the specific component, 
drug product container, closure, in-process material, or drug product, 
and lot tested.
    (5) A record of all calculations performed in connection with the 
test, including units of measure, conversion factors, and equivalency 
factors.
    (6) A statement of the results of tests and how the results compare 
with established standards of identity, strength, quality, and purity 
for the component, drug product container, closure, in-process material, 
or drug product tested.
    (7) The initials or signature of the person who performs each test 
and the date(s) the tests were performed.
    (8) The initials or signature of a second person showing that the 
original records have been reviewed for accuracy, completeness, and 
compliance with established standards.
    (b) Complete records shall be maintained of any modification of an 
established method employed in testing. Such records shall include the 
reason for the modification and data to verify that the modification 
produced results that are at least as accurate and reliable for the 
material being tested as the established method.
    (c) Complete records shall be maintained of any testing and 
standardization of laboratory reference standards, reagents, and 
standard solutions.
    (d) Complete records shall be maintained of the periodic calibration 
of laboratory instruments, apparatus, gauges, and recording devices 
required by Sec. 211.160(b)(4).
    (e) Complete records shall be maintained of all stability testing 
performed in accordance with Sec. 211.166.

[43 FR 45077, Sept. 29, 1978, as amended at 55 FR 11577, Mar. 29, 1990]



Sec. 211.196  Distribution records.

    Distribution records shall contain the name and strength of the 
product and description of the dosage form, name and address of the 
consignee, date and quantity shipped, and lot or control number of the 
drug product. For compressed medical gas products, distribution records 
are not required to contain lot or control numbers.

(Approved by the Office of Management and Budget under control number 
0910-0139)

[49 FR 9865, Mar. 16, 1984]



Sec. 211.198  Complaint files.

    (a) Written procedures describing the handling of all written and 
oral complaints regarding a drug product shall be established and 
followed. Such procedures shall include provisions for review by the 
quality control unit, of any complaint involving the possible failure of 
a drug product to meet any of its specifications and, for such drug 
products, a determination as to the need for an investigation in 
accordance with

[[Page 134]]

Sec. 211.192. Such procedures shall include provisions for review to 
determine whether the complaint represents a serious and unexpected 
adverse drug experience which is required to be reported to the Food and 
Drug Administration in accordance with Sec. 310.305 of this chapter.
    (b) A written record of each complaint shall be maintained in a file 
designated for drug product complaints. The file regarding such drug 
product complaints shall be maintained at the establishment where the 
drug product involved was manufactured, processed, or packed, or such 
file may be maintained at another facility if the written records in 
such files are readily available for inspection at that other facility. 
Written records involving a drug product shall be maintained until at 
least 1 year after the expiration date of the drug product, or 1 year 
after the date that the complaint was received, whichever is longer. In 
the case of certain OTC drug products lacking expiration dating because 
they meet the criteria for exemption under Sec. 211.137, such written 
records shall be maintained for 3 years after distribution of the drug 
product.
    (1) The written record shall include the following information, 
where known: the name and strength of the drug product, lot number, name 
of complainant, nature of complaint, and reply to complainant.
    (2) Where an investigation under Sec. 211.192 is conducted, the 
written record shall include the findings of the investigation and 
followup. The record or copy of the record of the investigation shall be 
maintained at the establishment where the investigation occurred in 
accordance with Sec. 211.180(c).
    (3) Where an investigation under Sec. 211.192 is not conducted, the 
written record shall include the reason that an investigation was found 
not to be necessary and the name of the responsible person making such a 
determination.

[43 FR 45077, Sept. 29, 1978, as amended at 51 FR 24479, July 3, 1986]



             Subpart K--Returned and Salvaged Drug Products



Sec. 211.204  Returned drug products.

    Returned drug products shall be identified as such and held. If the 
conditions under which returned drug products have been held, stored, or 
shipped before or during their return, or if the condition of the drug 
product, its container, carton, or labeling, as a result of storage or 
shipping, casts doubt on the safety, identity, strength, quality or 
purity of the drug product, the returned drug product shall be destroyed 
unless examination, testing, or other investigations prove the drug 
product meets appropriate standards of safety, identity, strength, 
quality, or purity. A drug product may be reprocessed provided the 
subsequent drug product meets appropriate standards, specifications, and 
characteristics. Records of returned drug products shall be maintained 
and shall include the name and label potency of the drug product dosage 
form, lot number (or control number or batch number), reason for the 
return, quantity returned, date of disposition, and ultimate disposition 
of the returned drug product. If the reason for a drug product being 
returned implicates associated batches, an appropriate investigation 
shall be conducted in accordance with the requirements of Sec. 211.192. 
Procedures for the holding, testing, and reprocessing of returned drug 
products shall be in writing and shall be followed.



Sec. 211.208  Drug product salvaging.

    Drug products that have been subjected to improper storage 
conditions including extremes in temperature, humidity, smoke, fumes, 
pressure, age, or radiation due to natural disasters, fires, accidents, 
or equipment failures shall not be salvaged and returned to the 
marketplace. Whenever there is a question whether drug products have 
been subjected to such conditions, salvaging operations may be conducted 
only if there is (a) evidence from laboratory tests and assays 
(including animal feeding studies where applicable)

[[Page 135]]

that the drug products meet all applicable standards of identity, 
strength, quality, and purity and (b) evidence from inspection of the 
premises that the drug products and their associated packaging were not 
subjected to improper storage conditions as a result of the disaster or 
accident. Organoleptic examinations shall be acceptable only as 
supplemental evidence that the drug products meet appropriate standards 
of identity, strength, quality, and purity. Records including name, lot 
number, and disposition shall be maintained for drug products subject to 
this section.



PART 216--PHARMACY COMPOUNDING--Table of Contents




Subpart A--General Provisions [Reserved]

                   Subpart B--Compounded Drug Products

Sec.
216.23  [Reserved]
216.24   Drug products withdrawn or removed from the market for reasons 
          of safety or effectiveness.

    Authority: 21 U.S.C. 351, 352, 353a, 355, and 371.

    Source: 64 FR 10944, Mar. 8, 1999, unless otherwise noted.

Subpart A--General Provisions [Reserved]



                   Subpart B--Compounded Drug Products



Sec. 216.23  [Reserved]



Sec. 216.24  Drug products withdrawn or removed from the market for reasons of safety or effectiveness.

    The following drug products were withdrawn or removed from the 
market because such drug products or components of such drug products 
were found to be unsafe or not effective. The following drug products 
may not be compounded under the exemptions provided by section 503A(a) 
of the Federal Food, Drug, and Cosmetic Act:

Adenosine phosphate: All drug products containing adenosine phosphate.
Adrenal cortex: All drug products containing adrenal cortex.
Azaribine: All drug products containing azaribine.
Benoxaprofen: All drug products containing benoxaprofen.
Bithionol: All drug products containing bithionol.
Bromfenac sodium: All drug products containing bromfenac sodium.
Butamben: All parenteral drug products containing butamben.
Camphorated oil: All drug products containing camphorated oil.
Carbetapentane citrate: All oral gel drug products containing 
carbetapentane citrate.
Casein, iodinated: All drug products containing iodinated casein.
Chlorhexidine gluconate: All tinctures of chlorhexidine gluconate 
formulated for use as a patient preoperative skin preparation.
Chlormadinone acetate: All drug products containing chlormadinone 
acetate.
Chloroform: All drug products containing chloroform.
Cobalt: All drug products containing cobalt salts (except radioactive 
forms of cobalt and its salts and cobalamin and its derivatives).
Dexfenfluramine hydrochloride: All drug products containing 
dexfenfluramine hydrochloride.
Diamthazole dihydrochloride: All drug products containing diamthazole 
dihydrochloride.
Dibromsalan: All drug products containing dibromsalan.
Diethylstilbestrol: All oral and parenteral drug products containing 25 
milligrams or more of diethylstilbestrol per unit dose.
Dihydrostreptomycin sulfate: All drug products containing 
dihydrostreptomycin sulfate.
Dipyrone: All drug products containing dipyrone.
Encainide hydrochloride: All drug products containing encainide 
hydrochloride.
Fenfluramine hydrochloride: All drug products containing fenfluramine 
hydrochloride.
Flosequinan: All drug products containing flosequinan.
Gelatin: All intravenous drug products containing gelatin.
Glycerol, iodinated: All drug products containing iodinated glycerol.
Gonadotropin, chorionic: All drug products containing chorionic 
gonadotropins of animal origin.
Mepazine: All drug products containing mepazine hydrochloride or 
mepazine acetate.
Metabromsalan: All drug products containing metabromsalan.
Methamphetamine hydrochloride: All parenteral drug products containing 
methamphetamine hydrochloride.
Methapyrilene: All drug products containing methapyrilene.
Methopholine: All drug products containing methopholine.
Mibefradil dihydrochloride: All drug products containing mibefradil 
dihydrochloride.

[[Page 136]]

Nitrofurazone: All drug products containing nitrofurazone (except 
topical drug products formulated for dermatalogic application).
Nomifensine maleate: All drug products containing nomifensine maleate.
Oxyphenisatin: All drug products containing oxyphenisatin.
Oxyphenisatin acetate: All drug products containing oxyphenisatin 
acetate.
Phenacetin: All drug products containing phenacetin.
Phenformin hydrochloride: All drug products containing phenformin 
hydrochloride.
Pipamazine: All drug products containing pipamazine.
Potassium arsenite: All drug products containing potassium arsenite.
Potassium chloride: All solid oral dosage form drug products containing 
potassium chloride that supply 100 milligrams or more of potassium per 
dosage unit (except for controlled-release dosage forms and those 
products formulated for preparation of solution prior to ingestion).
Povidone: All intravenous drug products containing povidone.
Reserpine: All oral dosage form drug products containing more than 1 
milligram of reserpine.
Sparteine sulfate: All drug products containing sparteine sulfate.
Sulfadimethoxine: All drug products containing sulfadimethoxine.
Sulfathiazole: All drug products containing sulfathiazole (except those 
formulated for vaginal use).
Suprofen: All drug products containing suprofen (except ophthalmic 
solutions).
Sweet spirits of nitre: All drug products containing sweet spirits of 
nitre.
Temafloxacin hydrochloride: All drug products containing temafloxacin.
Terfenadine: All drug products containing terfenadine.
 3,3',4',5-tetrachlorosalicylanilide: All drug products containing 
3,3',4',5-tetrachlorosalicylanilide.
Tetracycline: All liquid oral drug products formulated for pediatric use 
containing tetracycline in a concentration greater than 25 milligrams/
milliliter.
Ticrynafen: All drug products containing ticrynafen.
Tribromsalan: All drug products containing tribromsalan.
Trichloroethane: All aerosol drug products intended for inhalation 
containing trichloroethane.
Urethane: All drug products containing urethane.
Vinyl chloride: All aerosol drug products containing vinyl chloride.
Zirconium: All aerosol drug products containing zirconium.
Zomepirac sodium: All drug products containing zomepirac sodium.



PART 225--CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS--Table of Contents




                      Subpart A--General Provisions

Sec.
225.1  Current good manufacturing practice.
225.10  Personnel.

   Subpart B--Construction and Maintenance of Facilities and Equipment

225.20  Buildings.
225.30  Equipment.
225.35  Use of work areas, equipment, and storage areas for other 
          manufacturing and storage purpose.

                   Subpart C--Product Quality Control

225.42  Components.
225.58  Laboratory controls.
225.65  Equipment cleanout procedures.

                    Subpart D--Packaging and Labeling

225.80  Labeling.

                     Subpart E--Records and Reports

225.102  Master record file and production records.
225.110  Distribution records.
225.115  Complaint files.

                   Subpart F--Facilities and Equipment

225.120  Buildings and grounds.
225.130  Equipment.
225.135  Work and storage areas.

                  Subpart G--Product Quality Assurance

225.142  Components.
225.158  Laboratory assays.
225.165  Equipment cleanout procedures.

                           Subpart H--Labeling

225.180  Labeling.

                           Subpart I--Records

225.202  Formula, production, and distribution records.

    Authority: 21 U.S.C. 351, 352, 360b, 371, 374.

    Source: 41 FR 52618, Nov. 30, 1976, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 225.1  Current good manufacturing practice.

    (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act 
provides

[[Page 137]]

that a drug (including a drug contained in a medicated feed) shall be 
deemed to be adulterated if the methods used in, or the facilities or 
controls used for, its manufacture, processing, packing, or holding do 
not conform to or are not operated or administered in conformity with 
current good manufacturing practice to assure that such drug meets the 
requirement of the act as to safety and has the identity and strength, 
and meets the quality and purity characteristics, which it purports or 
is represented to possess.
    (b)(1) The provisions of this part set forth the criteria for 
determining whether the manufacture of a medicated feed is in compliance 
with current good manufacturing practice. These regulations shall apply 
to all types of facilities and equipment used in the production of 
medicated feeds, and they shall also govern those instances in which 
failure to adhere to the regulations has caused nonmedicated feeds that 
are manufactured, processed, packed, or held to be adulterated. In such 
cases, the medicated feed shall be deemed to be adulterated within the 
meaning of section 501(a)(2)(B) of the act, and the nonmedicated feed 
shall be deemed to be adulterated within the meaning of section 
402(a)(2)(D) of the act.
    (2) The regulations in Secs. 225.10 through 225.115 apply to 
facilities manufacturing one or more medicated feeds for which an 
approved medicated feed mill license is required. The regulations in 
Secs. 225.120 through 225.202 apply to facilities manufacturing solely 
medicated feeds for which an approved license is not required.
    (c) In addition to the recordkeeping requirements in this part, Type 
B and Type C medicated feeds made from Type A articles or Type B feeds 
under approved NADA's and a medicated feed mill license are subject to 
the requirements of Sec. 510.301 of this chapter.

[41 FR 52618, Nov. 30, 1976, as amended at 51 FR 7389, Mar. 3, 1986; 64 
FR 63203, Nov. 19, 1999]



Sec. 225.10  Personnel.

    (a) Qualified personnel and adequate personnel training and 
supervision are essential for the proper formulation, manufacture, and 
control of medicated feeds. Training and experience leads to proper use 
of equipment, maintenance of accurate records, and detection and 
prevention of possible deviations from current good manufacturing 
practices.
    (b)(1) All employees involved in the manufacture of medicated feeds 
shall have an understanding of the manufacturing or control operation(s) 
which they perform, including the location and proper use of equipment.
    (2) The manufacturer shall provide an on-going program of evaluation 
and supervision of employees in the manufacture of medicated feeds.

[41 FR 52618, Nov. 30, 1976, as amended at 42 FR 12426, Mar. 4, 1977]



   Subpart B--Construction and Maintenance of Facilities and Equipment



Sec. 225.20  Buildings.

    (a) The location, design, construction, and physical size of the 
buildings and other production facilities are factors important to the 
manufacture of medicated feed. The features of facilities necessary for 
the proper manufacture of medicated feed include provision for ease of 
access to structures and equipment in need of routine maintenance; ease 
of cleaning of equipment and work areas; facilities to promote personnel 
hygiene; structural conditions for control and prevention of vermin and 
pest infestation; adequate space for the orderly receipt and storage of 
drugs and feed ingredients and the controlled flow of these materials 
through the processing and manufacturing operations; and the equipment 
for the accurate packaging and delivery of a medicated feed of specified 
labeling and composition.
    (b) The construction and maintenance of buildings in which medicated 
feeds are manufactured, processed, packaged, labeled, or held shall 
conform to the following:
    (1) The building grounds shall be adequately drained and routinely 
maintained so that they are reasonably free from litter, waste, refuse, 
uncut weeds or grass, standing water, and improperly stored equipment.

[[Page 138]]

    (2) The building(s) shall be maintained in a reasonably clean and 
orderly manner.
    (3) The building(s) shall be of suitable construction to minimize 
access by rodents, birds, insects, and other pests.
    (4) The buildings shall provide adequate space and lighting for the 
proper performance of the following medicated feed manufacturing 
operations:
    (i) The receipt, control, and storage of components.
    (ii) Component processing.
    (iii) Medicated feed manufacturing.
    (iv) Packaging and labeling.
    (v) Storage of containers, packaging materials, labeling and 
finished products.
    (vi) Routine maintenance of equipment.



Sec. 225.30  Equipment.

    (a) Equipment which is designed to perform its intended function and 
is properly installed and used is essential to the manufacture of 
medicated feeds. Such equipment permits production of feeds of uniform 
quality, facilitates cleaning, and minimizes spillage of drug components 
and finished product.
    (b)(1) All equipment shall possess the capability to produce a 
medicated feed of intended potency, safety, and purity.
    (2) All equipment shall be maintained in a reasonably clean and 
orderly manner.
    (3) All equipment, including scales and liquid metering devices, 
shall be of suitable size, design, construction, precision, and accuracy 
for its intended purpose.
    (4) All scales and metering devices shall be tested for accuracy 
upon installation and at least once a year thereafter, or more 
frequently as may be necessary to insure their accuracy.
    (5) All equipment shall be so constructed and maintained as to 
prevent lubricants and coolants from becoming unsafe additives in feed 
components or medicated feed.
    (6) All equipment shall be designed, constructed, installed and 
maintained so as to facilitate inspection and use of cleanout 
procedure(s).



Sec. 225.35  Use of work areas, equipment, and storage areas for other manufacturing and storage purpose.

    (a) Many manufacturers of medicated feeds are also involved in the 
manufacture, storage, or handling of products which are not intended for 
animal feed use, such as fertilizers, herbicides, insecticides, 
fungicides, rodenticides, and other pesticides. Manufacturing, storage, 
or handling of nonfeed and feed products in the same facilities may 
cause adulteration of feed products with toxic or otherwise unapproved 
feed additives.
    (b) Work areas and equipment used for the manufacture or storage of 
medicated feeds or components thereof shall not be used for, and shall 
be physically separated from, work areas and equipment used for the 
manufacture of fertilizers, herbicides, insecticides, fungicides, 
rodenticides, and other pesticides unless such articles are approved 
drugs or approved food additives intended for use in the manufacture of 
medicated feed.



                   Subpart C--Product Quality Control



Sec. 225.42  Components.

    (a) A medicated feed, in addition to providing nutrients, is a 
vehicle for the administration of a drug, or drugs, to animals. To 
ensure proper safety and effectiveness, such medicated feeds must 
contain the labeled amounts of drugs. It is necessary that adequate 
procedures be established for the receipt, storage, and inventory 
control for all such drugs to aid in assuring their identity, strength, 
quality, and purity when incorporated into products.
    (b) The receipt, storage, and inventory of drugs, including 
undiluted drug components, medicated premixes, and semiprocessed (i.e., 
intermediate premixes, inplant premixes and concentrates) intermediate 
mixes containing drugs, which are used in the manufacture and processing 
of medicated feeds shall conform to the following:
    (1) Incoming shipments of drugs shall be visually examined for 
identity and damage. Drugs which have been subjected to conditions which 
may have

[[Page 139]]

adversely affected their identity, strength, quality, or purity shall 
not be accepted for use.
    (2) Packaged drugs in the storage areas shall be stored in their 
original closed containers.
    (3) Bulk drugs shall be identified and stored in a manner such that 
their identity, strength, quality, and purity will be maintained.
    (4) Drugs in the mixing areas shall be properly identified, stored, 
handled, and controlled to maintain their integrity and identity. 
Sufficient space shall be provided for the location of each drug.
    (5) A receipt record shall be prepared and maintained for each lot 
of drug received. The receipt record shall accurately indicate the 
identity and quantity of the drug, the name of the supplier, the 
supplier's lot number or an identifying number assigned by the feed 
manufacturer upon receipt which relates to the particular shipment, the 
date of receipt, the condition of the drug when received, and the return 
of any damaged drugs.
    (6) A daily inventory record for each drug used shall be maintained 
and shall list by manufacturer's lot number or the feed manufacturer's 
shipment identification number at least the following information:
    (i) The quantity of drug on hand at the beginning and end of the 
work day (the beginning amount being the same as the previous day's 
closing inventory if this amount has been established to be correct); 
the quantity shall be determined by weighing, counting, or measuring, as 
appropriate.
    (ii) The amount of each drug used, sold, or otherwise disposed of.
    (iii) The batches or production runs of medicated feed in which each 
drug was used.
    (iv) When the drug is used in the preparation of a semiprocessed 
intermediate mix intended for use in the manufacture of medicated feed, 
any additional information which may be required for the purpose of 
paragraph (b)(7) of this section.
    (v) Action taken to reconcile any discrepancies in the daily 
inventory record.
    (7) Drug inventory shall be maintained of each lot or shipment of 
drug by means of a daily comparison of the actual amount of drug used 
with the theoretical drug usage in terms of the semiprocessed, 
intermediate and finished medicated feeds manufactured. Any significant 
discrepancy shall be investigated and corrective action taken. The 
medicated feed(s) remaining on the premises which are affected by this 
discrepancy shall be detained until the discrepancy is reconciled.
    (8) All records required by this section shall be maintained on the 
premises for at least one year after complete use of a drug component of 
a specific lot number or feed manufacturer's shipment identification 
number.



Sec. 225.58  Laboratory controls.

    (a) The periodic assay of medicated feeds for drug components 
provides a measure of performance of the manufacturing process in 
manufacturing a uniform product of intended potency.
    (b) The following assay requirements shall apply to medicated feeds:
    (1) For feeds requiring a medicated feed mill license (Form FDA 
3448) for their manufacture and marketing, at least three representative 
samples of medicated feed containing each drug or drug combination used 
in the establishment shall be collected and assayed by approved official 
methods, at periodic intervals during the calendar year, unless 
otherwise specified in this chapter. At least one of these assays shall 
be performed on the first batch using the drug. If a medicated feed 
contains a combination of drugs, only one of the drugs need be subject 
to analysis each time, provided the one tested is different from the 
one(s) previously tested.
    (2) [Reserved]
    (c) The originals or copies of all results of assays, including 
those from State feed control officials and any other governmental 
agency, shall be maintained on the premises for a period of not less 
than 1 year after distribution of the medicated feed. The results of 
assays performed by State feed control officials may be considered 
toward fulfillment of the periodic assay requirements of this section.
    (d) Where the results of assays indicate that the medicated feed is 
not in accord with label specifications or is

[[Page 140]]

not within permissible assay limits as specified in this chapter, 
investigation and corrective action shall be implemented and an original 
or copy of the record of such action maintained on the premises.
    (e) Corrective action shall include provisions for discontinuing 
distribution where the medicated feed fails to meet the labeled drug 
potency. Distribution of subsequent production of the particular feed 
shall not begin until it has been determined that proper control 
procedures have been established.

[41 FR 52618, Nov. 30, 1976, as amended at 51 FR 7390, Mar. 3, 1986; 55 
FR 11577, Mar. 29, 1990; 64 FR 63203, Nov. 19, 1999]



Sec. 225.65  Equipment cleanout procedures.

    (a) Adequate cleanout procedures for all equipment used in the 
manufacture and distribution of medicated feeds are essential to 
maintain proper drug potency and avoid unsafe contamination of feeds 
with drugs. Such procedures may consist of cleaning by physical means, 
e.g., vacuuming, sweeping, washing, etc. Alternatively, flushing or 
sequencing or other equally effective techniques may be used whereby the 
equipment is cleaned either through use of a feed containing the same 
drug(s) or through use of drug free feedstuffs.
    (b) All equipment, including that used for storage, processing, 
mixing, conveying, and distribution that comes in contact with the 
active drug component, feeds in process, or finished medicated feed 
shall be subject to all reasonable and effective procedures to prevent 
unsafe contamination of manufactured feed. The steps used to prevent 
unsafe contamination of feeds shall include one or more of the 
following, or other equally effective procedures:
    (1) Such procedures shall, where appropriate, consist of physical 
means (vacuuming, sweeping, or washing), flushing, and/or sequential 
production of feeds.
    (2) If flushing is utilized, the flush material shall be properly 
identified, stored, and used in a manner to prevent unsafe contamination 
of other feeds.
    (3) If sequential production of medicated feeds is utilized, it 
shall be on a predetermined basis designed to prevent unsafe 
contamination of feeds with residual drugs.



                    Subpart D--Packaging and Labeling



Sec. 225.80  Labeling.

    (a) Appropriate labeling identifies the medicated feed, and provides 
the user with directions for use which, if adhered to, will assure that 
the article is safe and effective for its intended purposes.
    (b)(1) Labels and labeling, including placards, shall be received, 
handled, and stored in a manner that prevents labeling mixups and 
assures that correct labeling is employed for the medicated feed.
    (2) Labels and labeling, including placards, upon receipt from the 
printer shall be proofread against the Master Record File to verify 
their suitability and accuracy. The proofread label shall be dated, 
initialed by a responsible individual, and kept for 1 year after all the 
labels from that batch have been used.
    (3) In those instances where medicated feeds are distributed in 
bulk, complete labeling shall accompany the shipment and be supplied to 
the consignee at the time of delivery. Such labeling may consist of a 
placard or other labels attached to the invoice or delivery ticket, or 
manufacturer's invoice that identifies the medicated feed and includes 
adequate information for the safe and effective use of the medicated 
feed.
    (4) Label stock shall be reviewed periodically and discontinued 
labels shall be discarded.



                     Subpart E--Records and Reports



Sec. 225.102  Master record file and production records.

    (a) The Master Record File provides the complete procedure for 
manufacturing a specific product, setting forth the formulation, 
theoretical yield, manufacturing procedures, assay requirements, and 
labeling of batches or production runs. The production record(s) 
includes the complete history

[[Page 141]]

of a batch or production run. This record includes the amounts of drugs 
used, the amount of medicated feed manufactured, and provides a check 
for the daily inventory record of drug components.
    (b) The Master Record File and production records shall comply with 
the following provisions:
    (1) A Master Record File shall be prepared, checked, dated, and 
signed or initialed by a qualified person and shall be retained for not 
less than 1 year after production of the last batch or production run of 
medicated feed to which it pertains. The Master Record File or card 
shall include at least the following:
    (i) The name of the medicated feed.
    (ii) The name and weight percentage or measure of each drug or drug 
combination and each nondrug ingredient to be used in manufacturing a 
stated weight of the medicated feed.
    (iii) A copy or description of the label or labeling that will 
accompany the medicated feed.
    (iv) Manufacturing instructions or reference thereto that have been 
determined to yield a properly mixed medicated feed of the specified 
formula for each medicated feed produced on a batch or continuous 
operation basis, including mixing steps, mixing times and, in the case 
of medicated feeds produced by continuous production run, any additional 
manufacturing directions including, when indicated, the settings of 
equipment.
    (v) Appropriate control directions or reference thereto, including 
the manner and frequency of collecting the required number of samples 
for specified laboratory assay.
    (2) The original production record or copy thereof shall be prepared 
by qualified personnel for each batch or run of medicated feed produced 
and shall be retained on the premises for not less than 1 year. The 
production record shall include at least the following:
    (i) Product identification, date of production, and a written 
endorsement in the form of a signature or initials by a responsible 
individual.
    (ii) The quantity and name of drug components used.
    (iii) The theoretical quantity of medicated feed to be produced.
    (iv) The actual quantity of medicated feed produced. In those 
instances where the finished feed is stored in bulk and actual yield 
cannot be accurately determined, the firm shall estimate the quantity 
produced and provide the basis for such estimate in the Master Record 
File.
    (3) In the case of a custom formula feed made to the specifications 
of a customer, the Master Record File and production records required by 
this section shall consist either of such records or of copies of the 
customer's purchase orders and the manufacturer's invoices bearing the 
information required by this section. When a custom order is received by 
telephone, the manufacturer shall prepare the required production 
records.
    (4) Batch production records shall be checked by a responsible 
individual at the end of the working day in which the product was 
manufactured to determine whether all required production steps have 
been performed. If significant discrepancies are noted, an investigation 
shall be instituted immediately, and the production record shall 
describe the corrective action taken.
    (5) Each batch or production run of medicated feed shall be 
identified with its own individual batch or production run number, code, 
date, or other suitable identification applied to the label, package, 
invoice or shipping document. This identification shall permit the 
tracing of the complete and accurate manufacturing history of the 
product by the manufacturer.



Sec. 225.110  Distribution records.

    (a) Distribution records permit the manufacturer to relate 
complaints to specific batches and/or production runs of medicated feed. 
This information may be helpful in instituting a recall.
    (b) Distribution records for each shipment of a medicated feed shall 
comply with the following provisions:
    (1) Each distribution record shall include the date of shipment, the 
name and address of purchaser, the quantity shipped, and the name of the 
medicated feed. A lot or control number, or date

[[Page 142]]

of manufacture or other suitable identification shall appear on the 
distribution record or the label issued with each shipment.
    (2) The originals or copies of the distribution records shall be 
retained on the premises for not less than one year after the date of 
shipment of the medicated feed.



Sec. 225.115  Complaint files.

    (a) Complaints and reports of experiences of product defects 
relative to the drug's efficacy or safety may provide an indicator as to 
whether or not medicated feeds have been manufactured in conformity with 
current good manufacturing practices. These complaints and experiences 
may reveal the existence of manufacturing problems not otherwise 
detected through the normal quality control procedures. Timely and 
appropriate follow-up action can serve to correct a problem and minimize 
future problems.
    (b) The medicated feed manufacturer shall maintain on the premises a 
file which contains the following information:
    (1) The original or copy of a record of each oral and written 
complaint received relating to the safety and effectiveness of the 
product produced. The record shall include the date of the complaint, 
the complainant's name and address, name and lot or control number or 
date of manufacture of the medicated feed involved, and the specific 
details of the complaint. This record shall also include all 
correspondence from the complainant and/or memoranda of conversations 
with the complainant, and a description of all investigations made by 
the manufacturer and of the method of disposition of the complaint.
    (2) For medicated feeds whose manufacture require a medicated feed 
mill license (Form FDA 3448), records and reports of clinical and other 
experience with the drug shall be maintained and reported, under 
Sec. 510.301 of this chapter.

[41 FR 52618, Nov. 30, 1976, as amended at 51 FR 7390, Mar. 3, 1986; 57 
FR 6475, Feb. 25, 1992; 64 FR 63203, Nov. 19, 1999]



                   Subpart F--Facilities and Equipment

    Source: 51 FR 7390, Mar. 3, 1986, unless otherwise noted.



Sec. 225.120  Buildings and grounds.

    Buildings used for production of medicated feed shall provide 
adequate space for equipment, processing, and orderly receipt and 
storage of medicated feed. Areas shall include access for routine 
maintenance and cleaning of equipment. Buildings and grounds shall be 
constructed and maintained in a manner to minimize vermin and pest 
infestation.



Sec. 225.130  Equipment.

    Equipment shall be capable of producing a medicated feed of intended 
potency and purity, and shall be maintained in a reasonably clean and 
orderly manner. Scales and liquid metering devices shall be accurate and 
of suitable size, design, construction, precision, and accuracy for 
their intended purposes. All equipment shall be designed, constructed, 
installed, and maintained so as to facilitate inspection and use of 
cleanout procedure(s).



Sec. 225.135  Work and storage areas.

    Work areas and equipment used for the production or storage of 
medicated feeds or components thereof shall not be used for, and shall 
be physically separated from, work areas and equipment used for the 
manufacture and storage of fertilizers, herbicides, insecticides, 
fungicides, rodenticides, and other pesticides unless such articles are 
approved for use in the manufacture of animal feed.



                  Subpart G--Product Quality Assurance

    Source: 51 FR 7390, Mar. 3, 1986, unless otherwise noted.



Sec. 225.142  Components.

    Adequate procedures shall be established and maintained for the 
identification, storage, and inventory control (receipt and use) of all 
Type A medicated articles and Type B medicated

[[Page 143]]

feeds intended for use in the manufacture of medicated feeds to aid in 
assuring the identity, strength, quality, and purity of these drug 
sources. Packaged Type A medicated articles and Type B medicated feeds 
shall be stored in designated areas in their original closed containers. 
Bulk Type A medicated articles and bulk Type B medicated feeds shall be 
identified and stored in a manner such that their identity, strength, 
quality, and purity will be maintained. All Type A medicated articles 
and Type B medicated feeds shall be used in accordance with their 
labeled mixing directions.



Sec. 225.158  Laboratory assays.

    Where the results of laboratory assays of drug components, including 
assays by State feed control officials, indicate that the medicated feed 
is not in accord with the permissible limits specified in this chapter, 
investigation and corrective action shall be implemented immediately by 
the firm and such records shall be maintained on the premises for a 
period of 1 year.



Sec. 225.165  Equipment cleanout procedures.

    Adequate procedures shall be established and used for all equipment 
used in the production and distribution of medicated feeds to avoid 
unsafe contamination of medicated and nonmedicated feeds.



                           Subpart H--Labeling



Sec. 225.180  Labeling.

    Labels shall be received, handled, and stored in a manner that 
prevents label mixups and assures that the correct labels are used for 
the medicated feed. All deliveries of medicated feeds, whether bagged or 
in bulk, shall be adequately labeled to assure that the feed can be 
properly used.

[51 FR 7390, Mar. 3, 1986]



                           Subpart I--Records



Sec. 225.202  Formula, production, and distribution records.

    Records shall be maintained identifying the formulation, date of 
mixing, and if not for own use, date of shipment. The records shall be 
adequate to facilitate the recall of specific batches of medicated feed 
that have been distributed. Such records shall be retained on the 
premises for 1 year following the date of last distribution.

(Approved by the Office of Management and Budget under control number 
0910-0152)

[51 FR 7390, Mar. 3, 1986]



PART 226--CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES--Table of Contents




                      Subpart A--General Provisions

Sec.
226.1  Current good manufacturing practice.
226.10  Personnel.

   Subpart B--Construction and Maintenance of Facilities and Equipment

226.20  Buildings.
226.30  Equipment.

                   Subpart C--Product Quality Control

226.40  Production and control procedures.
226.42  Components.
226.58  Laboratory controls.

                    Subpart D--Packaging and Labeling

226.80  Packaging and labeling.

                     Subpart E--Records and Reports

226.102  Master-formula and batch-production records.
226.110  Distribution records.
226.115  Complaint files.

    Authority: 21 U.S.C. 351, 352, 360b, 371, 374.

    Source: 40 FR 14031, Mar. 27, 1975, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 226.1  Current good manufacturing practice.

    The criteria in Secs. 226.10 through 226.115, inclusive, shall apply 
in determining whether the methods used in, or the facilities and 
controls used for the manufacture, processing, packing, or holding of a 
Type A medicated article(s) conform to or are operated or administered 
in conformity with current good manufacturing practice to assure that a 
Type A medicated article(s) meets the requirements of the act as to

[[Page 144]]

safety, and has the identity and strength, and meets the quality and 
purity characteristics which it purports or is represented to possess, 
as required by section 501(a)(2)(B) of the act. The regulations in this 
part 226 permit the use of precision, automatic, mechanical, or 
electronic equipment in the production of a Type A medicated article(s) 
when adequate inspection and checking procedures or other quality 
control procedures are used to assure proper performance.



Sec. 226.10  Personnel.

    The key personnel and any consultants involved in the manufacture 
and control of the Type A medicated article(s) shall have a background 
of appropriate education or appropriate experience or combination 
thereof for assuming responsibility to assure that the Type A medicated 
article(s) has the proper labeling and the safety, identity, strength, 
quality, and purity that it purports to possess.



   Subpart B--Construction and Maintenance of Facilities and Equipment



Sec. 226.20  Buildings.

    Buildings in which Type A medicated article(s) are manufactured, 
processed, packaged, labeled, or held shall be maintained in a clear and 
orderly manner and shall be of suitable size, construction and location 
in relation to surroundings to facilitate maintenance and operation for 
their intended purpose. The building shall:
    (a) Provide adequate space for the orderly placement of equipment 
and materials used in any of the following operations for which they are 
employed to minimize risk of mixups between different Type A medicated 
article(s), their components, packaging, or labeling:
    (1) The receipt, sampling, control, and storage of components.
    (2) Manufacturing and processing operations performed on the Type A 
medicated article(s).
    (3) Packaging and labeling operations.
    (4) Storage of containers, packaging materials, labeling, and 
finished products.
    (5) Control laboratory operations.
    (b) Provide adequate lighting and ventilation, and when necessary 
for the intended production or control purposes, adequate screening, 
dust and temperature controls, to avoid contamination of Type A 
medicated article(s), and to avoid other conditions unfavorable to the 
safety, identity, strength, quality, and purity of the raw materials and 
Type A medicated article(s) before, during, and after production.
    (c) Provide for adequate washing, cleaning, toilet, and locker 
facilities.

Work areas and equipment used for the production of Type A medicated 
article(s) or for the storage of the components of Type A medicated 
article(s) shall not be used for the production, mixing or storage of 
finished or unfinished insecticides, fungicides, rodenticides, or other 
pesticides or their components unless such materials are recognized as 
approved drugs intended for use in animal feeds.



Sec. 226.30  Equipment.

    Equipment used for the manufacture, processing, packaging, bulk 
shipment, labeling, holding, or control of Type A medicated article(s) 
or their components shall be maintained in a clean and orderly manner 
and shall be of suitable design, size, construction, and location to 
facilitate maintenance and operation for its intended purpose. The 
equipment shall:
    (a) Be so constructed that any surfaces that come into contact with 
Type A medicated article(s) are suitable, in that they are not reactive, 
additive, or absorptive to an extent that significantly affects the 
identity, strength, quality, or purity of the Type A medicated 
article(s) or its components.
    (b) Be so constructed that any substance required for the operation 
of the equipment, such as lubricants, coolants, etc., may be employed 
without hazard of becoming an unsafe additive to the Type A medicated 
article(s).
    (c) Be constructed to facilitate adjustment, cleaning, and 
maintenance, and to assure uniformity of production and reliability of 
control procedures and to assure the exclusion from Type

[[Page 145]]

A medicated article(s) of contamination, including cross-contamination 
from manufacturing operations.
    (d) Be suitably grounded electrically to prevent lack of uniform 
mixing due to electrically charged particles.
    (e) Be of suitable size and accuracy for use in any intended 
measuring, mixing, or weighing operations.



                   Subpart C--Product Quality Control



Sec. 226.40  Production and control procedures.

    Production and control procedures shall include all reasonable 
precautions, including the following, to assure that the Type A 
medicated article(s) produced have the identity, strength, quality, and 
purity they purport to possess:
    (a) Each critical step in the process, such as the selection, 
weighing, and measuring of components; the addition of drug components 
during the process; weighing and measuring during various stages of the 
processing; and the determination of the finished yield, shall be 
performed by one or more competent, responsible individuals. If such 
steps in the processing are controlled by precision, automatic, 
mechanical, or electronic equipment, their proper performance shall be 
adequately checked by one or more competent, responsible individuals.
    (b) All containers to be used for undiluted drugs, drug components, 
intermediate mixtures thereof, and Type A medicated article(s) shall be 
received, adequately identified, and properly stored and handled in a 
manner adequate to avoid mixups and contamination.
    (c) Equipment, including dust-control and other equipment, such as 
that used for holding and returning recovered or flush-out materials 
back into production, shall be maintained and operated in a manner to 
avoid contamination of the Type A medicated article(s) and to insure the 
integrity of the finished product.
    (d) Competent and responsible personnel shall check actual against 
theoretical yield of a batch of Type A medicated article(s), and, in the 
event of any significant discrepancies, key personnel shall prevent 
distribution of the batch in question and other associated batches of 
Type A medicated article(s) that may have been involved in a mixup with 
it.
    (e) Adequate procedures for cleaning of those parts of storage, 
mixing conveying and other equipment coming in contact with the drug 
component of the Type A medicated article(s) shall be used to avoid 
contamination of Type A medicated article(s).
    (f) If there is sequential production of batches of a Type A 
medicated article(s) containing the same drug component (or components) 
at the same or lower levels, there shall be sufficient safeguards to 
avoid any buildup above the specified levels of the drug components in 
any of the batches of the Type A medicated article(s).
    (g) Production and control procedures shall include provision for 
discontinuing distribution of any Type A medicated article(s) found by 
the assay procedures, or other controls performed to fail to conform to 
appropriate specifications. Distribution of subsequent production of 
such Type A medicated article(s) shall not begin until it has been 
determined that proper control procedures have been established.



Sec. 226.42  Components.

    (a) Drug components, including undiluted drugs and any intermediate 
mixes containing drugs used in the manufacture and processing of Type A 
medicated article(s), shall be received, examined or tested, stored, 
handled, and otherwise controlled in a manner to maintain the integrity 
and identification of such articles. Appropriate receipt and inventory 
records shall be maintained for 2 years, and such records shall show the 
origin of any drug components, the manufacturer's control number (if 
any), the dates and batches in which they were used, and the results of 
any testing of them.
    (b) Nondrug components shall be stored and otherwise handled in a 
manner to avoid contamination, including cross-contamination from 
manufacturing operations.

[[Page 146]]



Sec. 226.58  Laboratory controls.

    Laboratory controls shall include the establishment of adequate 
specifications and test procedures to assure that the drug components 
and the Type A medicated article(s) conform to appropriate standards of 
identity, strength, quality, and purity. Laboratory controls shall 
include:
    (a) The establishment of master records containing appropriate 
specifications and a description of the test procedures used to check 
them for each kind of drug component used in the manufacture of Type A 
medicated article(s). This may consist of the manufacturer's or 
supplier's statement of specifications and methods of analyses.
    (b) The establishment of specifications for Type A medicated 
article(s) and a description of necessary laboratory test procedures to 
check such specifications.
    (c) Assays which shall be made of representative samples of finished 
Type A medicated article(s) in accordance with the following schedule:
    (1) Each batch of a Type A medicated article(s) manufactured from an 
undiluted drug shall be assayed for its drug component(s).
    (2) In the case of Type A medicated article(s) which are 
manufactured by dilution of Type A medicated article(s) assayed in 
accordance with paragraph (c)(1) of this section, each batch shall be 
assayed for its drug component(s) with the first five consecutive 
batches assaying within the limitations, followed thereafter by assay of 
representative samples of not less than 5 percent of all batches 
produced. When any batch does not assay within limitations, each batch 
should again be assayed until five consecutive batches are within 
limitations.
    (d) A determination establishing that the drug components remain 
uniformly dispersed and stable in the Type A medicated article(s) under 
ordinary conditions of shipment, storage, and use. This may consist of a 
determination on a Type A medicated article(s) of substantially the same 
formula and characteristics. Suitable expiration dates shall appear on 
the labels of the Type A medicated article(s) to assure that the 
articles meet the appropriate standards of identity, strength, quality, 
and purity at the time of use.
    (e) Adequate provision to check the reliability, accuracy, and 
precision of any laboratory test procedure used. The official methods in 
``Methods of Analysis of the Association of Official Analytical 
Chemists,'' \1\ methods described in an official compendium, and any 
method submitted as a part of a food additive petition or new-drug 
application that has been accepted by the Food and Drug Administration 
shall be regarded as meeting this provision.
---------------------------------------------------------------------------

    \1\ Copies may be obtained from: Association of Official Analytical 
Chemists, 2200 Wilson Blvd., Suite 400, Arlington, VA 22201-3301.
---------------------------------------------------------------------------

    (f) Provisions for the maintenance of the results of any assays, 
including dates and endorsement of analysts. Such records shall be 
retained in the possession of the manufacturer and shall be maintained 
for a period of at least 2 years after distribution by the manufacturer 
of the Type A medicated article(s) has been completed.

[40 FR 14031, Mar. 27, 1975, as amended at 55 FR 11577, Mar. 29, 1990; 
55 FR 23703, June 12, 1990]



                    Subpart D--Packaging and Labeling



Sec. 226.80  Packaging and labeling.

    (a) Packaging and labeling operations shall be adequately 
controlled:
    (1) To assure that only those Type A medicated article(s) that have 
met the specifications established in the master-formula records shall 
be distributed.
    (2) To prevent mixups during the packaging and labeling operations.
    (3) To assure that correct labeling is employed for each Type A 
medicated article(s).
    (4) To identify Type A medicated article(s) with lot or control 
numbers that permit determination of the history of the manufacture and 
control of the batch of Type A medicated article(s).
    (b) Packaging and labeling operations shall provide:
    (1) For storage of labeling in a manner to avoid mixups.

[[Page 147]]

    (2) For careful checking of labeling for identity and conformity to 
the labeling specified in the batch-production records.
    (3) For adequate control of the quantities of labeling issued for 
use with the Type A medicated article(s).
    (c) Type A medicated article(s) shall be distributed in suitable 
containers to insure the safety, identity, strength, and quality of the 
finished product.



                     Subpart E--Records and Reports



Sec. 226.102  Master-formula and batch-production records.

    (a) For each Type A medicated article(s) master-formula records 
shall be prepared, endorsed, and dated by a competent and responsible 
individual and shall be independently checked, reconciled, endorsed, and 
dated by a second competent and responsible individual. The record shall 
include:
    (1) The name of the Type A medicated article(s) and a specimen copy 
of its label.
    (2) The weight or measure of each ingredient, adequately identified, 
to be used in manufacturing a stated weight of the Type A medicated 
article(s).
    (3) A complete formula for each batch size, or of appropriate size 
in the case of continuous systems to be produced from the master-formula 
record, including a complete list of ingredients designated by names or 
codes sufficiently specific to indicate any special quality 
characteristics; an accurate statement of the weight or measure of each 
ingredient, except that reasonable variations may be permitted in the 
amount of ingredients necessary in the preparation of the Type A 
medicated article(s), provided that the variations are stated in the 
master formula; an appropriate statement concerning any calculated 
excess of an ingredient; and a statement of the theoretical yield.
    (4) Manufacturing instructions for each type of Type A medicated 
article(s) produced on a batch or continuous operation basis, including 
mixing steps and mixing times that have been determined to yield an 
adequately mixed Type A medicated article(s); and in the case of Type A 
medicated article(s) produced by continuous production run, any 
additional manufacturing directions including, when indicated, the 
settings of equipment that have been determined to yield an adequately 
mixed Type A medicated article(s) of the specified formula.
    (5) Control instructions, procedures, specifications, special 
notations, and precautions to be followed.
    (b) A separate batch-production and control record shall be prepared 
for each batch or run of Type A medicated article(s) produced and shall 
be retained for at least 2 years after distribution by the manufacturer 
has been completed. The batch-production and control record shall 
include:
    (1) Product identification, date of production, and endorsement by a 
competent and responsible individual.
    (2) Records of each step in the manufacturing, packaging, labeling, 
and controlling of the batch, including dates, specific identification 
of drug components used, weights or measures of all components, 
laboratory-control results, mixing times, and the endorsements of the 
individual actively performing or the individual actively supervising or 
checking each step in the operation.
    (3) A batch number that permits determination of all laboratory-
control procedures and results on the batch and all lot or control 
numbers appearing on the labels of the Type A medicated article(s).



Sec. 226.110  Distribution records.

    Complete records shall be maintained for each shipment of Type A 
medicated article(s) in a manner that will facilitate the recall, 
diversion, or destruction of the Type A medicated article(s), if 
necessary. Such records shall be retained for at least 2 years after the 
date of the shipment by the manufacturer and shall include the name and 
address of the consignee, the date and quantity shipped, and the 
manufacturing dates, control numbers, or marks identifying the Type A 
medicated article(s) shipped.



Sec. 226.115  Complaint files.

    Records shall be maintained for a period of 2 years of all written 
or verbal complaints concerning the safety or efficacy of each Type A 
medicated article(s). Complaints shall be evaluated

[[Page 148]]

by competent and responsible personnel and, where indicated, appropriate 
action shall be taken. The record shall indicate the evaluation and the 
action.



PART 250--SPECIAL REQUIREMENTS FOR SPECIFIC HUMAN DRUGS--Table of Contents




                 Subpart A--Drugs Regarded as Misbranded

Sec.
250.11  Thyroid-containing drug preparations intended for treatment of 
          obesity in humans.
250.12  Stramonium preparations labeled with directions for use in self-
          medication regarded as misbranded.

      Subpart B--New Drug or Prescription Status of Specific Drugs

250.100  Amyl nitrite inhalant as a prescription drug for human use.
250.101  Amphetamine and methamphetamine inhalers regarded as 
          prescription drugs.
250.102  Drug preparations intended for human use containing certain 
          ``coronary vasodilators''.
250.103-250.104  [Reserved]
250.105  Gelsemium-containing preparations regarded as prescription 
          drugs.
250.106-250.107  [Reserved]
250.108  Potassium permanganate preparations as prescription drugs.

               Subpart C--Requirements for Drugs and Foods

250.201  Preparations for the treatment of pernicious anemia.

             Subpart D--Requirements for Drugs and Cosmetics

250.250  Hexachlorophene, as a component of drug and cosmetic products.

    Authority: 21 U.S.C. 321, 336, 342, 352, 353, 355, 361(a), 362(a) 
and (c), 371, 375(b).

    Source: 40 FR 14033, Mar. 27, 1975, unless otherwise noted.



                 Subpart A--Drugs Regarded as Misbranded



Sec. 250.11  Thyroid-containing drug preparations intended for treatment of obesity in humans.

    (a) Investigation by the Food and Drug Administration has revealed 
that a large number of drug preparations containing thyroid or 
thyrogenic substances in combination with central nervous system 
stimulants, with or without one or more additional drug substances such 
as barbiturates or laxatives, are being marketed for or as adjuncts to 
the treatment, control, or management of obesity in humans. The 
Commissioner of Food and Drugs finds that the administration of such 
combinations for said purposes is without medical rationale except 
possibly in those relatively uncommon instances where the condition is 
directly related to hypothyroidism and there exists a concurrent need 
for appetite control (in such instances the safety and effectiveness of 
such combinations are not generally recognized). In particular, the 
Commissioner of Food and Drugs finds that neither the consensus of 
informed medical opinion nor clinical experience justifies any 
representation that such combinations are safe and effective in 
connection with the treatment, control, or management of obesity in 
patients having normal thyroid function.
    (b) Combinations of thyroid or other thyrogenic drugs with central 
nervous system stimulants with or without other drug substances when 
offered for or as adjuncts to the treatment, control, or management of 
obesity not related to hypothyroidism are regarded as misbranded. Such 
combinations when offered for obesity in humans directly attributable to 
established hypothyroidism are regarded as new drugs within the meaning 
of section 201(p) of the Federal Food, Drug, and Cosmetic Act.



Sec. 250.12  Stramonium preparations labeled with directions for use in self-medication regarded as misbranded.

    (a) Stramonium products for inhalation have been offered for use in 
the therapy of the acute attacks of bronchial asthma for many years 
although their reliability and effectiveness are questionable. Recently, 
a significantly increased number of reports have come to the attention 
of the Food and Drug Administration showing that such products have been 
subject to abuse and misuse on a fairly large scale, mostly by young 
people, through oral

[[Page 149]]

ingestion for the purpose of producing hallucinations. Reports of such 
use have been received from physicians and police and other law 
enforcement authorities. Reports have also appeared in the public press 
and in medical journals.
    (b) Labeling these products with a warning that they are not for 
oral ingestion has not been effective in protecting the public. Misuse 
of stramonium preparations can cause serious toxic effects including 
toxic delirium, visual disturbances, fever, and coma. A number of 
serious reactions have already occurred from the oral ingestion of such 
products.
    (c) On the basis of this information, the Commissioner of Food and 
Drugs has concluded that such articles have a potentiality for harmful 
effect through misuse and are not safe for use except under the 
supervision of a physician. In the interest of public health protection, 
therefore, the Food and Drug Administration adopts the following policy:
    (1) Preparations containing stramonium supplied from the leaves, 
seeds, or any other part of the plant in the form of a powder, pipe 
mixture, cigarette, or any other form, with or without admixture of 
other ingredients, will be regarded as misbranded if they are labeled 
with directions for use in self-medication.
    (2) The Food and Drug Administration will, on request, furnish 
comment on proposed labeling limiting any such preparation to 
prescription sale.
    (d) The labeling or dispensing of stramonium preparations contrary 
to this statement after 60 days following the date of its publication in 
the Federal Register may be made the subject of regulatory proceedings.



      Subpart B--New Drug or Prescription Status of Specific Drugs



Sec. 250.100  Amyl nitrite inhalant as a prescription drug for human use.

    (a) Amyl nitrite inhalant has been available over-the-counter for 
emergency use by the patient in the management of angina pectoris for a 
number of years. As a result of a proposed policy statement published 
August 25, 1967 (32 FR 12404), the Commissioner of Food and Drugs 
received reports of the abuse of this drug by those who do not require 
it for medical purposes. Additionally, comment included a great deal of 
concern expressed by individual physicians, medical associations, 
pharmaceutical associations, manufacturers, and State and local health 
authorities. Based on the information available, it is the opinion of 
the Commissioner of Food and Drugs, concurred in by the Food and Drug 
Administration Medical Advisory Board, that amyl nitrite inhalant is a 
drug with a potentiality for harmful effect and that it should be 
removed from over-the-counter status and restricted to sale on the 
prescription of a practitioner licensed by law to administer such drug.
    (b) Therefore, amyl nitrite inhalant will be regarded as misbranded 
unless the labeling on or within the package from which the drug is to 
be dispensed bears adequate information for its safe and effective use 
by physicians, in accordance with Sec. 201.100(c) of this chapter, and 
its label bears the legend ``Caution: Federal law prohibits dispensing 
without prescription.''
    (c) Regulatory proceedings may be initiated with regard to the 
interstate shipment of amyl nitrite inhalant that is labeled, 
advertised, or dispensed contrary to this statement of policy if such 
act occurs after July 1, 1969.



Sec. 250.101  Amphetamine and methamphetamine inhalers regarded as prescription drugs.

    (a) Recurring reports of abuse and misuse of methamphetamine (also 
known as desoxyephedrine) inhalers show that they have a potentiality 
for harmful effect and that they should not be freely available to the 
public through over-the-counter sale. From complaints by law-enforcement 
officials, health officials, individual physicians, parents, and others 
as well as from Food and Drug Administration investigations, it is 
evident that the wicks from these inhalers are being removed and the 
methamphetamine they contain is being used as a substitute for 
amphetamine tablets. Amphetamine tablets and amphetamine inhalers have 
been restricted to prescription sale because of their potentiality for 
harm to the user.

[[Page 150]]

    (b) It is the considered opinion of the Food and Drug Administration 
that, in order to adequately protect the public health, inhalers 
containing methamphetamine or methamphetamine salts (d-desoxyephedrine, 
or dl-desoxyephedrine, or their salts), as well as amphetamine inhalers 
should be restricted to prescription sale and should be labeled with the 
legend ``Caution: Federal law prohibits dispensing without 
prescription.''



Sec. 250.102  Drug preparations intended for human use containing certain ``coronary vasodilators''.

    (a)(1) The Food and Drug Administration finds that the following 
``coronary vasodilators'' are extensively regarded by physicians as safe 
and useful as employed under medical supervision for the management of 
angina pectoris in some patients:

Amyl nitrite.
Erythrityl tetranitrate.
Mannitol hexanitrate.
Nitroglycerin.
Potassium nitrite.
Sodium nitrite.

    (2) Additionally, new-drug applications have been approved for 
products containing:

Inositol hexanitrate.
Isosorbide dinitrate.
Octyl nitrite.
Pentaerythritol tetranitrate.
Triethanolamine trinitrate biphosphate (trolnitrate phosphate).

    (b) The Food and Drug Administration also finds that there is 
neither substantial evidence of effectiveness nor a general recognition 
by qualified experts that such drugs are effective for any of the other 
purposes for which some such drugs are promoted to the medical 
profession in labeling and advertising. In particular, neither clinical 
investigations nor clinical experience justify any representations that 
such drugs are effective in the management of hypertension; in the 
management of coronary insufficiency or coronary artery disease, except 
for their anginal manifestations; or in the management of the post 
coronary state, except angina pectoris present after coronary occlusion 
and myocardial infarction.
    (c) Any preparation containing such drugs that is labeled or 
advertised for any use other than management of angina pectoris, or that 
is represented to be efficacious for any other purpose by reason of its 
containing such drug, will be regarded by the Food and Drug 
Administration as misbranded and subject to regulatory proceedings, 
unless such recommendations are covered by the approval of a new-drug 
application based on a showing of safety and effectiveness.
    (d) Any such drug in long-acting dosage form is regarded as a new 
drug that requires an approved new-drug application before marketing.
    (e) Any of the drugs listed in paragraph (a)(2) of this section is 
regarded as a new drug that requires an approved new-drug application. 
Articles for which new-drug approvals are now in effect should be 
covered by supplemental new-drug applications as necessary to provide 
for labeling revisions consistent with this policy statement.



Secs. 250.103-250.104  [Reserved]



Sec. 250.105  Gelsemium-containing preparations regarded as prescription drugs.

    It is the consensus of informed medical opinion that the margin of 
safety between the therapeutic and toxic concentration of gelsemium is 
narrow and it is difficult to predict the point at which the dose will 
be toxic. Very small doses may cause toxic symptoms. It is therefore the 
view of the Food and Drug Administration that gelsemium is not a proper 
ingredient in any product that is to be sold without prescription. 
Accordingly, any drug containing gelsemium will be regarded as 
misbranded under section 503(b)(4) of the Federal Food, Drug, and 
Cosmetic Act if its label fails to bear in a prominent and conspicuous 
fashion the statement ``Caution: Federal law prohibits dispensing 
without prescription.''



Secs. 250.106-250.107  [Reserved]



Sec. 250.108  Potassium permanganate preparations as prescription drugs.

    (a) There have been a number of reports in the medical literature of 
serious injuries to women resulting from the misuse of potassium 
permanganate

[[Page 151]]

in an effort to induce abortion. Reports from physicians who have 
treated such cases show that the injuries are commonly caused by 
introducing tablets or crystals of potassium permanganate into the 
vagina. Experience with these cases shows that such use of potassium 
permanganate is not effective in producing abortion, but that instead 
the drug produces serious and painful injury to the walls of the vagina, 
causing ulcers, massive hemorrhage, and infection. Such dangerous and 
useless employment of potassium permanganate is apparently encouraged 
among the misinformed by the mistaken idea that the vaginal bleeding 
caused by the corrosive action of the drug indicates a termination of 
pregnancy, which it does not.
    (b) Potassium permanganate is a strong oxidizing agent, a highly 
caustic, tissue-destroying chemical, and a poison. There are no 
circumstances under which crystals and tablets of potassium permanganate 
constitute safe dosage forms for use in self-medication. It is the 
consensus of informed medical opinion that the only dosage forms of 
potassium permanganate known to be safe for use in self-medication are 
aqueous solutions containing not more than 0.04 percent potassium 
permanganate. Such solutions are safe for use in self-medication only by 
external application to the skin.
    (c) In view of the very real potentiality for harmful effect, and 
the actual injuries caused by the misuse of potassium permanganate, the 
Food and Drug Administration believes that in order adequately to 
protect the public health:
    (1) Potassium permanganate and potassium permanganate tablets 
intended for human use are drugs subject to section 503(b)(1) of the 
Federal Food, Drug, and Cosmetic Act and should be restricted to 
prescription sale. Such drugs will be regarded as misbranded if at any 
time prior to dispensing the label fails to bear the legend, ``Caution: 
Federal law prohibits dispensing without prescription.''
    (2) Potassium permanganate labeled for use as a prescription 
component in human drugs under the exemption provided in Sec. 201.120 of 
this chapter or labeled for manufacturing use under the exemption 
provided in Sec. 201.122 of this chapter will be regarded as misbranded 
unless the label bears the statement, ``Caution: Federal law prohibits 
dispensing without prescription.''
    (3) These drugs will be regarded as misbranded when intended for 
veterinary use unless the label bears the legend, ``Caution: Federal law 
restricts this drug to sale by or on the order of a licensed 
veterinarian''; Provided, however, That this shall not apply to a drug 
labeled and marketed for veterinary use if such drug contains not more 
than 50 percent of potassium permanganate and includes other ingredients 
which make it unsuitable for human use and unlikely that the article 
would be used in an attempt to induce abortion.
    (4) Any preparation of potassium permanganate intended for over-the-
counter sale for human use internally or by application to any mucous 
membranes or for use in the vagina will be regarded as misbranded under 
the provisions of section 502(f) (1) and (2) and section 502(j) of the 
act.
    (5) Any other preparation of potassium permanganate intended for 
over-the-counter sale for human use will be regarded as misbranded under 
section 502(f) (1) and (2) and section 502(j) of the act unless, among 
other things, all of the following conditions are met:
    (i) It is an aqueous solution containing not more than 0.04 percent 
potassium permanganate.
    (ii) The label and labeling bear, in juxtaposition with adequate 
directions for use, clear warning statements designated as ``Warning,'' 
and to the effect: ``Warning--For external use on the skin only. Severe 
injury may result from use internally or as a douche. Avoid contact with 
mucous membranes.''
    (d) The labeling or dispensing of any potassium permanganate 
preparations intended for drug use within the jurisdiction of the 
Federal Food, Drug, and Cosmetic Act contrary to this statement after 60 
days from the date of its publication in the Federal Register may be 
made the subject of regulatory proceedings.

[[Page 152]]



               Subpart C--Requirements for Drugs and Foods



Sec. 250.201  Preparations for the treatment of pernicious anemia.

    (a) The ninth announcement of the Anti-anemia Preparations Advisory 
Board of the United States Pharmacopeia is concerned with the status of 
the treatment of pernicious anemia. It clearly presents the following 
facts:
    (1) The Sixteenth Revision of the Pharmacopeia of the United States, 
which became official on October 1, 1960, does not include preparations 
intended for the treatment of pernicious anemia by oral administration.
    (2) The U.S.P. unit for anti-anemia preparations no longer has any 
significance.
    (3) The U.S.P. Anti-anemia Preparations Advisory Board was 
disbanded.
    (b) On the basis of the scientific evidence and conclusions 
summarized in the statement of the U.S.P. Anti-anemia Preparations 
Advisory Board as well as pertinent information from other sources, the 
Commissioner of Food and Drugs finds it is the consensus of well 
informed medical opinion that:
    (1) The parenteral administration of cyanocobalamin or vitamin 
B12 is generally recognized as a fully effective treatment of 
pernicious anemia. Parenteral cyanocobalamin preparations have not been 
and are not authorized for use except by or on the prescription of a 
duly licensed medical practitioner.
    (2) Some patients afflicted with pernicious anemia do not respond to 
orally ingested products. There is no known way to predict which 
patients will fail to respond or will cease to respond to the treatment 
of pernicious anemia with orally ingested preparations.
    (3) The substitution of a possibly inadequate treatment, such as the 
ingestion of oral preparations of vitamin B12 with intrinsic 
factor concentrate, in place of parenteral vitamin B12 
products for a disease condition as serious as pernicious anemia cannot 
be regarded as safe in all cases.
    (4) The development of the classical symptoms of pernicious anemia 
that would cause a person to seek medical attention may in some cases be 
delayed by oral ingestion of intrinsic factor. Pernicious anemia is a 
disease that is associated, among other things, with a higher than 
normal incidence of cancer of the stomach and that for the safety of the 
patient, requires continuous expert medical supervision.
    (5) With inadequate treatment there may be markedly deleterious 
effects on the nervous system. It is well established that whereas the 
development of anemia is completely reversible with adequate treatment, 
the involvement of the nervous system may not be completely reversible 
and thus may result in permanent damage.
    (6) Some hematologists prescribe oral preparations of vitamin 
B12 in the treatment of pernicious-anemia patients.
    (7) Intrinsic factor and intrinsic factor concentrate serve no known 
useful therapeutic or nutritive purpose except to the extent that they 
do increase the gastrointestinal absorption of vitamin B12 in 
patients with a deficiency or absence of intrinsic factor, which may 
eventually lead to pernicious anemia. This conclusion does not apply to 
diagnostic procedures using radioactive cyanocobalamin.
    (8) Medical expertise is required for the diagnosis as well as the 
management of pernicious anemia.
    (c) The Eleventh Edition of The National Formulary and its first 
Interim Revision include monographs for oral preparations of vitamin 
B12 with intrinsic factor concentrate, establish a unit of 
vitamin B12 with intrinsic factor concentrate, and provide 
for a National Formulary Anti-anemia Preparations Advisory Board to 
assign the potency of such preparations. This provides for the 
availability of such oral preparations, standardized within the meaning 
of the broad limits characteristic of the evaluation of such 
preparations.
    (d) Any drug that is offered for or purports to contain intrinsic 
factor or intrinsic factor concentrate will be regarded as misbranded 
within the meaning of section 503(b) of the Federal Food, Drug, and 
Cosmetic Act unless it is labeled with the legend ``Caution--Federal law 
prohibits dispensing without prescription.''

[[Page 153]]

    (e) Any drug for oral ingestion intended, represented, or advertised 
for the prevention or treatment of pernicious anemia or which purports 
to contain any substance or mixture of substances described in paragraph 
(d) of this section (other than diagnostic drugs containing radioactive 
cyanocobalamin) will be regarded as misbranded under sections 502 (f)(2) 
and (j) of the act unless its labeling bears a statement to the effect 
that some patients afflicted with pernicious anemia may not respond to 
the orally ingested product and that there is no known way to predict 
which patients will respond or which patients may cease to respond to 
the orally ingested products. The labeling shall also bear a statement 
that periodic examinations and laboratory studies of pernicious anemia 
patients are essential and recommended.
    (f) Under section 409 of the Federal Food, Drug, and Cosmetic Act, 
intrinsic factor and intrinsic factor concentrate are regarded as food 
additives. No food additive regulation nor existing extension of the 
effective date of section 409 of the act authorizes these additives in 
foods, including foods for special dietary uses. Any food containing 
added intrinsic factor or intrinsic factor concentrate will be regarded 
as adulterated within the meaning of section 402(a)(2)(C) of the act.
    (g) Regulatory action may be initiated with respect to any article 
shipped within the jurisdiction of the act contrary to the provisions of 
this policy statement after the 180th day following publication of this 
statement in the Federal Register.



             Subpart D--Requirements for Drugs and Cosmetics



Sec. 250.250  Hexachlorophene, as a component of drug and cosmetic products.

    (a) Antibacterial component. The use of hexachlorophene as an 
antibacterial component in drug and cosmetic products has expanded 
widely in recent years. It is used in such products because of its 
bacteriostatic action against gram-positive organisms, especially 
against strains of staphylococcus; however, hexachlorophene offers no 
protection against gram-negative infections. In addition the 
antibacterial activity depends largely on repeated use. A notice 
published in the Federal Register of April 4, 1972 (37 FR 6775), invited 
data on OTC antimicrobial ingredients, including hexachlorophene, for 
review by an OTC Drug Advisory Review Panel to be convened under the 
procedures set forth in the Federal Register of May 11, 1972 (37 FR 
9464). This statement of policy will remain in effect unless and until 
replaced by a monograph resulting from the OTC Drug Advisory Review 
Panel.
    (b) Adverse effects. Though considered safe for many years, recent 
information has become available associating hexachlorophene with toxic 
effects, including deaths. Studies have shown that toxic amounts of 
hexachlorophene can be absorbed through the skin of humans, especially 
the skin of premature babies or damaged skin. Human toxicity reports 
include data on symptomatology, blood and tissue levels of 
hexachlorophene, and descriptions of neuropathologic lesions. Recent 
infant deaths due to use of baby powder accidentally contaminated with 6 
percent hexachlorophene have occurred. The accumulated evidence of 
toxicity is sufficient to require that continued marketing of 
hexachlorophene containing products be carefully defined in order to 
protect consumers.
    (c) Prescription drugs. (1) Because of their potential for harmful 
effect, drugs containing hexachlorophene, other than as a preservative 
as described below, are not considered to have been shown to be safe and 
effective, are regarded as new drugs requiring approved new drug 
applications, and would be misbranded for over-the-counter distribution. 
In the interest of public health protection, hexachlorophene containing 
drugs will be regarded as misbranded and subject to regulatory 
proceedings unless the label bears the legend ``Caution: Federal law 
prohibits dispensing without a prescription,'' and the labeling on or 
within the package from which the drug is to be dispensed bears adequate 
information for its safe and effective use by practitioners, in accord 
with Sec. 201.100(c) of this chapter.

[[Page 154]]

    (2) The Food and Drug Administration recognizes that hexachlorophene 
is useful as a bacteriostatic skin cleanser. It further concludes that 
the margin of safety is such that products containing hexachlorophene 
may appropriately be used within clearly delineated conditions of use.
    (3) In order for such drugs to bear adequate information for safe 
and effective use the following statements are representative of the 
type of labeling for products shown to be effective bacteriostatic skin 
cleansers. Labeling for products other than bacteriostatic skin 
cleansers will be determined through the new drug procedures based on 
the available data.
    (i) In the labeling other than on the immediate container label.

                               Indications

    1. Bacteriostatic skin cleanser for surgical scrubbing or 
handwashing as part of patient care.
    2. For topical application to control an outbreak of gram-positive 
infection where other infection control procedures have been 
unsuccessful. Use only as long as necessary for infection control.

                            Contraindications

    1. Not for use on burned or denuded skin or on mucous membranes.
    2. Not for routine prophylactic total body bathing.

                                Warnings

    Rinse thoroughly after use. Patients should be closely monitored and 
use should be immediately discontinued at the first sign of any of the 
symptoms described below.
    Hexachlorophene is rapidly absorbed and may produce toxic blood 
levels when applied to skin lesions such as ichthyosis congenita or the 
dermatitis of Letterer-Siwe's syndrome or other generalized dermatologic 
conditions. Application to burns has also produced neurotoxicity and 
death.
    Infants have developed dermatitis, irritability, generalized clonic 
muscular contractions and decerebrate rigidity following application of 
a 6 percent hexachlorophene powder. Examination of brainstems of those 
infants revealed vacuolization like that which can be produced in 
newborn experimental animals following repeated topical application of 3 
percent hexachlorophene. Moreover, a study of histologic sections of 
premature infants who died of unrelated causes has shown a positive 
correlation between hexachlorophene baths and lesions in white matter of 
brains.

    (ii) On the immediate container label prominently displayed and in 
bold print:

    ``Special Warning: This compound may be toxic if used other than as 
directed. Rinse thoroughly after use. Monitor patients closely for 
toxicity symptoms.''

    (4) Marketing of products for the indications listed in paragraph 
(c)(3) of this section may be continued without an approved new drug 
application (or required supplement thereto) either until a notice of 
opportunity for hearing is issued on a proposal by the Director of the 
Center for Drug Evaluation and Research to refuse to approve such new 
drug application (or required supplement) or until January 31, 1978, 
whichever comes first, if all the following conditions were met after 
September 27, 1972:
    (i) The product is labeled with the prescription legend and adequate 
information for safe and effective use as set forth in paragraph (c)(3) 
of this section.
    (ii) Within 30 days, or by (10-27-72) the holder of an approved new 
drug application submits a supplement to provide for the revised label 
and full disclosure labeling. As the label and labeling will have been 
put into use, the supplement should be submitted under the provision of 
Sec. 314.70(c)(2) of this chapter.
    (iii) Within 30 days, or by (10-27-72) the holder of an approved new 
drug application submits a supplement to provide for a revised 
formulation where appropriate to comply with this order.
    (iv) Within 90 days, or by (12-26-72) the holder of an approved new 
drug application submits a supplement containing blood level data 
obtained from use of the drug as recommended, unless such information is 
a part of the new drug application file.
    (v) Within 90 days, or by (12-26-72), the manufacturer or 
distributor of such a drug for which a new drug approval is not in 
effect submits a new drug application in accord with Sec. 314.50 of the 
new drug regulations (21 CFR 314.50), including blood level data 
obtained from use of the drug as recommended.
    (5) Prescription drug products may contain hexachlorophene as part 
of an effective preservative system only under the conditions and 
limitations

[[Page 155]]

provided for under paragraph (d) of this section.
    (d) Over-the-counter (OTC) drugs. Over-the-counter drug products, 
other than those which in normal use may be applied to mucous membranes 
or which are intended to be used on mucous membranes, may contain 
hexachlorophene only as part of an effective preservative system, at a 
level that is no higher than necessary to achieve the intended 
preservative function, and in no event higher than 0.1 percent. Such use 
of hexachlorophene shall be limited to situations where an alternative 
preservative has not yet been shown to be as effective or where adequate 
integrity and stability data for the reformulated product are not yet 
available. This use of hexachlorophene will not, by itself, require an 
approved new drug application. Use of hexachlorophene as a preservative 
at a level higher than 0.1 percent is regarded as a new drug use 
requiring an approved new drug application, which must be submitted 
within the time set out in paragraph (c)(4) of this section.
    (e) Cosmetics. Hexachlorophene may be used as a preservative in 
cosmetic products other than those which in normal use may be applied to 
mucous membranes or which are intended to be used on mucous membranes, 
at a level that is no higher than necessary to achieve the intended 
preservative function, and in no event higher than 0.1 percent. Such use 
of hexachlorophene shall be limited to situations where an alternative 
preservative has not yet been shown to be as effective or where adequate 
integrity and stability data for the reformulated product are not yet 
available. The component of a preservative system whether 
hexachlorophene or other antimicrobial agent, should be selected on the 
basis of the effect on the total microbial ecology of the product, not 
merely on gram-positive bacteria.
    (1) Adequate safety data do not presently exist to justify wider use 
of hexachlorophene in cosmetics.
    (2) Antibacterial ingredients used as substitutes for 
hexachlorophene in cosmetic products, and finished cosmetic products 
containing such ingredients, shall be adequately tested for safety prior 
to marketing. Any such ingredient or product whose safety is not 
adequately substantiated prior to marketing may be adulterated and will 
in any event be deemed misbranded unless it contains a conspicuous front 
panel statement that the product has not been adequately tested for 
safety and may be hazardous.
    (f) Content statement. All reference to hexachlorophene limit in 
this order is on a weight-in-weight (w/w) basis. Quantitative 
declaration of hexachlorophene content on the labeling of the products, 
where required, shall be on a w/w basis.
    (g) Shipments of products. Shipments of products falling within the 
scope of paragraphs (c), (d), or (e) of this section which are not in 
compliance with the guidelines stated herein shall be the subject of 
regulatory proceedings after the effective date of the final order.
    (h) Prior notices. This order preempts any conditions for marketing 
products set forth in the following prior notices.

1. DESI No. 4749 (34 FR 15389, October 2, 1969), ``Certain OTC Drugs for 
Topical Use.''
2. DESI No. 2855 (35 FR 12423, August 4, 1970), ``Certain Mouthwash and 
Gargle Preparations.''
3. DESI No. 8940 (36 FR 14510, August 6, 1971), ``Topical Cream 
Containing Pyrilamine Maleate, Benzocaine, Hexachlorophene, and 
Cetrimonium Bromide.''
4. DESI No. 6615 (36 FR 18022, September 8, 1971), ``Deodorant/
Antiperspirant.''
5. DESI No. 6270 (36 FR 23330, December 8, 1971), ``Certain Preparations 
Containing Hexachlorophene''.

[40 FR 14033, Mar. 27, 1975, as amended at 42 FR 63773, Dec. 20, 1977; 
55 FR 11577, Mar. 29, 1990]



PART 290--CONTROLLED DRUGS--Table of Contents




                      Subpart A--General Provisions

Sec.
290.5  Drugs; statement of required warning.
290.6  Spanish-language version of required warning.
290.10  Definition of emergency situation.

Subpart B [Reserved]

Subpart C--Requirements for Specific Controlled Drugs [Reserved]

    Authority: 21 U.S.C. 352, 353, 355, 371.

    Source: 40 FR 14040, Mar. 27, 1975, unless otherwise noted.

[[Page 156]]



                      Subpart A--General Provisions



Sec. 290.5  Drugs; statement of required warning.

    The label of any drug listed as a ``controlled substance'' in 
schedule II, III, or IV of the Federal Controlled Substances Act shall, 
when dispensed to or for a patient, contain the following warning: 
``Caution: Federal law prohibits the transfer of this drug to any person 
other than the patient for whom it was prescribed.'' This statement is 
not required to appear on the label of a controlled substance dispensed 
for use in clinical investigations which are ``blind.''



Sec. 290.6  Spanish-language version of required warning.

    By direction of section 305(c) of the Federal Controlled Substances 
Act, Sec. 290.5, promulgated under section 503(b) of the Federal Food, 
Drug, and Cosmetic Act, requires the following warning on the label of 
certain drugs when dispensed to or for a patient: ``Caution: Federal law 
prohibits the transfer of this drug to any person other than the patient 
for whom it was prescribed.'' The Spanish version of this is: 
``Precaucion: La ley Federal prohibe el transferir de esta droga a otra 
persona que no sea el paciente para quien fue recetada.''



Sec. 290.10  Definition of emergency situation.

    For the purposes of authorizing an oral prescription of a controlled 
substance listed in schedule II of the Federal Controlled Substances 
Act, the term emergency situation means those situations in which the 
prescribing practitioner determines:
    (a) That immediate administration of the controlled substance is 
necessary, for proper treatment of the intended ultimate user; and
    (b) That no appropriate alternative treatment is available, 
including administration of a drug which is not a controlled substance 
under schedule II of the Act, and
    (c) That it is not reasonably possible for the prescribing 
practitioner to provide a written prescription to be presented to the 
person dispensing the substance, prior to the dispensing.

Subpart B [Reserved]

Subpart C--Requirements for Specific Controlled Drugs [Reserved]



PART 291--DRUGS USED FOR TREATMENT OF NARCOTIC ADDICTS--Table of Contents




Sec.
291.501  Narcotic drugs in the maintenance treatment of narcotic 
          addicts.
291.505  Conditions for the use of narcotic drugs; appropriate methods 
          of professional practice for medical treatment of the narcotic 
          addiction of various classes of narcotic addicts under section 
          4 of the Comprehensive Drug Abuse Prevention and Control Act 
          of 1970.

    Authority: 21 U.S.C. 355, 371, 823; 42 U.S.C. 241(d), 257a, 290ee-3, 
300y-11.



Sec. 291.501  Narcotic drugs in the maintenance treatment of narcotic addicts.

    (a) The Food and Drug Administration, the National Institute on Drug 
Abuse, and the Drug Enforcement Administration, Department of Justice, 
recognize that the use of narcotic drugs in the prolonged maintenance of 
narcotic dependence has been shown to be an effective part of a total 
treatment effort in the management and rehabilitation of selected 
narcotic addicts. It is also recognized that a number of dangers and 
possible abuses may arise from such efforts if professional services and 
controls are inadequately applied.
    (b) Therefore, the Commissioner of Food and Drugs, the Director of 
the National Institute on Drug Abuse, and the Administrator of the Drug 
Enforcement Administration, Department of Justice, agree that interested 
professionals, municipalities, and organizations should be allowed to 
use narcotic drugs in the medical treatment of narcotic addiction within 
a framework of adequate controls designed to protect the individual 
patients and the community. Narcotic drugs that are to be used as part 
of the treatment of narcotic addiction must have an approved new drug 
application for such use. To facilitate this purpose, the Food and Drug 
Administration, the National Institute

[[Page 157]]

on Drug Abuse, and the Drug Enforcement Administration, Department of 
Justice, have jointly agreed upon acceptable conditions for the use of 
narcotic drugs in a treatment program, which are set forth in 
Sec. 291.505. In addition, such other provisions of the Federal narcotic 
laws and regulations as are applicable must also be observed.

[58 FR 38709, July 20, 1993]



Sec. 291.505  Conditions for the use of narcotic drugs; appropriate methods of professional practice for medical treatment of the narcotic addiction of various
 
          classes of narcotic addicts under section 4 of the 
          Comprehensive Drug Abuse Prevention and Control Act of 1970.

    (a) Definitions. As used in this part:
    (1) Detoxification treatment means the dispensing of a narcotic drug 
in decreasing doses to an individual to alleviate adverse physiological 
or psychological effects incident to withdrawal from the continuous or 
sustained use of a narcotic drug and as a method of bringing the 
individual to a narcotic drug-free state within such period. There are 
two types of detoxification treatment: short-term detoxification 
treatment and long-term detoxification treatment.
    (i) Short-term detoxification treatment is for a period not in 
excess of 30 days.
    (ii) Long-term detoxification treatment is for a period more than 30 
days but not in excess of 180 days.
    (2) Maintenance treatment means the dispensing of a narcotic drug, 
at relatively stable dosage levels, in the treatment of an individual 
for dependence on heroin or other morphine-like drug. There are two 
types of maintenance treatment: comprehensive maintenance treatment and 
interim maintenance treatment.
    (i) Comprehensive maintenance treatment is maintenance treatment 
provided in conjunction with a comprehensive range of appropriate 
medical and rehabilitative services.
    (ii) Interim maintenance treatment is maintenance treatment provided 
in conjunction with appropriate medical services while a patient is 
awaiting transfer to comprehensive maintenance treatment.
    (3) A medical director is a physician, licensed to practice medicine 
in the jurisdiction in which the program is located, who assumes 
responsibility for the administration of all medical services performed 
by the narcotic treatment program including ensuring that the program is 
in compliance with all Federal, State, and local laws and regulations 
regarding the medical treatment of narcotic addiction with a narcotic 
drug.
    (4) A medication unit is a facility established as part of, but 
geographically dispersed, i.e., separate from a narcotic treatment 
program from which licensed private practitioners and community 
pharmacists--
    (i) Are permitted to administer and dispense a narcotic drug, and
    (ii) Are authorized to collect samples for drug testing or analysis 
for narcotic drugs.
    (5) Narcotic dependent means an individual who physiologically needs 
heroin or a morphine-like drug to prevent the onset of signs of 
withdrawal.
    (6) A narcotic treatment program is an organization (or a person, 
including a private physician) that administers or dispenses a narcotic 
drug to a narcotic addict for maintenance or detoxification treatment, 
provides, when appropriate or necessary, a comprehensive range of 
medical and rehabilitative services, is approved by the State authority 
and the Food and Drug Administration, and that is registered with the 
Drug Enforcement Administration to use a narcotic drug for the treatment 
of narcotic addiction.
    (7) A program sponsor is a person (or representative of an 
organization) who is responsible for the operation of a narcotic 
treatment program and who assumes responsibility for all its employees 
including any practitioners, agents, or other persons providing services 
at the program (including its medication units).
    (8) The term services, as used in this part, includes medical 
evaluations, counseling, rehabilitative and other social programs (e.g., 
vocational and educational guidance, employment placement), which will 
help the patient become a productive member of society.
    (9) A State authority is the agency designated by the Governor or 
other

[[Page 158]]

appropriate official to exercise the responsibility and authority within 
the State or Territory for governing the treatment of narcotic addiction 
with a narcotic drug.
    (10) The term HIV disease means infection with the etiologic agent 
for acquired immunodeficiency syndrome.
    (b) Organizational structure and approval requirements--(1) 
Organizational structure. (i) A narcotic treatment program may be an 
independent organization or part of a centralized organization. For 
example, if a centralized organizational structure consists of a primary 
facility and other outpatient facilities, all of which conduct initial 
evaluation of patients and administer or dispense medication, the 
primary facility and each outpatient facility are separate programs, 
even though some services (e.g., the same hospital or rehabilitative 
services) are shared.
    (ii) The program sponsor shall submit to the Food and Drug 
Administration and the State authority a description of the 
organizational structure of the program, the name of the persons 
responsible for the program, the address of the program, and the 
responsibilities of each facility or medication unit. The sources of 
funding for each program shall be listed and the name and address of 
each governmental agency providing funding shall be stated.
    (iii) Where two or more programs share a central administration 
(e.g., a city or State-wide organization), the person responsible for 
the organization (administrator or program sponsor) is required to be 
listed as the program sponsor for each separate participating program. 
An individual program shall indicate its participation in the central 
organization at the time of its application. The administrator or 
sponsor may fulfill all recordkeeping and reporting requirements for 
these programs, but each program must continue to receive separate 
approval.
    (iv) One physician may assume primary medical responsibility for 
more than one program and be listed as medical director. If a physician 
assumes medical responsibility for more than one program, a statement 
documenting the feasibility of the arrangement is required to be 
attached to the application.
    (v) Interim maintenance treatment. A public or nonprofit private 
narcotic treatment program may provide interim maintenance treatment 
only if the program also provides comprehensive maintenance treatment to 
which interim maintenance treatment patients may be transferred.
    (2)(i) Program approval. Before a narcotic treatment program may be 
lawfully operated, the program, whether an outpatient facility or a 
private practitioner, shall submit the applications specified in this 
section simultaneously to the Food and Drug Administration and the State 
authority and must receive the approval of both, except as provided for 
in paragraph (h)(5) of this section. Before granting approval, the Food 
and Drug Administration will consult with the Drug Enforcement 
Administration, Department of Justice, to ascertain if the program is in 
compliance with Federal controlled substances laws. Each physical 
location within any program is required to be identified and listed in 
the approval application. At the time of application for approval, the 
program sponsor shall indicate whether medication will be administered 
or dispensed at the facility. Before medication may be administered or 
dispensed at a location not previously approved for this purpose, the 
program is required to obtain approval from FDA and the State agency. 
However, no approval is necessary, but notification is required when a 
facility in which medication is administered or dispensed is deleted by 
a program. In that event, the program shall notify the Food and Drug 
Administration and the State authority within three weeks of the 
deletion. Similarly, addition or deletion of facilities which provide 
services other than administering or dispensing medication is also 
permitted without approval, but notification must be made within 3 weeks 
to the Food and Drug Administration and the State authority about the 
addition and/or deletion.
    (ii) Exemption of Federal programs. The provisions of this section 
requiring approval (or permitting disapproval or revocation of approval) 
by the State authority, compliance with requirements imposed by State 
law, or the submission of applications or reports

[[Page 159]]

required by the State authority do not apply to programs operated 
directly by the Veterans' Administration or any other department or 
agency of the United States. Federal agencies operating narcotic 
treatment programs have agreed to cooperate voluntarily with State 
agencies by granting permission on an informal basis for designated 
State representatives to visit Federal narcotic treatment programs and 
by furnishing a copy of Federal reports to the State authority, 
including the reports required under this section.
    (iii) Services. Each narcotic treatment program shall provide 
medical and rehabilitative services and programs. (See paragraph (d)(4) 
of this section.) These services should normally be made available at 
the primary facility, but the program sponsor may enter into a formal 
documented agreement with private or public agencies, organizations, or 
institutions for these services if they are available elsewhere. The 
program sponsor, in any event, must be able to document that medical and 
rehabilitative services are fully available to patients.
    (iv) Prohibition against unapproved use of narcotic drugs. No 
prescribing, administering, or dispensing of a narcotic drug for the 
treatment of narcotic addiction may occur without prior approval by the 
Food and Drug Administration and the State authority, except as provided 
for in paragraph (h)(5) of this section, unless specifically exempted by 
this section.
    (v) Approved narcotic drugs for use in treatment programs. The 
following narcotic drugs have been approved for use in the treatment of 
narcotic addiction: Methadone and Levo-Alpha-Acetyl-Methadol (LAAM).
    (vi) Interim maintenance treatment program approval. Before a public 
or nonprofit private narcotic treatment program may provide interim 
maintenance treatment, the program must receive approval of both the 
Food and Drug Administration and the chief public health officer of the 
State. Before such approval is granted, the program must provide the 
Food and Drug Administration with certification from the chief public 
health officer of the State that:
    (A) Such officer does not object to the authorization of programs 
providing interim maintenance treatment in the State and that programs 
seeking such authorization are unable to place patients in a public or 
nonprofit private comprehensive treatment program within a reasonable 
geographic area within 14 days of the time patients seek admission to 
such programs;
    (B) The authorization of programs providing interim maintenance 
treatment in the State will not reduce the capacity of comprehensive 
programs in the State to admit individuals to these programs (relative 
to the date on which such officer so certifies);
    (C) The State guarantees that individuals enrolled in interim 
maintenance treatment will be transferred to comprehensive programs not 
later than 120 days, as provided by section 1923 of the Public Health 
Service Act (the PHS Act) and applicable regulations; and
    (D) Requests for authorization should be submitted to the address 
specified in paragraph (l) of this section.
    (3)(i) Medication unit. A program may establish a medication unit to 
facilitate the needs of patients who are stabilized on an optimal dosage 
level. To lawfully operate a medication unit, the program shall, for 
each separate unit, obtain approval from the Food and Drug 
Administration, the Drug Enforcement Administration, and the State 
authority, except as provided for in paragraph (h)(5) of this section. 
The Food and Drug Administration, in determining whether to approve a 
medication unit, will consider the distribution of units within a 
particular geographic area. Any new medication unit is required to 
receive approval before it may lawfully commence operation.
    (ii) Revocation of approval. If the Food and Drug Administration 
revokes the primary program's approval, the approval for any medication 
unit associated with the program is deemed to be automatically revoked. 
The Food and Drug Administration's revocation of the approval of a 
particular medication unit, will not, in and of itself, affect the 
approval of the primary program.
    (iii) Narcotic drug supply. A medication unit must receive its 
supply of the narcotic drug directly from the stocks

[[Page 160]]

of the primary facility. Only persons permitted to administer or 
dispense the drug or security personnel licensed or otherwise authorized 
by State law to do so may deliver the drug to a medication unit.
    (iv) Referral. (A) The patient shall be stabilized at his or her 
optimal dosage level before he or she may be referred to a medication 
unit.
    (B) Since the medication unit does not provide a range of services, 
the program sponsor shall determine that the patient to be referred is 
not in need of frequent counseling, rehabilitative, and other services 
which are only available at the primary program facility.
    (v) Services. A medication unit is limited to administering or 
dispensing a narcotic drug and collecting samples for drug testing or 
analysis for narcotic drugs in accordance with paragraph (d)(2) of this 
section. If a private practitioner wishes to provide other services 
besides administering or dispensing a narcotic drug and collecting 
samples for drug testing or analysis for narcotic drugs, he or she must 
submit an application for separate approval.
    (vi) Responsibility for patient. After a patient is referred to a 
medication unit, the program sponsor retains continuing responsibility 
for the patient's care. The program sponsor shall ensure that the 
patient receives needed medical and rehabilitative services at the 
primary facility.
    (c) Conditions for approval of the use of a narcotic drug in a 
treatment program--(1) Applicants. An individual listed as program 
sponsor for a treatment program using a narcotic drug need not 
personally be a licensed practitioner but shall employ a licensed 
physician for the position of medical director. Persons responsible for 
administering or dispensing the narcotic drug shall be practitioners as 
defined by section 102(21) of the Controlled Substances Act (21 U.S.C. 
802(21)) and licensed to practice by the State in which the program is 
to be established.
    (2)(i) Assent to regulation. A person who sponsors a narcotic 
treatment program, and any persons responsible for a particular program, 
shall agree to adhere to all the rules, directives, and procedures, set 
forth in this section, and any regulation regarding the use of narcotic 
drugs in the treatment of narcotic addiction which may be promulgated in 
the future. The program sponsor has responsibility for all personnel and 
individuals providing services, who work in the program at the primary 
facility or at other facilities or medication units. The program 
sponsors shall agree to inform all personnel and individuals providing 
services of the provisions of this section and to monitor their 
activities to assure compliance with the provisions.
    (ii) The Food and Drug Administration and the State authority are 
required to be notified within 3 weeks of any replacement of the program 
sponsor or medical director. Activities in violation of this regulation 
may give rise to the sanctions set forth in paragraph (i) of this 
section.
    (3) Description of facilities. Only program site(s) approved by 
Federal, State, and local authorities may treat narcotic addicts with a 
narcotic drug. To obtain program approval, the applicant shall 
demonstrate that he or she will have access to adequate physical 
facilities to provide all necessary services. A program must have ready 
access to a comprehensive range of medical and rehabilitative services 
so that the services may be provided when necessary. The name, address, 
and description of each hospital, institution, clinical laboratory, or 
other facility available to provide the necessary services are required 
to be included in the application submitted to the Food and Drug 
Administration and the State authority. The application is also required 
to include the name and address of each medication unit.
    (4) Submission of proper applications. The following applications 
shall be filed simultaneously with both the Food and Drug Administration 
and the State authority:
    (i) Form FDA-2632 ``Application for Approval of Use of Narcotic 
Drugs in a Treatment Program.'' This form, required by paragraph (l) of 
this section, shall be completed and signed by the program sponsor and 
submitted in duplicate to the Food and Drug Administration and the State 
authority.
    (ii) Form FDA-2633 ``Medical Responsibility Statement for Use of 
Narcotic Drugs

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in a Treatment Program.'' This form, required by paragraph (l) of this 
section, shall be completed and signed by each licensed physician 
authorized to administer or dispense narcotic drugs and submitted in 
duplicate to the Food and Drug Administration and the State authority. 
The names of any other persons licensed by law to administer or dispense 
narcotic drugs working in the program shall be listed even if they are 
not responsible for administering or dispensing the drug at the time the 
application is submitted.
    (5) State and Federal approval, denial, and revocation of approval 
of narcotic treatment programs. (i) The Food and Drug Administration may 
grant approval to a program only after FDA has received notification 
from both the State authority and the Drug Enforcement Administration 
that the program conforms to all pertinent State and Federal 
requirements.
    (ii) The Food and Drug Administration will revoke the approval of a 
narcotic treatment program if so requested by the State authority or the 
Drug Enforcement Administration. If approval of a program is denied or 
revoked, the program shall have a right to appeal to the Commissioner, 
as provided for in paragraph (h)(5) of this section.
    (iii) No shipment of a narcotic drug may lawfully be made to any 
program which does not have current approval from the Food and Drug 
Administration. Within 60 days after receipt of the application from the 
program sponsor for approval, the Food and Drug Administration will 
notify the sponsor whether the application is approved or denied.
    (d)(1) Minimum standards for admission--(i) History of addiction and 
current physiologic dependence. (A) A person may be admitted as a 
patient for a comprehensive maintenance program only if a program 
physician determines that the person is currently physiologically 
dependent upon a narcotic drug and became physiologically dependent at 
least 1 year before admission for comprehensive maintenance treatment. A 
1-year history of addiction means that an applicant for admission to a 
comprehensive maintenance program was physiologically addicted to a 
narcotic at a time at least 1 year before admission to a program and was 
addicted, continuously or episodically, for most of the year immediately 
before admission to a program. In the case of a person for whom the 
exact date on which physiological addiction began cannot be ascertained, 
the admitting program physician may, in his or her reasonable clinical 
judgment, admit the person to comprehensive maintenance treatment, if 
from the evidence presented, observed, and recorded in the patient's 
record, it is reasonable to conclude that there was physiologic 
dependence at a time approximately 1 year before admission.
    (B) Although daily use of a narcotic for an entire year could 
satisfy the regulatory definition of a 1-year history of addiction, 
operationally one might be physiologically dependent without daily use 
during the entire 1-year period and still satisfy the definition. The 
following, although not exhaustive, are examples of applicants who would 
meet the minimum standard of a 1-year history of addiction and who, if 
currently physiologically dependent on the date of application for 
admission, would be eligible for admission to a comprehensive 
maintenance program:
    (1) Physiologic addiction began in August 1987 and continued to the 
date of application for admission in August 1988.
    (2) Physiologic addiction began in January 1988 and continued until 
April 1988. Physiologic addiction began again in July 1988 and continued 
until the application for admission in January 1989.
    (3) Physiologic addiction began in January 1987 and continued until 
October 1987. The date of application for admission was January 1988, at 
which time the patient had been readdicted for 1 month preceding his or 
her admission.
    (4) Physiologic addiction consisted of four episodes in the last 
year, each episode lasting 2\1/2\ months.
    (C) The program physician or an appropriately trained staff member 
designated and supervised by the physician shall record in the patient's 
record the criteria used to determine the patient's current physiologic 
dependence and history of addiction. In the latter

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circumstance, the program physician shall review, date, and countersign 
the supervised staff member's evaluation to demonstrate his or her 
agreement with the evaluation. The program physician shall make the 
final determination concerning a patient's physiologic dependence and 
history of addiction. The program physician shall sign, date, and record 
a statement that he or she has reviewed all the documented evidence to 
support a 1-year history of addiction and the current physiologic 
dependence and that in his or her reasonable clinical judgment the 
patient fulfills the requirements for admission to comprehensive 
maintenance treatment. The program physician shall complete and record 
the statement before the program administers any narcotic drug to the 
patient.
    (ii) Voluntary participation, informed consent. The person 
responsible for the program shall ensure that: A patient voluntarily 
chooses to participate in a program; all relevant facts concerning the 
use of the narcotic drug used by the program are clearly and adequately 
explained to the patient; all patients, with full knowledge and 
understanding of its contents, sign the ``Consent to Treatment with an 
Approved Narcotic Drug'' Form FDA-2635 (see paragraph (l) of this 
section); a parent, legal guardian, or responsible adult designated by 
the State authority (e.g., ``emancipated minor'' laws) sign for patients 
under the age of 18 the second part of Form FDA-2635 ``Consent to 
Treatment with an Approved Narcotic Drug.''
    (iii) Exceptions to minimum admission criteria--(A) Penal or chronic 
care. A person who has resided in a penal or chronic care institution 
for 1 month or longer may be admitted to comprehensive maintenance 
treatment within 14 days before release or discharge, or within 6 months 
after release from such an institution without documented evidence to 
support findings of physiological dependence, provided the person would 
have been eligible for admission before he or she was incarcerated or 
institutionalized and, in the reasonable clinical judgment of a program 
physician, treatment is medically justified. Documented evidence of the 
prior residence in a penal or chronic care institution and evidence of 
all other findings and the criteria used to determine the findings are 
required to be recorded in the patient's record by the admitting program 
physician, or by program personnel supervised by the admitting program 
physician. The admitting program physician shall date and sign these 
recordings or review the health-care professional's recordings before 
the initial dose is administered to the patient. In the latter case, the 
admitting program physician shall date and sign the recordings in the 
patient's record made by the health-care professional within 72 hours of 
administration of the initial dose to the patient.
    (B) Pregnant patients. (1) Pregnant patients, regardless of age, who 
have had a documented narcotic dependency in the past and who may return 
to narcotic dependency, with all its attendant dangers during pregnancy, 
may be placed on a comprehensive maintenance regimen, except as provided 
in paragraph (d)(1)(iii)(B)(6) of this section. For such patients, 
evidence of current physiological dependence on narcotic drugs is not 
needed if a program physician certifies the pregnancy and, in his or her 
reasonable clinical judgment, finds treatment to be medically justified. 
Evidence of all findings and the criteria used to determine the findings 
are required to be recorded in the patient's record by the admitting 
program physician, or by program personnel supervised by the admitting 
program physician. The admitting program physician shall date and sign 
these recordings or review the health-care professional's recordings 
before the initial dose is administered to the patient. In the latter 
case, the admitting program physician shall date and sign the recordings 
in the patient's record made by the health-care professional within 72 
hours of administration of the initial dose to the patient. Pregnant 
patients are required to be given the opportunity for prenatal care 
either by the program or by referral to appropriate health-care 
providers.
    (2) If a program cannot provide direct prenatal care for pregnant 
patients in treatment, the program shall establish a system for 
informing the patients of

[[Page 163]]

the publicly or privately funded prenatal care opportunities available. 
If there are no publicly funded prenatal referral opportunities and the 
program cannot provide such services or the patient cannot afford them 
or refuses them, then the treatment program shall, at a minimum, offer 
her basic prenatal instruction on maternal, physical, and dietary care 
as part of its counseling service.
    (3) Counseling records and/or other appropriate patient records are 
required to reflect the nature of prenatal support provided by the 
program. If the patient is referred for prenatal services, the physician 
to whom she is referred is required to be notified that she is in 
comprehensive maintenance treatment, provided that notification is in 
accordance with the Department of Health and Human Services' 
confidentiality regulations (42 CFR part 2). If a pregnant patient 
refuses direct treatment or appropriate referral for treatment, the 
treating program physician should consider using informed consent 
procedures; e.g., to have the patient acknowledge in writing that she 
had the opportunity for this treatment but refuses it. The program 
physician, consistent with the confidentiality regulations, shall 
request the physician or the hospital to which a patient is referred to 
provide, following birth, a summary of the delivery and treatment 
outcome for the patient and offspring. If the program physician does not 
receive a response to the request, he or she shall document in the 
record that such a request was made.
    (4) Within 3 months after termination of pregnancy, the program 
physician shall enter an evaluation of the patient's treatment state 
into her record and state whether she should remain in the comprehensive 
maintenance program or be detoxified.
    (5) Caution should be taken in the comprehensive maintenance 
treatment of pregnant patients. Dosage levels should be maintained at 
the lowest effective dose if treatment is deemed necessary. The program 
sponsor shall ensure that each female patient is fully informed of the 
possible risks to her or to her unborn child from continued use of 
illicit drugs and from the use of, or withdrawal from, a narcotic drug 
administered or dispensed by the program in comprehensive maintenance or 
detoxification treatment.
    (6) Patients who are or become pregnant shall not be started or 
continued on LAAM, except by the written order of a physician who 
determines this to be the best choice of therapy for that patient. 
Clinics providing treatment with LAAM must advise all patients of 
childbearing potential of the risks of LAAM and make a medical 
evaluation available to all patients who become pregnant while taking 
the drug. An initial pregnancy test shall be performed for each 
prospective female patient of childbearing potential before admission to 
LAAM comprehensive maintenance treatment and monthly pregnancy tests 
performed thereafter on such female patients in LAAM comprehensive 
maintenance treatment. Analysis of such tests shall be performed in a 
laboratory approved under the Clinical Laboratory Improvement Amendments 
of 1988 or in a laboratory certified by a State or private accrediting 
body approved by the Health Care Financing Administration.
    (C) Previously treated patients. Under certain circumstances a 
patient who has been treated and later voluntarily detoxified from 
comprehensive maintenance treatment may be readmitted to maintenance 
treatment, without evidence to support findings of current physiologic 
dependence, up to 2 years after discharge, if the program attended is 
able to document prior narcotic drug comprehensive maintenance treatment 
of 6 months or more, and the admitting program physician, in his or her 
reasonable clinical judgment, finds readmission to comprehensive 
maintenance treatment to be medically justified. For patients meeting 
these criteria, the quantity of take-home medication, if take-home 
medication is permitted for the narcotic drug, will be determined in the 
reasonable clinical judgment of the program physician, but in no case 
may the quantity of take-home medication be greater than would have been 
allowed at the time the patient voluntarily terminated previous 
treatment. The admitting program physician or a program employee

[[Page 164]]

under supervision of the admitting program physician must enter in the 
patient's record documented evidence of the patient's prior treatment 
and evidence of all decisions and criteria used relating to the 
admission of the patient and the quantity of take-home medication 
permitted. The admitting program physician shall date and sign these 
entries in the patient's record or review the health-care professional's 
entries therein before the program administers any medication to the 
patient. In the latter case, the admitting program physician shall date 
and sign the entries in the patient's record made by the health-care 
professional within 72 hours of administration of the initial dose to 
the patient.
    (iv) Special limitation; treatment of patients under 18 years of 
age. (A) A person under 18 years of age is required to have had two 
documented attempts at short-term detoxification or drug-free treatment 
to be eligible for maintenance treatment, except as provided in 
paragraph (d)(1)(iv)(B) of this section. A 1-week waiting period is 
required after such a detoxification attempt, however, before an attempt 
is repeated. The program physician shall document in the patient's 
record that the patient continues to be or is again physiologically 
dependent on narcotic drugs. No person under 18 years of age may be 
admitted to a maintenance treatment program unless a parent, legal 
guardian, or responsible adult designated by the State authority (e.g., 
``emancipated minor'' laws) completes and signs consent form, Form FDA-
2635 ``Consent to Treatment with an Approved Narcotic Drug.''
    (B) A person under 18 years of age shall not be admitted to LAAM 
maintenance treatment.
    (v) Denial of admission. If in the reasonable clinical judgment of 
the medical director a particular patient would not benefit from 
treatment with a narcotic drug, the patient may be refused such 
treatment even if the patient meets the admission standards.
    (2) Minimum testing or analysis for drugs: Uses and frequency. (i) 
The person(s) responsible for a program shall ensure that: An initial 
drug-screening test or analysis is completed for each prospective 
patient; at least eight additional random tests or analyses are 
performed on each patient during the first year in comprehensive 
maintenance treatment; and at least quarterly random tests or analyses 
are performed on each patient in comprehensive maintenance treatment for 
each subsequent year, except that a random test or analysis is performed 
monthly on each patient who receives a 6-day supply of take-home 
medication. When a sample is collected from each patient for such test 
or analysis, it must be done in a manner that minimizes opportunity for 
falsification. Each test or analysis must be analyzed for opiates, 
methadone, amphetamines, cocaine, and barbiturates. In addition, if any 
other drug or drugs have been determined by a program to be abused in 
that program's locality, or as otherwise indicated, each test or 
analysis must be analyzed for any of those drugs as well. Any laboratory 
that performs the testing required under this regulation shall be in 
compliance with all applicable Federal proficiency testing and licensing 
standards and all applicable State standards. If a program proposes to 
change a laboratory used for such testing or analysis, the program shall 
have the change approved by the Food and Drug Administration.
    (ii) The person responsible for a program shall ensure that test 
results are not used as the sole criterion to force a patient out of 
treatment but are used as a guide to change treatment approaches. The 
person responsible for a program shall also ensure that when test 
results are used, presumptive laboratory results are distinguished from 
results that are definitive.
    (3) Patient evaluation; minimum admission and periodic 
requirements--(i) Minimum contents of medical evaluation. Each patient 
is required to have a medical evaluation by a program physician or an 
authorized health-care professional under the supervision of a program 
physician on admission to a program. At a minimum, this evaluation is 
required to consist of a medical history which includes the required 
history of narcotic dependence, evidence of current physiologic 
dependence unless excepted by the regulations, and a physical 
examination, and includes the

[[Page 165]]

following laboratory examinations: serological test for syphilis, a 
tuberculin skin test, and a test or analysis for drug determination. A 
pregnancy test is required for any woman of childbearing potential 
before she may be administered LAAM as directed in paragraph 
(d)(1)(iii)(B)(1) of this section. If in the reasonable clinical 
judgment of the program physician, a patient's subcutaneous veins are 
severely damaged to the extent that a blood specimen cannot be obtained, 
the serological test for syphilis may be omitted. The physical 
examination is required to consist of an investigation of the organ 
systems for possibilities of infectious disease, pulmonary, liver, and 
cardiac abnormalities, and dermatologic sequelae of addiction. In 
addition, the physical examination is required to include a 
determination of the patient's vital signs (temperature, pulse, and 
blood pressure and respiratory rate); an examination of the patient's 
general appearance, head, ears, eyes, nose, throat (thyroid), chest 
(including heart, lungs, and breasts), abdomen, extremities, skin, and 
neurological assessment; and the program physician's overall impression 
of the patient.
    (ii) Recordings of findings. The admitting program physician or an 
appropriately trained health care professional supervised by the 
admitting program physician shall record in the patient's record all 
findings from the admission medical evaluation. In each case the 
admitting program physician shall date and sign these entries, or date, 
review, and countersign these recordings in the patient's record to 
signify his or her review of and concurrence with the history and 
physical findings.
    (iii) Admission evaluation. (A) Each patient seeking admission or 
readmission for treatment services is required to be interviewed by a 
well-trained program counselor, qualified by virtue of education, 
training, or experience to assess the psychological and sociological 
background of drug abusers, to determine the appropriate treatment plan 
for the patient. To determine the most appropriate treatment plan for a 
patient, the interviewer shall obtain and document in the patient's 
record the patient's history.
    (B) A patient's history includes information relating to his or her 
educational and vocational achievements. If a patient has no such 
history; i.e., he or she has no formal education or has never had an 
occupation, this requirement is met by writing this information in the 
patient's history.
    (iv) Initial treatment plan. (A)(1) The initial treatment plan is 
required to contain a statement that outlines realistic short-term 
treatment goals which are mutually acceptable to the patient and the 
program. The initial treatment plan is also required to spell out the 
behavioral tasks a patient must perform to complete each short-term 
goal; the patient's requirements for education, vocational 
rehabilitation, and employment; and the medical, psychosocial, economic, 
legal, or other supportive services that a patient needs. The plan is 
also required to identify the frequency with which these services are 
likely to be provided. Prior to developing a treatment plan, the 
patient's needs for medical, social, and psychological services; 
education; vocational rehabilitation; and employment must be assessed, 
and the needs reflected, when clinically appropriate, in the treatment 
plan.
    (2) A primary counselor is one who is assigned by the program to 
develop, implement, and evaluate the patient's initial and periodic 
treatment plan and to monitor a patient's progress in treatment. The 
primary counselor shall enter in the patient's record the counselor's 
name, the contents of a patient's initial assessment, and the initial 
treatment plan. The primary counselor shall make these entries 
immediately after the patient is stabilized on a dose or within 4 weeks 
after admission, whichever is sooner.
    (B) It is recognized that patients need varying degrees of treatment 
and rehabilitative services which are often dependent on or limited by a 
number of variables; e.g., patient resources, available program, and 
community services. It is not the intent of this regulation to prescribe 
a particular treatment and rehabilitative service or the frequency at 
which a service should be offered.
    (C) The program supervisory counselor or other appropriate program 
personnel so designated by the program

[[Page 166]]

physician shall review and countersign all the information and findings 
required to be recorded in each patient's record under paragraph 
(d)(3)(iv) of this section.
    (v) Periodic treatment plan evaluation. (A) The program physician or 
the primary counselor shall review, reevaluate, and alter where 
necessary each patient's treatment plan at least once each 90 days 
during the first year of treatment, and then at least twice a year after 
the first year of continuous treatment.
    (B) The program physician shall ensure that the periodic treatment 
plan becomes part of each patient's record and that it is signed and 
dated in the patient's record by the primary counselor and is 
countersigned and dated by the supervisory counselor.
    (C) At least once a year, the program physician shall date, review, 
and countersign the treatment plan recorded in each patient's record and 
ensure that each patient's progress or lack of progress in achieving the 
treatment goals is entered in the patient's record by the primary 
counselor. When appropriate, the treatment plan and progress notes 
should deal with the patient's mental and physical problems, apart from 
drug abuse. The treatment plan is required to include the name of and 
the reasons for prescribing any medication for emotional or physical 
problems.
    (D) The requirement for annual physician review and signature by the 
program physician in paragraph (d)(3)(v)(C) of this section is 
discretionary, however, as it applies to a patient who has 
satisfactorily adhered to program rules for at least 3 consecutive years 
from his or her entrance into the comprehensive maintenance treatment 
program and who has made substantial progress in rehabilitation.
    (4) Minimum program services--(i)(A) Access to a range of services. 
A treatment program shall provide a comprehensive range of medical and 
rehabilitative services to its patients especially during the first 3 
years of treatment.
    (B) Pregnant patients. (1) For pregnant patients in a treatment 
program who were not admitted under paragraph (d)(1)(iii)(B) of this 
section, a treatment program shall give them the opportunity for 
prenatal care either by the narcotic treatment program or by referral to 
appropriate health care providers. If a program cannot provide direct 
prenatal care for pregnant patients in treatment, it shall establish a 
system of referring them for prenatal care which may be either publicly 
or privately funded. If there is no publicly funded prenatal care 
available to which a patient may be referred, and the program cannot 
provide such services, or the patient cannot afford or refuses prenatal 
care services, then the treatment program shall, at a minimum, offer her 
basic prenatal instruction on maternal, physical, and dietary care as a 
part of its counseling service.
    (2) Counseling records and other appropriate patient records are 
required to reflect the nature of prenatal support provided by the 
program. If the program refers a patient for prenatal services, it shall 
inform the physician to whom she is referred that the patient is in 
comprehensive maintenance treatment, provided such notification is in 
accordance with the Department of Health and Human Services' 
confidentiality regulations (42 CFR part 2). If a pregnant patient 
refuses direct prenatal services or appropriate referral for prenatal 
services, the treating program physician should consider using informed 
consent procedures; i.e., to have the patient acknowledge in writing 
that she has the opportunity for this treatment but refuses it. The 
program physician shall request the physician or the hospital to which a 
patient is referred to provide, following birth, a summary of the 
delivery and treatment outcome for the patient and offspring. The 
information should be obtained in accordance with the Department of 
Health and Human Services' confidentiality regulations (42 CFR part 2). 
If no response is received, the program physician shall document in the 
record that such a request was made and no response was received.
    (3) Caution should be taken in the maintenance treatment of pregnant 
patients. Dosage levels should be maintained at the lowest effective 
dose if continued treatment is deemed necessary. It is the 
responsibility of the program sponsor to ensure that each female patient 
is fully informed of the

[[Page 167]]

possible risks to a pregnant woman and her unborn child from continued 
use of illicit drugs and from the use of, or withdrawal from, a narcotic 
drug administered or dispensed by the program in maintenance or 
detoxification treatment.
    (C) Counseling on HIV disease. A narcotic treatment program shall 
provide counseling on preventing exposure to, and the transmission of, 
HIV disease for each patient admitted or readmitted to maintenance or 
detoxification treatment. Although HIV testing is not required, an 
interim program shall inform patients of the availability of HIV 
testing. The program sponsor shall also ensure that HIV testing is 
accessible to patients who request such testing either on site or by the 
programs entering into agreements with HIV testing facilities to make 
HIV testing accessible to those patients who request it.
    (D) Off-site services. Any service not furnished at the primary 
facility is required to be listed in any application for approval 
submitted to the Food and Drug Administration or to the State authority. 
The addition, modification, or deletion of any program service is 
required to be reported immediately to the Food and Drug Administration.
    (ii) Minimum medical services; designation of medical director and 
responsibilities. Each program shall have a designated medical director 
who assumes responsibility for administering all medical services 
performed by the program. The medical director and other authorized 
program physicians are required to be licensed to practice medicine in 
the jurisdiction in which the program is located. The medical director 
is responsible for ensuring that the program is in compliance with all 
Federal, State, and local laws and regulations regarding medical 
treatment of narcotic addiction. In addition, the medical director or 
other authorized physicians shall:
    (A) Ensure that evidence of current physiologic dependence, length 
of history of addiction, or exceptions to criteria for admission are 
documented in the patient's record before the patient receives the 
initial dose.
    (B) Ensure that a medical evaluation including a medical history has 
been taken, and physical examination has been done before the patient 
receives the initial dose (except that in an emergency situation, the 
initial dose may be given before the physical examination).
    (C) Ensure that appropriate laboratory studies have been performed 
and reviewed.
    (D) Sign or countersign all medical orders as required by Federal or 
State law. (Such medical orders include but are not limited to the 
initial medication orders and all subsequent medication order changes, 
all changes in the frequency of take-home medication, and prescribing 
additional take-home medication for an emergency situation.)
    (E) Review and countersign treatment plans at least annually as 
qualified by paragraph (d)(3)(v)(D) of this section.
    (F) Ensure that justification is recorded in the patient's record 
for reducing the frequency of clinic visits for observed drug ingesting, 
providing additional take-home medication under exceptional 
circumstances or when there is physicial disability, or prescribing any 
medication for physical or emotional problems.
    (iii) Use of health-care professionals. Although the final decision 
to accept a patient for treatment may be made only by the medical 
director or other designated program physician, it is recognized that 
physicians can train program personnel to detect and document narcotic 
abstinence symptons and that some jurisdictions allow State-licensed or 
certified health-care professionals; e.g., physician's assistants, nurse 
practitioners, to perform certain functions--record medical histories, 
perform physicial examinations, and prescribe, administer, or dispense 
certain medications--that are ordinarily performed by a licensed 
physician. These regulations do not prohibit licensed or certified 
health-care professionals from performing those functions in narcotic 
treatment programs if it is authorized by Federal, State, and local laws 
and regulations, and if those functions are delegated to them by the 
medical director, and records are properly countersigned by the medical 
director or a licensed physician.

[[Page 168]]

    (iv) Vocational rehabilitation, education, and employment. Each 
program shall provide opportunities directly, or through referral to 
community resources, for patients who either desire or have been deemed 
by the program staff to be ready to participate in educational job 
training programs or to obtain gainful employment as soon as possible.
    (v) Authorized dispensers of narcotic drugs; responsibility. A 
narcotic drug may be administered or dispensed only by a practitioner 
licensed under the appropriate State law and registered under the 
appropriate State and Federal laws to order narcotic drugs for patients, 
or by an agent of such a practitioner, supervised by and under the order 
of the practitioner. This agent is required to be a pharmacist, 
registered nurse, or licensed practical nurse, or any other health care 
professional authorized by Federal and State law to administer or 
dispense narcotic drugs. The licensed practitioner assumes 
responsibility for the amounts of narcotic drugs administered or 
dispensed and shall record and countersign all changes in dosage 
schedule.
    (5) Staffing patterns--(i) Program personnel. The person(s) 
responsible for a program shall determine program personnel requirements 
after considering the number of patients who are vocationally and 
educationally impaired; the number of patients with significant 
psychopathology; the number of patients who are also nonnarcotic drug or 
alcohol abusers; the number of patients with behavioral problems in the 
program; and the number of patients with serious medical problems.
    (ii) Supportive services. The person(s) responsible for the program 
shall take notice, when considering the staffing pattern, that 
comprehensive maintenance treatment programs need to establish 
supportive services in accordance with the varying characteristics and 
needs of their patient populations. The person(s) responsible for a 
program shall also take notice of the availability of existing community 
resources which may complement or enhance the program's delivery of 
supportive services and then establish a staffing pattern based on a 
combination of patient needs and available, accessible community 
resources.
    (6) Use of methadone in a treatment program; frequency of 
attendance; quantity of take-home medication; dosage of methadone; 
initial and stabilization--(i) Dosage and responsibility. (A) The 
person(s) responsible for the program shall ensure that the initial dose 
of methadone does not exceed 30 milligrams and that the total dose for 
the first day does not exceed 40 milligrams, unless the program medical 
director documents in the patient's record that 40 milligrams did not 
suppress opiate abstinence symptoms.
    (B) A licensed physician shall assume responsibility for the amount 
of the narcotic drug administered or dispensed and shall record, date, 
and sign in each patient's record each change in the dosage schedule.
    (C) The administering licensed physician shall ensure that a daily 
dose greater than 100 milligrams is justified in the patient's record.
    (ii) [Reserved]
    (iii) Form. Methadone may be administered or dispensed in oral form 
only when used in a treatment program. Hospitalized patients under care 
for a medical or surgical condition are permitted to receive methadone 
in parenteral form when the attending physician judges it advisable. 
Although tablet, syrup concentrate, or other formulations may be 
distributed to the program, all oral medication is required to be 
administered or dispensed in a liquid formulation. The oral dosage form 
is required to be formulated in such a way as to reduce its potential 
for parenteral abuse. Take-home medication is required to be labeled 
with the treatment center's name, address, and telephone number and must 
be packaged in special packaging as required by 16 CFR 1700.14 in 
accordance with the Poison Prevention Packaging Act (Pub. L. 91-601, 15 
U.S.C. 1471 et seq.) to reduce the chances of accidental ingestion. 
Exceptions may be granted when these provisions conflict with State law 
with regard to the administering or dispensing of drugs.
    (iv) Take-home medication. (A) Take-home medication may be given 
only to

[[Page 169]]

a patient who, in the reasonable clinical judgment of the program 
physician, is responsible in handling narcotic drugs. Before the program 
physician reduces the frequency of a patient's clinical visits, she or 
he or a designated staff member shall record the rationale for the 
decision in the patient's clinical record. If this is done by a 
designated staff member, a program physician shall review, countersign, 
and date the patient's record where this information is recorded.
    (B) The program physician shall consider the following in 
determining whether, in his or her reasonable clinical judgment, a 
patient is responsible in handling narcotic drugs:
    (1) Absence of recent abuse of drugs (narcotic or nonnarcotic), 
including alcohol;
    (2) Regularity of clinic attendance;
    (3) Absence of serious behavioral problems at the clinic;
    (4) Absence of known recent criminal activity, e.g., drug dealing;
    (5) Stability of the patient's home environment and social 
relationships;
    (6) Length of time in comprehensive maintenance treatment;
    (7) Assurance that take-home medication can be safely stored within 
the patient's home; and
    (8) Whether the rehabilitative benefit to the patient derived from 
decreasing the frequency of clinic attendance outweighs the potential 
risks of diversion.
    (v) Take-home requirements. The requirement of time in treatment is 
a minimum reference point after which a patient may be eligible for 
take-home privileges. The time reference is not intended to mean that a 
patient in treatment for a particular time has a specific right to take-
home medication. Thus, regardless of time in treatment, a program 
physician may, in his or her reasonable judgment, deny or rescind the 
take-home medication privileges of a patient.
    (A)(1) In comprehensive maintenance treatment it is required that a 
patient come to the clinic for observation daily or at least 6 days a 
week. If, in the reasonable clinical judgment of the program physician, 
a patient demonstrates that he or she has satisfactorily adhered to 
program rules for at least 3 months, has made substantial progress in 
rehabilitation and responsibility in handling narcotic drugs (see 
paragraphs (d)(6)(iv)(B) (1) through (8) of this section, and would 
improve his or her rehabilitative progress by decreasing the frequency 
of attendance at the clinic for observation, the patient may be 
permitted to reduce his or her attendance at the clinic for observation 
to three times weekly. The patient may receive no more than a 2-day 
take-home supply of medication.
    (2) If, in the reasonable clinical judgment of the program 
physician, a patient demonstrates that he or she has satisfactorily 
ahered to program rules for at least 2 years from his or her entrance 
into the program, has made substantial progress in rehabilitation and 
responsibility in handling narcotic drugs (see paragraphs (d)(6)(iv)(B) 
(1) through (8) of this section), and would improve his or her 
rehabilitative progress by decreasing the frequency of attendance at the 
clinic for observation, the patient may be permitted to reduce his or 
her clinic attendance at the clinic for observation to twice weekly. 
Such a patient may receive no more than a 3-day take-home supply of 
medication.
    (3) If, in the reasonable clinical judgment of the program 
physician, a patient demonstrates that he or she has satisfactorily 
adhered to program rules for at least 3 consecutive years from his or 
her entrance into the comprehensive maintenance treatment program, has 
made substantial progress in rehabilitation, has no major behavioral 
problems, is responsible in handling narcotic drugs (see paragraphs 
(d)(6)(iv)(B) (1) through (8) of this section), and would improve his or 
her rehabilitative progress by decreasing the frequency of his or her 
clinic attendance for observation, the patient may be permitted to 
reduce clinic attendance for observation to once weekly, provided that 
the following additional criteria are met: The program physician has 
written into the patient's record an evaluation that the patient is 
responsible in handling narcotic drugs (paragraphs (d)(6)(iv)(B) (1) 
through (8) of this section); the patient is employed (or actively 
seeking employment), attends school, is a homemaker, or is considered 
unemployable

[[Page 170]]

for mental or physical reasons by a program physician; the patient is 
not known to have abused drugs including alcohol in the last year; and 
the patient is not known to have engaged in criminal activity; e.g., 
drug dealing, in the last year. A patient permitted to reduce clinic 
attendance for observation to once weekly may receive no more than a 6-
day take-home supply of medication.
    (B)(1) If a patient, after receiving a supply of take-home 
medication, is inexcusably absent from or misses a scheduled appointment 
with a treatment program without authorization from the program staff, 
the program physician shall increase the frequency of the patient's 
clinic attendance for drug ingestion under observation. For such a 
patient, the program physician shall not reduce the frequency of the 
patient's clinic attendance for drug ingestion under observation until 
she or he has had at least three consecutive monthly tests or analyses 
that are neither positive for morphine-like drugs (except from the 
narcotic drug administered or dispensed by the program) or other drugs 
of abuse, nor negative for the narcotic drug administered or dispensed 
by the program, and until she or he is again determined by a program 
physician to be responsible in handling narcotic drugs (see paragraphs 
(d)(6)(iv)(B) (1) through (8) of this section) and to meet criteria in 
paragraph (d)(6)(v)(A) of this section.
    (2) If a patient, after receiving a 6-day supply of take-home 
medication, has a test or analysis which is confirmed to be positive for 
morphine-like drugs (except for the narcotic drug administered or 
dispensed by the program) or other drugs of abuse, or negative for the 
narcotic drug administered or dispensed by the program, the program 
physician shall place the patient on probation for 3 months. If, during 
this probation, the patient has a test or analysis either positive for 
morphine-like drugs (except for the narcotic drug administered or 
dispensed by the program) or other drugs of abuse, or negative for the 
narcotic drug administered or dispensed by the program, the program 
physician shall increase the frequency of the patient's clinic 
attendance for observation to at least twice weekly. Such a patient may 
receive no more than a 3-day take-home supply of medication until she or 
he has had at least three consecutive monthly tests or analyses which 
are neither positive for morphine-like drugs (except for the narcotic 
drug administered or dispensed by the program) or other drugs of abuse, 
nor negative for the narcotic drug administered or dispensed by the 
program, and the program physician again determines that the patient is 
responsible in handling narcotic drugs (see paragraphs (d)(6)(iv)(B) (1) 
through (8) of this section) and meets the criteria contained in 
paragraph (d)(6)(v)(A) of this section.
    (C) In calculating the number of years of comprehensive maintenance 
treatment, the period is considered to begin on the first day the 
medication is administered, or on readmission if a patient has had a 
continuous absence of 90 days or more. Cumulative time spent by the 
patient in more than one program is counted toward the number of years 
of treatment, provided there has not been a continuous absence of 90 
days or more.
    (D) Each patient whose daily dose is above 100 milligrams is 
required to be under observation while ingesting the drug at least 6 
days per week irrespective of the length of time in treatment, unless 
the program has received prior approval from the Food and Drug 
Administration with the concurrence of the State authority.
    (vi) Exceptions to take-home requirements. If, in the reasonable 
clinical judgment of the program physician:
    (A) A patient is found to have a physical disability which 
interferes with his or her ability to conform to the applicable 
mandatory schedule, she or he may be permitted a temporarily or 
permanently reduced schedule, provided she or he is also found to be 
responsible in handling narcotic drugs.
    (B) A patient, because of exceptional circumstances such as illness, 
personal or family crises, travel, or other hardship, is unable to 
conform to the applicable mandatory schedule, she or he may be permitted 
a temporarily reduced schedule, provided she or he is also found to be 
responsible in handling narcotic drugs. The rationale for an exception 
to a mandatory schedule is to

[[Page 171]]

be based on the reasonable clinical judgment of the program physician 
and shall be recorded in the patient's record by the program physician 
or by program personnel supervised by the program physician. In the 
latter situation, the physician shall review, countersign, and date the 
patient's record where this rationale is recorded. In any event, a 
patient may not be given more than a 2-week supply of narcotic drugs at 
one time.
    (vii) Official State holidays. If a treatment center program is not 
in operation due to the observance of an official State holiday, 
patients may be permitted one extra take-home dose per visit and one 
fewer clinic visit per week to allow patients not to have to attend the 
clinic on an official State holiday. An official State holiday is a 
holiday on which most State offices are usually closed and routine State 
government business is not conducted.
    (7) Minimum standards for interim maintenance treatment. The 
person(s) responsible for a program may place an individual, who is 
eligible for admission to comprehensive maintenance treatment, in 
interim maintenance treatment if the individual cannot be placed in a 
public or nonprofit private comprehensive program within a reasonable 
geographic area and within 14 days of the individual's application for 
admission. An initial and at least two other urine screens shall be 
taken from interim patients during the maximum of 120 days permitted for 
such treatment. A program shall establish and follow reasonable criteria 
for establishing priorities for transferring patients from interim 
maintenance to comprehensive maintenance treatment. These transfer 
criteria shall be in writing and available for inspection and shall 
include, at a minimum, a preference for pregnant women in admitting 
patients to interim maintenance and in transferring patients from 
interim maintenance to comprehensive maintenance treatment. Interim 
maintenance shall be provided in a manner consistent with all applicable 
Federal and State laws including sections 1923 (mandatory transfer) and 
1927(a) (pregnant patients) of the PHS Act. The program shall notify the 
State health officer when a patient begins interim treatment, when a 
patient leaves interim treatment, and before the date of mandatory 
transfer to a comprehensive program, and shall document such 
notifications. Programs in States not in compliance with provisions of 
this regulation risk loss of authorization for interim maintenance. All 
requirements for comprehensive maintenance treatment apply to interim 
maintenance treatment with the following exceptions:
    (i) The narcotic drug is required to be administered daily under 
observation;
    (ii) Take-home medication is not allowed;
    (iii) The initial treatment plan and periodic treatment plan 
evaluation are not required;
    (iv) A primary counselor is not required to be assigned to a 
patient;
    (v) Interim maintenance cannot be provided for longer than 120 days 
in any 12 month-period; and
    (vi) The requirements and exceptions in paragraphs (b)(2)(iii) (as 
apply to rehabilitative services), in paragraphs (b)(3)(iv)(B) and 
(d)(4)(i)(A) (as apply to rehabilitative services), and in paragraphs 
(d)(4)(ii)(E), (d)(4)(ii)(F), (d)(4)(iv), (d)(6)(iv), (d)(6)(v), 
(d)(6)(vi), and (d)(6)(vii) of this section do not apply.
    (8) Minimum standards for short-term detoxification treatment. (i) 
For short-term detoxification from narcotic drugs, the narcotic drug is 
required to be administered by the program physician or by an authorized 
agent of the physician, supervised by and under the order of the 
physician. The narcotic drug is required to be administered daily, under 
close observation, in reducing dosages over a period not to exceed 30 
days. All requirements for comprehensive maintenance treatment apply to 
short-term detoxification treatment with the following exceptions:
    (A) Take-home medication is not allowed during short-term 
detoxification.
    (B) A history of 1 year physiologic dependence is not required for 
admission to short-term detoxification.
    (C) Patients who have been determined by the program physician to be 
currently physiologically narcotic dependent may be placed in short-term

[[Page 172]]

detoxification treatment, regardless of age.
    (D) No test or analysis is required except for the initial drug 
screening test or analysis.
    (E) The initial treatment plan and periodic treatment plan 
evaluation required for comprehensive maintenance patients are not 
necessary for short-term detoxification patients. However, a primary 
counselor must be assigned by the program to monitor a patient's 
progress toward the goal of short-term detoxification and possible drug-
free treatment referral.
    (F) The requirements of paragraph (d)(4) of this section, except 
paragraphs (d)(4)(i)(C), (d)(4)(ii)(A) through (d)(4)(ii)(D), and 
(d)(4)(iii) of this section, do not apply to short-term detoxification 
treatment.
    (ii) A patient is required to wait at least 7 days between 
concluding a short-term detoxification treatment episode and beginning 
another. Before a short-term detoxification attempt is repeated, the 
program physician shall document in the patient's record that the 
patient continues to be, or is again, physiologically dependent on 
narcotic drugs. The provisions of these requirements, except as noted in 
paragraph (d)(8)(i) of this section, apply to both inpatient and 
ambulatory short-term detoxification treatment.
    (iii) Short-term detoxification treatment is not recommended for a 
pregnant patient.
    (9) Minimum standards for long-term detoxification treatment. (i) 
For long-term detoxification from narcotic drugs, the narcotic drug is 
required to be administered by the program physician or by an authorized 
agent of the physician, supervised by and under the order of the 
physician. The narcotic drug is required to be administered on a regimen 
designed to reach a drug-free state and to make progress in 
rehabilitation in 180 days or less. All requirements for comprehensive 
maintenance treatment apply to long-term detoxification treatment with 
the following exceptions.
    (A) In long-term detoxification treatment it is required that the 
patient be under observation while ingesting the drug daily or at least 
6 days a week, for the duration of the long-term detoxification 
treatment.
    (B) A history of 1 year physiologic dependence is not required for 
admission to long-term detoxification.
    (C) The program physician shall document in the patient's record 
that short-term detoxification is not a sufficiently long enough 
treatment course to provide the patient with the additional program 
services he or she deems necessary for the patient's rehabilitation. The 
program physician shall document this information in the patient's 
record before long-term detoxification may begin.
    (D) Patients who have been determined by the program physician to be 
currently physiologically dependent on narcotics may be placed in long-
term detoxification treatment, regardless of age.
    (E) An initial drug screening test or analysis is required for each 
patient. And at least one additional random test or analysis must be 
performed monthly on each patient during long-term detoxification.
    (F) The initial treatment plan and periodic treatment plan 
evaluation required for comprehensive maintenance patients are also 
required for long-term detoxification patients, except that the required 
periodic treatment plan evaluation is required to occur monthly.
    (ii) A patient is required to wait at least 7 days between 
concluding a long-term treatment episode and beginning another. Before a 
long-term detoxification attempt is repeated, the program physician 
shall document in the patient's record that the patient continues to be 
or is again physicologically dependent on narcotic drugs. The provisions 
of these requirements apply to both inpatient and ambulatory long-term 
detoxification treatment.
    (iii) Long-term detoxification is not recommended for a pregnant 
patient.
    (10) Inspections of programs; patient confidentiality. A program 
shall allow

[[Page 173]]

inspections by duly authorized employees of the State authority, and in 
accordance with Federal controlled substances laws and Federal 
confidentiality laws, by duly authorized employees of the Food and Drug 
Administration, the Drug Enforcement Administration of the Department of 
Justice, and the National Institute on Drug Abuse.
    (11) Exemptions from specific program standards. (i) A program is 
permitted, at the time of application or any time thereafter, to request 
exemption from specific program standards. The rationale for an 
exemption shall be thoroughly documented in an appendix to be submitted 
with the application or at some later time. The Food and Drug 
Administration will approve such exemptions of program standards at the 
time of application, or any time thereafter, with the concurrence of the 
State authority. An example of a case in which an exemption might be 
granted would be for a private practitioner who wishes to treat a 
limited number of patients in a nonmetropolitan area with few physicians 
and no rehabilitative services geographically accessible and requests 
exemption from some of the staffing and service standards.
    (ii) The Food and Drug Administration has the right to withhold the 
granting of an exemption requested at the time of application until a 
program is in actual operation in order to assess if the exemption is 
necessary. If periodic inspections of the progam reveal that 
discrepancies or adverse conditions exist, the Food and Drug 
Administration shall reserve the right to revoke any or all exemptions 
previously granted.
    (12) Research. When a program conducts research on human subjects or 
provides subjects for research, there must be written policies and 
written review to assure the rights of the patients involved. 
Appropriate informed consent forms are required to be signed by the 
patient and to be retained in his or her patient record at the program. 
All research, development, and related activities which involve human 
subjects and which are funded by grants from or contracts with the 
Department of Health and Human Services are required to comply with the 
Department of Health and Human Services' regulations on the protection 
of human subjects, 45 CFR part 46, and confidentiality of information, 
42 CFR part 2. All investigational research involving human subjects 
conducted for submission to the Food and Drug Administration must be 
conducted in compliance with part 312 of this chapter.
    (13) Patient record system--(i) Patient care. The person(s) 
responsible for a program shall establish a record system to document 
and monitor patient care. This system is required to comply with all 
Federal and State reporting requirements relevant to narcotic drugs 
approved for use in treatment of narcotic addiction. All records are 
required to be kept confidential and in accordance with all applicable 
Federal and State regulations regarding confidentiality.
    (ii) Drug dispensing. The person(s) responsible for a program shall 
ensure that accurate records traceable to specific patients are 
maintained showing dates, quantity, and batch or code marks of the drug 
dispensed. These records must be retained for a period of 3 years from 
the date of dispensing.
    (iii) Patient's record. An adequate record must be maintained for 
each patient. The record is required to contain a copy of the signed 
consent form(s), the date of each visit, the amount of drug administered 
or dispensed, the results of each test or analysis for drugs, any 
significant physical or psychological disability, the type of 
rehabilitative and counseling efforts employed, an account of the 
patient's progress, and other relevant aspects of the treatment program. 
For recordkeeping purposes, if a patient misses appointments for 2 weeks 
or more without notifying the program, the episode of care is considered 
terminated and is to be so noted in the patient's record. This does not 
mean that the patient cannot return for care. If the patient does return 
for care and is accepted into the program, this is considered a 
readmission and is to be so noted in the patient's record. This method 
of recordkeeping helps assure the easy detection of sporadic attendance 
and decreases the possibility of administering inappropriate doses of 
narcotic drugs (e.g., the patient who has received no medication

[[Page 174]]

for several days or more and upon return receives the usual 
stabilization dose). An annual evaluation of the patient's progress must 
be entered in the patient's record.
    (14) Security of drug stocks. adequate security is required to be 
maintained over drug stocks, over the manner in which it is administered 
or dispensed, over the manner in which it is distributed to medication 
units, and over the manner in which it is stored to guard against theft 
and diversion of the drug. The program is required to meet the security 
standards for the distribution and storage of controlled substances as 
required by the Drug Enforcement Administration, Department of Justice 
(21 CFR 1301.72-1301.76).
    (e) Multiple enrollments--(1) Administering or dispensing to 
patients enrolled in other programs. There is a danger of drug dependent 
persons attempting to enroll in more than one narcotic treatment program 
to obtain quantities of drugs for the purpose of self-administration or 
illicit marketing. Therefore, except in an emergency situation, drugs 
shall not be provided to a patient who is known to be currently 
receiving drugs from another treatment program
    (2) Patient attendance requirements. The patient shall always report 
to the same treatment facility unless prior approval is obtained from 
the program sponsor for treatment at another program. Permission to 
report for treatment at the facility of another program shall be granted 
only in exceptional circumstances and shall be noted on the patient's 
clinical record.
    (f) Conditions for use of narcotic drugs in hospitals for 
detoxification treatment--(1) Form. The drug may be administered or 
dispensed in either oral or parenteral form. (See paragraph (d)(6)(iii) 
of this section.)
    (2) Use of narcotic drugs in hospitals--(i) Approved uses. For 
hospitalized patients, the use of a narcotic drug for narcotic addict 
treatment may be administered or dispensed only for detoxification 
treatment. If a narcotic drug is administered for treatment of narcotic 
dependence for more than 180 days, the procedure is no longer considered 
detoxification but is, rather, considered maintenance treatment. Only 
approved narcotic treatment programs may undertake maintenance 
treatment. This does not preclude the maintenance treatment of a patient 
who is hospitalized for treatment of medical conditions other than 
addiction and who requires temporary maintenance treatment during the 
critical period of his or her stay or whose enrollment in a program 
which has approval for maintenance treatment using narcotic drugs has 
been verified. (See 21 CFR 1306.07(c).) Any hospital which already has 
received approval under this paragraph (f) may serve as a temporary 
narcotic treatment program when an approved treatment program has been 
terminated and there is no other facility immediately available in the 
area to provide narcotic drug treatment for the patients. The Food and 
Drug Administration may give this approval upon the request of the State 
authority or the hospital, When no State authority has been established.
    (ii) Individuals responsible for supplies. Hospitals shall submit to 
the Food and Drug Administration and the State authority the name of the 
individual (e.g., pharmacist) responsible for receiving and securing 
supplies of narcotic drugs for the treatment of narcotic addicts. The 
individual responsible for supplies shall ensure that the only persons 
who receive supplies of narcotic drugs are those who are authorized to 
do so by Federal or State law.
    (iii) General description. The hospital shall submit to the Food and 
Drug Administration and the State authority a general description of the 
hospital including the number of beds, specialized treatment facilities 
for drug dependence, and nature of patient care undertaken.
    (iv) Anticipated quantity of drug needed. The hospital shall submit 
to the Food and Drug Administration and the State authority the 
anticipated quantity of narcotic drugs for narcotic addict treatment 
needed per year.
    (v) Records. The hospital shall maintain accurate records showing 
dates, quantity, and batch or code marks of the drug used for inpatient 
treatment. The hospital shall retain the records for at least a period 
of 3 years.
    (vi) Inspection. The hospital shall permit the Food and Drug 
Administration

[[Page 175]]

and the State authority to inspect supplies of the drug at the hospital 
and evaluate the uses to which the drug is being put. The Food and Drug 
Administration and the State authority will keep the identity of the 
patients confidential in accordance with confidentiality requirements of 
42 CFR part 2. Records on the receipt, storage, and distribution of 
narcotic medication are subject to inspection under Federal controlled 
substances laws; but use or disclosure of records identifying patients 
will, in any case, be limited to actions involving the program or its 
personnel.
    (vii) Approval of hospital pharmacy. Application for a hospital 
pharmacy to provide narcotic drugs for detoxification treatment must be 
submitted to the Food and Drug Administration and the State authority 
and approval from both is required, except as provided for in paragraph 
(h)(5) of this section. Within 60 days after the Food and Drug 
Administration receives the application, it will notify the applicant of 
approval or denial or will request additional information, when 
necessary.
    (viii) Approval of shipments to hospital pharmacies. Before a 
hospital pharmacy may lawfully receive shipments of narcotic drugs for 
detoxification treatment, a responsible official shall complete, sign, 
and file in duplicate with the Food and Drug Administration and the 
State authority Form FDA-2636 ``Hospital Request for Methadone 
Detoxification Treatment'' (see paragraph (l) of this section) and must 
have received from the Food and Drug Administration a notice that the 
request has been approved.
    (ix) Sanctions. Failure to abide by the requirements described in 
this section may result in revocation of approval to receive shipments 
of narcotic drugs for narcotic addict treatment, seizure of the drug 
supply on hand, injunction, and criminal prosecution.
    (g) Confidentiality of patient records. (1) Except as provided in 
paragraph (g)(2) of this section, disclosure of patient records 
maintained by any program is governed by the provisions of 42 CFR part 
2, and every program must comply with that part. Records on the receipt, 
storage, and distribution of narcotic medication are also subject to 
inspection under Federal controlled substances laws: But use or 
disclosure of records identifying patients will, in any case, be limited 
to actions involving the program or its personnel.
    (2) A treatment program or medication unit or any part thereof, 
including any facility or any individual, shall permit a duly authorized 
employee of the Food and Drug Administration to have access to and to 
copy all records on the use of narcotic drugs in accordance with the 
provisions of 42 CFR part 2. A treatment program may reveal such records 
only when necessary in a related administrative or court proceeding.
    (h) Denial or revocation of approval. (1) Complete or partial denial 
or revocation of approval of an application to receive shipments of 
narcotic drugs (Forms FDA-2632 ``Application for Approval of Use of 
Narcotic Drugs in a Treatment Program'' and FDA-2636 ``Hospital Request 
for Methadone Detoxification Treatment'') may be proposed to the 
Commissioner of Food and Drugs by the Director of the Food and Drug 
Administration's Center for Drug Evaluation and Research, on his or her 
own initiative or at the request of representatives of the Drug 
Enforcement Administration, Department of Justice, National Institute of 
Drug Abuse, the State authority, or any other interested person.
    (2) Before presenting such a proposal to the Commissioner, the 
Director of the Center for Drug Evaluation and Research, or his or her 
representative, will notify the applicant in writing of the proposed 
action and the reasons therefor and will offer the applicant an 
opportunity to explain the matters in question in an informal conference 
and/or in writing within 10 days after receipt of such notification. The 
applicant shall have the right to hear and to question the information 
on which the proposal to deny or revoke approval is based, and may 
present any oral or written information and views.
    (3) If the explanation offered by the applicant is not accepted by 
the Center for Drug Evaluation and Research as sufficient to justify 
approval of the application, and denial or revocation of approval is 
therefore proposed, the

[[Page 176]]

Commissioner will evaluate information obtained in the informal 
conference and/or in writing before the Director of the Center for Drug 
Evaluation and Research. If the Commissioner finds that the applicant 
has failed to submit adequate assurance justifying approval of the 
application, the Commissioner shall issue a notice of opportunity for 
hearing with respect to the matter pursuant to Sec. 314.200 of this 
chapter and the matter shall thereafter be handled in accordance with 
established procedures for denial or revocation of approval of a new 
drug application. If the Secretary determines that there is an imminent 
hazard to health, revocation of approval will become effective 
immediately and any administrative procedure will be expedited. Upon 
revocation of approval of an application, the Commissioner will notify 
the applicant, the State authority, the Drug Enforcement Administration, 
Department of Justice, and all other appropriate persons that the 
applicant may no longer receive shipments of narcotic drugs, and will 
require the recall of all of the drugs from the applicant. Revocation of 
approval may also result in criminal prosecution.
    (4) Denial or revocation of approval may be reversed when the 
Commissioner determines that the applicant has justified approval of the 
application.
    (5) A treatment program or medication unit or any part thereof, 
including any facility or any individual, may appeal to the Food and 
Drug Administration a complete or partial denial or revocation of 
approval by the State authority unless the denial or revocation is based 
upon a State law or regulation. The appeal shall first be made to the 
Director of the Center for Drug Evaluation and Research, who shall hold 
an informal conference on the matter in accordance with paragraph (h)(2) 
of this section. The State authority may participate in the conference. 
The appellant or the State authority may appeal the Director's decision 
to the Commissioner, who shall decide the matter in accordance with 
paragraph (h)(3) of this section. If the Commissioner denies or revokes 
approval, such action shall be handled in accordance with paragraph 
(h)(3) of this section. The Commissioner may not grant or retain Food 
and Drug Administration approval if the Commissioner finds that the 
appellant is not in compliance with all applicable State laws and 
regulations and with this section.
    (i) Sanctions--(1) Program sponsor or individual responsible for a 
particular program. If the program sponsor or the person responsible for 
a particular program fails to abide by all the requirements set forth in 
this regulation, or fails to adequately monitor the activities of those 
employed in the program, he or she may have the approval of his or her 
application revoked, his or her narcotic drug supply seized, an 
injunction granted precluding operation of his or her program, and 
criminal prosecution instituted against him or her.
    (2) Persons responsible for administering or dispensing narcotic 
drugs. If a person responsible for administering or dispensing narcotic 
drugs for narcotic addict treatment fails to abide by all the 
requirements set forth in this regulation, criminal prosecution may be 
instituted against him or her, his or her drug supply may be seized, the 
approval of the program may be revoked, and an injunction may be granted 
precluding operation of the program.
    (j) Requirements for distribution by manufacturers of narcotic drugs 
for narcotic addict treatment--(1) Distribution requirements. Shipments 
of narcotic drugs for narcotic addict treatment are restricted to direct 
shipments by manufacturers of the drugs to approved treatment programs 
using the narcotic drugs and to approved hospital pharmacies. If 
requested by a manufacturer or State authority, wholesale pharmacy 
outlets in some regions or States may be authorized to stock narcotic 
drugs for narcotic addict treatment for that area and then transship the 
drug to approved narcotic treatment programs and approved hospital 
pharmacies. Alternative methods of distribution will be permitted if 
they are approved by the Food and Drug Administration and the State 
authority. Prior to any approval of an alternative method of 
distribution there will be consultation with the Drug Enforcement 
Administration, Department of Justice, to assure compliance with its

[[Page 177]]

regulations regarding controlled substance distribution.
    (2) Information regarding approved programs and hospitals. The Food 
and Drug Administration will provide manufacturers and the public with 
names and locations of programs and hospitals that have been approved to 
receive shipments of narcotic drugs for narcotic addiction treatment. 
All information contained in the forms required by paragraph (k) of this 
section is available for public disclosure, except the names or other 
identifying information with respect to patients.
    (3) Acceptance of delivery. Delivery shall only be made to a 
licensed practitioner or a licensed pharmacist employed at the facility. 
At the time of delivery the licensed practitioner or licensed pharmacist 
shall sign for the drugs and place his or her specific title and 
identification number on any invoice. Copies of these signed invoices 
shall be kept by the manufacturer.
    (k) Use of narcotics other than methadone in a treatment program. 
Narcotic drug products other than methadone that have been approved for 
treatment of narcotic addiction are listed in paragraph (b)(2)(v) of 
this section. Detailed information on the conditions for use of narcotic 
drug products other than methadone, with the exception of take-home and 
dosage form requirements, can be found in the respective approved 
product labeling. Treatment programs shall review the most recent 
approved product labeling for up-to-date information on important 
treatment parameters for each drug. Deviation from doses, frequencies, 
and conditions of usage described in the approved labeling shall be 
justified in the patient's record. Treatment programs that dispense 
narcotics other than methadone shall conform with the requirements set 
forth under paragraphs (a), (b), (c), (d)(1) through (d)(5), (d)(8) 
through (d)(14), and (e) through (l) of this section. Specifics 
regarding take-home and dosage form requirements along with any 
additional requirements are set forth in this paragraph.
    (1) LAAM--(i) Dosage and responsibility for administration. After a 
patient's tolerance to LAAM is established, LAAM shall be administered 
no more frequently than every other day. Dosage of LAAM shall be 
individualized at doses, frequencies, and under conditions of usage 
described in approved labeling and as follows:
    (A) New patients. The persons responsible for the program shall 
ensure that the initial dose of LAAM to a patient whose tolerance for 
the drug is unknown does not exceed 40 milligrams.
    (B) Stabilized methadone maintenance patient. The persons 
responsible for the program shall ensure that the initial dose of LAAM 
for a previously stabilized methadone maintenance patient is less than 
or equal to 1.3 times the patient's daily methadone dose, not to exceed 
120 milligrams.
    (C) A licensed physician shall assume responsibility for the amount 
of the narcotic drug administered or dispensed and shall record, date, 
and sign or countersign in each patient's record each change in dosage 
schedule.
    (D) The administering licensed physician shall ensure that a single 
dose of LAAM greater than 140 milligrams is justified in the patient's 
record.
    (ii) Dosage form. LAAM may be administered in oral form when used in 
a maintenance treatment program. Hospitalized patients under care for a 
medical or surgical condition are permitted to receive LAAM in oral form 
when the attending physician judges it advisable. Although syrup 
concentrate or other formulations may be distributed to the program, all 
oral medication is required to be administered in a liquid formulation. 
Clinics that administer both LAAM and methadone shall take appropriate 
measures, including contrasting color and taste, to ensure that dosage 
forms of LAAM and methadone are easily distinguished.
    (iii) Take-home medication. Take-home doses of LAAM are not 
permitted. A patient who is eligible for one or more take-home doses of 
methadone under paragraph (d)(6) of this section and who is unable to 
conform to the applicable mandatory LAAM dosing schedule because of 
exceptional circumstances such as illness, personal or family crises, 
travel, or other hardship, or official State holidays, may be 
temporarily transferred to methadone. Take-home doses of methadone for a 
patient eligible for a planned temporary discontinuation of treatment

[[Page 178]]

with LAAM shall be individualized at doses, frequencies, and under 
conditions of usage described in the approved labeling and the 
applicable provisions for take-home methadone medication under paragraph 
(d)(6) of this section. The maximum number of take-home doses of 
methadone shall be determined in accordance with the provisions of 21 
CFR 291.505 (d)(6)(v) and (d)(6)(vi).
    (2) [Reserved]
    (l) Program forms. The program sponsor must ensure that the 
following forms are completed by the proper program staff and submitted 
to the appropriate State authority and the Division of Scientific 
Investigations, Regulatory Management Branch (HFD-342), Food and Drug 
Administration, 7520 Standish Pl., Rockville, MD 20855. The sponsor will 
indicate on the appropriate form which treatment drug is being utilized. 
Forms are available upon request from the Regulatory Management Branch 
(HFD-342) at the same address.

                                  Forms

FDA-2632 Application for Approval of Use of Narcotic Drugs in a 
Treatment Program.
FDA-2633 Medical Responsibility Statement for Use of Narcotic Drugs in a 
Treatment Program.
FDA-2635 Consent to Treatment with an Approved Narcotic Drug.
FDA-2636 Hospital Request for Methadone Detoxification Treatment.

(Approved by the Office of Management and Budget under number 0910-0140)

[54 FR 8960, Mar. 2, 1989; 54 FR 12531, Mar. 27, 1989; 58 FR 498, Jan. 
6, 1993; 58 FR 38709, July 20, 1993]



PART 299--DRUGS; OFFICIAL NAMES AND ESTABLISHED NAMES--Table of Contents




                      Subpart A--General Provisions

Sec.
299.3  Definitions and interpretations.
299.4  Established names for drugs.
299.5  Drugs; compendial name.

    Authority: 21 U.S.C. 331, 351, 352, 355, 358, 360b, 371.

    Source: 40 FR 14041, Mar. 27, 1975, unless otherwise noted.



                      Subpart A--General Provisions



Sec. 299.3  Definitions and interpretations.

    (a) As used in this part 299, act means the Federal Food, Drug, and 
Cosmetic Act, sections 201-902, 52 Stat. 1040 (21 U.S.C. 321-392), with 
all amendments thereto.
    (b) The definitions and interpretations contained in section 201 of 
the act shall be applicable to such terms when used in this part 299.
    (c) The term official name means, with respect to a drug or 
ingredient thereof, the name designated in this part 299 under section 
508 of the act as the official name.



Sec. 299.4  Established names for drugs.

    (a) Section 508 of the Federal Food, Drug, and Cosmetic Act (added 
by the Kefauver-Harris Drug Amendments of 1962; Pub. L. 87-781) 
authorizes the Commissioner of Food and Drugs to designate an official 
name for any drug if he determines that such action is necessary or 
desirable in the interest of usefulness and simplicity. Section 502(e) 
of the act (as amended by said Drug Amendments) prescribes that the 
labeling of a drug must bear its established name, if there is one, to 
the exclusion of any other nonproprietary name (except the applicable 
systematic chemical name or the chemical formula) and, if the drug is 
fabricated from two or more ingredients, the established name of each 
active ingredient.
    (b) The term established name is defined in section 502(e)(3) of the 
act as (1) an official name designated pursuant to section 508 of the 
act; (2) if no such official name has been designated for the drug and 
the drug is an article recognized in an official compendium, then the 
official title thereof in such compendium; and (3) if neither paragraphs 
(b) (1) or (2) of this section applies, then the common or usual name of 
the drug.
    (c) The Food and Drug Administration recognizes the skill and 
experience of the U.S. Adopted Names Council (USAN) in deriving names 
for drugs. The U.S. Adopted Names Council is a private organization 
sponsored by the American Medical Association, the United States 
Pharmacopeia, and the

[[Page 179]]

American Pharmaceutical Association, and has been engaged in the 
assignment of names to drugs since January 1964. The Council negotiates 
with manufacturing firms in the selection of nonproprietary names for 
drugs.
    (d) The Food and Drug Administration cooperates with and is 
represented on the USAN Council. In addition, the Food and Drug 
Administration agrees with ``Guiding Principles for Coining U.S. Adopted 
Names for Drugs,'' published in USAN and the USP Dictionary of Drug 
Names (USAN 1985 ed., 1961-1984 cumulative list), which is incorporated 
by reference. Copies are available from: U.S. Pharmacopeial Convention, 
Inc., 12601 Twinbrook Parkway, Rockville, MD 20852, or are available for 
inspection at the Office of the Federal Register, 800 North Capitol 
Street, NW., suite 700, Washington, DC 20408. All applicants for new-
drug applications and sponsors for ``Investigational New Drug 
Applications'' (IND's) are encouraged to contact the USAN Council for 
assistance in selection of a simple and useful name for a new chemical 
entity. Approval of a new-drug application providing for the use of a 
new drug substance may be delayed if a simple and useful nonproprietary 
name does not exist for the substance and if one is not proposed in the 
application that meets the above-cited guidelines. Prior use of a name 
in the medical literature or otherwise will not commit the Food and Drug 
Administration to adopting such terminology as official.
    (e) The Food and Drug Administration will not routinely designate 
official names under section 508 of the act. As a result, the 
established name under section 502(e) of the act will ordinarily be 
either the compendial name of the drug or, if there is no compendial 
name, the common and usual name of the drug. Interested persons, in the 
absence of the designation by the food and Drug Administration of an 
official name, may rely on as the established name for any drug the 
current compendial name or the USAN adopted name listed in USAN and the 
USP Dictionary of Drug Names. The Food and Drug Administration, however, 
will continue to publish official names under the provisions of section 
508 of the act when the agency determines that:
    (1) The USAN or other official or common or usual name is unduly 
complex or is not useful for any other reason;
    (2) Two or more official names have been applied to a single drug, 
or to two or more drugs that are identical in chemical structure and 
pharmacological action and that are substantially identical in strength, 
quality, and purity; or
    (3) No USAN or other official or common or usual name has been 
applied to a medically useful drug. Any official name published under 
section 508 of the act will be the established name of the drug.
    (f) A cumulative list of U.S. adopted names selected and released 
since June 15, 1961, is published yearly by the U.S. Pharmacopeial 
Convention, Inc., in USAN and the USP Dictionary of Drug Names. Copies 
may be purchased from the U.S. Pharmacopeial Convention, Inc., 12601 
Twinbrook Parkway, Rockville, MD 20852.

[40 FR 14041, Mar. 27, 1975, as amended at 49 FR 37575, Sept. 25, 1984; 
53 FR 5369, Feb. 24, 1988; 55 FR 11577, Mar. 29, 1990; 64 FR 401, Jan. 
5, 1999]



Sec. 299.5  Drugs; compendial name.

    (a) The name by which a drug is designated shall be clearly 
distinguishing and differentiating from any name recognized in an 
official compendium unless such drug complies in identity with the 
identity prescribed in an official compendium under such recognized 
name.
    (b) The term drug defined in an official compendium means a drug 
having the identity prescribed for a drug in an official compendium.
    (c) A statement that a drug defined in an official compendium 
differs in strength, quality, or purity from the standard of strength, 
quality, or purity set forth for such drug in an official compendium 
shall show all the respects in which such drug so differs, and the 
extent of each such difference.


[[Page 181]]



                              FINDING AIDS




  --------------------------------------------------------------------

  A list of CFR titles, subtitles, chapters, subchapters and parts and 
an alphabetical list of agencies publishing in the CFR are included in 
the CFR Index and Finding Aids volume to the Code of Federal Regulations 
which is published separately and revised annually.

  Material Approved for Incorporation by Reference
  Table of CFR Titles and Chapters
  Alphabetical List of Agencies Appearing in the CFR
  List of CFR Sections Affected

[[Page 183]]

            Material Approved for Incorporation by Reference

                      (Revised as of April 1, 2000)

  The Director of the Federal Register has approved under 5 U.S.C. 
552(a) and 1 CFR Part 51 the incorporation by reference of the following 
publications. This list contains only those incorporations by reference 
effective as of the revision date of this volume. Incorporations by 
reference found within a regulation are effective upon the effective 
date of that regulation. For more information on incorporation by 
reference, see the preliminary pages of this volume.


21 CFR (PARTS 200 TO 299)

FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                                                  21 CFR


American Plywood Association

  P.O. Box 11700, Tacoma, WA 98411-0770
APA PRP-108, ``Performance Standards and Policies                200.944
  for Structural-Use Panels,'' June 1988.
Form No. E30K, ``APA Design/Construction Guide-                  200.944
  Residential and Commercial,'' January 1989.


American Society for Testing and Materials

  100 Barr Harbor Drive, West Conshohocken, PA 
  19428-2959, Telephone (610) 832-9585, FAX (610) 
  832-9555
ASTM D-3043-87, ``Standard Methods of Testing                    200.944
  Structural Panels in Flexure,'' August 28, 1987.


U.S. Department of Commerce

  National Institute of Standards and Technology, 
  Office of Product Standards, Gaithersburg, MD 
  20899
Voluntary Product Standard, PS 1-83,                             200.944
  ``Construction and Industrial Plywood,'' May 
  1984.


U.S. Pharmacopeial Convention, Inc.

  12601 Twinbrook Parkway, Rockville, MD 20852
USAN and the USP Dictionary of Drug Names:                         299.4
  ``Guiding Principles for Coining U.S. Adopted 
  Names for Drugs'' (USAN 1985).
  NOTE: The following materials are available 
  through the Food and Drug Administration at the 
  addresses indicated.


Center for Food Safety and Applied Nutrition (HFS-215), Food and Drug 
Administration

  200 C St. SW., Washington, DC 20204
``Procedures for Detecting and Measuring                         211.176
  Penicillin Contamination in Drugs''.



[[Page 185]]



                    Table of CFR Titles and Chapters




                      (Revised as of April 1, 2000)

                      Title 1--General Provisions

         I  Administrative Committee of the Federal Register 
                (Parts 1-49)
        II  Office of the Federal Register (Parts 50-299)
        IV  Miscellaneous Agencies (Parts 400-500)

                          Title 2 [Reserved]

                        Title 3--The President

         I  Executive Office of the President (Parts 100-199)

                           Title 4--Accounts

         I  General Accounting Office (Parts 1-99)
        II  Federal Claims Collection Standards (General 
                Accounting Office--Department of Justice) (Parts 
                100-299)

                   Title 5--Administrative Personnel

         I  Office of Personnel Management (Parts 1-1199)
        II  Merit Systems Protection Board (Parts 1200-1299)
       III  Office of Management and Budget (Parts 1300-1399)
         V  The International Organizations Employees Loyalty 
                Board (Parts 1500-1599)
        VI  Federal Retirement Thrift Investment Board (Parts 
                1600-1699)
       VII  Advisory Commission on Intergovernmental Relations 
                (Parts 1700-1799)
      VIII  Office of Special Counsel (Parts 1800-1899)
        IX  Appalachian Regional Commission (Parts 1900-1999)
        XI  Armed Forces Retirement Home (Part 2100)
       XIV  Federal Labor Relations Authority, General Counsel of 
                the Federal Labor Relations Authority and Federal 
                Service Impasses Panel (Parts 2400-2499)
        XV  Office of Administration, Executive Office of the 
                President (Parts 2500-2599)
       XVI  Office of Government Ethics (Parts 2600-2699)
       XXI  Department of the Treasury (Parts 3100-3199)
      XXII  Federal Deposit Insurance Corporation (Part 3201)

[[Page 186]]

     XXIII  Department of Energy (Part 3301)
      XXIV  Federal Energy Regulatory Commission (Part 3401)
       XXV  Department of the Interior (Part 3501)
      XXVI  Department of Defense (Part 3601)
    XXVIII  Department of Justice (Part 3801)
      XXIX  Federal Communications Commission (Parts 3900-3999)
       XXX  Farm Credit System Insurance Corporation (Parts 4000-
                4099)
      XXXI  Farm Credit Administration (Parts 4100-4199)
    XXXIII  Overseas Private Investment Corporation (Part 4301)
      XXXV  Office of Personnel Management (Part 4501)
        XL  Interstate Commerce Commission (Part 5001)
       XLI  Commodity Futures Trading Commission (Part 5101)
      XLII  Department of Labor (Part 5201)
     XLIII  National Science Foundation (Part 5301)
       XLV  Department of Health and Human Services (Part 5501)
      XLVI  Postal Rate Commission (Part 5601)
     XLVII  Federal Trade Commission (Part 5701)
    XLVIII  Nuclear Regulatory Commission (Part 5801)
         L  Department of Transportation (Part 6001)
       LII  Export-Import Bank of the United States (Part 6201)
      LIII  Department of Education (Parts 6300-6399)
       LIV  Environmental Protection Agency (Part 6401)
      LVII  General Services Administration (Part 6701)
     LVIII  Board of Governors of the Federal Reserve System (Part 
                6801)
       LIX  National Aeronautics and Space Administration (Part 
                6901)
        LX  United States Postal Service (Part 7001)
       LXI  National Labor Relations Board (Part 7101)
      LXII  Equal Employment Opportunity Commission (Part 7201)
     LXIII  Inter-American Foundation (Part 7301)
       LXV  Department of Housing and Urban Development (Part 
                7501)
      LXVI  National Archives and Records Administration (Part 
                7601)
      LXIX  Tennessee Valley Authority (Part 7901)
      LXXI  Consumer Product Safety Commission (Part 8101)
    LXXIII  Department of Agriculture (Part 8301)
     LXXIV  Federal Mine Safety and Health Review Commission (Part 
                8401)
     LXXVI  Federal Retirement Thrift Investment Board (Part 8601)
    LXXVII  Office of Management and Budget (Part 8701)

                          Title 6 [Reserved]

              

[[Page 187]]

                         Title 7--Agriculture

            Subtitle A--Office of the Secretary of Agriculture 
                (Parts 0-26)
            Subtitle B--Regulations of the Department of 
                Agriculture
         I  Agricultural Marketing Service (Standards, 
                Inspections, Marketing Practices), Department of 
                Agriculture (Parts 27-209)
        II  Food and Nutrition Service, Department of Agriculture 
                (Parts 210-299)
       III  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 300-399)
        IV  Federal Crop Insurance Corporation, Department of 
                Agriculture (Parts 400-499)
         V  Agricultural Research Service, Department of 
                Agriculture (Parts 500-599)
        VI  Natural Resources Conservation Service, Department of 
                Agriculture (Parts 600-699)
       VII  Farm Service Agency, Department of Agriculture (Parts 
                700-799)
      VIII  Grain Inspection, Packers and Stockyards 
                Administration (Federal Grain Inspection Service), 
                Department of Agriculture (Parts 800-899)
        IX  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Fruits, Vegetables, Nuts), Department 
                of Agriculture (Parts 900-999)
         X  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Milk), Department of Agriculture 
                (Parts 1000-1199)
        XI  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Miscellaneous Commodities), Department 
                of Agriculture (Parts 1200-1299)
      XIII  Northeast Dairy Compact Commission (Parts 1300-1399)
       XIV  Commodity Credit Corporation, Department of 
                Agriculture (Parts 1400-1499)
        XV  Foreign Agricultural Service, Department of 
                Agriculture (Parts 1500-1599)
       XVI  Rural Telephone Bank, Department of Agriculture (Parts 
                1600-1699)
      XVII  Rural Utilities Service, Department of Agriculture 
                (Parts 1700-1799)
     XVIII  Rural Housing Service, Rural Business-Cooperative 
                Service, Rural Utilities Service, and Farm Service 
                Agency, Department of Agriculture (Parts 1800-
                2099)
      XXVI  Office of Inspector General, Department of Agriculture 
                (Parts 2600-2699)
     XXVII  Office of Information Resources Management, Department 
                of Agriculture (Parts 2700-2799)
    XXVIII  Office of Operations, Department of Agriculture (Parts 
                2800-2899)
      XXIX  Office of Energy, Department of Agriculture (Parts 
                2900-2999)
       XXX  Office of the Chief Financial Officer, Department of 
                Agriculture (Parts 3000-3099)
      XXXI  Office of Environmental Quality, Department of 
                Agriculture (Parts 3100-3199)

[[Page 188]]

     XXXII  Office of Procurement and Property Management, 
                Department of Agriculture (Parts 3200-3299)
    XXXIII  Office of Transportation, Department of Agriculture 
                (Parts 3300-3399)
     XXXIV  Cooperative State Research, Education, and Extension 
                Service, Department of Agriculture (Parts 3400-
                3499)
      XXXV  Rural Housing Service, Department of Agriculture 
                (Parts 3500-3599)
     XXXVI  National Agricultural Statistics Service, Department 
                of Agriculture (Parts 3600-3699)
    XXXVII  Economic Research Service, Department of Agriculture 
                (Parts 3700-3799)
   XXXVIII  World Agricultural Outlook Board, Department of 
                Agriculture (Parts 3800-3899)
       XLI  [Reserved]
      XLII  Rural Business-Cooperative Service and Rural Utilities 
                Service, Department of Agriculture (Parts 4200-
                4299)

                    Title 8--Aliens and Nationality

         I  Immigration and Naturalization Service, Department of 
                Justice (Parts 1-599)

                 Title 9--Animals and Animal Products

         I  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 1-199)
        II  Grain Inspection, Packers and Stockyards 
                Administration (Packers and Stockyards Programs), 
                Department of Agriculture (Parts 200-299)
       III  Food Safety and Inspection Service, Department of 
                Agriculture (Parts 300-599)

                           Title 10--Energy

         I  Nuclear Regulatory Commission (Parts 0-199)
        II  Department of Energy (Parts 200-699)
       III  Department of Energy (Parts 700-999)
         X  Department of Energy (General Provisions) (Parts 1000-
                1099)
      XVII  Defense Nuclear Facilities Safety Board (Parts 1700-
                1799)

                      Title 11--Federal Elections

         I  Federal Election Commission (Parts 1-9099)

                      Title 12--Banks and Banking

         I  Comptroller of the Currency, Department of the 
                Treasury (Parts 1-199)

[[Page 189]]

        II  Federal Reserve System (Parts 200-299)
       III  Federal Deposit Insurance Corporation (Parts 300-399)
        IV  Export-Import Bank of the United States (Parts 400-
                499)
         V  Office of Thrift Supervision, Department of the 
                Treasury (Parts 500-599)
        VI  Farm Credit Administration (Parts 600-699)
       VII  National Credit Union Administration (Parts 700-799)
      VIII  Federal Financing Bank (Parts 800-899)
        IX  Federal Housing Finance Board (Parts 900-999)
        XI  Federal Financial Institutions Examination Council 
                (Parts 1100-1199)
       XIV  Farm Credit System Insurance Corporation (Parts 1400-
                1499)
        XV  Department of the Treasury (Parts 1500-1599)
      XVII  Office of Federal Housing Enterprise Oversight, 
                Department of Housing and Urban Development (Parts 
                1700-1799)
     XVIII  Community Development Financial Institutions Fund, 
                Department of the Treasury (Parts 1800-1899)

               Title 13--Business Credit and Assistance

         I  Small Business Administration (Parts 1-199)
       III  Economic Development Administration, Department of 
                Commerce (Parts 300-399)
        IV  Emergency Steel Guarantee Loan Board (Parts 400-499)
         V  Emergency Oil and Gas Guaranteed Loan Board (Parts 
                500-599)

                    Title 14--Aeronautics and Space

         I  Federal Aviation Administration, Department of 
                Transportation (Parts 1-199)
        II  Office of the Secretary, Department of Transportation 
                (Aviation Proceedings) (Parts 200-399)
       III  Commercial Space Transportation, Federal Aviation 
                Administration, Department of Transportation 
                (Parts 400-499)
         V  National Aeronautics and Space Administration (Parts 
                1200-1299)

                 Title 15--Commerce and Foreign Trade

            Subtitle A--Office of the Secretary of Commerce (Parts 
                0-29)
            Subtitle B--Regulations Relating to Commerce and 
                Foreign Trade
         I  Bureau of the Census, Department of Commerce (Parts 
                30-199)
        II  National Institute of Standards and Technology, 
                Department of Commerce (Parts 200-299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300-399)

[[Page 190]]

        IV  Foreign-Trade Zones Board, Department of Commerce 
                (Parts 400-499)
       VII  Bureau of Export Administration, Department of 
                Commerce (Parts 700-799)
      VIII  Bureau of Economic Analysis, Department of Commerce 
                (Parts 800-899)
        IX  National Oceanic and Atmospheric Administration, 
                Department of Commerce (Parts 900-999)
        XI  Technology Administration, Department of Commerce 
                (Parts 1100-1199)
      XIII  East-West Foreign Trade Board (Parts 1300-1399)
       XIV  Minority Business Development Agency (Parts 1400-1499)
            Subtitle C--Regulations Relating to Foreign Trade 
                Agreements
        XX  Office of the United States Trade Representative 
                (Parts 2000-2099)
            Subtitle D--Regulations Relating to Telecommunications 
                and Information
     XXIII  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 
                2300-2399)

                    Title 16--Commercial Practices

         I  Federal Trade Commission (Parts 0-999)
        II  Consumer Product Safety Commission (Parts 1000-1799)

             Title 17--Commodity and Securities Exchanges

         I  Commodity Futures Trading Commission (Parts 1-199)
        II  Securities and Exchange Commission (Parts 200-399)
        IV  Department of the Treasury (Parts 400-499)

          Title 18--Conservation of Power and Water Resources

         I  Federal Energy Regulatory Commission, Department of 
                Energy (Parts 1-399)
       III  Delaware River Basin Commission (Parts 400-499)
        VI  Water Resources Council (Parts 700-799)
      VIII  Susquehanna River Basin Commission (Parts 800-899)
      XIII  Tennessee Valley Authority (Parts 1300-1399)

                       Title 19--Customs Duties

         I  United States Customs Service, Department of the 
                Treasury (Parts 1-199)
        II  United States International Trade Commission (Parts 
                200-299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300-399)

[[Page 191]]

                          Employees' Benefits

         I  Office of Workers' Compensation Programs, Department 
                of Labor (Parts 1-199)
        II  Railroad Retirement Board (Parts 200-399)
       III  Social Security Administration (Parts 400-499)
        IV  Employees' Compensation Appeals Board, Department of 
                Labor (Parts 500-599)
         V  Employment and Training Administration, Department of 
                Labor (Parts 600-699)
        VI  Employment Standards Administration, Department of 
                Labor (Parts 700-799)
       VII  Benefits Review Board, Department of Labor (Parts 800-
                899)
      VIII  Joint Board for the Enrollment of Actuaries (Parts 
                900-999)
        IX  Office of the Assistant Secretary for Veterans' 
                Employment and Training, Department of Labor 
                (Parts 1000-1099)

                       Title 21--Food and Drugs

         I  Food and Drug Administration, Department of Health and 
                Human Services (Parts 1-1299)
        II  Drug Enforcement Administration, Department of Justice 
                (Parts 1300-1399)
       III  Office of National Drug Control Policy (Parts 1400-
                1499)

                      Title 22--Foreign Relations

         I  Department of State (Parts 1-199)
        II  Agency for International Development (Parts 200-299)
       III  Peace Corps (Parts 300-399)
        IV  International Joint Commission, United States and 
                Canada (Parts 400-499)
         V  Broadcasting Board of Governors (Parts 500-599)
       VII  Overseas Private Investment Corporation (Parts 700-
                799)
        IX  Foreign Service Grievance Board Regulations (Parts 
                900-999)
         X  Inter-American Foundation (Parts 1000-1099)
        XI  International Boundary and Water Commission, United 
                States and Mexico, United States Section (Parts 
                1100-1199)
       XII  United States International Development Cooperation 
                Agency (Parts 1200-1299)
      XIII  Board for International Broadcasting (Parts 1300-1399)
       XIV  Foreign Service Labor Relations Board; Federal Labor 
                Relations Authority; General Counsel of the 
                Federal Labor Relations Authority; and the Foreign 
                Service Impasse Disputes Panel (Parts 1400-1499)
        XV  African Development Foundation (Parts 1500-1599)
       XVI  Japan-United States Friendship Commission (Parts 1600-
                1699)
      XVII  United States Institute of Peace (Parts 1700-1799)

[[Page 192]]

                          Title 23--Highways

         I  Federal Highway Administration, Department of 
                Transportation (Parts 1-999)
        II  National Highway Traffic Safety Administration and 
                Federal Highway Administration, Department of 
                Transportation (Parts 1200-1299)
       III  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 1300-1399)

                Title 24--Housing and Urban Development

            Subtitle A--Office of the Secretary, Department of 
                Housing and Urban Development (Parts 0-99)
            Subtitle B--Regulations Relating to Housing and Urban 
                Development
         I  Office of Assistant Secretary for Equal Opportunity, 
                Department of Housing and Urban Development (Parts 
                100-199)
        II  Office of Assistant Secretary for Housing-Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 200-299)
       III  Government National Mortgage Association, Department 
                of Housing and Urban Development (Parts 300-399)
        IV  Office of Housing and Office of Multifamily Housing 
                Assistance Restructuring, Department of Housing 
                and Urban Development (Parts 400-499)
         V  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 500-599)
        VI  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 600-699) [Reserved]
       VII  Office of the Secretary, Department of Housing and 
                Urban Development (Housing Assistance Programs and 
                Public and Indian Housing Programs) (Parts 700-
                799)
      VIII  Office of the Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Section 8 Housing Assistance 
                Programs, Section 202 Direct Loan Program, Section 
                202 Supportive Housing for the Elderly Program and 
                Section 811 Supportive Housing for Persons With 
                Disabilities Program) (Parts 800-899)
        IX  Office of Assistant Secretary for Public and Indian 
                Housing, Department of Housing and Urban 
                Development (Parts 900-999)
         X  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Interstate Land Sales 
                Registration Program) (Parts 1700-1799)
       XII  Office of Inspector General, Department of Housing and 
                Urban Development (Parts 2000-2099)
        XX  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 3200-3899)
       XXV  Neighborhood Reinvestment Corporation (Parts 4100-
                4199)

[[Page 193]]

                           Title 25--Indians

         I  Bureau of Indian Affairs, Department of the Interior 
                (Parts 1-299)
        II  Indian Arts and Crafts Board, Department of the 
                Interior (Parts 300-399)
       III  National Indian Gaming Commission, Department of the 
                Interior (Parts 500-599)
        IV  Office of Navajo and Hopi Indian Relocation (Parts 
                700-799)
         V  Bureau of Indian Affairs, Department of the Interior, 
                and Indian Health Service, Department of Health 
                and Human Services (Part 900)
        VI  Office of the Assistant Secretary-Indian Affairs, 
                Department of the Interior (Part 1001)
       VII  Office of the Special Trustee for American Indians, 
                Department of the Interior (Part 1200)

                      Title 26--Internal Revenue

         I  Internal Revenue Service, Department of the Treasury 
                (Parts 1-799)

           Title 27--Alcohol, Tobacco Products and Firearms

         I  Bureau of Alcohol, Tobacco and Firearms, Department of 
                the Treasury (Parts 1-299)

                   Title 28--Judicial Administration

         I  Department of Justice (Parts 0-199)
       III  Federal Prison Industries, Inc., Department of Justice 
                (Parts 300-399)
         V  Bureau of Prisons, Department of Justice (Parts 500-
                599)
        VI  Offices of Independent Counsel, Department of Justice 
                (Parts 600-699)
       VII  Office of Independent Counsel (Parts 700-799)

                            Title 29--Labor

            Subtitle A--Office of the Secretary of Labor (Parts 0-
                99)
            Subtitle B--Regulations Relating to Labor
         I  National Labor Relations Board (Parts 100-199)
        II  Office of Labor-Management Standards, Department of 
                Labor (Parts 200-299)
       III  National Railroad Adjustment Board (Parts 300-399)
        IV  Office of Labor-Management Standards, Department of 
                Labor (Parts 400-499)
         V  Wage and Hour Division, Department of Labor (Parts 
                500-899)
        IX  Construction Industry Collective Bargaining Commission 
                (Parts 900-999)
         X  National Mediation Board (Parts 1200-1299)

[[Page 194]]

       XII  Federal Mediation and Conciliation Service (Parts 
                1400-1499)
       XIV  Equal Employment Opportunity Commission (Parts 1600-
                1699)
      XVII  Occupational Safety and Health Administration, 
                Department of Labor (Parts 1900-1999)
        XX  Occupational Safety and Health Review Commission 
                (Parts 2200-2499)
       XXV  Pension and Welfare Benefits Administration, 
                Department of Labor (Parts 2500-2599)
     XXVII  Federal Mine Safety and Health Review Commission 
                (Parts 2700-2799)
        XL  Pension Benefit Guaranty Corporation (Parts 4000-4999)

                      Title 30--Mineral Resources

         I  Mine Safety and Health Administration, Department of 
                Labor (Parts 1-199)
        II  Minerals Management Service, Department of the 
                Interior (Parts 200-299)
       III  Board of Surface Mining and Reclamation Appeals, 
                Department of the Interior (Parts 300-399)
        IV  Geological Survey, Department of the Interior (Parts 
                400-499)
        VI  Bureau of Mines, Department of the Interior (Parts 
                600-699)
       VII  Office of Surface Mining Reclamation and Enforcement, 
                Department of the Interior (Parts 700-999)

                 Title 31--Money and Finance: Treasury

            Subtitle A--Office of the Secretary of the Treasury 
                (Parts 0-50)
            Subtitle B--Regulations Relating to Money and Finance
         I  Monetary Offices, Department of the Treasury (Parts 
                51-199)
        II  Fiscal Service, Department of the Treasury (Parts 200-
                399)
        IV  Secret Service, Department of the Treasury (Parts 400-
                499)
         V  Office of Foreign Assets Control, Department of the 
                Treasury (Parts 500-599)
        VI  Bureau of Engraving and Printing, Department of the 
                Treasury (Parts 600-699)
       VII  Federal Law Enforcement Training Center, Department of 
                the Treasury (Parts 700-799)
      VIII  Office of International Investment, Department of the 
                Treasury (Parts 800-899)

                      Title 32--National Defense

            Subtitle A--Department of Defense
         I  Office of the Secretary of Defense (Parts 1-399)
         V  Department of the Army (Parts 400-699)
        VI  Department of the Navy (Parts 700-799)

[[Page 195]]

       VII  Department of the Air Force (Parts 800-1099)
            Subtitle B--Other Regulations Relating to National 
                Defense
       XII  Defense Logistics Agency (Parts 1200-1299)
       XVI  Selective Service System (Parts 1600-1699)
     XVIII  National Counterintelligence Center (Parts 1800-1899)
       XIX  Central Intelligence Agency (Parts 1900-1999)
        XX  Information Security Oversight Office, National 
                Archives and Records Administration (Parts 2000-
                2099)
       XXI  National Security Council (Parts 2100-2199)
      XXIV  Office of Science and Technology Policy (Parts 2400-
                2499)
     XXVII  Office for Micronesian Status Negotiations (Parts 
                2700-2799)
    XXVIII  Office of the Vice President of the United States 
                (Parts 2800-2899)
      XXIX  Presidential Commission on the Assignment of Women in 
                the Armed Forces (Part 2900)

               Title 33--Navigation and Navigable Waters

         I  Coast Guard, Department of Transportation (Parts 1-
                199)
        II  Corps of Engineers, Department of the Army (Parts 200-
                399)
        IV  Saint Lawrence Seaway Development Corporation, 
                Department of Transportation (Parts 400-499)

                          Title 34--Education

            Subtitle A--Office of the Secretary, Department of 
                Education (Parts 1-99)
            Subtitle B--Regulations of the Offices of the 
                Department of Education
         I  Office for Civil Rights, Department of Education 
                (Parts 100-199)
        II  Office of Elementary and Secondary Education, 
                Department of Education (Parts 200-299)
       III  Office of Special Education and Rehabilitative 
                Services, Department of Education (Parts 300-399)
        IV  Office of Vocational and Adult Education, Department 
                of Education (Parts 400-499)
         V  Office of Bilingual Education and Minority Languages 
                Affairs, Department of Education (Parts 500-599)
        VI  Office of Postsecondary Education, Department of 
                Education (Parts 600-699)
       VII  Office of Educational Research and Improvement, 
                Department of Education (Parts 700-799)
        XI  National Institute for Literacy (Parts 1100-1199)
            Subtitle C--Regulations Relating to Education
       XII  National Council on Disability (Parts 1200-1299)

[[Page 196]]

                        Title 35--Panama Canal

         I  Panama Canal Regulations (Parts 1-299)

             Title 36--Parks, Forests, and Public Property

         I  National Park Service, Department of the Interior 
                (Parts 1-199)
        II  Forest Service, Department of Agriculture (Parts 200-
                299)
       III  Corps of Engineers, Department of the Army (Parts 300-
                399)
        IV  American Battle Monuments Commission (Parts 400-499)
         V  Smithsonian Institution (Parts 500-599)
       VII  Library of Congress (Parts 700-799)
      VIII  Advisory Council on Historic Preservation (Parts 800-
                899)
        IX  Pennsylvania Avenue Development Corporation (Parts 
                900-999)
         X  Presidio Trust (Parts 1000-1099)
        XI  Architectural and Transportation Barriers Compliance 
                Board (Parts 1100-1199)
       XII  National Archives and Records Administration (Parts 
                1200-1299)
       XIV  Assassination Records Review Board (Parts 1400-1499)
        XV  Oklahoma City National Memorial Trust (Part 1501)

             Title 37--Patents, Trademarks, and Copyrights

         I  Patent and Trademark Office, Department of Commerce 
                (Parts 1-199)
        II  Copyright Office, Library of Congress (Parts 200-299)
        IV  Assistant Secretary for Technology Policy, Department 
                of Commerce (Parts 400-499)
         V  Under Secretary for Technology, Department of Commerce 
                (Parts 500-599)

           Title 38--Pensions, Bonuses, and Veterans' Relief

         I  Department of Veterans Affairs (Parts 0-99)

                       Title 39--Postal Service

         I  United States Postal Service (Parts 1-999)
       III  Postal Rate Commission (Parts 3000-3099)

                  Title 40--Protection of Environment

         I  Environmental Protection Agency (Parts 1-799)
         V  Council on Environmental Quality (Parts 1500-1599)
       VII  Environmental Protection Agency and Department of 
                Defense; Uniform National Discharge Standards for 
                Vessels of the Armed Forces (Parts 1700-1799)

[[Page 197]]

          Title 41--Public Contracts and Property Management

            Subtitle B--Other Provisions Relating to Public 
                Contracts
        50  Public Contracts, Department of Labor (Parts 50-1--50-
                999)
        51  Committee for Purchase From People Who Are Blind or 
                Severely Disabled (Parts 51-1--51-99)
        60  Office of Federal Contract Compliance Programs, Equal 
                Employment Opportunity, Department of Labor (Parts 
                60-1--60-999)
        61  Office of the Assistant Secretary for Veterans 
                Employment and Training, Department of Labor 
                (Parts 61-1--61-999)
            Subtitle C--Federal Property Management Regulations 
                System
       101  Federal Property Management Regulations (Parts 101-1--
                101-99)
       102  Federal Management Regulation (Parts 102-1--102-299)
       105  General Services Administration (Parts 105-1--105-999)
       109  Department of Energy Property Management Regulations 
                (Parts 109-1--109-99)
       114  Department of the Interior (Parts 114-1--114-99)
       115  Environmental Protection Agency (Parts 115-1--115-99)
       128  Department of Justice (Parts 128-1--128-99)
            Subtitle D--Other Provisions Relating to Property 
                Management [Reserved]
            Subtitle E--Federal Information Resources Management 
                Regulations System
       201  Federal Information Resources Management Regulation 
                (Parts 201-1--201-99) [Reserved]
            Subtitle F--Federal Travel Regulation System
       300  General (Parts 300-1--300.99)
       301  Temporary Duty (TDY) Travel Allowances (Parts 301-1--
                301-99)
       302  Relocation Allowances (Parts 302-1--302-99)
       303  Payment of Expenses Connected with the Death of 
                Certain Employees (Part 303-70)
       304  Payment from a Non-Federal Source for Travel Expenses 
                (Parts 304-1--304-99)

                        Title 42--Public Health

         I  Public Health Service, Department of Health and Human 
                Services (Parts 1-199)
        IV  Health Care Financing Administration, Department of 
                Health and Human Services (Parts 400-499)
         V  Office of Inspector General-Health Care, Department of 
                Health and Human Services (Parts 1000-1999)

                   Title 43--Public Lands: Interior

            Subtitle A--Office of the Secretary of the Interior 
                (Parts 1-199)
            Subtitle B--Regulations Relating to Public Lands

[[Page 198]]

         I  Bureau of Reclamation, Department of the Interior 
                (Parts 200-499)
        II  Bureau of Land Management, Department of the Interior 
                (Parts 1000-9999)
       III  Utah Reclamation Mitigation and Conservation 
                Commission (Parts 10000-10005)

             Title 44--Emergency Management and Assistance

         I  Federal Emergency Management Agency (Parts 0-399)
        IV  Department of Commerce and Department of 
                Transportation (Parts 400-499)

                       Title 45--Public Welfare

            Subtitle A--Department of Health and Human Services 
                (Parts 1-199)
            Subtitle B--Regulations Relating to Public Welfare
        II  Office of Family Assistance (Assistance Programs), 
                Administration for Children and Families, 
                Department of Health and Human Services (Parts 
                200-299)
       III  Office of Child Support Enforcement (Child Support 
                Enforcement Program), Administration for Children 
                and Families, Department of Health and Human 
                Services (Parts 300-399)
        IV  Office of Refugee Resettlement, Administration for 
                Children and Families Department of Health and 
                Human Services (Parts 400-499)
         V  Foreign Claims Settlement Commission of the United 
                States, Department of Justice (Parts 500-599)
        VI  National Science Foundation (Parts 600-699)
       VII  Commission on Civil Rights (Parts 700-799)
      VIII  Office of Personnel Management (Parts 800-899)
         X  Office of Community Services, Administration for 
                Children and Families, Department of Health and 
                Human Services (Parts 1000-1099)
        XI  National Foundation on the Arts and the Humanities 
                (Parts 1100-1199)
       XII  Corporation for National and Community Service (Parts 
                1200-1299)
      XIII  Office of Human Development Services, Department of 
                Health and Human Services (Parts 1300-1399)
       XVI  Legal Services Corporation (Parts 1600-1699)
      XVII  National Commission on Libraries and Information 
                Science (Parts 1700-1799)
     XVIII  Harry S. Truman Scholarship Foundation (Parts 1800-
                1899)
       XXI  Commission on Fine Arts (Parts 2100-2199)
     XXIII  Arctic Research Commission (Part 2301)
      XXIV  James Madison Memorial Fellowship Foundation (Parts 
                2400-2499)

[[Page 199]]

       XXV  Corporation for National and Community Service (Parts 
                2500-2599)

                          Title 46--Shipping

         I  Coast Guard, Department of Transportation (Parts 1-
                199)
        II  Maritime Administration, Department of Transportation 
                (Parts 200-399)
       III  Coast Guard (Great Lakes Pilotage), Department of 
                Transportation (Parts 400-499)
        IV  Federal Maritime Commission (Parts 500-599)

                      Title 47--Telecommunication

         I  Federal Communications Commission (Parts 0-199)
        II  Office of Science and Technology Policy and National 
                Security Council (Parts 200-299)
       III  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 300-
                399)

           Title 48--Federal Acquisition Regulations System

         1  Federal Acquisition Regulation (Parts 1-99)
         2  Department of Defense (Parts 200-299)
         3  Department of Health and Human Services (Parts 300-
                399)
         4  Department of Agriculture (Parts 400-499)
         5  General Services Administration (Parts 500-599)
         6  Department of State (Parts 600-699)
         7  United States Agency for International Development 
                (Parts 700-799)
         8  Department of Veterans Affairs (Parts 800-899)
         9  Department of Energy (Parts 900-999)
        10  Department of the Treasury (Parts 1000-1099)
        12  Department of Transportation (Parts 1200-1299)
        13  Department of Commerce (Parts 1300-1399)
        14  Department of the Interior (Parts 1400-1499)
        15  Environmental Protection Agency (Parts 1500-1599)
        16  Office of Personnel Management Federal Employees 
                Health Benefits Acquisition Regulation (Parts 
                1600-1699)
        17  Office of Personnel Management (Parts 1700-1799)
        18  National Aeronautics and Space Administration (Parts 
                1800-1899)
        19  Broadcasting Board of Governors (Parts 1900-1999)
        20  Nuclear Regulatory Commission (Parts 2000-2099)
        21  Office of Personnel Management, Federal Employees 
                Group Life Insurance Federal Acquisition 
                Regulation (Parts 2100-2199)
        23  Social Security Administration (Parts 2300-2399)
        24  Department of Housing and Urban Development (Parts 
                2400-2499)

[[Page 200]]

        25  National Science Foundation (Parts 2500-2599)
        28  Department of Justice (Parts 2800-2899)
        29  Department of Labor (Parts 2900-2999)
        34  Department of Education Acquisition Regulation (Parts 
                3400-3499)
        35  Panama Canal Commission (Parts 3500-3599)
        44  Federal Emergency Management Agency (Parts 4400-4499)
        51  Department of the Army Acquisition Regulations (Parts 
                5100-5199)
        52  Department of the Navy Acquisition Regulations (Parts 
                5200-5299)
        53  Department of the Air Force Federal Acquisition 
                Regulation Supplement (Parts 5300-5399)
        54  Defense Logistics Agency, Department of Defense (Part 
                5452)
        57  African Development Foundation (Parts 5700-5799)
        61  General Services Administration Board of Contract 
                Appeals (Parts 6100-6199)
        63  Department of Transportation Board of Contract Appeals 
                (Parts 6300-6399)
        99  Cost Accounting Standards Board, Office of Federal 
                Procurement Policy, Office of Management and 
                Budget (Parts 9900-9999)

                        Title 49-Transportation

            Subtitle A--Office of the Secretary of Transportation 
                (Parts 1-99)
            Subtitle B--Other Regulations Relating to 
                Transportation
         I  Research and Special Programs Administration, 
                Department of Transportation (Parts 100-199)
        II  Federal Railroad Administration, Department of 
                Transportation (Parts 200-299)
       III  Federal Motor Carrier Safety Administration, 
                Department of Transportation (Parts 300-399)
        IV  Coast Guard, Department of Transportation (Parts 400-
                499)
         V  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 500-599)
        VI  Federal Transit Administration, Department of 
                Transportation (Parts 600-699)
       VII  National Railroad Passenger Corporation (AMTRAK) 
                (Parts 700-799)
      VIII  National Transportation Safety Board (Parts 800-999)
         X  Surface Transportation Board, Department of 
                Transportation (Parts 1000-1399)
        XI  Bureau of Transportation Statistics, Department of 
                Transportation (Parts 1400-1499)

[[Page 201]]

                   Title 50--Wildlife and Fisheries

         I  United States Fish and Wildlife Service, Department of 
                the Interior (Parts 1-199)
        II  National Marine Fisheries Service, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 200-299)
       III  International Fishing and Related Activities (Parts 
                300-399)
        IV  Joint Regulations (United States Fish and Wildlife 
                Service, Department of the Interior and National 
                Marine Fisheries Service, National Oceanic and 
                Atmospheric Administration, Department of 
                Commerce); Endangered Species Committee 
                Regulations (Parts 400-499)
         V  Marine Mammal Commission (Parts 500-599)
        VI  Fishery Conservation and Management, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 600-699)

                      CFR Index and Finding Aids

            Subject/Agency Index
            List of Agency Prepared Indexes
            Parallel Tables of Statutory Authorities and Rules
            List of CFR Titles, Chapters, Subchapters, and Parts
            Alphabetical List of Agencies Appearing in the CFR



[[Page 203]]





           Alphabetical List of Agencies Appearing in the CFR




                      (Revised as of April 1, 2000)

                                                  CFR Title, Subtitle or 
                     Agency                               Chapter

Administrative Committee of the Federal Register  1, I
Advanced Research Projects Agency                 32, I
Advisory Commission on Intergovernmental          5, VII
     Relations
Advisory Council on Historic Preservation         36, VIII
African Development Foundation                    22, XV
  Federal Acquisition Regulation                  48, 57
Agency for International Development, United      22, II
     States
  Federal Acquisition Regulation                  48, 7
Agricultural Marketing Service                    7, I, IX, X, XI
Agricultural Research Service                     7, V
Agriculture Department                            5, LXXIII
  Agricultural Marketing Service                  7, I, IX, X, XI
  Agricultural Research Service                   7, V
  Animal and Plant Health Inspection Service      7, III; 9, I
  Chief Financial Officer, Office of              7, XXX
  Commodity Credit Corporation                    7, XIV
  Cooperative State Research, Education, and      7, XXXIV
       Extension Service
  Economic Research Service                       7, XXXVII
  Energy, Office of                               7, XXIX
  Environmental Quality, Office of                7, XXXI
  Farm Service Agency                             7, VII, XVIII
  Federal Acquisition Regulation                  48, 4
  Federal Crop Insurance Corporation              7, IV
  Food and Nutrition Service                      7, II
  Food Safety and Inspection Service              9, III
  Foreign Agricultural Service                    7, XV
  Forest Service                                  36, II
  Grain Inspection, Packers and Stockyards        7, VIII; 9, II
       Administration
  Information Resources Management, Office of     7, XXVII
  Inspector General, Office of                    7, XXVI
  National Agricultural Library                   7, XLI
  National Agricultural Statistics Service        7, XXXVI
  Natural Resources Conservation Service          7, VI
  Operations, Office of                           7, XXVIII
  Procurement and Property Management, Office of  7, XXXII
  Rural Business-Cooperative Service              7, XVIII, XLII
  Rural Development Administration                7, XLII
  Rural Housing Service                           7, XVIII, XXXV
  Rural Telephone Bank                            7, XVI
  Rural Utilities Service                         7, XVII, XVIII, XLII
  Secretary of Agriculture, Office of             7, Subtitle A
  Transportation, Office of                       7, XXXIII
  World Agricultural Outlook Board                7, XXXVIII
Air Force Department                              32, VII
  Federal Acquisition Regulation Supplement       48, 53
Alcohol, Tobacco and Firearms, Bureau of          27, I
AMTRAK                                            49, VII
American Battle Monuments Commission              36, IV
American Indians, Office of the Special Trustee   25, VII
Animal and Plant Health Inspection Service        7, III; 9, I
Appalachian Regional Commission                   5, IX
Architectural and Transportation Barriers         36, XI
   Compliance Board
[[Page 204]]

Arctic Research Commission                        45, XXIII
Armed Forces Retirement Home                      5, XI
Army Department                                   32, V
  Engineers, Corps of                             33, II; 36, III
  Federal Acquisition Regulation                  48, 51
Assassination Records Review Board                36, XIV
Benefits Review Board                             20, VII
Bilingual Education and Minority Languages        34, V
     Affairs, Office of
Blind or Severely Disabled, Committee for         41, 51
     Purchase From People Who Are
Board for International Broadcasting              22, XIII
Broadcasting Board of Governors                   22, V
  Federal Acquisition Regulation                  48, 19
Census Bureau                                     15, I
Central Intelligence Agency                       32, XIX
Chief Financial Officer, Office of                7, XXX
Child Support Enforcement, Office of              45, III
Children and Families, Administration for         45, II, III, IV, X
Civil Rights, Commission on                       45, VII
Civil Rights, Office for                          34, I
Coast Guard                                       33, I; 46, I; 49, IV
Coast Guard (Great Lakes Pilotage)                46, III
Commerce Department                               44, IV
  Census Bureau                                   15, I
  Economic Affairs, Under Secretary               37, V
  Economic Analysis, Bureau of                    15, VIII
  Economic Development Administration             13, III
  Emergency Management and Assistance             44, IV
  Export Administration, Bureau of                15, VII
  Federal Acquisition Regulation                  48, 13
  Fishery Conservation and Management             50, VI
  Foreign-Trade Zones Board                       15, IV
  International Trade Administration              15, III; 19, III
  National Institute of Standards and Technology  15, II
  National Marine Fisheries Service               50, II, IV, VI
  National Oceanic and Atmospheric                15, IX; 50, II, III, IV, 
       Administration                             VI
  National Telecommunications and Information     15, XXIII; 47, III
       Administration
  National Weather Service                        15, IX
  Patent and Trademark Office                     37, I
  Productivity, Technology and Innovation,        37, IV
       Assistant Secretary for
  Secretary of Commerce, Office of                15, Subtitle A
  Technology, Under Secretary for                 37, V
  Technology Administration                       15, XI
  Technology Policy, Assistant Secretary for      37, IV
Commercial Space Transportation                   14, III
Commodity Credit Corporation                      7, XIV
Commodity Futures Trading Commission              5, XLI; 17, I
Community Planning and Development, Office of     24, V, VI
     Assistant Secretary for
Community Services, Office of                     45, X
Comptroller of the Currency                       12, I
Construction Industry Collective Bargaining       29, IX
     Commission
Consumer Product Safety Commission                5, LXXI; 16, II
Cooperative State Research, Education, and        7, XXXIV
     Extension Service
Copyright Office                                  37, II
Corporation for National and Community Service    45, XII, XXV
Cost Accounting Standards Board                   48, 99
Council on Environmental Quality                  40, V
Customs Service, United States                    19, I
Defense Contract Audit Agency                     32, I
Defense Department                                5, XXVI; 32, Subtitle A; 
                                                  40, VII
  Advanced Research Projects Agency               32, I
  Air Force Department                            32, VII

[[Page 205]]

  Army Department                                 32, V; 33, II; 36, III, 
                                                  48, 51
  Defense Intelligence Agency                     32, I
  Defense Logistics Agency                        32, I, XII; 48, 54
  Engineers, Corps of                             33, II; 36, III
  Federal Acquisition Regulation                  48, 2
  National Imagery and Mapping Agency             32, I
  Navy Department                                 32, VI; 48, 52
  Secretary of Defense, Office of                 32, I
Defense Contract Audit Agency                     32, I
Defense Intelligence Agency                       32, I
Defense Logistics Agency                          32, XII; 48, 54
Defense Nuclear Facilities Safety Board           10, XVII
Delaware River Basin Commission                   18, III
Drug Enforcement Administration                   21, II
East-West Foreign Trade Board                     15, XIII
Economic Affairs, Under Secretary                 37, V
Economic Analysis, Bureau of                      15, VIII
Economic Development Administration               13, III
Economic Research Service                         7, XXXVII
Education, Department of                          5, LIII
  Bilingual Education and Minority Languages      34, V
       Affairs, Office of
  Civil Rights, Office for                        34, I
  Educational Research and Improvement, Office    34, VII
       of
  Elementary and Secondary Education, Office of   34, II
  Federal Acquisition Regulation                  48, 34
  Postsecondary Education, Office of              34, VI
  Secretary of Education, Office of               34, Subtitle A
  Special Education and Rehabilitative Services,  34, III
       Office of
  Vocational and Adult Education, Office of       34, IV
Educational Research and Improvement, Office of   34, VII
Elementary and Secondary Education, Office of     34, II
Emergency Oil and Gas Guaranteed Loan Board       13, V
Emergency Steel Guarantee Loan Board              13, IV
Employees' Compensation Appeals Board             20, IV
Employees Loyalty Board                           5, V
Employment and Training Administration            20, V
Employment Standards Administration               20, VI
Endangered Species Committee                      50, IV
Energy, Department of                             5, XXIII; 10, II, III, X
  Federal Acquisition Regulation                  48, 9
  Federal Energy Regulatory Commission            5, XXIV; 18, I
  Property Management Regulations                 41, 109
Energy, Office of                                 7, XXIX
Engineers, Corps of                               33, II; 36, III
Engraving and Printing, Bureau of                 31, VI
Environmental Protection Agency                   5, LIV; 40, I, VII
  Federal Acquisition Regulation                  48, 15
  Property Management Regulations                 41, 115
Environmental Quality, Office of                  7, XXXI
Equal Employment Opportunity Commission           5, LXII; 29, XIV
Equal Opportunity, Office of Assistant Secretary  24, I
     for
Executive Office of the President                 3, I
  Administration, Office of                       5, XV
  Environmental Quality, Council on               40, V
  Management and Budget, Office of                25, III, LXXVII; 48, 99
  National Drug Control Policy, Office of         21, III
  National Security Council                       32, XXI; 47, 2
  Presidential Documents                          3
  Science and Technology Policy, Office of        32, XXIV; 47, II
  Trade Representative, Office of the United      15, XX
       States
Export Administration, Bureau of                  15, VII
Export-Import Bank of the United States           5, LII; 12, IV
Family Assistance, Office of                      45, II
Farm Credit Administration                        5, XXXI; 12, VI
Farm Credit System Insurance Corporation          5, XXX; 12, XIV

[[Page 206]]

Farm Service Agency                               7, VII, XVIII
Federal Acquisition Regulation                    48, 1
Federal Aviation Administration                   14, I
  Commercial Space Transportation                 14, III
Federal Claims Collection Standards               4, II
Federal Communications Commission                 5, XXIX; 47, I
Federal Contract Compliance Programs, Office of   41, 60
Federal Crop Insurance Corporation                7, IV
Federal Deposit Insurance Corporation             5, XXII; 12, III
Federal Election Commission                       11, I
Federal Emergency Management Agency               44, I
  Federal Acquisition Regulation                  48, 44
Federal Employees Group Life Insurance Federal    48, 21
     Acquisition Regulation
Federal Employees Health Benefits Acquisition     48, 16
     Regulation
Federal Energy Regulatory Commission              5, XXIV; 18, I
Federal Financial Institutions Examination        12, XI
     Council
Federal Financing Bank                            12, VIII
Federal Highway Administration                    23, I, II
Federal Home Loan Mortgage Corporation            1, IV
Federal Housing Enterprise Oversight Office       12, XVII
Federal Housing Finance Board                     12, IX
Federal Labor Relations Authority, and General    5, XIV; 22, XIV
     Counsel of the Federal Labor Relations 
     Authority
Federal Law Enforcement Training Center           31, VII
Federal Management Regulation                     41, 102
Federal Maritime Commission                       46, IV
Federal Mediation and Conciliation Service        29, XII
Federal Mine Safety and Health Review Commission  5, LXXIV; 29, XXVII
Federal Motor Carrier Safety Administration       49, III
Federal Prison Industries, Inc.                   28, III
Federal Procurement Policy Office                 48, 99
Federal Property Management Regulations           41, 101
Federal Property Management Regulations System    41, 101, 102, 105
Federal Railroad Administration                   49, II
Federal Register, Administrative Committee of     1, I
Federal Register, Office of                       1, II
Federal Reserve System                            12, II
  Board of Governors                              5, LVIII
Federal Retirement Thrift Investment Board        5, VI, LXXVI
Federal Service Impasses Panel                    5, XIV
Federal Trade Commission                          5, XLVII; 16, I
Federal Transit Administration                    49, VI
Federal Travel Regulation System                  41, Subtitle F
Fine Arts, Commission on                          45, XXI
Fiscal Service                                    31, II
Fish and Wildlife Service, United States          50, I, IV
Fishery Conservation and Management               50, VI
Food and Drug Administration                      21, I
Food and Nutrition Service                        7, II
Food Safety and Inspection Service                9, III
Foreign Agricultural Service                      7, XV
Foreign Assets Control, Office of                 31, V
Foreign Claims Settlement Commission of the       45, V
     United States
Foreign Service Grievance Board                   22, IX
Foreign Service Impasse Disputes Panel            22, XIV
Foreign Service Labor Relations Board             22, XIV
Foreign-Trade Zones Board                         15, IV
Forest Service                                    36, II
General Accounting Office                         4, I, II
General Services Administration                   5, LVII
  Contract Appeals, Board of                      48, 61
  Federal Acquisition Regulation                  48, 5
  Federal Property Management Regulations System  41, 101, 102, 105
  Federal Travel Regulation System                41, Subtitle F
  General                                         41, 300
  Payment From a Non-Federal Source for Travel    41, 304
     Expenses
[[Page 207]]

  Payment of Expenses Connected With the Death    41, 303
       of Certain Employees
  Relocation Allowances                           41, 302
  Temporary Duty (TDY) Travel Allowances          41, 301
Geological Survey                                 30, IV
Government Ethics, Office of                      5, XVI
Government National Mortgage Association          24, III
Grain Inspection, Packers and Stockyards          7, VIII; 9, II
     Administration
Harry S. Truman Scholarship Foundation            45, XVIII
Health and Human Services, Department of          5, XLV; 45, Subtitle A
  Child Support Enforcement, Office of            45, III
  Children and Families, Administration for       45, II, III, IV, X
  Community Services, Office of                   45, X
  Family Assistance, Office of                    45, II
  Federal Acquisition Regulation                  48, 3
  Food and Drug Administration                    21, I
  Health Care Financing Administration            42, IV
  Human Development Services, Office of           45, XIII
  Indian Health Service                           25, V
  Inspector General (Health Care), Office of      42, V
  Public Health Service                           42, I
  Refugee Resettlement, Office of                 45, IV
Health Care Financing Administration              42, IV
Housing and Urban Development, Department of      5, LXV; 24, Subtitle B
  Community Planning and Development, Office of   24, V, VI
       Assistant Secretary for
  Equal Opportunity, Office of Assistant          24, I
       Secretary for
  Federal Acquisition Regulation                  48, 24
  Federal Housing Enterprise Oversight, Office    12, XVII
       of
  Government National Mortgage Association        24, III
  Housing--Federal Housing Commissioner, Office   24, II, VIII, X, XX
       of Assistant Secretary for
  Inspector General, Office of                    24, XII
  Multifamily Housing Assistance Restructuring,   24, IV
       Office of
  Public and Indian Housing, Office of Assistant  24, IX
       Secretary for
  Secretary, Office of                            24, Subtitle A, VII
Housing--Federal Housing Commissioner, Office of  24, II, VIII, X, XX
     Assistant Secretary for
Human Development Services, Office of             45, XIII
Immigration and Naturalization Service            8, I
Independent Counsel, Office of                    28, VII
Indian Affairs, Bureau of                         25, I, V
Indian Affairs, Office of the Assistant           25, VI
     Secretary
Indian Arts and Crafts Board                      25, II
Indian Health Service                             25, V
Information Resources Management, Office of       7, XXVII
Information Security Oversight Office, National   32, XX
     Archives and Records Administration
Inspector General
  Agriculture Department                          7, XXVI
  Health and Human Services Department            42, V
  Housing and Urban Development Department        24, XII
Institute of Peace, United States                 22, XVII
Inter-American Foundation                         5, LXIII; 22, X
Intergovernmental Relations, Advisory Commission  5, VII
     on
Interior Department
  American Indians, Office of the Special         25, VII
       Trustee
  Endangered Species Committee                    50, IV
  Federal Acquisition Regulation                  48, 14
  Federal Property Management Regulations System  41, 114
  Fish and Wildlife Service, United States        50, I, IV
  Geological Survey                               30, IV
  Indian Affairs, Bureau of                       25, I, V
  Indian Affairs, Office of the Assistant         25, VI
       Secretary
  Indian Arts and Crafts Board                    25, II
  Land Management, Bureau of                      43, II
  Minerals Management Service                     30, II

[[Page 208]]

  Mines, Bureau of                                30, VI
  National Indian Gaming Commission               25, III
  National Park Service                           36, I
  Reclamation, Bureau of                          43, I
  Secretary of the Interior, Office of            43, Subtitle A
  Surface Mining and Reclamation Appeals, Board   30, III
       of
  Surface Mining Reclamation and Enforcement,     30, VII
       Office of
Internal Revenue Service                          26, I
International Boundary and Water Commission,      22, XI
     United States and Mexico, United States 
     Section
International Development, United States Agency   22, II
     for
  Federal Acquisition Regulation                  48, 7
International Development Cooperation Agency,     22, XII
     United States
International Fishing and Related Activities      50, III
International Investment, Office of               31, VIII
International Joint Commission, United States     22, IV
     and Canada
International Organizations Employees Loyalty     5, V
     Board
International Trade Administration                15, III; 19, III
International Trade Commission, United States     19, II
Interstate Commerce Commission                    5, XL
James Madison Memorial Fellowship Foundation      45, XXIV
Japan-United States Friendship Commission         22, XVI
Joint Board for the Enrollment of Actuaries       20, VIII
Justice Department                                5, XXVIII; 28, I
  Drug Enforcement Administration                 21, II
  Federal Acquisition Regulation                  48, 28
  Federal Claims Collection Standards             4, II
  Federal Prison Industries, Inc.                 28, III
  Foreign Claims Settlement Commission of the     45, V
       United States
  Immigration and Naturalization Service          8, I
  Offices of Independent Counsel                  28, VI
  Prisons, Bureau of                              28, V
  Property Management Regulations                 41, 128
Labor Department                                  5, XLII
  Benefits Review Board                           20, VII
  Employees' Compensation Appeals Board           20, IV
  Employment and Training Administration          20, V
  Employment Standards Administration             20, VI
  Federal Acquisition Regulation                  48, 29
  Federal Contract Compliance Programs, Office    41, 60
       of
  Federal Procurement Regulations System          41, 50
  Labor-Management Standards, Office of           29, II, IV
  Mine Safety and Health Administration           30, I
  Occupational Safety and Health Administration   29, XVII
  Pension and Welfare Benefits Administration     29, XXV
  Public Contracts                                41, 50
  Secretary of Labor, Office of                   29, Subtitle A
  Veterans' Employment and Training, Office of    41, 61; 20, IX
       the Assistant Secretary for
  Wage and Hour Division                          29, V
  Workers' Compensation Programs, Office of       20, I
Labor-Management Standards, Office of             29, II, IV
Land Management, Bureau of                        43, II
Legal Services Corporation                        45, XVI
Library of Congress                               36, VII
  Copyright Office                                37, II
Management and Budget, Office of                  5, III, LXXVII; 48, 99
Marine Mammal Commission                          50, V
Maritime Administration                           46, II
Merit Systems Protection Board                    5, II
Micronesian Status Negotiations, Office for       32, XXVII
Mine Safety and Health Administration             30, I
Minerals Management Service                       30, II
Mines, Bureau of                                  30, VI
Minority Business Development Agency              15, XIV

[[Page 209]]

Miscellaneous Agencies                            1, IV
Monetary Offices                                  31, I
Multifamily Housing Assistance Restructuring,     24, IV
     Office of
National Aeronautics and Space Administration     5, LIX; 14, V
  Federal Acquisition Regulation                  48, 18
National Agricultural Library                     7, XLI
National Agricultural Statistics Service          7, XXXVI
National and Community Service, Corporation for   45, XII, XXV
National Archives and Records Administration      5, LXVI; 36, XII
  Information Security Oversight Office           32, XX
National Bureau of Standards                      15, II
National Capital Planning Commission              1, IV
National Commission for Employment Policy         1, IV
National Commission on Libraries and Information  45, XVII
     Science
National Council on Disability                    34, XII
National Counterintelligence Center               32, XVIII
National Credit Union Administration              12, VII
National Drug Control Policy, Office of           21, III
National Foundation on the Arts and the           45, XI
     Humanities
National Highway Traffic Safety Administration    23, II, III; 49, V
National Imagery and Mapping Agency               32, I
National Indian Gaming Commission                 25, III
National Institute for Literacy                   34, XI
National Institute of Standards and Technology    15, II
National Labor Relations Board                    5, LXI; 29, I
National Marine Fisheries Service                 50, II, IV, VI
National Mediation Board                          29, X
National Oceanic and Atmospheric Administration   15, IX; 50, II, III, IV, 
                                                  VI
National Park Service                             36, I
National Railroad Adjustment Board                29, III
National Railroad Passenger Corporation (AMTRAK)  49, VII
National Science Foundation                       5, XLIII; 45, VI
  Federal Acquisition Regulation                  48, 25
National Security Council                         32, XXI
National Security Council and Office of Science   47, II
     and Technology Policy
National Telecommunications and Information       15, XXIII; 47, III
     Administration
National Transportation Safety Board              49, VIII
National Weather Service                          15, IX
Natural Resources Conservation Service            7, VI
Navajo and Hopi Indian Relocation, Office of      25, IV
Navy Department                                   32, VI
  Federal Acquisition Regulation                  48, 52
Neighborhood Reinvestment Corporation             24, XXV
Northeast Dairy Compact Commission                7, XIII
Nuclear Regulatory Commission                     5, XLVIII; 10, I
  Federal Acquisition Regulation                  48, 20
Occupational Safety and Health Administration     29, XVII
Occupational Safety and Health Review Commission  29, XX
Offices of Independent Counsel                    28, VI
Oklahoma City National Memorial Trust             36, XV
Operations Office                                 7, XXVIII
Overseas Private Investment Corporation           5, XXXIII; 22, VII
Panama Canal Commission                           48, 35
Panama Canal Regulations                          35, I
Patent and Trademark Office                       37, I
Payment From a Non-Federal Source for Travel      41, 304
     Expenses
Payment of Expenses Connected With the Death of   41, 303
     Certain Employees
Peace Corps                                       22, III
Pennsylvania Avenue Development Corporation       36, IX
Pension and Welfare Benefits Administration       29, XXV
Pension Benefit Guaranty Corporation              29, XL
Personnel Management, Office of                   5, I, XXXV; 45, VIII
  Federal Acquisition Regulation                  48, 17
  Federal Employees Group Life Insurance Federal  48, 21
     Acquisition Regulation
[[Page 210]]

  Federal Employees Health Benefits Acquisition   48, 16
       Regulation
Postal Rate Commission                            5, XLVI; 39, III
Postal Service, United States                     5, LX; 39, I
Postsecondary Education, Office of                34, VI
President's Commission on White House             1, IV
     Fellowships
Presidential Commission on the Assignment of      32, XXIX
     Women in the Armed Forces
Presidential Documents                            3
Presidio Trust                                    36, X
Prisons, Bureau of                                28, V
Procurement and Property Management, Office of    7, XXXII
Productivity, Technology and Innovation,          37, IV
     Assistant Secretary
Public Contracts, Department of Labor             41, 50
Public and Indian Housing, Office of Assistant    24, IX
     Secretary for
Public Health Service                             42, I
Railroad Retirement Board                         20, II
Reclamation, Bureau of                            43, I
Refugee Resettlement, Office of                   45, IV
Regional Action Planning Commissions              13, V
Relocation Allowances                             41, 302
Research and Special Programs Administration      49, I
Rural Business-Cooperative Service                7, XVIII, XLII
Rural Development Administration                  7, XLII
Rural Housing Service                             7, XVIII, XXXV
Rural Telephone Bank                              7, XVI
Rural Utilities Service                           7, XVII, XVIII, XLII
Saint Lawrence Seaway Development Corporation     33, IV
Science and Technology Policy, Office of          32, XXIV
Science and Technology Policy, Office of, and     47, II
     National Security Council
Secret Service                                    31, IV
Securities and Exchange Commission                17, II
Selective Service System                          32, XVI
Small Business Administration                     13, I
Smithsonian Institution                           36, V
Social Security Administration                    20, III; 48, 23
Soldiers' and Airmen's Home, United States        5, XI
Special Counsel, Office of                        5, VIII
Special Education and Rehabilitative Services,    34, III
     Office of
State Department                                  22, I
  Federal Acquisition Regulation                  48, 6
Surface Mining and Reclamation Appeals, Board of  30, III
Surface Mining Reclamation and Enforcement,       30, VII
     Office of
Surface Transportation Board                      49, X
Susquehanna River Basin Commission                18, VIII
Technology Administration                         15, XI
Technology Policy, Assistant Secretary for        37, IV
Technology, Under Secretary for                   37, V
Tennessee Valley Authority                        5, LXIX; 18, XIII
Thrift Supervision Office, Department of the      12, V
     Treasury
Trade Representative, United States, Office of    15, XX
Transportation, Department of                     5, L
  Coast Guard                                     33, I; 46, I; 49, IV
  Coast Guard (Great Lakes Pilotage)              46, III
  Commercial Space Transportation                 14, III
  Contract Appeals, Board of                      48, 63
  Emergency Management and Assistance             44, IV
  Federal Acquisition Regulation                  48, 12
  Federal Aviation Administration                 14, I
  Federal Highway Administration                  23, I, II
  Federal Motor Carrier Safety Administration     49, III
  Federal Railroad Administration                 49, II
  Federal Transit Administration                  49, VI
  Maritime Administration                         46, II
  National Highway Traffic Safety Administration  23, II, III; 49, V
  Research and Special Programs Administration    49, I

[[Page 211]]

  Saint Lawrence Seaway Development Corporation   33, IV
  Secretary of Transportation, Office of          14, II; 49, Subtitle A
  Surface Transportation Board                    49, X
  Transportation Statistics Bureau                49, XI
Transportation, Office of                         7, XXXIII
Transportation Statistics Brureau                 49, XI
Travel Allowances, Temporary Duty (TDY)           41, 301
Treasury Department                               5, XXI; 12, XV; 17, IV
  Alcohol, Tobacco and Firearms, Bureau of        27, I
  Community Development Financial Institutions    12, XVIII
       Fund
  Comptroller of the Currency                     12, I
  Customs Service, United States                  19, I
  Engraving and Printing, Bureau of               31, VI
  Federal Acquisition Regulation                  48, 10
  Federal Law Enforcement Training Center         31, VII
  Fiscal Service                                  31, II
  Foreign Assets Control, Office of               31, V
  Internal Revenue Service                        26, I
  International Investment, Office of             31, VIII
  Monetary Offices                                31, I
  Secret Service                                  31, IV
  Secretary of the Treasury, Office of            31, Subtitle A
  Thrift Supervision, Office of                   12, V
Truman, Harry S. Scholarship Foundation           45, XVIII
United States and Canada, International Joint     22, IV
     Commission
United States and Mexico, International Boundary  22, XI
     and Water Commission, United States Section
Utah Reclamation Mitigation and Conservation      43, III
     Commission
Veterans Affairs Department                       38, I
  Federal Acquisition Regulation                  48, 8
Veterans' Employment and Training, Office of the  41, 61; 20, IX
     Assistant Secretary for
Vice President of the United States, Office of    32, XXVIII
Vocational and Adult Education, Office of         34, IV
Wage and Hour Division                            29, V
Water Resources Council                           18, VI
Workers' Compensation Programs, Office of         20, I
World Agricultural Outlook Board                  7, XXXVIII

[[Page 213]]



List of CFR Sections Affected



All changes in this volume of the Code of Federal Regulations which were 
made by documents published in the Federal Register since January 1, 
1986, are enumerated in the following list. Entries indicate the nature 
of the changes effected. Page numbers refer to Federal Register pages. 
The user should consult the entries for chapters and parts as well as 
sections for revisions.
For the period before January 1, 1986, see ``List of CFR Sections 
Affected, 1949-1963, 1964-1972, and 1973-1985'' published in seven 
separate volumes.

                                  1986

21 CFR
                                                                   51 FR
                                                                    Page
Chapter I
Mandatory compliance date 1-1-89...................................34085
201  Authority citation revised....................................8182,
41783, 43904
201.20  (a) revised................................................41783
201.22  Added; eff. 6-3-87.........................................43904
201.314  (h) added; eff. 6-5-86.....................................8182
207  Authority citation revised.....................................7389
207.10  (f) revised; eff. 5-2-86....................................7389
210  Heading and authority citation revised; eff. 5-2-86............7389
210.3  (b) (13) and (14) revised; eff. 5-2-86.......................7389
211  Authority citation revised....................................24479
211.198  (a) amended...............................................24479
    Technical correction...........................................28810
225  Authority citation revised.....................................7389
225.1  (b) revised; eff. 5-2-86.....................................7389
225.58  (b)(1) amended; (b)(2) removed; (c) revised; eff. 5-2-86 
                                                                    7390
225.115  (b)(2) amended; eff. 5-2-86................................7390
225.120--225.135 (Subpart F)  Added; eff. 5-2-86....................7390
225.142--225.165 (Subpart G)  Added; eff. 5-2-86....................7390
225.180 (Subpart H)  Added; eff. 5-2-86.............................7390
225.202 (Subpart I)  Added; eff. 5-2-86.............................7390
226  Heading and authority citation revised; nomenclature change; 
        eff. 5-2-86.................................................7390

                                  1987

21 CFR
                                                                   52 FR
                                                                    Page
Chapter I
201  Authority citation revised.....................................2111
201.20  (a) revised; (c) added.....................................21509
201.21  Effective date deferred in part............................12152
201.21  Added; eff. 4-20-87.........................................2111
207  Authority citation revised.....................................2682
207.20  (a) amended.................................................2682
207.25  (b) (1) and (6) amended.....................................2682
207.35  (b)(2)(iii) amended.........................................2682

                                  1988

21 CFR
                                                                   53 FR
                                                                    Page
Chapter I
Uniform compliance date 1-1-91.....................................44861
201  Authority citation revised.....................................4135
201.20  (c) suspended..............................................49138
201.21  OMB number..................................................4135
201.314  (h)(1) amended; (h)(5) removed............................21637
    (h)(1) corrected...............................................24830
299  Authority citation revised.....................................5369
299.4  (e) revised..................................................5369

                                  1989

21 CFR
                                                                   54 FR
                                                                    Page
Chapter I
200  Authority citation revised; sectional authority citations 
        removed....................................................39635

[[Page 214]]

201  Authority citation revised; sectional authority citations 
        removed....................................................39635
202  Authority citation revised....................................39635
202.1  Authority citation removed..................................39635
207  Authority citation revised....................................39635
207.35  Authority citation removed.................................39635
210  Authority citation revised....................................39635
211  Authority citation revised.....................................5228
    Authority citation revised; sectional authority citations 
removed............................................................39635
211.132  Revised; eff. 2-2-90.......................................5228
225  Authority citation revised....................................39635
226  Authority citation revised....................................39635
250  Authority citation revised; sectional authority citations 
        removed....................................................39635
290  Authority citation revised....................................39635
290.6  Authority citation removed..................................39635
291  Authority citation added; sectional authorities removed........8960
    Authority citation revised.....................................39635
291.505  Revised; eff. 4-3-89.......................................8960
    (b)(2)(i) and (d)(1)(iv) corrected.............................12531
299  Authority citation revised; sectional authority citations 
        removed....................................................39635

                                  1990

21 CFR
                                                                   55 FR
                                                                    Page
Chapter I
200.10  (c) amended................................................11576
201.57  (b)(2)(ii), (c)(2), (3)(i) and (v), (f)(9), (g)(2) and 
        (4), and (m)(1) amended....................................11576
201.58  Revised....................................................11576
201.59  (a)(2) and (3) amended.....................................11576
201.63  (e) added..................................................27784
201.122  (b) amended...............................................11576
201.200  (d) amended...............................................11576
201.305  (d)(2) amended............................................11576
201.306  (a)(2) amended............................................11576
201.307  (c)(3) amended............................................11576
205  Added.........................................................38023
207.3  (a)(5) amended..............................................11576
207.7  (a) and (d) amended.........................................11576
207.20  (c) amended................................................11576
207.21  (a) amended................................................11576
207.22  (a) and (b) amended........................................11576
207.25  (b)(2) amended.............................................11577
207.26  Amended....................................................11577
207.35  (b)(3)(v) amended..........................................11577
207.37  Introductory text and (b) amended..........................11577
207.40  (b) amended................................................11577
211.176  Amended...................................................11577
211.194  (a)(2) footnote amended...................................11577
225.58  (b)(1) amended.............................................11577
226.58  (e) footnote amended.......................................11577
    (d) amended....................................................23703
250.10  (c) revised................................................11577
250.103  (d) revised...............................................11577
250.106  (c) revised...............................................11577
250.250  (c)(4) introductory text, (ii), and (v) amended...........11577
299.4  (b) and (d) amended.........................................11577

                                  1991

                       (No regulations published)

                                  1992

21 CFR
                                                                   57 FR
                                                                    Page
Chapter I
201  Authority citation revised....................................54300
201.105  Introductory text and (a) revised.........................54300
201.110  Removed...................................................54301
201.122  Introductory text revised.................................54301
201.307  Removed; eff. 12-9-93.....................................58374
225.115  (b)(2) amended.............................................6475

                                  1993

21 CFR
                                                                   58 FR
                                                                    Page
Chapter I
201  Authority citation revised....................................45201
201.319  Added.....................................................45201
206  Added; eff. 9-13-95...........................................47958
207.25  (c) added; eff. 9-13-95....................................47959
207.37  (a)(1)(xi) added; eff. 9-13-95.............................47959
210.3  (b)(22) added; eff. 8-3-94..................................41353
211.122  (f) revised; (g) redesignated as (h); new (g) added; eff. 
        8-3-94.....................................................41353
211.125  (c) revised; eff. 8-3-94..................................41354
211.130  (b), (c) and (d) redesignated as (c), (d) and (e); new 
        (b) added; eff. 8-3-94.....................................41354
291  Authority citation revised......................................498
291.501  Revised; interim..........................................38709

[[Page 215]]

291.505  (d)(1)(i), (iii), (iv), (2)(i), (3)(v), (D), 
        (4)(i)(B)(2), (5)(ii), (6)(iv)(B)(6), (v)(A)(1), (3), (C), 
        (8)(i) introductory text, (E), (9)(i) introductory text 
        and (F) amended; (a)(2) and (d)(8)(i)(F) revised; (a)(10), 
        (b)(1)(v), (2)(vi), (d)(4)(i)(C) and (7) added...............498
291.505  (d)(1)(i)(C), (iii)(B)(1), (C), (3)(i), (13)(i) and 
        (f)(2)(viii) amended; (d)(6)(ii) removed; (k) redesignated 
        as (l); (b)(2)(v), (vi)(D), (c)(4)(i), (ii), (d)(1)(ii), 
        (iv), (6) heading, (6)(i) heading, (h)(1) and new (l) 
        revised; (d)(1)(iii)(B)(6), (4)(v) and new (k) added.......38709

                                  1994

21 CFR
                                                                   59 FR
                                                                    Page
Chapter I
201.20  (a) and (b) amended........................................60898
    Regulation at 59 FR 60898 eff. date corrected to 12-30-94......61929
201.57  (f)(9) revised.............................................64249
201.63  (d) amended................................................14364
210  Compliance date extended......................................39255
211  Compliance date extended......................................39255

                                  1995

21 CFR
                                                                   60 FR
                                                                    Page
Chapter I
201.20  Regulations at 59 FR 60898 and 61929 eff. date confirmed 
        as 12-30-94.................................................5131
202.1  (e)(4)(i)(b)(3) amended.....................................38480
206.10  (a) amended................................................19846
210  Compliance date extension.....................................20897
211  Compliance date extension.....................................20897
211.42  (c) introductory text amended...............................4091
211.68  (b) amended.................................................4091
211.137  (g) redesignated as (h); new (g) added.....................4091
211.170  (b) introductory text amended..............................4091
211.180  (e)(1) revised.............................................4091

                                  1996

21 CFR
                                                                   61 FR
                                                                    Page
Chapter I
200.100  Removed...................................................29476
200.101  Removed...................................................29476
201  Comment period extension......................................38046
    Compliance date extension......................................68623
201.64  Added; eff. 4-22-97........................................17806
201.320  Added; interim............................................20100
211  Compliance date extension.....................................37679
250.104  Removed...................................................29476
250.203  Removed...................................................29476

                                  1997

21 CFR
                                                                   62 FR
                                                                    Page
Chapter I
200  Authority citation revised....................................51515
200.30--200.31 (Subpart B)  Removed; eff. 4-14-97..................12084
201  Authority citation revised....................................51515
201.57  (f)(10) added; eff. 8-27-98................................45325
201.64  (a) through (h) stayed; (i) revised........................19925
202  Authority citation revised....................................51515
205  Authority citation revised....................................51515
206  Authority citation revised....................................51515
207  Authority citation revised....................................51515
210  Authority citation revised....................................51516
211  Compliance date extension.....................................40447
    Authority citation revised.....................................51516
211.1  (d) added...................................................19497
    (d) removed....................................................66522
225  Authority citation revised....................................51516
226  Authority citation revised....................................51516
250  Authority citation revised....................................51516
250.10  Removed; eff. 4-14-97......................................12084
250.103  Removed; eff. 4-14-97.....................................12084
250.106  Removed; eff. 4-14-97.....................................12084
290  Authority citation revised....................................51516
291  Authority citation revised....................................51516
299  Authority citation revised....................................51516

                                  1998

21 CFR
                                                                   63 FR
                                                                    Page
Chapter I
200  Authority citation revised....................................26698
200.15  Revised....................................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
201  Authority citation revised....................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
    Stay of compliance.............................................67399
201.23  Added......................................................66668

[[Page 216]]

201.50  (b) amended................................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
201.57  (f)(2) revised; eff. 6-1-99................................66396
201.100  (c)(2) amended............................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
201.307  Added.....................................................27843
201.322  Added; eff. 4-23-99.......................................56801
207  Authority citation revised....................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
207.25  (b)(2), (4), (5) and (6) amended...........................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
207.31  (a)(1), (2), (3) and (c) amended...........................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
207.37  (a)(2)(i) amended..........................................26698
    Regulation at 63 FR 26698 eff. date confirmed..................48576
208  Added; eff. 6-1-99............................................66396
210  Authority citation revised....................................26698
211  Authority citation revised....................................26698
211.84  (c)(5) amended.............................................14356
211.132  Heading revised; (a), (d) introductory text and (2) 
        amended; (b) and (c) revised...............................59470

                                  1999

21 CFR
                                                                   64 FR
                                                                    Page
Chapter I
200  Authority citation revised......................................400
    Effective date confirmation....................................26657
201  Authority citation revised......................................400
    Compliance date................................................13066
    Regulation at 64 FR 13292 eff. date corrected to 5-16-99.......18571
    Effective date confirmation....................................26657
201.59  (a)(1) revised; eff. 5-20-99.................................400
201.63  Heading and (e) revised; (a) amended; eff. 4-16-99.........13286
    Regulation at 64 FR 13286 eff. date corrected to 5-16-99.......18571
201.64  (b) amended; eff. 4-16-99..................................13286
    Regulation at 64 FR 13286 eff. date corrected to 5-16-99.......18571
201.66  Added; eff. 4-16-99........................................13286
    Regulation at 64 FR 13286 eff. date corrected to 5-16-99.......18571
201.100  (c)(2) and (d)(1) amended; eff. 5-20-99.....................400
201.150  (e) through (h) removed; eff. 5-20-99.......................400
201.314  (a) amended; (g)(1) and (h)(1) revised; eff. 4-16-99......13291
201.319  (b) revised; eff. 4-16-99.................................13292
    Regulation at 64 FR 13292 eff. date corrected to 5-16-99.......18571
201  Appendix A added; eff. 4-16-99................................13292
202  Authority citation revised......................................400
    Effective date confirmation....................................26657
202.1  (e)(4)(ii) removed; (e)(4)(iii) redesignated as (e)(4)(ii); 
        new (e)(4)(ii), (6)(i), (ii)(a), (b) and (xvii) amended; 
        eff. 5-20-99.................................................400
203  Added; eff. 12-4-00...........................................67756
205.3  (f)(9), (10) and (h) added; eff. 12-4-00....................67762
205.50  (f)(2) revised; eff. 12-4-00...............................67763
206  Authority citation revised......................................400
    Effective date confirmation....................................26657
207  Authority citation revised......................................400
    Effective date confirmation....................................26657
207.10  (f) revised................................................63203
207.20  (c) amended; eff. 5-20-99....................................400
    (c) revised....................................................56448
    (c) amended....................................................63203
207.21  (a) amended; eff. 5-20-99....................................400
    (a) amended....................................................56448
    (a) amended....................................................63203
207.25  (b)(2), (4), (5) and (6) amended; eff. 5-20-99...............400
207.31  (a)(1), (2), (3) and (c) amended; eff. 5-20-99...............400
207.35  (b)(3)(v) amended; eff. 5-20-99..............................400
207.37  (a)(2)(i) amended; eff. 5-20-99..............................400
210  Authority citation revised......................................401
    Effective date confirmation....................................26657
211  Authority citation revised......................................401
    Effective date confirmation....................................26657
216  Added; eff. 4-17-99...........................................10947
225.1  (b)(2) revised; (c) added...................................63203
225.58  (b)(1) amended.............................................63203
225.115  (b)(2) revised............................................63203
299  Effective date confirmation...................................26657
299.4  (d) amended; eff. 5-20-99.....................................401

[[Page 217]]

                                  2000

     (Regulations published January 1, 2000, through April 1, 2000)

21 CFR
                                                                   65 FR
                                                                    Page
Chapter I
201.66  (c)(5)(ii)(A) and (c)(5)(ii)(B) redesignated as 
        (c)(5)(ii)(B) and (c)(5)(ii)(A); (d)(3) revised................8
201.314  (h)(1) revised................................................8
201.323  Added; eff. 1-26-01........................................4110