[Federal Register Volume 59, Number 106 (Friday, June 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-13586]


[[Page Unknown]]

[Federal Register: June 3, 1994]


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Part VIII





Department of Health and Human Services





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Food and Drug Administration



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21 CFR Part 341




Cold, Cough, Allergy, Bronchodilator, and Antiasthmatic Drug Products 
for Over-the-Counter Human Use; Final Rule
DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 341

[Docket No. 89P-0040]
RIN 0905-AA06

 
Cold, Cough, Allergy, Bronchodilator, and Antiasthmatic Drug 
Products for Over-the-Counter Human Use; Amendment of Final Monograph 
for OTC Antitussive Drug Products

AGENCY: Food and Drug Administration, HHS.

ACTION: Final rule.

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

SUMMARY: The Food and Drug Administration (FDA) is issuing a final rule 
amending the final monograph for over-the-counter (OTC) antitussive 
drug products to include the ingredients diphenhydramine citrate and 
diphenhydramine hydrochloride. OTC antitussive drug products are used 
to relieve cough. This final rule addresses only single-ingredient 
antitussive drug products containing one of these ingredients. In a 
future issue of the Federal Register, the agency will propose to amend 
the tentative final monograph for OTC cold, cough, allergy, 
bronchodilator, and antiasthmatic combination drug products to address 
combination cough-cold drug products containing diphenhydramine citrate 
or diphenhydramine hydrochloride. This final rule is part of the 
ongoing review of OTC drug products conducted by FDA.

EFFECTIVE DATE: June 5, 1995.

FOR FURTHER INFORMATION CONTACT: William E. Gilbertson, Center for Drug 
Evaluation and Research (HFD-810), Food and Drug Administration, 5600 
Fishers Lane, Rockville, MD 20857, 301-594-5000.

SUPPLEMENTARY INFORMATION:

I. Background

    In the Federal Register of August 12, 1987 (52 FR 30042), FDA 
issued a final monograph for OTC antitussive drug products in part 341 
(21 CFR part 341) that lists in Sec. 341.14 (21 CFR 341.14) the active 
ingredients that are generally recognized as safe and effective for use 
in these products. Diphenhydramine citrate and diphenhydramine 
hydrochloride were not included in Sec. 341.14 at that time. 
Subsequently, two manufacturers petitioned the agency to amend the 
final monograph for OTC antitussive drug products to include 
diphenhydramine citrate and diphenhydramine hydrochloride as monograph 
active ingredients (Refs. 1 and 2). The petitions are on display in the 
Dockets Management Branch (HFA-305), Food and Drug Administration, rm. 
1-23, 12420 Parklawn Dr., Rockville, MD 20857.
    In the Federal Register of December 9, 1992 (57 FR 58378), the 
agency discussed these petitions and proposed that diphenhydramine 
citrate and diphenhydramine hydrochloride be generally recognized as 
safe and effective for OTC antitussive use. The agency previously 
determined that diphenhydramine citrate is bioequivalent and 
therapeutically equivalent to diphenhydramine hydrochloride (54 FR 6814 
at 6824, February 14, 1989). The agency proposed specific warnings and 
directions for these ingredients for OTC antitussive use. The agency 
advised in its proposed rule (57 FR 58378 at 58380) that any final rule 
resulting from this proposed rule would be effective 12 months after 
the final rule's date of publication in the Federal Register.
    The agency invited written comments by February 8, 1993, on the 
proposed rule and the agency's economic impact determination for the 
proposal. In response to the proposed rule, the agency received two 
comments from manufacturers. Copies of the comments are on public 
display in the Dockets Management Branch (address above).

References

    (1) Comment No. CP2, Docket No. 89P-0040, Dockets Management 
Branch.
    (2) Comment No. CP3, Docket No. 89P-0040, Dockets Management 
Branch.

II. The Agency's Conclusions on the Comments

    1. Two comments requested that the agency's proposed OTC 
antitussive dosage for diphenhydramine hydrochloride (25 milligrams 
(mg) every 4 hours (h), not to exceed 150 mg in 24 h) be expanded to a 
range of 25 to 50 mg every 4 to 6 h, not to exceed 300 mg in 24 h. One 
of the comments also requested a corresponding expansion of the OTC 
antitussive dosage for diphenhydramine citrate, i.e., a dosage of 38 to 
76 mg every 4 to 6 h, not to exceed 456 mg in 24 h.
    To support an expanded dosage range for antitussive use, one of the 
comments provided pharmacokinetic data for diphenhydramine 
hydrochloride dosed at 25 mg every 4 h and 50 mg every 6 h. The data 
included the following steady state concentrations (Css), minimum 
concentrations at steady state (Css min), and maximum 
concentrations at steady state (Css max) in nanograms/milliliter 
(ng/mL) for both dosages; and the areas under the curve (AUC) for both 
dosages in ng x h/mL:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                   Diphenhydramine Hydrochloride Pharmacokinetic Data                                                   
---------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            (Css max)                (Css min)                  (Css)                     (AUC)         
--------------------------------------------------------------------------------------------------------------------------------------------------------
25 mg every 4 h                                              55 ng/mL                27.5 ng/mL                40 ng/mL               160 ng x h/mL     
50 mg 312 ng x h/mL                                          85 ng/mL                 30 ng/mL                 52 ng/mL                                 
--------------------------------------------------------------------------------------------------------------------------------------------------------

The comment pointed out that the two Css min concentrations are 
comparable. The comment stated that the 50 mg every 6 h dosing regimen 
is as efficacious as the 25 mg every 4 h regimen because the 50 mg dose 
does not fall below the minimum effective concentration. The comment 
added that further substantiation is provided by the Css and AUC 
data, which fall within the minimum effective concentration levels.
    The other comment stated that the potential for conflict between 
the different dosages for antitussive and antihistamine use of 
diphenhydramine would be eliminated by accepting the broader 
antihistamine dosage (e.g., for diphenhydramine hydrochloride, 25 to 50 
mg every 4 to 6 h, not to exceed 300 mg in 24 h) for products intended 
for both uses. The comment added that this approach would reduce the 
potential for consumer confusion. The comment argued that it would not 
be in the consumer's interest to establish a lower dose for 
diphenhydramine in products that will not meet consumer expectations of 
the antihistamine effect. The comment contended that, based on the 
established safety of diphenhydramine citrate and diphenhydramine 
hydrochloride for both antitussive and antihistamine use, monograph 
status for four uses, and potential use for more than one indication in 
a cough-cold product, the broader dosage range (e.g., for 
diphenhydramine hydrochloride, 25 to 50 mg every 4 to 6 h) should be 
permitted to provide maximum effectiveness. Both comments concluded 
that diphenhydramine hydrochloride has been found safe for a variety of 
OTC uses at dosages of 25 to 50 mg every 4 to 6 h and, thus, safety is 
not an issue at this dosage range.
    In the Federal Register of September 9, 1976 (41 FR 38312 at 
38341), the Advisory Review Panel on OTC Cold, Cough, Allergy, 
Bronchodilator, and Antiasthmatic Drug Products based its 25 mg every 4 
h recommendation for diphenhydramine hydrochloride for antitussive use 
on data demonstrating effectiveness and acceptable tolerability at this 
dosage. All approved applications for diphenhydramine hydrochloride as 
an OTC antitussive are for a dosage of 25 mg every 4 h, based on 
supporting clinical data. No clinical data have been received by the 
agency to support the safety or increased effectiveness of higher 
dosages of diphenhydramine hydrochloride or diphenhydramine citrate for 
OTC antitussive use either under the OTC drug review or an approved 
application. One comment submitted pharmacokinetic data concerning 
diphenhydramine at both the 25 mg every 4 h dose and the 50 mg every 6 
h dose showing that Css min for both regimens were similar. It is 
therefore likely that dosing at 50 mg every 6 h is effective. That 
regimen, however, produces higher Css max and almost twice the 
drug exposure, with increased potential adverse effects such as 
sedation, but with no evidence of greater effectiveness than the every 
4 h regimen. In conclusion, the agency cannot consider to be generally 
recognized as safe and effective an antitussive dosage (25 to 50 mg 
every 4 to 6 h for diphenhydramine hydrochloride) that is not supported 
by clinical data. Therefore, based on the Panel's recommended dosage 
and the approved application labeling for OTC antitussive drug products 
containing diphenhydramine hydrochloride, the agency is establishing 
the monograph antitussive dosage of diphenhydramine hydrochloride as 
follows:
    Adults and children 12 years of age and over: oral dosage is 25 
milligrams every 4 hours, not to exceed 150 milligrams in 24 hours, 
or as directed by a doctor. Children 6 to under 12 years of age: 
oral dosage is 12.5 milligrams every 4 hours, not to exceed 75 
milligrams in 24 hours, or as directed by a doctor. Children under 6 
years of age: consult a doctor.
    The monograph antitussive dosage of diphenhydramine citrate is as 
follows:
    Adults and children 12 years of age and over: oral dosage is 38 
milligrams every 4 hours, not to exceed 228 milligrams in 24 hours, 
or as directed by a doctor. Children 6 to under 12 years of age: 
oral dosage is 19 milligrams every 4 hours, not to exceed 114 
milligrams in 24 hours, or as directed by a doctor. Children under 6 
years of age: consult a doctor.
    With respect to the comment's discussion of a single ingredient 
drug product containing diphenhydramine for concurrent use as both an 
antihistamine and an antitussive, this issue will be addressed in an 
amendment to the OTC cough-cold combinations tentative final monograph 
in a future issue of the Federal Register.
    2. One comment discussed ``multiuse'' labeling of OTC drug products 
that contain diphenhydramine. The comment described this as labeling a 
product with some or all of the proven pharmacologic activities of the 
drug whether or not the conditions to be treated are related. As an 
example, the comment stated that a product containing diphenhydramine 
could be labeled for both antitussive and antihistamine use. If this 
occurred, the statement of identity could be expressed as ``cough 
suppressant/antihistamine.'' The comment stated that the product's 
labeling could describe each use separately under the product's 
``Indications,'' with accompanying warnings and directions for both 
uses. The comment contended that there is no legal restriction that 
prevents ``multiuse'' labeling whether or not the conditions to be 
treated are related. The comment discussed several aspects of 
``multiuse'' labeling.
    This final rule addresses only single-ingredient diphenhydramine 
citrate and diphenhydramine hydrochloride drug products for antitussive 
use. The agency acknowledges that ``multiuse'' labeling is possible for 
products containing diphenhydramine but is not aware of any such 
products having been or currently being in the marketplace. The agency 
intends to address ``multiuse'' labeling in a future issue of the 
Federal Register in an amendment to the tentative final monograph for 
OTC cough-cold combination drug products. The agency will discuss: (1) 
Concurrent use of diphenhydramine as an antitussive and as an 
antihistamine for concurrent symptoms, and (2) different uses of 
diphenhydramine with separate full labeling for different, 
nonconcurrent symptoms. Manufacturers may not introduce diphenhydramine 
products having ``multiuse'' labeling into the OTC marketplace until 
the agency's proposal on how this should be done appears in a future 
issue of the Federal Register.
    3. One comment contended that an agency statement in the proposed 
rule appeared to be inconsistent with the agency's general provisions 
and administrative procedures for marketing OTC combination drug 
products under 21 CFR 330.13(b)(2) and Compliance Policy Guide 
7132b.16. The agency statement said: ``Until the agency amends the 
tentative final monograph for OTC cough-cold combination drug products, 
no cough-cold combination drug product containing diphenhydramine 
citrate or diphenhydramine hydrochloride labeled for antitussive use 
can be marketed OTC unless it is the subject of an approved NDA or 
ANDA'' (57 FR 58378 at 58380). The comment stated that, because FDA 
recognizes diphenhydramine as both an OTC antihistamine and an OTC 
antitussive, marketing of diphenhydramine for both claims in 
combination drug products should be allowed under the provisions of the 
tentative final monograph for OTC cough-cold combination drug products. 
The comment listed a number of examples where an antitussive can be 
combined with an antihistamine and stated that diphenhydramine should 
be able to perform both functions in the product. The comment contended 
that this approach should be acceptable provided that all of the 
labeled uses are for Category I combinations.
    This final rule does not address combination drug products 
containing diphenhydramine citrate or diphenhydramine hydrochloride as 
an antitussive active ingredient. There are a number of issues that 
need to be resolved before diphenhydramine can be used to perform both 
functions (antitussive and antihistamine) in a single product. These 
include, among others, a difference in the monograph directions for use 
(amount of drug to be taken and time interval for taking the drug) and 
different warnings related to the individual uses. The agency intends 
to discuss these matters in a future issue of the Federal Register, as 
noted above. At this time, the agency reaffirms its position stated 
above that any OTC cough-cold combination drug product containing 
diphenhydramine citrate or diphenhydramine hydrochloride labeled for 
antitussive use can only be marketed if it is the subject of an 
approved application.
    No comments were received in response to the agency's request for 
specific comment on the economic impact of this rulemaking. FDA has 
examined the impacts of this final rule under Executive Order 12866 and 
the Regulatory Flexibility Act (Pub. L. 96-354). Executive Order 12866 
directs agencies to assess all costs and benefits of available 
regulatory alternatives and, when regulation is necessary, to select 
regulatory approaches that maximize net benefits (including potential 
economic, environmental, public health and safety, and other 
advantages; distributive impacts; and equity). The agency believes that 
this final rule is consistent with the regulatory philosophy and 
principles identified in the Executive Order. In addition, the final 
rule is not a significant regulatory action as defined by the Executive 
Order and, thus, is not subject to review under the Executive Order.
    The Regulatory Flexibility Act requires agencies to analyze 
regulatory options that would minimize any significant impact of a rule 
on small entities. Currently marketed OTC single ingredient 
diphenhydramine drug products already meet the conditions of the final 
monograph. Other manufacturers will be able to enter the OTC 
marketplace without having to obtain an approved application. 
Accordingly, the agency certifies that the final rule will not have a 
significant economic impact on a substantial number of small entities. 
Therefore, under the Regulatory Flexibility Act, no further analysis is 
required.
    The agency has determined under 21 CFR 25.24(c)(6) that this action 
is of a type that does not individually or cumulatively have a 
significant effect on the human environment. Therefore, neither an 
environmental assessment nor an environmental impact statement is 
required.

List of Subjects in 21 CFR Part 341

    Labeling, Over-the-counter drugs.
    Therefore, under the Federal Food, Drug, and Cosmetic Act and under 
authority delegated to the Commissioner of Food and Drugs, 21 CFR part 
341 is amended as follows:

PART 341--COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC 
DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE

    1. The authority citation for 21 CFR part 341 continues to read as 
follows:

    Authority: Secs. 201, 501, 502, 503, 505, 510, 701 of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321, 351, 352, 353, 
355, 360, 371).
    2. Section 341.14 is amended by adding new paragraphs (a)(5) and 
(a)(6) to read as follows:

Sec. 341.14  Antitussive active ingredients.

* * * * *
    (a) * * *
    (5) Diphenhydramine citrate.
    (6) Diphenhydramine hydrochloride.
* * * * *
    3. Section 341.74 is amended by adding new paragraphs (c)(4)(vii), 
(c)(4)(viii), (c)(4)(ix), (d)(1)(iv), and (d)(1)(v) to read as follows:


Sec. 341.74  Labeling of antitussive drug products.

* * * * *
    (c) * * *
    (4) * * *
    (vii) For products containing diphenhydramine citrate or 
diphenhydramine hydrochloride identified in Sec. 341.14(a)(5) and 
(a)(6). ``May cause excitability especially in children.''
    (viii) For products containing diphenhydramine citrate or 
diphenhydramine hydrochloride identified in Sec. 341.14(a)(5) and 
(a)(6) when labeled only for children under 12 years of age--(A) ``Do 
not give this product to children who have a breathing problem such as 
chronic bronchitis, or who have glaucoma, without first consulting the 
child's doctor.''
    (B) ``May cause marked drowsiness. Sedatives and tranquilizers may 
increase the drowsiness effect. Do not give this product to children 
who are taking sedatives or tranquilizers, without first consulting the 
child's doctor.''
    (ix) For products containing diphenhydramine citrate or 
diphenhydramine hydrochloride identified in Sec. 341.14(a)(5) and 
(a)(6) when labeled for use in adults and children under 12 years of 
age--(A) ``Do not take this product, unless directed by a doctor, if 
you have a breathing problem such as emphysema or chronic bronchitis, 
or if you have glaucoma or difficulty in urination due to enlargement 
of the prostate gland.''
    (B) ``May cause marked drowsiness; alcohol, sedatives, and 
tranquilizers may increase the drowsiness effect. Avoid alcoholic 
beverages while taking this product. Do not take this product if you 
are taking sedatives or tranquilizers, without first consulting your 
doctor. Use caution when driving a motor vehicle or operating 
machinery.''
* * * * *
    (d) * * *
    (1) * * *
    (iv) For products containing diphenhydramine citrate identified in 
Sec. 341.14(a)(5). ``Adults and children 12 years of age and over: oral 
dosage is 38 milligrams every 4 hours, not to exceed 228 milligrams in 
24 hours, or as directed by a doctor. Children 6 to under 12 years of 
age: oral dosage is 19 milligrams every 4 hours, not to exceed 114 
milligrams in 24 hours, or as directed by a doctor. Children under 6 
years of age: consult a doctor.''
    (v) For products containing diphenhydramine hydrochloride 
identified in Sec. 341.14(a)(6). ``Adults and children 12 years of age 
and over: oral dosage is 25 milligrams every 4 hours, not to exceed 150 
milligrams in 24 hours, or as directed by a doctor. Children 6 to under 
12 years of age: oral dosage is 12.5 milligrams every 4 hours, not to 
exceed 75 milligrams in 24 hours, or as directed by a doctor. Children 
under 6 years of age: consult a doctor.''
* * * * *
    4. Section 341.90 is amended by adding new paragraphs (r) and (s) 
to read as follows:


Sec. 341.90  Professional labeling.

* * * * *
    (r) For products containing diphenhydramine citrate identified in 
Sec. 341.14(a)(5). ``Children 2 to under 6 years of age: oral dosage is 
9.5 milligrams every 4 hours, not to exceed 57 milligrams in 24 
hours.''
    (s) For products containing diphenhydramine hydrochloride 
identified in Sec. 341.14(a)(6). ``Children 2 to under 6 years of age: 
oral dosage is 6.25 milligrams every 4 hours, not to exceed 37.5 
milligrams in 24 hours.''

    Dated: May 16, 1994.
 Michael R. Taylor,
 Deputy Commissioner for Policy.
[FR Doc. 94-13586 Filed 6-2-94; 8:45 am]
BILLING CODE 4160-01-F