[Federal Register Volume 61, Number 223 (Monday, November 18, 1996)]
[Rules and Regulations]
[Pages 58629-58630]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-29387]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
21 CFR Part 328

[Docket No. 95N-0341]


Over-the-Counter Drug Products Intended for Oral Ingestion that 
Contain Alcohol; Amendment of Final Rule

AGENCY: Food and Drug Administration, HHS.

ACTION: Final rule.

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SUMMARY: The Food and Drug Administration (FDA) is issuing a final rule 
amending the regulations for over-the-counter (OTC) drug products 
intended for oral ingestion that contain alcohol as an inactive 
ingredient by exempting ipecac syrup from the maximum concentration 
limits of 0.5 percent alcohol or less when used by children under 6 
years of age. This final rule is part of the ongoing review of OTC drug 
products conducted by FDA.

EFFECTIVE DATE: December 18, 1996.

FOR FURTHER INFORMATION CONTACT: William E. Gilbertson, Center for Drug 
Evaluation and Research (HFD-105), Food and Drug Administration, 5600 
Fishers Lane, Rockville, MD 20857, 301-827-2304.

SUPPLEMENTARY INFORMATION:

I. Background

    In the Federal Register of March 13, 1995 (60 FR 13590), the agency 
issued a final rule establishing in Sec. 328.10 (21 CFR 328.10) maximum 
concentration limits for alcohol (ethyl alcohol) as an inactive 
ingredient in OTC drug products intended for oral ingestion. The 
maximum concentration limit was set at 0.5 percent for any OTC drug 
product labeled for use by children under 6 years of age, and 5 percent 
for any OTC drug product labeled for use by children 6 to under 12 
years of age. The final rule did not discuss ipecac syrup, an OTC drug 
product used to cause vomiting when poisoning occurs.
    The United States Pharmacopeia (USP) 23d Revision states that 
alcohol is contained in ipecac syrup in concentrations between 1.0 and 
2.5 percent (Ref. 1). Alcohol is used in the preparation of the syrup 
to ensure the complete extraction of alkaloids as their amine salts 
from ipecac powder and to reject extraneous material when ipecac syrup 
is prepared by percolation (Ref. 2).
    Under Sec. 201.308(c) (21 CFR 201.308(c)), OTC marketing of ipecac 
syrup is limited to a 1-fluid-ounce (30 milliliters (mL)) package. The 
product's labeling must contain a statement conspicuously boxed and in 
red letters that states: ``For emergency use to cause vomiting in 
poisoning. Before using, call physician, the Poison Control Center, or 
hospital emergency room immediately for advice.'' The labeling also 
must state: ``Usual dosage: 1 tablespoon (15 milliliters) in persons 
over 1 year of age.''
    As part of the rulemaking for OTC poison treatment drug products 
(50 FR 2244, January 15, 1985), the agency proposed a dose of 1 
tablespoonful (15 mL or 1/2 bottle) of ipecac syrup for children 1 to 
under 12 years of age. The agency also proposed a dose of 1 teaspoonful 
(5 mL) for children 6 months to under 1 year of age, and that ipecac 
syrup not be given to children under 6 months of age unless directed by 
a health professional. The agency will finalize these directions for 
use in a future issue of the Federal Register.
    In the Federal Register of May 10, 1996 (61 FR 21392), the agency 
published a proposed amendment of Sec. 328.10 to exempt ipecac syrup 
from the requirements of Sec. 328.10(d), which

[[Page 58630]]

limit alcohol content to 0.5 percent or less in OTC drug products 
intended for oral ingestion for use by children 6 years of age or less.
    The agency noted that the maximum amount of ipecac syrup per 
packaged container does not exceed 30 mL, and the maximum quantity of 
alcohol at a 2.5 percent concentration contained in 30 mL of ipecac 
syrup is 0.75 mL. If a child under 6 years old swallowed the entire 
contents of a 30 mL container of ipecac syrup, the ingested amount of 
alcohol (0.75 mL) is insignificant. The labeled dose of ipecac syrup is 
a one-time treatment of 15 mL (0.375 mL alcohol) for children 1 to 
under 12 years of age. In addition, the alcohol and the ipecac syrup 
are generally vomited together with other stomach contents. Thus, the 
benefit of ipecac syrup as an emetic outweighs any risk of adverse 
effects from ingestion of 0.375 to 0.75 mL of alcohol.
    Interested persons were invited to submit comments by June 10, 
1996, and comments on the agency's economic impact determination by 
June 10, 1996. No comments were submitted in response to the proposed 
rule.

II. References

    (1) United States Pharmacopeia 23/National Formulary 18, United 
States Pharmacopeial Convention, Inc., Rockville, MD, pp. 834-835, 
1994.
    (2) ``Solutions Using Mixed Solvent Systems: Spirits, Elixirs, 
and Extracted Products,'' in Sprowls' American Pharmacy, 7th ed., J. 
B. Lipincott Co., Philadelphia, pp. 100-101, 1974.

III. The Agency's Final Conclusions

    The agency is adding new Sec. 328.10(f) to state: ``Ipecac syrup is 
exempt from the provisions of paragraph (d) of this section.'' This 
means that ipecac syrup may contain more than 0.5 percent alcohol even 
though labeled for use by children under 6 years of age. Also, the 
agency is redesignating current Sec. 328.10(f) as Sec. 328.10(g).

IV. Analysis of Impacts

    No comments regarding the economic impact of the proposed 
rulemaking were received.
    FDA has examined the impacts of this final rule under Executive 
Order 12866 and the Regulatory Flexibility Act (5 U.S.C. 601-612). 
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 so is not subject to review under the Executive Order.
    Under the Regulatory Flexibility Act, if a rule has a significant 
impact on a substantial number of small entities, an agency must 
analyze regulatory options that would minimize any significant impact 
of a rule on small entities. Because this final rule has no effect on 
the OTC marketing of ipecac syrup drug products, it will not impose a 
significant economic burden on affected entities. Therefore, under the 
Regulatory Flexibility Act (5 U.S.C. 605(b)), the Commissioner of Food 
and Drugs certifies that the final rule will not have a significant 
economic impact on a substantial number of small entities. No further 
analysis is required.

V. Environmental Impact

    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 328

    Drugs, Labeling, Alcohol.
    Therefore, under the Federal Food, Drug, and Cosmetic Act and under 
authority delegated to the Commissioner of Food and Drugs, 21 CFR part 
328 is amended as follows:

PART 328--OVER-THE-COUNTER DRUG PRODUCTS INTENDED FOR ORAL 
INGESTION THAT CONTAIN ALCOHOL

    1. The authority citation for 21 CFR part 328 continues to read as 
follows:

    Authority: Secs. 201, 301, 501, 502, 503, 505, 701 of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321, 331, 351, 352, 
353, 355, 371).

    2. Section 328.10 is amended by redesignating paragraph (f) as 
paragraph (g) and by adding new paragraph (f) to read as follows:


Sec. 328.10  Alcohol.

 * * * * *
    (f) Ipecac syrup is exempt from the provisions of paragraph (d) of 
this section.
 * * * * *

    Dated: November 5, 1996.
William K. Hubbard,
Associate Commissioner for Policy Coordination.
[FR Doc. 96-29387 Filed 11-15-96; 8:45 am]
BILLING CODE 4160-01-F