GFI Dear Heath Care Provider 0754 Guidance

Guidance for Industry
and FDA Staff
Dear Health Care Provider
Letters: Improving
Communication of Important
Safety Information

U.S. Department of Health and Human Services
Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)

January 2014
Procedural

OMB Control No. 0910-0754
Expiration Date 12/31/2016
See additional PRA statement in section VII of this guidance

Guidance for Industry
and FDA Staff
Dear Health Care Provider
Letters: Improving
Communication of Important
Safety Information
Additional copies are available from:
Office of Communications
Division of Drug Information, WO51, Room 2201
Center for Drug Evaluation and Research
Food and Drug Administration
10903 New Hampshire Ave., Silver Spring, MD 20993
Phone: 301-796-3400; Fax: 301-847-8714
[email protected]
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/default.htm

and/or
Office of Communication, Outreach and
Development, HFM-40
Center for Biologics Evaluation and Research
Food and Drug Administration
1401 Rockville Pike, Rockville, MD 20852-1448
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm

(Tel) 800-835-4709 or 301-827-1800

U.S. Department of Health and Human Services
Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)
January 2014
Procedural

Contains Nonbinding Recommendations
TABLE OF CONTENTS

I.

INTRODUCTION............................................................................................................. 1

II.

BACKGROUND ............................................................................................................... 2

III.

FDA CONSULTATION ON DEVELOPMENT OF DHCP LETTERS ..................... 2

IV.

WHEN TO USE A DHCP LETTER AND WHICH TYPE OF DHCP LETTER TO
USE ..................................................................................................................................... 3

A.

Important Drug Warning Letters ................................................................................................ 3

B.

Important Prescribing Information Letters ................................................................................ 4

C.

Important Correction of Drug Information Letters ................................................................... 4

V.

CONTENT AND FORMAT OF DHCP LETTERS ...................................................... 5
A.

Content Recommendations ........................................................................................................... 5

B.

Format Recommendations .......................................................................................................... 10

VI.

ASSESSMENT OF THE DHCP LETTER IMPACT ................................................. 10

VII.

PAPERWORK REDUCTION ACT OF 1995 .............................................................. 11

APPENDIX A: IMPORTANT DRUG WARNING - MODEL LETTER ............................ 12
APPENDIX B: IMPORTANT PRESCRIBING INFORMATION - MODEL LETTER ... 14
APPENDIX C: CORRECTION OF DRUG INFORMATION - MODEL LETTER ......... 16

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Guidance for Industry and FDA Staff1
Dear Health Care Provider Letters:
Improving Communication of Important Safety Information

This guidance represents the Food and Drug Administration’s (FDA’s) current thinking on this topic. It
does not create or confer any rights for or on any person and does not operate to bind FDA or the public.
You can use an alternative approach if the approach satisfies the requirements of the applicable statutes
and regulations. If you want to discuss an alternative approach, contact the FDA staff responsible for
implementing this guidance. If you cannot identify the appropriate FDA staff, call the appropriate
number listed on the title page of this guidance.

I.

INTRODUCTION

This guidance provides recommendations to industry and FDA staff on the content and format of
Dear Health Care Provider (DHCP) letters. 2 DHCP letters are correspondence ― often in the
form of a mass mailing from the manufacturer or distributor of a human drug or biologic or from
FDA ― intended to alert physicians and other health care providers about important new or
updated information regarding a human drug or biologic (hereafter “drug” and “product” refer to
both biologic and small molecule drug products). DHCP letters may also be distributed by email
and are often made available on the Internet (e.g., on company Web sites or through patient
advocacy groups). This guidance provides recommendations on (1) when to issue a DHCP
letter, (2) the types of information to include in a DHCP letter, (3) how to organize that
information so that it is communicated effectively to health care providers, and (4) formatting
techniques to make the information more accessible.
FDA’s guidance documents, including this guidance, do not establish legally enforceable
responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should
be viewed only as recommendations, unless specific regulatory or statutory requirements are
cited. The use of the word should in Agency guidances means that something is suggested or
recommended, but not required.

1

This guidance has been prepared by the Office of Medical Policy in the Center for Drug Evaluation and Research
(CDER) and the Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration.
2
The concepts provided in this guidance may be used, in appropriate circumstances, to help develop correspondence
to meet certain communication plan requirements for Risk Evaluation and Mitigation Strategies (REMS) under
section 505-1(e)(3) of the Federal Food, Drug, and Cosmetic Act.
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II.

BACKGROUND

New or updated information about drug products emerges throughout a product’s life cycle. For
marketed products, there are occasions when it is important to communicate this information
promptly to health care providers involved in prescribing or dispensing a drug or in caring for
patients who receive a drug. The DHCP letter is one of the mechanisms used to communicate
important new information about a marketed product. FDA regulations describe the process for
mailing important new information about drug products (21 CFR 200.5), but do not provide
instructions on the format and content of the actual letter. Nor do the regulations provide
information on electronic or other means of communication.
Formal and informal evaluations of DHCP letters have shown that the communication quality of
these letters — the extent to which the information is accessible and can be understood — has
varied widely. A 2005 study (the Mazor study) evaluated the quality of a group of DHCP letters
sent during 2000 and 2001 that were intended to communicate important new drug safety
information. 3 The Mazor study found a correlation between the quality or perceived quality of a
DHCP letter and the extent to which physicians perceived the new information as important.
Letters that were evaluated as clearer, more concise, better organized and formatted and that
focused on the most important aspects of the new safety information were considered more
effective in communicating the new information.
FDA therefore believes that guidance on the format and content of the DHCP letter would help
improve the effectiveness of DHCP letters in communicating drug information. This guidance
provides recommendations intended to improve the quality of DHCP letters and enhance the
communication of important drug information. These recommendations are based on some of
the findings and recommendations from the Mazor study, FDA’s own experience in evaluating
DHCP letters, and the Agency’s general risk communication experience.
III.

FDA CONSULTATION ON DEVELOPMENT OF DHCP LETTERS

FDA believes that effective communication of important new information in DHCP letters can
best be accomplished if FDA and the manufacturer work together to determine:
•
•
•
•

Whether a DHCP letter should be used to convey new information
How to present the new information in the DHCP letter
The target audience for the information in the DHCP letter
The time frame for distributing the DHCP letter

FDA encourages manufacturers to consult with the appropriate review division (e.g., the Offices
of Drug Evaluation within the Office of New Drugs, the Office of Generic Drugs) during the
development of a DHCP letter to ensure that the letter clearly and accurately reflects both the
manufacturer’s and FDA’s understanding of the issue and the action required. In addition to

3

Mazor KM, Andrade SE, Auger J, Fish L, Gurwitz JH, 2005, “Communicating Safety Information to Physicians:
An Examination of Dear Doctor Letters,” Pharmacoepidemiol Drug Saf, 14 (12):869-875.
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providing a broader range of input into the content of the letter, such consultation could help
ensure FDA’s concurrence that the content of the letter is not in some way false or misleading.
Discussion with the appropriate FDA review division should also address the intended target
audience(s) for the DHCP letter so the letter can be directed more selectively to those health care
providers (and their professional societies) who need the information. For example, a DHCP
letter describing a product used to treat Alzheimer’s disease should be sent to neurologists,
psychiatrists, geriatricians, and internists. A DHCP letter describing a recommended action for
pharmacists should be directed to pharmacists; a letter describing revised safety information and
use instructions for dialysis patients should be distributed to dialysis centers and nephrologists.
Further, the means by which the letter will be distributed (e.g., mass mailing, electronic
distribution) should be discussed.
The planned time frame for distributing the letter to the target audience should be determined
through discussion between the manufacturer and the FDA review division so that the intended
audience receives the information promptly, as appropriate to the issue being communicated.
IV.

WHEN TO USE A DHCP LETTER AND WHICH TYPE OF DHCP LETTER TO
USE

When is a DHCP Letter Needed?
In general, a DHCP letter is used to notify health care providers about important new or updated
information about a drug. In most cases, the information relates to an important safety concern
that could affect the decision to use a drug or require some change in behavior by health care
providers, patients, or caregivers to reduce the potential for harm from a drug. Some DHCP
letters are written as part of Risk Evaluation and Mitigation Strategies (REMS) communication
programs to inform intended target audiences about the implementation of a new or modified
REMS or to present additional required safety information about the product. In some cases, a
DHCP letter provides information on how to improve the effectiveness of a drug or information
about drug shortage issues. A DHCP letter also may be needed to correct misleading
information in advertising or other types of prescription drug promotion.
Three types of DHCP letters are specifically described in FDA regulations (21 CFR 200.5):
Important Drug Warning Letters, Important Prescribing Information Letters, and Important
Correction of Drug Information Letters. As described in the previous paragraph, DHCP letters
relating to other topics (e.g., REMS, drug shortages) may use the concepts and recommendations
from this guidance.
A.

Important Drug Warning Letters

Important Drug Warning letters are used to convey important new safety information that
“concerns a significant hazard to health” (21 CFR 200.5(c)(1)) and therefore could affect the
decision to use a drug or require a change in behavior concerning use of the drug (e.g., a specific
type of monitoring). This type of DHCP letter is used to convey information that is being
incorporated into one or more of the following sections of the prescribing information: BOXED

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WARNINGS, CONTRAINDICATIONS, or WARNINGS AND PRECAUTIONS. Examples of
the types of safety concerns that are communicated in Important Drug Warning letters include,
but are not limited to, the following:
•
•
•
•
•
•

Previously unknown serious or life-threatening adverse reactions
Clinically important new information about a known adverse reaction
Identification of a subpopulation at greater risk in whom the drug should be used
with added caution (e.g., patients with renal or hepatic failure, HIV+ patients)
Identification of a subpopulation in which the drug is contraindicated
A drug interaction or medication error that may result in a serious or lifethreatening adverse reaction
Implementation of a new or modified REMS

See Appendix A: Important Drug Warning - Model Letter.
B.

Important Prescribing Information Letters

Important Prescribing Information letters (21 CFR 200.5(c)(2)) are used to convey important
changes to the prescribing information other than those changes that are described in an
Important Drug Warning letter (section IV.A). An Important Prescribing Information letter
ordinarily is used to convey important changes to the INDICATIONS AND USAGE and
DOSAGE AND ADMINISTRATION sections of the prescribing information. The types of
information that are communicated in Important Prescribing Information letters include, but are
not limited to, the following:
•
•
•

Change in the INDICATIONS AND USAGE section intended to minimize risk,
improve effectiveness, or convey a limitation of the indications
Change to the dose or dosage regimen intended to minimize risk or improve
effectiveness
Change in the supply of the drug to address a drug shortage issue

A DHCP letter should not be used to merely announce a new indication, even an important one.
If the new information results in the addition of serious risk information to the BOXED
WARNINGS, CONTRAINDICATIONS, or WARNINGS AND PRECAUTIONS sections of the
prescribing information, in addition to changes to the INDICATIONS AND USAGE or
DOSAGE AND ADMINISTRATION sections, the letter should be elevated to an Important
Drug Warning letter.
See Appendix B: Important Prescribing Information - Model Letter.
C.

Important Correction of Drug Information Letters

Important Correction of Drug Information letters (21 CFR 200.5(c)(3)) are intended to correct
false or misleading information or other misinformation in prescription drug promotional
labeling and advertising that is the subject of a Warning Letter or other Agency action. This
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Contains Nonbinding Recommendations
guidance provides recommendations for the format and content of such letters (see, in particular,
section V.A.6). However, the circumstances in which FDA would seek to have a manufacturer
disseminate corrective information using a DHCP letter are outside the scope of this guidance.
See Appendix C: Important Correction of Drug Information - Model Letter.
V.

CONTENT AND FORMAT OF DHCP LETTERS
A.

Content Recommendations

In general, FDA believes that a DHCP letter should clearly state the following at or near the
beginning of the letter to most effectively communicate new information:
•
•
•
•

Purpose of the letter (e.g., to inform prescribers about a specific new drug safety issue)
Description of the new information
Existing information that has changed, if any (e.g., information that is no longer valid in
light of the new information)
Action for a health care provider to take in response to the new information, if any

The letter should be clear and concise and contain sufficient detail to meaningfully inform the
target audience. We recommend the letter not exceed two pages (or comparable length of
electronic content). The letter should avoid discussion of noncritical information that could
obscure the more important information and should include the appropriate contact information.
(See Appendix A for an example of a letter that reflects these recommendations.) For example,
if the letter concerns an adverse reaction, it should provide manufacturer and FDA contact
information for reporting new cases of the reaction. Ordinarily, it is not sufficient merely to state
that the labeling has changed and to provide the new labeling language. New information should
be summarized, highlighted, and presented using language from the new labeling, as appropriate.
The recommended content and format for DHCP letters is described below in items 1–8.
These content recommendations apply to DHCP letters distributed electronically to the extent
practicable for the type of communication used. For additional recommendations specific to
electronic distribution, consult the guidance for industry Using Electronic Means to Distribute
Certain Product Information. 4
1.

Envelope and Letter Heading

Depending on the nature of the information contained in the DHCP letter, one of the following
statements is required to appear on the envelope (corresponding to the three types of DHCP
letters described in section IV of this document) (21 CFR 200.5).
•

IMPORTANT DRUG WARNING

4

We update guidances periodically. To make sure you have the most recent version of a guidance, check the FDA
Drugs guidance Web page at http://www.fda.gov/RegulatoryInformation/Guidances/default.htm.
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•

IMPORTANT PRESCRIBING INFORMATION

•

IMPORTANT CORRECTION OF DRUG INFORMATION

FDA recommends repeating the heading from the envelope on the letter in a similar format
because mail may be opened and separated from its envelope before reaching the intended
recipient. The letter heading may use a smaller font than the envelope heading, if necessary. For
a DHCP letter distributed electronically, the letter heading should be the statement that would
have appeared on the envelope if paper distribution had been used. The electronic distribution
guidance referenced in footnote 4 contains recommendations on how to make an electronically
distributed DHCP letter distinctive in appearance so that it will be promptly recognized and read.
Additionally, if the letter is distributed by email, FDA recommends using the letter heading as
the subject line of the email. FDA also recommends including the letter as the body of the email,
not as a separate attachment.
2.

Addressees (Target Audience)

A DHCP letter should be directed to all health care providers who are likely to prescribe,
dispense, or administer the drug, as well as others who need to know the information. The letter
should be directed to the full range of health care providers who could prescribe the drug,
including nurse practitioners and physician assistants who have prescribing authority. The
DHCP letter should also be sent to other health care providers who may need to know the
information even if they do not prescribe the drug. For example, the emergency departments or
primary care physicians might not routinely prescribe the drug that is the subject of a DHCP
letter, but might be providing care for patients with a drug-induced adverse reaction described in
the letter. Similarly, a DHCP letter that announces the introduction of a new medication guide
should be sent to pharmacists who would be required to distribute the medication guide to their
patients.
3.

Subject Line

A subject line that includes the drug name (proprietary, followed by established or proper) and a
concise description of the issue that is addressed in the body of the letter (e.g., drug safety
concern) should immediately follow the letter heading. The subject line also may include
characterization of the seriousness of the problem (e.g., serious, life-threatening, or fatal adverse
reactions) and the population at risk. Vague terms intended to characterize the incidence of a
reaction (e.g., rare, infrequent) should generally be avoided. However, statements regarding a
well-defined increase in the magnitude of risk or rate of a reaction (e.g., rate of reaction X is
doubled) and the rate observed in controlled trials or epidemiological studies can be appropriate.
Consider placing the subject line within a border, text box, or in bold type to further draw
attention to the information. See the following examples:

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Subject:

Subject:

Severe, Life-Threatening, and Fatal Cases of Hepatoxicity Reported with
DRUG NAME

Limitations on Use of DRUG NAME in Patients with Decreased Renal
Function Because of Risk of Worsening Renal Function and Increased
Mortality

Subject: Threefold Increase in Risk of Macular Edema in Elderly Taking DRUG NAME

4.

Initial Paragraphs: Important Drug Warning or Important Prescribing Information
Letters

In the initial paragraphs of the letter, briefly summarize information essential to a health care
provider’s understanding of the nature and management of the problem and actions taken to
address the issue. This guidance describes a two-paragraph format, but in some cases a single
paragraph is adequate to convey the most important information.
Limit the initial paragraphs to the following types of information (to the extent known and
relevant to the issue that is the subject of the letter):
(a) First Paragraph: Concise Description of the Issue
•

Product name(s) and brief description of the indications and usage (more
detail about indications and usage can be included in subsequent paragraphs,
if warranted)

•

Concise description of the issue that gave rise to the new warning or other
change in the prescribing information, including the nature and severity of
the issue (e.g., adverse reaction or other potential harm)

•

For communicating labeling changes, verbatim language from prescribing
information may be included if brief (a few sentences). If the new language
is lengthy or the change involves more than one section of labeling,
summarize the new information in the letter and direct the reader to the full
prescribing information, as appropriate.

•

Population(s) at risk (may be a subpopulation of the population for whom
the drug is indicated)

•

Degree of risk, if known. If there are reliable incidence and/or prevalence
data from a controlled trial, observational study, or other source, include that
information. If the new information is based on spontaneous reports, the

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number of reports may be included if that number is an important factor in
explaining why FDA is taking regulatory action to revise the prescribing
information and alert the health care community.
•

Whether the risk occurred with indicated or unapproved use of the drug

•

Rationale for change in indication, usage or dose

•

Availability of a new or modified Medication Guide addressing the issue

(b) Second Paragraph: Actions Required to Address the Issue, If Any
• Recommended action, including but not limited to:
o
o
o
o
o

Discontinue use
Limitations to use (e.g., specific populations, second line therapy)
Dose reduction
Patient monitoring for specific clinical findings or laboratory results
Additional testing required before prescribing

• Patient counseling, including but not limited to, advising patients to:
o Contact their health care provider if they experience a specific clinical
sign or symptom
o Stop the drug immediately if they experience a specific clinical sign or
symptom
o Consult their health care provider before discontinuing the drug
5.

Interior Paragraphs: Important Drug Warning or Important Prescribing
Information Letters

Use subsequent interior paragraphs, if needed, to provide additional detail that would be helpful
in understanding the issue, such as:
•
•
•
•
•
•
•

Attributes of affected patient populations or subsets
Summary of the data or other information that is the basis for a new safety
warning (e.g., summary information about a controlled clinical trial,
epidemiologic study, or spontaneous adverse event reporting)
Limitations of the data and other information (e.g., what is known and what is not
known)
Mechanism of the adverse reaction
Whether the event is common to the drug class
Additional research undertaken to better understand an adverse reaction
Further discussion of a drug’s indication(s)

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6.

Correction of Drug Information Letters
For letters intended to correct information in prescription drug advertising or
promotional labeling, the letter should include:
•
•
•
•
•
•
•
•
•

Purpose of the letter (to correct false or misleading claims or other
misinformation)
Statement that the information was the subject of a Warning Letter or other
regulatory action by FDA, if applicable
Where and how the incorrect information was conveyed to health care providers
The information that was deemed false or misleading and why it was false or
misleading
Corrected information
Indication, including limitations to use
Risk information
Reference to the full prescribing information (which must be enclosed in the
letter) and to the medication guide or other approved patient information, if any.
Statement that the letter is not intended to be a complete description of the
benefits and risks

In addition, the letter should be free of promotional claims and presentations.
7.

Final Paragraph

The final paragraph should include the following information, to the extent relevant:
•
•
•

How to report new cases of the adverse reaction or other safety issue described in the
letter
Company contact information for direct inquiries regarding the safety issue
FDA contact information
Example:
Health care providers and patients are encouraged to report adverse events in patients
taking TRADENAME to SPONSOR at 1-800-xxx-xxxx. You are encouraged to report
negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or
call 1-800-FDA-1088.
You also may contact our medical information department at 1-800--xxx-xxxx if you
have any questions about the information contained in this letter or the safe and effective
use of TRADENAME.

Also include reference to the full prescribing information (which must be enclosed in the letter)
and to the medication guide or other approved patient information, if any.

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8. Types of Information That Should Not Be in a DHCP Letter
Additional detail that could obscure more important information or divert attention from more
important information should be omitted. Examples of such information include, but are not
limited to:
•
•
•
•
•
B.

Market information about the drug, including numbers of prescriptions, patient
exposures, approvals, and pending approvals
Extensive details about the design of a clinical study
Information about a safety review panel
Plans to further investigate the problem, if not specifically related to safety
Promotional language or claims
Format Recommendations

Format the letter in a way that will help make the information in the letter easily accessible to the
reader. We recommend using typographic and formatting techniques to maximize readability,
including:
•
•
•
•
•
•
•
•
•

Two-page limit
Informative paragraph headings
Vertical lists with bullets or numbering, where appropriate
Text emphasis techniques to draw attention to major points (e.g., bold font, larger
font, italics)
Minimum 12-point font
Easily readable font based on the type of media used (e.g., serif or sans serif)
Use of upper and lowercase letters (i.e., avoid all caps)
Adequate spacing and leading (i.e., letters should not touch within lines; lines of
text should not touch one another)
Use of white space to delineate paragraphs and organize text 5

These format recommendations also apply to DHCP letters distributed electronically to the
extent practicable for the type of communication used (see footnote 4).
VI.

ASSESSMENT OF THE DHCP LETTER IMPACT

Manufacturers should conduct an evaluation, for their own use, of the extent to which the target
audience received the DHCP letter and is aware of the information that was communicated in the
letter.
If the DHCP letter is part of a REMS, there must be an evaluation plan in place, as specified in
the REMS. Additional information on REMS evaluations may be found in the draft guidance for
5

See, for example, Chapparro B, Baker JR, Shaikh AD, Hull S, and Brady L, 2004, “Reading Online Text: A
Comparison of Four White Space Layouts,” Usability News, 6(2). Available at
http://psychology.wichita.edu/surl/usabilitynews/62/whitespace.htm.
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industry Format and Content of Proposed Risk Evaluation and Mitigation Strategies (REMS),
REMS Assessments, and Proposed REMS Modifications. 6
VII.

PAPERWORK REDUCTION ACT OF 1995

This guidance contains information collection provisions that are subject to review by the Office
of Management and Budget (OMB) under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3520). The time required to complete this information collection is estimated to
average 100 hours per response, including the time to review instructions, search existing data
sources, gather the data needed, and complete and review the information collection. Send
comments regarding this burden estimate or suggestions for reducing this burden to:
Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug
Administration, 10903 New Hampshire Avenue, WO Bldg. 51, Silver Spring, MD 20993-0002

An Agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. The OMB control
number for this information collection is 0910-0754 expires 12/31/2016.

6

When final, this guidance will represent the FDA’s current thinking on this topic.
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APPENDIX A
Month Year
IMPORTANT DRUG WARNING - MODEL LETTER
Subject:

Serious Risks with Use of Tradename (established name) Tablets:
• Central Nervous System Posttransplant
Lymphoproliferative Disorder (PTLD), and
• Progressive Multifocal Leukoencephalopathy (PML)

Dear Health Care Provider:
The purpose of this letter is to inform you of important safety information for Tradename, a
selective co-stimulation blocker approved for prophylaxis of organ rejection in adult patients
receiving liver transplants.
Serious Risks With Use of Tradename
Risk of Central Nervous System Posttransplant Lymphoproliferative Disorder (PTLD) and
Progressive Multifocal Leukoencephalopathy (PML)
• Patients treated with Tradename are at an increased risk for developing PTLD, specifically
involving the central nervous system (CNS), which can be fatal.
• Risk factors for PTLD include cytomegalovirus (CMV) infection and T cell depleting
therapy.
• In clinical trials with Tradename, three cases of PML were reported in patients receiving
Tradename at doses higher than the recommended regimen.
Contraindications (use only if relates to new drug warning)
Tradename is contraindicated in transplant recipients with CMV infection.
Prescriber Action
Counsel patients about the risks and benefits of Tradename, including:
• The potential risks for PTLD and PML
• The need for CMV prophylaxis for at least 6 months after transplantation
Tell your patients to contact their doctor immediately to report any changes in memory, speech,
behavior, or vision.

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Reporting Adverse Events
Health care providers and patients are encouraged to report adverse events in patients taking
TRADENAME to SPONSOR at 1-800-xxx-xxxx. You are encouraged to report negative side
effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA1088.
You may also contact our medical information department at 1-800-xxx-xxxx if you have any
questions about the information contained in this letter or the safe and effective use of
Tradename.
This letter is not intended as a complete description of the benefits and risks related to the use of
Tradename. Please refer to the enclosed full prescribing information (and medication guide, if
there is a medication guide for this product, or any other approved patient information).

Sincerely,

Company Representative

Enclosure(s): Tradename Full Prescribing Information

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APPENDIX B
Month Year

IMPORTANT PRESCRIBING INFORMATION - MODEL LETTER

Subject:

Introducing New Strength for Tradename (established name) for Oral
Suspension: Changing the Concentration from 12 mg/mL to 6 mg/mL and
Dispenser From mgs to mLs

Dear Health Care Provider:
The purpose of this letter is to introduce a new strength of Tradename for Oral Suspension
6 mg/mL. We have changed the concentration from 12 mg/mL to 6 mg/mL and the dispenser
from mgs to mLs to help reduce the potential for prescribing and dosing confusion. The
12 mg/mL concentration is no longer being manufactured. Tradename is indicated in patients
1 year and older for treatment of uncomplicated influenza.
Dosing and Administration
The dosing for Tradename for mL (Oral Suspension) is based on the patient’s weight. A 10 mL
oral dosing dispenser is provided with the oral suspension. Patients with a weight of 15 kg
(33 lbs) or less should receive 5 mL of the oral suspension for each dose. Patients weighing
16 kg thru 23 kg (34 lbs thru 51 lbs) should receive 7.5 mL per dose. Patients weighing 24 kg
thru 40 kg (52 lbs thru 88 lbs) should receive 10 mL per dose; and patients weighing 41 kg
(89 lbs) or more should receive 12.5 mL for each dose. (This requires administering a 10 mL
dose, followed by another 2.5 mL dose.) Frequency for treatment is twice daily for 5 days.
Prescriber Action (use only if relates to new prescribing information)
Counsel patients about the risks and benefits of Tradename, including:
• The new dosing requirements to ensure appropriate dosing.
• The potential risks for X . . . .
• Patients should stop using the drug immediately if they experience zzz side effect.
• Patients should contact their doctor immediately if they experience abcd side effect.
Reporting Adverse Events
Heath care providers and patients are encouraged to report adverse events in patients taking
TRADENAME to SPONSOR at 1-800-xxx-xxxx. You are encouraged to report negative side
effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA1088.

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You may also contact our medical information department at 1-800-xxx-xxxx if you have any
questions about the information contained in this letter or the safe and effective use of
Tradename.
This letter is not intended as a complete description of the benefits and risks related to the use of
Tradename. Please refer to the enclosed full prescribing information (and medication guide, if
there is a medication guide for the product, or any other approved patient information).
For additional information, please call Sponsor at 1-800-xxx-xxxx or visit www.tradename.com.

Sincerely,

Company Representative

Enclosure(s): Tradename Full Prescribing Information

15

Contains Nonbinding Recommendations
APPENDIX C
Month Year
CORRECTION OF DRUG INFORMATION - MODEL LETTER

Subject:
Correction of Information for Tradename (established name) Tablets in
response to FDA Warning Letter

Dear Health Care Provider:
You may have seen a Sales Aid for Tradename (established name) Tablets distributed by
SPONSOR sales representatives. The U.S. Food and Drug Administration (FDA) issued a
Warning Letter to SPONSOR because it determined that the Sales Aid failed to include
important risk information regarding Tradename. This letter is being sent to you at the request of
the U.S. Food and Drug Administration’s (FDA) Office of Prescription Drug Promotion (OPDP).
Important Risk Information Omitted from the Tradename Sales Aid Outlined in the FDA
Warning Letter
Risk of Central Nervous System Posttransplant Lymphoproliferative Disorder (PTLD) and
Progressive Multifocal Leukoencephalopathy (PML)
• Patients treated with Tradename are at an increased risk for developing PTLD, specifically
involving the central nervous system (CNS), which can be fatal.
• Risk factors for PTLD include cytomegalovirus (CMV) infection and T cell depleting
therapy.
• In clinical trials with Tradename, three cases of PML were reported in patients receiving
Tradename at doses higher than the recommended regimen.
Indication for Tradename
Tradename is indicated for the prophylaxis of organ rejection in adult patients receiving liver
transplants.
This letter is not intended as a complete description of the benefits and risks related to the use of
Tradename. Please refer to the enclosed full prescribing information (and medication guide, if
there is a Medication Guide for the product, or any other approved patient information).
Reporting Adverse Events
Heath care providers and patients are encouraged to report adverse events in patients taking
TRADENAME to SPONSOR at 1-800- xxx-xxxx. You are encouraged to report negative side

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Contains Nonbinding Recommendations
effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA1088.
You may also contact our medical information department at 1-800-xxx-xxxx if you have any
questions about the information contained in this letter or the safe and effective use of
Tradename.
For additional information, please call Sponsor at 1-800-xxx-xxxx or visit www.tradename.com.

Sincerely,

Company Representative

Enclosure(s): Tradename Full Prescribing Information

17