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U.S. Department of Health and Human Services

Drugs

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Pediatric use Supplement Rule

FDA Data Element Number.

CDER Data Element Number. C-DRG-00903

Data Element Name. Pediatric Use Supplement Rule

Description. Pediatric Use Supplement Rule describes the rules that are applicable to CDER Pediatric Labeling Use Supplements.

Source. 21CFR201.57 (f)(9).

Relationship.

FDA Specifications.

CDER Specifications. Pediatric Use Supplement Rule shall consist of an alphanumeric term which has a maximum length restricted to 240 characters, and a corresponding alphanumeric code with a maximum length of 3 characters.

FDA Approved Date.

CDER Approved Date.

FDA Revised Date.

CDER Revised Date.

Data Values.

NAME DEFINITION FDA CODE
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) ii If there is a specific pediatric indication (i.e., an indication different from those approved for adults) that is supported by adequate and well­controlled 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. 2
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) 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 well­controlled 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. 3
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) iv FDA may approve a drug for pediatric use based on adequate and well­controlled 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 well­controlled 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 well­controlled 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 dose­response information should 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. 4
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) 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. 5
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) 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. 6
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) 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. 7
SUPPLEMENTS SUBMITTED UNDER 21CFR201.57 (f)(9) 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. 8