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Droxia

Generic Name: hydroxyurea
Dosage Form: capsule

WARNING: MYELOSUPPRESSION AND MALIGNANCIES

Myelosuppression: Droxia may cause severe myelosuppression. Monitor blood counts at baseline and throughout treatment. Interrupt treatment and reduce dose as necessary [see Warnings and Precautions (5.1)].

Malignancies: Hydroxyurea is carcinogenic. Advise sun protection and monitor patients for malignancies [see Warnings and Precautions (5.2)].

Indications and Usage for Droxia

Droxia is indicated to reduce the frequency of painful crises and to reduce the need for blood transfusions in patients with sickle cell anemia with recurrent moderate to severe painful crises.

Droxia Dosage and Administration

  Dosing Information

Table 1:     Dosing Recommendation Based on Blood Count

Dosing Regimen

Dose

Dose Modification Criteria

Monitoring Parameters

Initial Recommended
Dosing

15 mg/kg/day as a single dose

Base dosage on the patient’s actual or ideal weight, whichever is less.

Monitor the patient’s blood count every 2 weeks [see Warnings and Precautions (5.1)].

Dosing Based on
Blood Counts

  In an acceptable
  range

Increase dose
5 mg/kg/day every 12 weeks

Maximal dose:
35 mg/kg/day*

*Maximal dose is the highest dose that does not produce toxic blood counts over 24 consecutive weeks.

Increase dosing only if blood counts are in an acceptable range.

Do not increase if myelosuppression occurs.

Blood Counts Acceptable Range

neutrophils ≥2500 cells/mm3

platelets ≥95,000/mm3

hemoglobin >5.3 g/dL

reticulocytes ≥95,000/mm3 if
    the hemoglobin
    concentration <9 g/dL

  Between acceptable
  and toxic range

Do not increase dose.

If blood counts are considered toxic, discontinue Droxia until hematologic recovery.

Blood Counts Toxic Range

neutrophils <2000 cells/mm3

platelets <80,000/mm3

hemoglobin <4.5 g/dL

reticulocytes <80,000/mm3 if
    the hemoglobin
    concentration <9 g/dL

Dosing After
Hematologic
Recovery

Reduce dose by
2.5 mg/kg/day.

Reduce the dose from the dose associated with hematologic toxicity.

May titrate up or down every 12 weeks in 2.5 mg/kg/day increments.

The patient should be at a stable dose with no hematologic toxicity for 24 weeks.

Discontinue the treatment permanently if a patient develops hematologic toxicity twice.

Patients must be able to follow directions regarding drug administration and their monitoring and care.

Fetal hemoglobin (HbF) levels may be used to evaluate the efficacy of Droxia in clinical use. Obtain HbF levels every three to four months. Monitor for an increase in HbF of at least two-fold over the baseline value.

Droxia causes macrocytosis, which may mask the incidental development of folic acid deficiency. Prophylactic administration of folic acid is recommended.

Droxia is a cytotoxic drug. Follow applicable special handling and disposal procedures [see References (15)].

Dose Modifications for Renal Impairment

Reduce the dose of Droxia by 50% in patients with creatinine clearance of less than 60 mL/min or with end-stage renal disease (ESRD) [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)]. Creatinine clearance values were obtained using 24-hour urine collections.

*  On dialysis days, administer Droxia to patients with ESRD following hemodialysis.

Creatinine Clearance

(mL/min)

Recommended Droxia Initial Dose

(mg/kg daily)

≥60

15

<60 or ESRD*

7.5

Monitor the hematologic parameters closely in these patients.

Dosage Forms and Strengths

Capsules:

200 mg opaque blue-green capsules, imprinted with black ink “Droxia” and “6335.”
300 mg opaque purple capsules, imprinted with black ink “Droxia” and “6336.”
400 mg opaque reddish-orange capsules, imprinted with black ink “Droxia” and “6337.”

Contraindications

Droxia is contraindicated in patients who have demonstrated a previous hypersensitivity to hydroxyurea or any other component of its formulation.

Warnings and Precautions

Myelosuppression

Hydroxyurea causes severe myelosuppression. Treatment with hydroxyurea should not be initiated if bone marrow function is markedly depressed. Bone marrow suppression may occur, and leukopenia is generally its first and most common manifestation. Thrombocytopenia and anemia occur less often, and are seldom seen without a preceding leukopenia.

Some patients, treated at the recommended initial dose of 15 mg/kg/day, have experienced severe or life-threatening myelosuppression.

Evaluate hematologic status prior to and during treatment with Droxia. Provide supportive care and modify dose or discontinue Droxia as needed. Recovery from myelosuppression is usually rapid when therapy is interrupted.

Malignancies

Hydroxyurea is a human carcinogen. In patients receiving long-term hydroxyurea for myeloproliferative disorders, secondary leukemia has been reported. Skin cancer has also been reported in patients receiving long-term hydroxyurea. Advise protection from sun exposure and monitor for the development of secondary malignancies.

Embryo-Fetal Toxicity

Hydroxyurea may cause fetal harm when administered to a pregnant woman. Hydroxyurea is genotoxic. Hydroxyurea has been demonstrated to be a potent teratogen in a wide variety of animal models, including mice, hamsters, cats, miniature swine, dogs, and monkeys at doses within 1-fold of the human dose given on a mg/m2 basis. Hydroxyurea is embryotoxic and causes fetal malformations at 180 mg/kg/day in rats and at 30 mg/kg/day in rabbits. Single doses of ≥375 mg/kg to rats caused growth retardation and impaired learning ability. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during and after treatment with Droxia for at least 30 days after therapy. Females of reproductive potential should also ensure that their male partner, who is/has taken Droxia, uses effective contraception during and after treatment for at least 1 year after therapy. Advise males of reproductive potential to use effective contraception during and after treatment with Droxia for at least 1 year after therapy [see Use in Specific Populations (8.1, 8.3)].

Vasculitic Toxicities

Cutaneous vasculitic toxicities, including vasculitic ulcerations and gangrene, have occurred in patients with myeloproliferative disorders during therapy with hydroxyurea. These vasculitic toxicities were reported most often in patients with a history of, or currently receiving, interferon therapy. If cutaneous vasculitic ulcers occur, institute treatment and discontinue Droxia.

Risks with Concomitant Use of Antiretroviral Drugs

Pancreatitis, hepatotoxicity, and peripheral neuropathy have occurred when hydroxyurea was administered concomitantly with antiretroviral drugs, including didanosine and stavudine [see Drug Interactions (7.1)].

Macrocytosis

Droxia may cause macrocytosis, which is self-limiting, and is often seen early in the course of treatment. The morphologic change resembles pernicious anemia, but is not related to vitamin B12 or folic acid deficiency. This may mask the diagnosis of pernicious anemia. Prophylactic administration of folic acid is recommended.

Adverse Reactions

The following adverse reactions are described in detail in other labeling sections:

Myelosuppression [see Warnings and Precautions (5.1)]
Malignancies [see Warnings and Precautions (5.2)]
Embryo-fetal toxicity [see Boxed Warning and Warnings and Precautions (5.3)]
Vasculitic toxicities [see Warnings and Precautions (5.4)]
Risks with concomitant use of antiretroviral drugs [see Warnings and Precautions (5.5)]
Macrocytosis [see Warnings and Precautions (5.6)]

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Clinical Trial Experience

In 299 patients treated for sickle cell anemia in the Multicenter Study of Hydroxyurea in Sickle Cell Anemia, the most common adverse reactions were hematologic, with neutropenia, and low reticulocyte and platelet levels necessitating temporary cessation in almost all patients. Hematologic recovery usually occurred in two weeks.

Other adverse reactions include hair loss, macrocytosis, bleeding, and melanonychia.

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of hydroxyurea in the treatment of neoplastic diseases. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency.

Gastrointestinal disorders: stomatitis, anorexia, nausea, vomiting, diarrhea, and constipation
Skin and subcutaneous tissue disorders: maculopapular rash, skin ulceration, dermatomyositis-like skin changes, peripheral and facial erythema, hyperpigmentation, atrophy of skin and nails, scaling, violet papules, and alopecia
Renal and urinary disorders: dysuria, elevations in serum uric acid, blood urea nitrogen (BUN), and creatinine levels
Nervous system disorders: headache, dizziness, drowsiness, disorientation, hallucinations, and convulsions
General disorders: fever, chills, malaise, edema, and asthenia
Hepatobiliary disorders: elevation of hepatic enzymes
Respiratory disorders: diffuse pulmonary infiltrates, dyspnea, and pulmonary fibrosis

Drug Interactions

Increased Toxicity with Concomitant Use of Antiretroviral Drugs

Pancreatitis

In patients with HIV infection during therapy with hydroxyurea and didanosine, with or without stavudine, fatal and nonfatal pancreatitis have occurred. Hydroxyurea is not indicated for the treatment of HIV infection; however, if patients with HIV infection are treated with hydroxyurea, and in particular, in combination with didanosine and/or stavudine, close monitoring for signs and symptoms of pancreatitis is recommended. Permanently discontinue therapy with hydroxyurea in patients who develop signs and symptoms of pancreatitis.

Hepatotoxicity

Hepatotoxicity and hepatic failure resulting in death have been reported during postmarketing surveillance in patients with HIV infection treated with hydroxyurea and other antiretroviral drugs. Fatal hepatic events were reported most often in patients treated with the combination of hydroxyurea, didanosine, and stavudine. Avoid this combination.

Peripheral Neuropathy

Peripheral neuropathy, which was severe in some cases, has been reported in patients with HIV infection receiving hydroxyurea in combination with antiretroviral drugs, including didanosine, with or without stavudine.

Test Interference

Interference with Uric Acid, Urea, or Lactic Acid Assays

Studies have shown that there is an analytical interference of hydroxyurea with the enzymes (urease, uricase, and lactate dehydrogenase) used in the determination of urea, uric acid, and lactic acid, rendering falsely elevated results of these in patients treated with hydroxyurea.

USE IN SPECIFIC POPULATIONS

Pregnancy

Pregnancy Category D

Risk Summary

Droxia may cause fetal harm when administered to a pregnant woman. There are no adequate and well-controlled studies in pregnant women. 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 harm to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant.

Drugs which affect DNA synthesis, such as hydroxyurea, may be potential mutagenic agents.

The physician should carefully consider this possibility before administering this drug to male or female patients who may contemplate conception [see Warnings and Precautions (5.3)].

Animal Data

Hydroxyurea has been demonstrated to be a potent teratogen in a wide variety of animal models, including mice, hamsters, cats, miniature swine, dogs, and monkeys at doses within 1-fold of the human dose given on a mg/m2 basis. Hydroxyurea is embryotoxic and causes fetal malformations (partially ossified cranial bones, absence of eye sockets, hydrocephaly, bipartite sternebrae, missing lumbar vertebrae) at 180 mg/kg/day (about 0.8 times the maximum recommended human daily dose on a mg/m2 basis) in rats and at 30 mg/kg/day (about 0.3 times the maximum recommended human daily dose on a mg/m2 basis) in rabbits. Embryotoxicity was characterized by decreased fetal viability, reduced live litter sizes, and developmental delays. Hydroxyurea crosses the placenta. Single doses of ≥375 mg/kg (about 1.7 times the maximum recommended human daily dose on a mg/m2 basis) to rats caused growth retardation and impaired learning ability.

Nursing Mothers

Hydroxyurea is excreted in human milk. Because of the potential for serious adverse reactions with hydroxyurea, discontinue nursing during treatment with Droxia.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Clinical studies of Droxia did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Elderly patients may be more sensitive to the effects of hydroxyurea, and may require a lower dose regimen. Hydroxyurea is excreted by the kidney, and the risk of adverse 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 [see Dosage and Administration (2.2)].

Renal Impairment

The exposure to hydroxyurea is higher in patients with creatinine clearance of less than 60 mL/min. Reduce dosage and closely monitor the hematologic parameters when Droxia is to be administered to these patients [see Dosage and Administration (2.2) and Clinical Pharmacology (12.3)].

Hepatic Impairment

There are no data that support specific guidance for dosage adjustment in patients with hepatic impairment. Close monitoring of hematologic parameters is advised in these patients.

Overdosage

Acute mucocutaneous toxicity has been reported in patients receiving hydroxyurea at dosages several times the therapeutic dose. Soreness, violet erythema, edema on palms and soles followed by scaling of hands and feet, severe generalized hyperpigmentation of the skin, and stomatitis have been observed.

Droxia Description

Droxia® (hydroxyurea capsules, USP) is available for oral use as capsules containing 200 mg, 300 mg, and 400 mg hydroxyurea. Inactive ingredients include citric acid, gelatin, lactose, magnesium stearate, sodium phosphate, titanium dioxide, and capsule colorants: FD&C Blue No. 1 and FD&C Green No. 3 (200 mg capsules); D&C Red No. 28, D&C Red No. 33, and FD&C Blue No. 1 (300 mg capsules); D&C Red No. 28, D&C Red No. 33, and D&C Yellow No. 10 (400 mg capsules).

Hydroxyurea is a white crystalline powder. It has a molecular weight of 76.05. Its structural formula is:

Droxia - Clinical Pharmacology

Mechanism of Action

The precise mechanism by which hydroxyurea produces its cytotoxic and cytoreductive effects is not known. However, various studies support the hypothesis that hydroxyurea causes an immediate inhibition of DNA synthesis by acting as a ribonucleotide reductase inhibitor, without interfering with the synthesis of ribonucleic acid or of protein.

The mechanisms by which Droxia produces its beneficial effects in patients with sickle cell anemia (SCA) are uncertain. Known pharmacologic effects of Droxia that may contribute to its beneficial effects include increasing hemoglobin F levels in red blood cells (RBCs), decreasing neutrophils, increasing the water content of RBCs, increasing deformability of sickled cells, and altering the adhesion of RBCs to endothelium.

Pharmacokinetics

Absorption

Following oral administration of Droxia, hydroxyurea reaches peak plasma concentrations in 1 to 4 hours. Mean peak plasma concentrations and AUCs increase more than proportionally with increase of dose.

There are no data on the effect of food on the absorption of hydroxyurea.

Distribution

Hydroxyurea distributes throughout the body with a volume of distribution approximating total body water.

Hydroxyurea concentrates in leukocytes and erythrocytes.

Metabolism

Up to 60% of an oral dose undergoes conversion through saturable hepatic metabolism and a minor pathway of degradation by urease found in intestinal bacteria.

Excretion

In patients with sickle cell anemia, the mean cumulative urinary recovery of hydroxyurea was about 40% of the administered dose.

Specific Populations

Renal Impairment

The effect of renal impairment on the pharmacokinetics of hydroxyurea was assessed in adult patients with sickle cell disease and renal impairment. Patients with normal renal function (creatinine clearance [CrCl] >80 mL/min), mild (CrCl 50-80 mL/min), moderate (CrCl =30-<50 mL/min), or severe (<30 mL/min) renal impairment received a single oral dose of 15 mg/kg hydroxyurea. Creatinine clearance values were obtained using 24-hour urine collections. Patients with ESRD received two doses of 15 mg/kg separated by 7 days; the first was given following a 4-hour hemodialysis session, the second prior to hemodialysis. The exposure to hydroxyurea (mean AUC) in patients with CrCl <60 mL/min and those with ESRD was 64% higher than in patients with normal renal function (CrCl >60 mL/min). Reduce the dose of Droxia when it is administered to patients with creatinine clearance of <60 mL/min or with ESRD following hemodialysis [see Dosage and Administration (2.2) and Use in Specific Populations (8.6)].

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

See Boxed Warning and Warnings and Precautions (5.2) for carcinogenesis and mutagenesis information.

Conventional long-term studies to evaluate the carcinogenic potential of Droxia have not been performed. However, intraperitoneal administration of 125 to 250 mg/kg hydroxyurea (about 0.6-1.2 times the maximum recommended human oral daily dose on a mg/m2 basis) thrice weekly for 6 months to female rats increased the incidence of mammary tumors in rats surviving to 18 months compared to control. Hydroxyurea is mutagenic in vitro to bacteria, fungi, protozoa, and mammalian cells. Hydroxyurea is clastogenic in vitro (hamster cells, human lymphoblasts) and in vivo (SCE assay in rodents, mouse micronucleus assay). Hydroxyurea causes the transformation of rodent embryo cells to a tumorigenic phenotype.

Impairment of Fertility: Hydroxyurea administered to male rats at 60 mg/kg/day (about 0.3 times the maximum recommended human daily dose on a mg/m2 basis) produced testicular atrophy, decreased spermatogenesis, and significantly reduced their ability to impregnate females.

Clinical Studies

The efficacy of hydroxyurea in sickle cell anemia was assessed in a large clinical study (Multicenter Study of Hydroxyurea in Sickle Cell Anemia) (see Table 2).

The study was a randomized, double-blind, placebo-controlled trial that evaluated 299 adult patients (≥18 years) with moderate to severe disease (≥3 painful crises yearly). The trial was stopped by the Data Safety Monitoring Committee, after accrual was completed but before the scheduled 24 months of follow-up was completed in all patients, based on observations of fewer painful crises among patients receiving hydroxyurea.

Compared to placebo treatment, treatment with hydroxyurea resulted in a significant decrease in the yearly rate of painful crises, the yearly rate of painful crises requiring hospitalization, the incidence of chest syndrome, the number of patients transfused, and units of blood transfused. Hydroxyurea treatment significantly increased the median time to both first and second painful crises.

Although patients with 3 or more painful crises during the preceding 12 months were eligible for the study, most of the benefit in crisis reduction was seen in the patients with 6 or more painful crises during the preceding 12 months.

Table 2:     Results from the Multicenter Study of Hydroxyurea in Sickle Cell Anemia
Event Hydroxyurea
(N=152)
Placebo
(N=147)
Percent Change Versus Placebo P-value
*   A painful crisis was defined in the study as acute sickling-related pain that resulted in a visit to a medical facility, that lasted more than 4 hours, and that required treatment with a parenteral narcotic or NSAID. Chest syndrome, priapism, and hepatic sequestration were also included in this definition.

Median yearly rate of painful crises*

2.5

4.6

−46

=0.001

Median yearly rate of painful crises requiring hospitalization

1.0

2.5

−60

=0.0027

Median time to first painful crisis (months)

2.76

1.35

+104

=0.014

Median time to second painful crisis (months)

6.58

4.13

+59

=0.0024

Incidence of chest syndrome (# episodes)

56

101

−45

=0.003

Number of patients transfused

55

79

−30

=0.002

Number of units of blood transfused

423

670

−37

=0.003

In patients with SCA treated with hydroxyurea, fetal hemoglobin (HbF) increases 4 to 12 weeks after initiation of treatment. In general, average HbF levels correlate with dose and plasma level with possible plateauing at higher dosages.

A clear relation between reduction in crisis frequency and increased HbF or F-cell levels has not been demonstrated. The dose-related cytoreductive effects of hydroxyurea, particularly on neutrophils, was the factor most strongly correlated with reduced crisis frequency.

REFERENCES

OSHA. http://www.osha.gov/SLTC/hazardousdrugs/index.html.

How Supplied/Storage and Handling

  How Supplied

Droxia® (hydroxyurea capsules, USP) is supplied in HDPE bottles with a plastic safety screw cap. Each bottle contains 60 capsules. Droxia is supplied in the following strengths:

200 mg opaque blue-green capsules, marked in black ink with “Droxia” and “6335” (NDC 0003-6335-17).

300 mg opaque purple capsules, marked in black ink with “Droxia” and “6336” (NDC 0003-6336-17).

400 mg opaque reddish-orange capsules, marked in black ink with “Droxia” and “6337” (NDC 0003-6337-17).

  Storage

Store at 25°C (77°F); excursions permitted to 15°C-30ºC (59°F-86ºF) [see USP Controlled Room Temperature]. Keep tightly closed.

  Handling and Disposal

Droxia is a cytotoxic drug. Follow applicable special handling and disposal procedures [see References (15)].

To decrease the risk of contact, advise caregivers to wear disposable gloves when handling Droxia or bottles containing Droxia. Wash hands with soap and water before and after contact with the bottle or capsules when handling Droxia. Do not open Droxia capsules. Avoid exposure to crushed or opened capsules. If contact with crushed or opened capsules occurs on the skin, wash affected area immediately and thoroughly with soap and water. If contact with crushed or opened capsules occurs on the eye(s), the affected area should be flushed thoroughly with water or isotonic eyewash designated for that purpose for at least 15 minutes. If the powder from the capsule is spilled, immediately wipe it up with a damp disposable towel and discard in a closed container, such as a plastic bag; as should the empty capsules. The spill areas should then be cleaned three times using a detergent solution followed by clean water. Keep the medication away from children and pets. Contact your doctor for instructions on how to dispose of outdated capsules.

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Patient Information).

There is a risk of myelosuppression. Monitoring blood counts every two weeks throughout the duration of therapy should be emphasized to patients taking Droxia [see Warnings and Precautions (5.1)]. Advise patients to report signs and symptoms of infection or bleeding immediately.
Advise patients that there is a risk of cutaneous vasculitic toxicities and secondary malignancies including leukemia and skin cancers. Advise use of sun protection [see Warnings and Precautions (5.2, 5.4)].
Advise females of reproductive potential of the potential risk to a fetus and to inform their healthcare provider of a known or suspected pregnancy. Advise females and males of reproductive potential to use contraception during and after treatment with Droxia [see Warnings and Precautions (5.3) and Use in Specific Populations (8.1)].
Advise females to discontinue breastfeeding during treatment with Droxia [see Use in Specific Populations (8.3)].
Patients with HIV infection should contact their physician for signs and symptoms of pancreatitis, hepatic events, and peripheral neuropathy [see Warnings and Precautions (5.5)].

Manufactured for:
Bristol-Myers Squibb Company
Princeton, New Jersey 08543 USA

Product of Italy
1357793


Patient Information
Droxia® (drock-SEE-yuh)
(hydroxyurea capsules, USP)

Read this Patient Information before you start using Droxia (hydroxyurea) and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your healthcare provider about your medical condition or treatment. You and your healthcare provider should talk about Droxia when you start taking it and at regular checkups.

What is the most important information I should know about Droxia?

Droxia can cause serious side effects including:

Low blood counts are common with Droxia, including low red blood cells, white blood cells, and platelets, and can be severe and life-threatening. If your white blood cell count becomes very low, you are at increased risk for infection. Your healthcare provider will check your blood cell counts before and during treatment with Droxia. Your healthcare provider may change your dose or tell you to stop taking Droxia if you have low blood cell counts. Tell your healthcare provider right away if you get any of the following symptoms:
fever
chills
body aches
feeling very tired
shortness of breath
bleeding
Cancer. Some people have developed cancer, such as leukemia and skin cancer, after taking Droxia for a long time. Your healthcare provider will check you for cancer. You should protect your skin from the sun using sunblock, hats, and sun-protective clothing.

Droxia may cause harm to your unborn baby.

For females taking Droxia who can become pregnant:

You should talk with your healthcare provider about the risks of Droxia to your unborn child.
You should use effective birth control during and after treatment with Droxia for at least 30 days after treatment.
Tell your healthcare provider right away if you become pregnant or think you may be pregnant.

For males taking Droxia:

Males should use effective contraception during and after treatment with Droxia for at least 1 year after therapy.

For females NOT taking Droxia who can become pregnant:

You should ensure that your male partner, who is/has taken Droxia, uses effective contraception during and after treatment for at least 1 year after therapy.

Droxia may cause fertility problems in males and females. Talk to your healthcare provider if this is a concern for you.

See “What are the possible side effects of Droxia?” for more information about side effects.

What is Droxia?

Droxia is a prescription medicine that is used to reduce the frequency of painful crises and reduce the need for blood transfusions in people with sickle cell anemia with recurrent moderate to severe painful crises.

It is not known if Droxia is safe and effective in children.

Who should not take Droxia?

Do not take Droxia if you are allergic to hydroxyurea or any of the ingredients in Droxia. See the end of this leaflet for a list of the ingredients in Droxia.

Before taking Droxia, tell your healthcare provider about all of your medical conditions, including if you:

have kidney problems or are receiving hemodialysis
have liver problems
have human immunodeficiency virus (HIV). Taking Droxia with certain HIV medicines can cause serious reactions and may lead to death.
have increased level of uric acid in your blood (hyperuricemia)
have a history of receiving interferon therapy or are currently receiving interferon therapy
are pregnant or plan to become pregnant. See “What is the most important information I should know about Droxia?
are breastfeeding or plan to breastfeed. Droxia can pass into your breast milk. Do not breastfeed during treatment with Droxia. Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take an antiretroviral medicine. Taking Droxia with certain antiretroviral medicines can cause serious side effects and may lead to death.

How should I take Droxia?

Take Droxia exactly as your healthcare provider tells you.
Droxia is taken 1 time a day.
Your healthcare provider will determine the right starting dose of Droxia for you based on your weight. Your dose will then be increased slowly to your maximum tolerated dose (a dose that does not produce severely low blood counts).
If you take too much Droxia, call your healthcare provider or go to the nearest hospital emergency room right away.
Droxia is a medicine that must be handled with care. People who are not taking Droxia should not be exposed to it. To decrease the risk of exposure, you or your caregivers should do the following when handling Droxia:
Wear disposable gloves when handling Droxia capsules or bottles containing Droxia.
Wash your hands before and after handling Droxia capsules or bottles containing Droxia.
Do not open the capsules.
Avoid contact with crushed or opened capsules. If contact from crushed or opened capsules happens on the skin, wash the skin area right away with soap and water. If contact from crushed or opened capsules happens on the eye(s), flush the eye(s) thoroughly with water or isotonic eyewash designated for that purpose for at least 15 minutes.
If the powder from the capsule is spilled, wipe it up right away with a damp disposable towel, and throw it away in a closed container, such as a plastic bag; as should the empty capsules. The spill areas should then be cleaned three times using a detergent solution followed by clean water.

What are the possible side effects of Droxia?

Droxia may cause serious side effects, including:

See “What is the most important information I should know about Droxia?
Skin ulcers have happened in people who take Droxia. This has occurred most often in people who receive interferon therapy or have a history of interferon therapy. Your healthcare provider will stop treatment with Droxia if you develop any skin ulcers.

The most common side effects of Droxia include:

hair loss
enlarged red blood cells (macrocytosis). Macrocytosis can make it difficult to detect a decrease of folic acid in people taking Droxia. Your healthcare provider may prescribe a folic acid supplement for you.
bleeding
brown or black colored nails

These are not all the possible side effects of Droxia. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How Should I store Droxia?

Store Droxia at room temperature between 68°F to 77°F (20°C to 25°C). Keep the bottle tightly closed.
Call your healthcare provider for instructions on how to throw away (dispose of) Droxia that is out of date or no longer needed.

Keep Droxia and all medicines out of the reach of children. Keep Droxia away from pets.

General information about the safe and effective use of Droxia

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Droxia for a condition for which it was not prescribed. Do not give Droxia to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about Droxia that is written for health professionals.

What are the ingredients of Droxia?

Active ingredient: hydroxyurea

Inactive ingredients: citric acid, gelatin, lactose, magnesium stearate, sodium phosphate, titanium dioxide, and capsule colorants: FD&C Blue No. 1 and FD&C Green No. 3 (200 mg capsules); D&C Red No. 28, D&C Red No. 33, and FD&C Blue No. 1 (300 mg capsules); D&C Red No. 28, D&C Red No. 33, and D&C Yellow No. 10 (400 mg capsules).

Manufactured for: Bristol-Myers Squibb Company, Princeton, New Jersey 08543 USA
Product of Italy

For more information, go to www.BMS.com or call 1-800-721-5072.
This Patient Information has been approved by the U.S. Food and Drug Administration.



1357793
Revised: July 2015

Droxia 200 mg capsules Representative Packaging

See How Supplied section for a complete list of available packages of Droxia.

60 CAPSULES
NDC 0003-6335-17
Droxia®
(hydroxyurea capsules, USP)
200 mg per capsule
Rx only
Bristol-Myers Squibb

Droxia 300 mg capsules Representative Packaging

60 CAPSULES
NDC 0003-6336-17
Droxia®
(hydroxyurea capsules, USP)
300 mg per capsule
Rx only
Bristol-Myers Squibb

Droxia 400 mg capsules Representative Packaging

60 CAPSULES
NDC 0003-6337-17
Droxia®
(hydroxyurea capsules, USP)
400 mg per capsule
Rx only
Bristol-Myers Squibb

Droxia 
hydroxyurea capsule
Product Information
Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:0003-6335
Route of Administration ORAL DEA Schedule     
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
hydroxyurea (hydroxyurea) hydroxyurea 200 mg
Inactive Ingredients
Ingredient Name Strength
citric acid monohydrate  
gelatin  
lactose  
magnesium stearate  
sodium phosphate  
titanium dioxide  
FD&C Blue No. 1  
FD&C Green No. 3  
Product Characteristics
Color TURQUOISE (blue-green) Score no score
Shape CAPSULE Size 16mm
Flavor Imprint Code Droxia;6335;Droxia;6335
Contains         
Packaging
# Item Code Package Description
1 NDC:0003-6335-17 60 CAPSULE in 1 BOTTLE
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
NDA NDA016295 06/01/2009
Droxia 
hydroxyurea capsule
Product Information
Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:0003-6336
Route of Administration ORAL DEA Schedule     
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
hydroxyurea (hydroxyurea) hydroxyurea 300 mg
Inactive Ingredients
Ingredient Name Strength
citric acid monohydrate  
gelatin  
lactose  
magnesium stearate  
sodium phosphate  
titanium dioxide  
D&C Red No. 28  
D&C Red No. 33  
FD&C Blue No. 1  
Product Characteristics
Color PURPLE Score no score
Shape CAPSULE Size 19mm
Flavor Imprint Code Droxia;6336;Droxia;6336
Contains         
Packaging
# Item Code Package Description
1 NDC:0003-6336-17 60 CAPSULE in 1 BOTTLE
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
NDA NDA016295 06/01/2009
Droxia 
hydroxyurea capsule
Product Information
Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:0003-6337
Route of Administration ORAL DEA Schedule     
Active Ingredient/Active Moiety
Ingredient Name Basis of Strength Strength
hydroxyurea (hydroxyurea) hydroxyurea 400 mg
Inactive Ingredients
Ingredient Name Strength
citric acid monohydrate  
gelatin  
lactose  
magnesium stearate  
sodium phosphate  
titanium dioxide  
D&C Red No. 28  
D&C Red No. 33  
D&C Yellow No. 10  
Product Characteristics
Color ORANGE Score no score
Shape CAPSULE Size 22mm
Flavor Imprint Code Droxia;6337;Droxia;6337
Contains         
Packaging
# Item Code Package Description
1 NDC:0003-6337-17 60 CAPSULE in 1 BOTTLE
Marketing Information
Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
NDA NDA016295 06/01/2009
Labeler - E.R. Squibb & Sons, L.L.C. (011550092)
Revised: 07/2015
 
E.R. Squibb & Sons, L.L.C.
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