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Tegaserod maleate (marketed as Zelnorm)

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On March 30, 2007, the Food and Drug Administration issued a Public Health Advisory titled: Voluntary Market Withdrawal of Zelnorm.

The drug is also known and marketed by its generic name Tegaserod [te-gas-a-rod] maleate.

I'm Pat Clarke from F-D-A's Center for Drug Evaluation and Research.

FDA issues this public health advisory to inform patients and health-care professionals that the sponsor of Zelnorm, Novartis Pharmaceuticals Corporation, has agreed to stop selling Zelnorm. Zelnorm is being taken off the market because a new safety analysis has found a higher chance of heart attack, stroke, and worsening heart chest pain that can become a heart attack in patients treated with Zelnorm compared to those treated with a sugar pill they thought was Zelnorm.

We announce the following four items effective immediately:

  • First, at our request, Novartis Pharmaceuticals Corporation has agreed to stop selling Zelnorm.

  • Second, patients being treated with Zelnorm should contact their physician to discuss alternative treatments for their condition.

  • Third, patients who are taking Zelnorm should seek emergency medical care right away if they experience severe chest pain, shortness of breath, dizziness, sudden onset of weakness or difficulty walking or talking or other symptoms of a heart attack or stroke.

  • Finally, physicians who prescribe Zelnorm should work with their patients and transition them to other therapies as appropriate to their symptoms and need.

Zelnorm is a prescription medication approved for the short-term treatment of women with irritable bowel syndrome with constipation and for patients younger than 65 years-of-age with chronic constipation.

In late February and early March 2007, Novartis Pharmaceuticals gave us the results of new analyses of 29 clinical studies of Zelnorm for treatment of a variety of gastrointestinal tract conditions. The data from all the studies were combined to assess the chance of side effects on the heart and blood vessels. In each study, patients were assigned at random to either Zelnorm or a sugar pill they thought was Zelnorm. These 29 studies included 11,614 patients treated with Zelnorm and 7,031 treated with a sugar pill. The average age of patients in these studies was 43 years and most patients ? 88 percent were women.

The number of patients who suffered a heart attack, stroke or severe heart chest pain that can turn into a heart attack was small. However, patients treated with Zelnorm had a higher chance of having any of these serious and life-threatening side effects than did those who were treated with a sugar pill.

Thirteen patients treated with Zelnorm or zero point one percent, had serious and life-threatening cardiovascular side effects; among these, four patients had a heart attack (one died) six had a type of severe heart chest pain which can quickly turn into a heart attack, and three had a stroke. Among the patients taking the sugar pill, only one or zero point zero one percent had symptoms suggesting the beginning of a stroke that went away without complication.

There may be patients for whom no other treatment options are available and in whom the benefits of Zelnorm treatment outweigh the chance of serious side effects. FDA will work with Novartis to allow access to Zelnorm for those patients through a special program.

We have also indicated to Novartis a willingness to consider limited re-introduction of Zelnorm at a later date if a population of patients can be identified in whom the benefits of the drug outweigh the risks. However, before we make a decision about limited re-introduction, any proposed plan would be discussed at a public advisory committee meeting.

We are asking health care professionals to report serious adverse events in connection with Zelnorm to us through the MedWatch program by phone at 1-800-F-D-A-ten-88 or by the Internet at W-W-W dot F-D-A dot gov slash MedWatch.

Updated information about drugs with emerging safety concerns is available 24 hours a day at our Web site W-W-W dot F-D-A dot gov slash C-D-E-R.

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