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Clinically significant adverse reactions that appear in other sections of the labeling include the following:

  • Somnolence or Sedation [see WARNINGS AND PRECAUTIONS]
  • Potentiation of Sedation from Concomitant Use with Central Nervous System Depressants [see WARNINGS AND PRECAUTIONS]
  • Withdrawal Symptoms [see WARNINGS AND PRECAUTIONS]
  • Serious Dermatological Reactions [see WARNINGS AND PRECAUTIONS]
  • Physical and Psychological Dependence [see WARNINGS AND PRECAUTIONS]
  • Suicidal Behavior and Ideation [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

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.

During its development for the adjunctive treatment of seizures associated with LGS, ONFI was administered to 333 healthy volunteers and 300 patients with a current or prior diagnosis of LGS, including 197 patients treated for 12 months or more. The conditions and duration of exposure varied greatly and included single- and multiple-dose clinical pharmacology studies in healthy volunteers and two double-blind studies in patients with LGS (Study 1 and 2) [see Clinical Studies ]. Only Study 1 included a placebo group, allowing comparison of adverse reaction rates on ONFI at several doses to placebo.

Adverse Reactions Leading To Discontinuation In An LGS Placebo Controlled Clinical Trial (Study 1)

The adverse reactions associated with ONFI treatment discontinuation in ≥ 1% patients in decreasing order of frequency included lethargy, somnolence, ataxia, aggression, fatigue, and insomnia.

Most Common Adverse Reactions In An LGS Placebo Controlled Clinical Trial (Study 1)

Table 3 lists the adverse reactions that occurred in ≥ 5% of ONFI treated patients (at any dose), and at a rate greater than placebo treated patients, in the randomized, double-blind, placebo-controlled, parallel group clinical study of adjunctive AED therapy for 15 weeks (Study 1).

Table 3: Adverse Reactions Reported for ≥ 5% of Patients and More Frequently than Placebo in Any Treatment Group

  Placebo
N=59 %
ONFI Dose Level All ONFI
N=179 %
Lowa
N=58 %
Mediumb
N=62 %
Highc N=59 %
Gastrointestinal Disorders
  Vomiting 5 9 5 7 7
  Constipation 0 2 2 10 5
  Dysphagia 0 0 0 5 2
General Disorders and Administration Site Conditions
  Pyrexia 3 17 10 12 13
  Irritability 5 3 11 5 7
  Fatigue 2 5 5 3 5
Infections and Infestations
  Upper respiratory tract infection 10 10 13 14 12
  Pneumonia 2 3 3 7 4
  Urinary tract infection 0 2 5 5 4
  Bronchitis 0 2 0 5 2
Metabolism and Nutrition Disorders
  Decreased appetite 3 3 0 7 3
  Increased appetite 0 2 3 5 3
Nervous System Disorders
  Somnolence or Sedation 15 17 27 32 26
  Somnolence 12 16 24 25 22
  Sedation 3 2 3 9 5
  Lethargy 5 10 5 15 10
  Drooling 3 0 13 14 9
  Ataxia 3 3 2 10 5
  Psychomotor hyperactivity 3 3 3 5 4
  Dysarthria 0 2 2 5 3
Psychiatric Disorders
  Aggression 5 3 8 14 8
  Insomnia 2 2 5 7 5
Respiratory Disorders
  Cough 0 3 5 7 5
a Maximum daily dose of 5 mg for ≤ 30 kg body weight; 10 mg for > 30 kg body weight
b Maximum daily dose of 10 mg for ≤ 30 kg body weight; 20 mg for > 30 kg body weight
c Maximum daily dose of 20 mg for ≤ 30 kg body weight; 40 mg for > 30 kg body weight

Post Marketing Experience

These reactions are reported voluntarily from a population of uncertain size; therefore, it is not possible to estimate their frequency or establish a causal relationship to drug exposure. Adverse reactions are categorized by system organ class.

Blood Disorders: Anemia, eosinophilia, leukopenia, thrombocytopenia

Eye Disorders: Diplopia, vision blurred

Gastrointestinal Disorders: Abdominal distention

Investigations: Hepatic enzyme increased

Musculoskeletal: Muscle spasms

Psychiatric Disorders: Agitation, anxiety, apathy, confusional state, depression, delirium, delusion, hallucination

Respiratory Disorders: Aspiration, respiratory depression

Skin and Subcutaneous Tissue Disorders: Rash, urticaria