Most common adverse reactions (incidence ≥ 10%) are oiliness/peeling, dryness and erythema at the application site (6). To report SUSPECTED ADVERSE REACTIONS, contact Allergan at 1-800-433-8871 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Studies 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. Serious adverse reactions reported in patients treated with ACZONE ® Gel, 5%, during clinical trials included but were not limited to the following: Nervous system/Psychiatric – Suicide attempt, tonic clonic movements. Gastrointestinal – Abdominal pain, severe vomiting, pancreatitis. Other – Severe pharyngitis In the clinical trials, a total of 12 out of 4032 patients were reported to have depression (3 of 1660 treated with vehicle and 9 of 2372 treated with ACZONE ® Gel, 5%). Psychosis was reported in 2 of 2372 patients treated with ACZONE ® Gel, 5%, and in 0 of 1660 patients treated with vehicle. Combined contact sensitization/irritation studies with ACZONE ® Gel, 5%, in 253 healthy subjects resulted in at least 3 subjects with moderate erythema. ACZONE ® Gel, 5%, did not induce phototoxicity or photoallergy in human dermal safety studies. ACZONE ® Gel, 5%, was evaluated for 12 weeks in four controlled studies for local cutaneous events in 1819 patients. The most common events reported from these studies include oiliness/peeling, dryness, and erythema. These data are shown by severity in Table 1 below. Table 1 – Application Site Adverse Reactions by Maximum Severity ACZONE ® (N=1819) Vehicle (N=1660) Application Site Event Mild Moderate Severe Mild Moderate Severe Erythema 9% 5% <1% 9% 6% <1% Dryness 14% 3% <1% 14% 4% <1% Oiliness/Peeling 13% 6% <1% 15% 6% <1% The adverse reactions occurring in at least 1% of patients in either arm in the four vehicle controlled studies are presented in Table 2. Table 2 – Adverse Reactions Occurring in at Least 1% of Patients NOS = Not otherwise specified ACZONE ® N=1819 Vehicle N=1660 Application Site Reaction NOS 18% 20% Application Site Dryness 16% 17% Application Site Erythema 13% 14% Application Site Burning 1% 2% Application Site Pruritus 1% 1% Pyrexia 1% 1% Nasopharyngitis 5% 6% Upper Respiratory Tract Inf. NOS 3% 3% Sinusitis NOS 2% 1% Influenza 1% 1% Pharyngitis 2% 2% Cough 2% 2% Joint Sprain 1% 1% Headache NOS 4% 4% One patient treated with ACZONE ® Gel in the clinical trials had facial swelling which led to discontinuation of medication. In addition, 486 patients were evaluated in a 12 month safety study. The adverse event profile in this study was consistent with that observed in the vehicle-controlled studies. 6.2 Experience with Oral Use of Dapsone Although not observed in the clinical trials with ACZONE ® Gel (topical dapsone) serious adverse reactions have been reported with oral use of dapsone, including agranulocytosis, hemolytic anemia, peripheral neuropathy (motor loss and muscle weakness), and skin reactions (toxic epidermal necrolysis, erythema multiforme, morbilliform and scarlatiniform reactions, bullous and exfoliative dermatitis, erythema nodosum, and urticaria). 6.3 Postmarketing Experience The following adverse reactions have been identified during post-approval use of ACZONE ® Gel, 5%. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Methemoglobinemia has been identified during postmarketing use of ACZONE ® Gel, 5% [see Warnings and Precautions (5.1)].