Glycopyrronium

12.1 Mechanism of Action Glycopyrronium is a competitive inhibitor of acetylcholine receptors that are located on certain peripheral tissues, including sweat glands. In hyperhidrosis, glycopyrronium inhibits the action of acetylcholine on sweat glands, reducing sweating.

1 INDICATIONS AND USAGE Qbrexza is indicated for topical treatment of primary axillary hyperhidrosis in adult and pediatric patients 9 years of age and older. Qbrexza is an anticholinergic indicated for topical treatment of primary axillary hyperhidrosis in adults and pediatric patients 9 years of age and older ( 1 ).

2 DOSAGE AND ADMINISTRATION For topical use only. Qbrexza is for topical use in the underarm area only and not for use in other body areas. Qbrexza is administered by a single-use pre-moistened cloth packaged in individual pouches. Qbrexza should be applied to clean dry skin on the underarm areas only. Qbrexza should not be used more frequently than once every 24 hours. Tear open the pouch and pull out the cloth, unfold the cloth, and wipe it across one entire underarm once. Using the same cloth, wipe the other underarm once. A single cloth should be used to apply Qbrexza to both underarms. After applying Qbrexza, discard the cloth in the household trash out of reach of children and others. Wash hands immediately with soap and water after applying and discarding the Qbrexza cloth. Qbrexza may cause temporary dilation of the pupils and blurred vision if it comes in contact with the eyes. Avoid transfer of Qbrexza to the periocular area [see Warnings and Precautions ( 5.3 )] . Do not apply Qbrexza to broken skin. Avoid using Qbrexza with occlusive dressings. For topical use only. Apply Qbrexza once daily to both axillae using a single cloth ( 2 ).

6 ADVERSE REACTIONS The following adverse reactions are described in greater detail in other sections • New or Worsening Urinary Retention [see Warnings and Precautions ( 5.1 )] Most common adverse reactions (incidence ≥2%) are dry mouth, mydriasis, oropharyngeal pain, headache, urinary hesitation, vision blurred, nasal dryness, dry throat, dry eye, dry skin, constipation. Local skin reactions, including erythema, burning/stinging and pruritus were also common (>5%) ( 6.1 ). To report SUSPECTED ADVERSE REACTIONS, contact Journey Medical Corp. at 1-855-531-1859 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 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. In two double-blind, vehicle-controlled clinical trials (Trial 1 [NCT02530281] and Trial 2 [NCT02530294]) of 459 subjects treated with Qbrexza once daily and 232 treated with vehicle, subjects were 9 to 76 years of age, 47% male, and the percentages of White, Black (including African Americans), and Asian subjects were 82%, 12%, and 1%, respectively. Table 1 summarizes the most frequent adverse reactions (≥2%) in subjects with primary axillary hyperhidrosis treated with Qbrexza. Table 1: Adverse Reactions Occurring in ≥2% of Subjects Adverse Reactions Qbrexza (N=459) n (%) Vehicle (N=232) n (%) Dry mouth 111 (24.2%) 13 (5.6%) Mydriasis 31 (6.8%) 0 Oropharyngeal pain 26 (5.7%) 3 (1.3%) Headache 23 (5.0%) 5 (2.2%) Urinary hesitation 16 (3.5%) 0 Vision blurred 16 (3.5%) 0 Nasal dryness 12 (2.6%) 1 (0.4%) Dry throat 12 (2.6%) 0 Dry eye 11 (2.4%) 1 (0.4%) Dry skin 10 (2.2%) 0 Constipation 9 (2.0%) 0 Table 2 shows the most frequently reported local skin reactions, which were relatively common in both the Qbrexza and vehicle groups. Table 2: Local Skin Reactions a Patients with a post-baseline local skin reaction assessment Local Skin Reactions Qbrexza (N=454) a n (%) Vehicle (N=231) a n (%) Erythema 77 (17.0%) 39 (16.9%) Burning/stinging 64 (14.1%) 39 (16.9%) Pruritus 37 (8.1%) 14 (6.1%) In an open-label safety trial (NCT02553798), 564 subjects were treated for up to an additional 44 weeks after completing Trial 1 or Trial 2. Adverse reactions occurring at a frequency ≥2.0% were: dry mouth (16.9%), vision blurred (6.7%), nasopharyngitis (5.8%), mydriasis (5.3%), urinary hesitation (4.2%), nasal dryness (3.6%), dry eye (2.9%), pharyngitis (2.2%), and application site reactions (pain [6.4%], dermatitis [3.8%], pruritus [3.8%], rash [3.8%], erythema [2.4%]). 6.2 Postmarketing Experience The following adverse reactions have been identified during post-approval use of Qbrexza. Because the 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 Qbrexza exposure. • Genitourinary system disorders : new onset urinary retention [ see Warnings and Precautions ( 5.1 ) ]

7 DRUG INTERACTIONS Coadministration of Qbrexza with anticholinergic medications may result in additive interaction leading to an increase in anticholinergic adverse effects. Avoid coadministration of Qbrexza with other anticholinergic-containing drugs ( 7 ) 7.1 Anticholinergics Coadministration of Qbrexza with anticholinergic medications may result in additive interaction leading to an increase in anticholinergic adverse effects [see Warnings and Precautions ( 5 ) and Adverse Reactions ( 6 )] . Avoid coadministration of Qbrexza with other anticholinergic-containing drugs.