Cutaneous treatment of Acne vulgaris when comedones, papules and pustules are present
Adapalene and benzoyl peroxide gel 0.1%/2.5% is indicated in adults and adolescents aged 9 years and over.

Adapalene and benzoyl peroxide gel 0.1%/2.5% should be applied to the entire acne affected areas once a day in the evening on a clean and dry skin. A thin film of gel should be applied, with the fingertips, avoiding the eyes and lips.
If irritation occurs, the patient should be directed to apply non-comedogenic moisturizers, to use the medication less frequently (e.g. every other day), to suspend use temporarily, or to discontinue use altogether.

Adapalene and benzoyl peroxide gel 0.1%/2.5% should not be applied to damaged skin, either broken (cuts or abrasions) or eczematous or sunburned. Adapalene and benzoyl peroxide gel 0.1%/2.5% should not come into contact with the eyes, mouth, nostrils or mucous membranes. If product enters the eye, wash immediately with warm water. This product contains propylene glycol that may cause skin irritation. If a reaction suggesting sensitivity to any component of the formula occurs, the use of Adapalene and benzoyl peroxide gel 0.1%/2.5% should be discontinued. Excessive exposure to sunlight or UV radiation should be avoided. Adapalene and benzoyl peroxide gel 0.1%/2.5% should not come into contact with any coloured material including hair and dyed fabrics as this may result in bleaching and discoloration.

No interaction studies have been performed. From previous experience with adapalene and benzoyl peroxide, there are no known interactions with other medicinal products which might be used cutaneously and concurrently with Adapalene and benzoyl peroxide gel 0.1%/2.5%. However, other retinoids or benzoyl peroxide or drugs with a similar mode of action should not be used concurrently. Caution should be exercised if cosmetics with desquamative, irritant or drying effects are used, as they may produce additive irritant effects with Adapalene and benzoyl peroxide gel 0.1%/2.5%. Absorption of adapalene through human skin is low, and therefore interaction with systemic medicinal products is unlikely. The percutaneous penetration of benzoyl peroxide in the skin is low and the drug substance is completely metabolised into benzoic acid which is rapidly eliminated. Therefore, the potential interaction of benzoic acid with systemic medicinal products is unlikely to occur.

Pregnancy:
Animal studies by the oral route have shown reproductive toxicity at high systemic exposure.
Clinical experience with locally applied adapalene and benzoyl peroxide in pregnancy is limited but the few available data do not indicate harmful effects in patients exposed in early pregnancy.
Due to the limited available data and because a very weak cutaneous passage of adapalene is possible; adapalene and benzoyl peroxide gel 0.1%/2.5% should not be used during pregnancy.
In case of unexpected pregnancy, treatment should be discontinued.

Breastfeeding:
No study on animal or human milk transfer was conducted after cutaneous application of adapalene and benzoyl peroxide gel 0.1%/2.5%.
No effects on the suckling child are anticipated since the systemic exposure of the breastfeeding woman to adapalene and benzoyl peroxide gel 0.1%/2.5% is negligible. Adapalene and benzoyl peroxide gel 0.1%/2.5% can be used during breastfeeding.
To avoid contact exposure of the infant, application of adapalene and benzoyl peroxide gel 0.1%/2.5% to the chest should be avoided when used during breastfeeding.

Not relevant.

Adapalene and benzoyl peroxide gel 0.1%/2.5% may cause the following adverse reactions at the site of application:

If skin irritation appears after application of adapalene and benzoyl peroxide gel 0.1%/2.5%, the intensity is generally mild or moderate, with local tolerability signs and symptoms (erythema, dryness, scaling, burning and pain of skin (stinging pain)) peaking during the first week and then subsiding spontaneously.
Reporting of suspected adverse reactions
Reporting suspected adverse reaction after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.
To report any side effect(s):
 Saudi Arabia:
-The National Pharmacovigilance and Drug Safety Centre (NPC)
 Fax: +966-11-205-7662
 Call NPC at +966-11-2038222, Exts: 2317-2356-2353-2354-2334-2340.
 Toll free phone: 8002490000
 E-mail: npc.drug@sfda.gov.sa
 Website: www.sfda.gov.sa/npc
 Other GCC States: Please contact the relevant competent authority.

Adapalene and benzoyl peroxide gel 0.1%/2.5% is for once-daily cutaneous use only.
In case of accidental ingestion, appropriate symptomatic measures should be taken.

Pharmacotherapeutic group: Anti-Acne Preparations for Topical Use; D10AD Retinoids for topical use in acne;
ATC code: D10AD53
Mechanism of action and Pharmacodynamic effects:
Adapalene and benzoyl peroxide gel 0.1%/2.5% combines two active substances, which act through different, but complementary, mechanisms of action.
– Adapalene: Adapalene is a chemically stable, naphthoic acid derivative with retinoid-like activity. Biochemical and pharmacological profile studies have demonstrated that adapalene acts in the pathology of Acne vulgaris: it is a potent modulator of cellular differentiation and keratinisation and it has anti-inflammatory properties. Mechanistically, adapalene binds to specific retinoic acid nuclear receptors. Current evidence suggests that topical adapalene normalizes the differentiation of follicular epithelial cells resulting in decreased microcomedone formation. Adapalene inhibits the chemotactic (directional) and chemokinetic (random) responses of human polymorphonuclear leucocytes in in vitro assay models; it also inhibits the metabolism of arachidonic acid to inflammatory mediators. In vitro studies have shown inhibition of the AP1 factors and the inhibition of the expression of toll like receptors 2. This profile suggests that the cell mediated inflammatory component of acne is reduced by adapalene.
– Benzoyl peroxide: Benzoyl peroxide has been shown to have antimicrobial activity; particularly against P. acnes, which is abnormally present in the acne-affected pilosebaceous unit. Additionally benzoyl peroxide has demonstrated exfoliative and keratolytic activities. Benzoyl peroxide is also sebostatic, counteracting the excessive sebum production associated with acne.

Clinical efficacy of adapalene and benzoyl peroxide gel 0.1%/2.5% in patients aged 12 years and older:
The safety and efficacy of adapalene and benzoyl peroxide gel 0.1%/2.5% applied once daily for the treatment of acne vulgaris were assessed in two 12-week, multicenter, controlled clinical studies of similar design, comparing adapalene and benzoyl peroxide gel 0.1%/2.5% to its individual active components, adapalene and benzoyl peroxide, and to the gel vehicle in acne patients. A total of 2185 patients were enrolled in Study 1 and Study 2. The distribution of patients in the two studies was approximately 49% male and 51% female, 12 years of age or older (mean age: 18.3 years; range 12 – 50), presenting 20 to 50 inflammatory lesions and 30 to 100 non-inflammatory lesions at baseline. The patients treated the face and other acne affected areas as needed once daily in the evening.
The efficacy criteria were:
(1) Success rate, percentage of patients rated 'Clear' and 'Almost Clear' at Week 12 based on the Investigator's Global Assessment (IGA);
(2) Change and Percent Change from baseline at Week 12 in
 Inflammatory lesion counts
 Non-inflammatory lesion counts
 Total lesion count
The efficacy results are presented for each study in Table 1 and combined results in Table 2. Adapalene and benzoyl peroxide gel 0.1%/2.5% was shown to be more effective compared to its monads and gel vehicle in both studies. Overall, the net beneficial effect (active minus vehicle) obtained from adapalene and benzoyl peroxide gel 0.1%/2.5% was greater than the sum of the net benefits obtained from the individual components, thus indicating a potentiation of the therapeutic activities of these substances when used in a fixed-dose combination. An early treatment effect of adapalene and benzoyl peroxide gel 0.1%/2.5% was consistently observed in Study 1 and Study 2 for Inflammatory Lesions at Week 1 of treatment. Non-inflammatory lesions (open and closed comedones) noticeably responded between the first and forth week of treatment. The benefit on nodules in acne has not been established.

Clinical efficacy of adapalene and benzoyl peroxide gel 0.1%/2.5% in children 9 to 11 years old
During a paediatric clinical trial, 285 children with acne vulgaris, aged 9-11 years (53% of the subjects were 11 years old, 33% were 10 years old and 14% were 9 years old) with a score of 3 (moderate) on the IGA scale and a minimum of 20 but not more than 100 total lesions (Non-inflammatory and/or Inflammatory) on the face (including the nose) at baseline were treated with adapalene and benzoyl peroxide gel 0.1%/2.5% once daily for 12 weeks.
The study concludes that the efficacy and safety profiles of adapalene and benzoyl peroxide gel 0.1%/2.5% in the treatment of facial acne in this specific younger age group are consistent with results of other pivotal studies in subjects with acne vulgaris aged 12 years and older showing significant efficacy with an acceptable tolerability.
A sustained early treatment effect of adapalene and benzoyl peroxide gel 0.1%/2.5% compared to Gel Vehicle was consistently observed for all Lesions (Inflammatory, Non-Inflammatory, and Total) at Week 1 and continuing to Week 12.

The pharmacokinetic (PK) properties of adapalene and benzoyl peroxide gel 0.1%/2.5% are similar to the PK profile of Adapalene 0.1% gel alone.
In a 30-day clinical PK study, conducted in patients with acne who were tested with either the fixed-combination gel or with an adapalene 0.1% matched formula under maximised conditions (with application of 2 g gel per day), adapalene was not quantifiable in the majority of plasma samples (limit of quantification 0.1 ng/ml). Low levels of adapalene (Cmax between 0.1 and 0.2 ng/ml) were measured in two blood samples taken from the subjects treated with adapalene and benzoyl peroxide gel 0.1%/2.5% and in three samples from the subjects treated with Adapalene 0.1% Gel. The highest adapalene AUC0-24h determined in the fixed-combination group was 1.99 ng.h/ml. These results are comparable to those obtained in previous clinical PK studies on various Adapalene 0.1% formulations, where systemic exposure to adapalene was consistently low.
The percutaneous penetration of benzoyl peroxide is low; when applied on the skin, it is completely converted into benzoic acid which is rapidly eliminated.

Preclinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, phototoxicity or carcinogenicity.
Reproductive toxicology studies with adapalene have been performed by the oral and dermal routes of administration in the rat and rabbit. A teratogenic effect has been demonstrated at high systemic exposures (oral doses from 25 mg/kg/day). At lower exposures (dermal dose of 6 mg/kg/day), changes in the numbers of ribs or vertebrae were seen.
Animal studies performed with adapalene and benzoyl peroxide gel 0.1%/2.5% include local tolerance studies and dermal repeat-dose toxicity studies in rat, dog and minipig up to 13 weeks and demonstrated local irritation and a potential for sensitisation, as expected for a combination containing benzoyl peroxide. Systemic exposure to adapalene following repeat dermal application of the fixed combination in animals is very low, consistent with clinical pharmacokinetic data. Benzoyl peroxide is rapidly and completely converted to benzoic acid in the skin and after absorption is eliminated in the urine, with limited systemic exposure.

Edetate Disodium, Docusate Sodium, Glycerin (Glycerol Anhydrous), Propylene Glycol, Poloxamer 124, Carbomer Homopolymer Type C, Sorbitan Oleate, Cyclomethicone, Sodium Hydroxide and Purified Water

Under normal conditions of use and storage, there are no generally recognized incompatibilities that would produce a hazardous situation other than what water alone would produce, e.g. water is incompatible with alkali metals, alkali hydrides, strong acids and bases. Product is insoluble in water.

Store below 25ºC.

Deriva BPO Gel is available in: 45g laminated tube packed in an outer carton with leaflet and containing white to pale yellow, opaque gel.

Avoid contact with eyes, mucous membranes, skin, or clothing