[Federal Register: June 12, 1998 (Volume 63, Number 113)] [Proposed Rules] [Page 32159-32161] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr12jn98-25] ======================================================================= ----------------------------------------------------------------------- CONSUMER PRODUCT SAFETY COMMISSION 16 CFR Part 1700 Poison Prevention Packaging Requirements; Proposed Exemption of Sucraid AGENCY: Consumer Product Safety Commission. ACTION: Proposed rule. ----------------------------------------------------------------------- SUMMARY: The Commission is proposing to exempt from its child-resistant packaging requirements the oral prescription drug Sucraid. Sucraid is a new liquid formulation of sacrosidase, a yeast derived form of the sucrase enzyme, used for the treatment of congenital sucrase-isomaltase deficiency. The Commission proposes this exemption because human experience has shown no evidence of serious toxicity. DATES: Comments on the proposal should be submitted no later than August 26, 1998. ADDRESSES: Comments should be mailed to the Office of the Secretary, Consumer Product Safety Commission, Washington, D.C. 20207, or delivered to the Office of the Secretary, Consumer Product Safety Commission, Room 502, 4330 East-West Highway, Bethesda, Maryland 20814- 4408, telephone (301) 504-0800. Comments may also be filed by telefacsimile to (301) 504-0127 or by email to cpsc-os@cpsc.gov. FOR FURTHER INFORMATION CONTACT: Jacqueline Ferrante, Ph.D., Division of Health Sciences, Directorate for Epidemiology and Health Sciences, Consumer Product Safety Commission, Washington, D.C. 20207; telephone (301) 504-0477 ext. 1199. SUPPLEMENTARY INFORMATION: A. Background The Poison Prevention Packaging Act of 1970 (``PPPA''), 15 U.S.C. 1471-1476, provides the Commission with authority to establish standards for the ``special packaging'' of household substances, such as drugs, when child resistant packaging is necessary to protect children from serious personal injury or illness due to the substance and the special packaging is technically feasible, practicable, and appropriate for such substance. Accordingly, the Commission requires that oral prescription drugs be in child resistant (``CR'') packaging. 16 CFR 1700.14(a)(10). The Commission's regulations allow companies to petition the Commission for exemption from CR requirements. 16 CFR Part 1702. Possible grounds for granting the exemption are that: (a) The degree or nature of the hazard to children in the availability of the substance, by reason of its packaging, is such that special packaging is not required to protect children from serious personal injury or serious illness resulting from handling, using or ingesting the substance, or (b) Special packaging is not technically feasible, practicable, or appropriate for the subject substance, or (c) Special packaging is incompatible with the particular substance.16 CFR 1702.17. On July 10, 1997, Orphan Medical, Inc. (``Orphan Medical'') petitioned the Commission to exempt its product, Sucraid, from the special packaging [[Page 32160]] requirements for oral prescription drugs. The petitioner stated that the exemption is justified because of lack of toxicity and lack of adverse human experience with the drug. The petitioner also stated that CR packaging is not technically feasible, practicable and appropriate for Sucraid. Because, as explained below, the Commission concludes that Sucraid lacks sufficient toxicity to justify special packaging, the Commission did not consider the technical feasibility, practicability, and appropriateness of special packaging for Sucraid. Sucraid is a liquid formulation of sacrosidase, a yeast derived form of the sucrase enzyme. It is used to treat patients with congenital sucrase-isomaltase deficiency (``CSID''). The petitioner estimates that there are approximately 3000 to 10,000 cases of CSID in the United States. CSID is a condition characterized by absent or low levels of sucrase and isomaltase, two enzymes in the small intestine. Sucrase breaks down sucrose (table sugar) so that it can be absorbed. Persons with CSID have such symptoms as diarrhea, abdominal pain, bloating, and gas. Patients with severe CSID may require hospitalization for diarrhea, dehydration, malnutrition, weakness and muscle wasting. Sacrosidase is an enzyme replacement therapy that reduces the symptoms of CSID. B. Toxicity Data Sacrosidase is derived from bakers yeast. It is Generally Recognized as Safe (``GRAS'') for use in food by the Food and Drug Administration (``FDA''). 21 CFR 170.30. Sucraid contains about 1.5 milligrams per milliliter of the enzyme in a 50:50 solution of glycerol and water. One bottle of Sucraid contains 150 mg of protein, 59 ml of water and 59 ml of glycerol. Similar to dietary proteins, the protein component of Sucraid is digested to amino acids which are used to make new protein and are not expected to cause toxicity. Glycerol is a sweet liquid used as a solvent, preservative, and moisturizer. FDA recognizes glycerol as GRAS for use as a food. 21 CFR 182.1320. It is also used as a drug, for example, to reduce intraocular and intracranial pressure. It also can be used as a laxative. Possible adverse effects associated with glycerol include nausea, vomiting, headache, and dehydration. Less commonly reported effects include diarrhea, thirst, dizziness, and mental confusion. Some more serious effects have been reported with intravenous administration of glycerol and with certain high risk patients. However, the Hazardous Chemicals Desk Reference indicates that glycerol is only mildly toxic by ingestion. In addition, the Handbook of Common Poisonings in Children characterizes glycerol as a laxative, stating that ``acute exposure to most laxatives produces nausea, vomiting, and diarrhea, which are usually mild and self-limiting.'' The CPSC staff found three cases in the National Electronic Injury Surveillance System (``NEISS'') of children under five years old ingesting products containing glycerol. The products involved were a glycerol suppository, a baby enema preparation, and an ear solution. In all three cases the child was treated and released or examined and released without treatment. Thus, based on the information discussed above, the glycerol component of Sucraid is not likely to cause significant toxicity to children. C. Human Experience Data According to the petitioner, there have been three clinical trials of Sucraid, two of which are complete. The clinical investigators conducting the trials did not rate any of the adverse effects encountered as probably or definitely related to the drug. Some effects were considered to be possibly related to the drug. The investigators considered most of the adverse effects to be unrelated to Sucraid and due to illnesses common to children (e.g., flu, ear infection and strep throat). Unrelated effects included sore throat, fever, cough, runny nose, diarrhea, cramping and abdominal pain. The clinical investigator did rate some adverse events in the second trial as possibly related to Sucraid. These symptoms included abdominal pain, diarrhea, nausea, vomiting, constipation, dehydration, cramps, headache, insomnia, nervousness, and wheezing. The petitioner noted that many of these were gastrointestinal symptoms typical of CSID. Thus, the dose of Sucraid given may not have been adequate to alleviate all symptoms of the disease. An asthmatic child had an acute hypersensitivity reaction (wheezing) to Sucraid that resolved without sequelae. This patient was withdrawn from the trial. D. Action on the Petition After considering the information provided by the petitioner and other available toxicity and human experience data, the Commission preliminarily concludes that the degree and nature of the hazard to children presented by the availability of Sucraid do not require special packaging to protect children from serious personal injury or serious illness resulting from handling, using, or ingesting the substance. Therefore, the Commission voted to grant the petition and begin a rulemaking proceeding to exempt Sucraid from the special packaging requirements for oral prescription drugs. E. Regulatory Flexibility Act Certification Under the Regulatory Flexibility Act, 5 U.S.C. 601 et seq., an agency that engages in rulemaking generally must prepare proposed and final regulatory flexibility analyses describing the impact of the rule on small businesses and other small entities. Section 605 of the Act provides that an agency is not required to prepare a regulatory flexibility analysis if the head of an agency certifies that the rule will not have a significant economic impact on a substantial number of small entities. The Commission's Directorate for Economic Analysis prepared a preliminary assessment of the impact of a rule to exempt Sucraid from special packaging requirements. The staff reports that because of the small number of cases of CSID (3,000 to 10,000 in the U.S.), the market for Sucraid is expected to be small. The petitioner, Orphan Medical, is a small manufacturer based on its employment and sales. Orphan Medical has marketing exclusivity for Sucraid for seven years. The exemption from special packaging requirements will allow the company to avoid costs associated with obtaining CR packaging. Based on this assessment, the Commission preliminarily concludes that the proposed amendment exempting Sucraid from special packaging requirements would not have a significant impact on a substantial number of small businesses or other small entities. F. Environmental Considerations Pursuant to the National Environmental Policy Act, and in accordance with the Council on Environmental Quality regulations and CPSC procedures for environmental review, the Commission has assessed the possible environmental effects associated with the proposed PPPA amendment. The Commission's regulations state that rules requiring special packaging for consumer products normally have little or no potential for affecting the human environment. 16 CFR 1021.5(c)(3). Nothing in this proposed rule alters that expectation. (3) Therefore, because the rule would have no adverse effect on the environment, neither an environmental assessment [[Page 32161]] nor an environmental impact statement is required. G. Executive Orders According to Executive Order 12988 (February 5, 1996), agencies must state in clear language the preemptive effect, if any, of new regulations. The PPPA provides that, generally, when a special packaging standard issued under the PPPA is in effect, ``no State or political subdivision thereof shall have any authority either to establish or continue in effect, with respect to such household substance, any standard for special packaging (and any exemption therefrom and requirement related thereto) which is not identical to the [PPPA] standard.'' 15 U.S.C. 1476(a). A State or local standard may be excepted from this preemptive effect if (1) the State or local standard provides a higher degree of protection from the risk of injury or illness than the PPPA standard; and (2) the State or political subdivision applies to the Commission for an exemption from the PPPA's preemption clause and the Commission grants the exemption through a process specified at 16 CFR Part 1061. 15 U.S.C. 1476(c)(1). In addition, the Federal government, or a State or local government, may establish and continue in effect a non-identical special packaging requirement that provides a higher degree of protection than the PPPA requirement for a household substance for the Federal, State or local government's own use. 15 U.S.C. 1476(b). Thus, with the exceptions noted above, the proposed rule exempting Sucraid from special packaging requirements would preempt non-identical state or local special packaging standards for the substance. In accordance with Executive Order 12612 (October 26, 1987), the Commission certifies that the proposed rule does not have sufficient implications for federalism to warrant a Federalism Assessment. List of Subjects in 16 CFR Part 1700 Consumer protection, Drugs, Infants and children, Packaging and containers, Poison prevention, Toxic substances. For the reasons given above, the Commission proposes to amend 16 CFR part 1700 as follows: PART 1700--[AMENDED] 1. The authority citation for part 1700 continues to read as follows: Authority: Pub. L. 91-601, secs. 1-9, 84 Stat. 1670-74, 15 U.S.C. 1471-76. Secs 1700.1 and 1700.14 also issued under Pub. L. 92-573, sec. 30(a), 88 Stat. 1231. 15 U.S.C. 2079(a). 2. Section 1700.14 is amended by republishing paragraph (a) introductory text and paragraph (a)(10) introductory text, and by adding new paragraph (a)(10)(xx) to read as follows: Sec. 1700.14 Substances requiring special packaging. (a) Substances. The Commission has determined that the degree or nature of the hazard to children in the availability of the following substances, by reason of their packaging, is such that special packaging meeting the requirements of Sec. 1700.20(a) is required to protect children from serious personal injury or serious illness resulting from handling, using, or ingesting such substances, and the special packaging herein required is technically feasible, practicable, and appropriate for these substances: * * * * * (10) Prescription Drugs. Any drug for human use that is in a dosage form intended for oral administration and that is required by Federal law to be dispensed only by or upon an oral or written prescription of a practitioner licensed by law to administer such drug shall be packaged in accordance with the provisions of Sec. 1700.15 (a), (b), and (c), except for the following: * * * * * (xx) Sacrosidase (sucrase) preparations in a solution of glycerol and water. Dated: June 4, 1998. Sadye E. Dunn, Secretary, Consumer Product Safety Commission. List of Relevant Documents 1. Briefing memorandum from Jaqueline Ferrante, Ph.D., EH, to the Commission, ``Petition (PP 97-1) to Exempt Sucraid from the Special Packaging Requirements for Oral Prescription Drugs,'' May 20, 1998. 2. Memorandum from Jaqueline Ferrante, Ph.D., EH, to Mary Ann Danello, Ph.D., Associate Executive Director, EH, ``Sucraid Review'' April 1, 1998. 3. Memorandum from Marcia P. Robins, EC, to Jacqueline Ferrante, Ph.D., EH, ``Economic Considerations: Petition for Exemption from PPPA Requirements for Oral Prescription Drug Sucraid,'' April 2, 1998. [FR Doc. 98-15493 Filed 6-11-98; 8:45 am] BILLING CODE 6355-01-P