PRODUCT MONOGRAPH INCLUDING PATIENT …

1 FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 1 of 55 PRODUCT MONOGRAPH INCLUDING PATIENT medication information PrFIBRISTAL ulipristal acetate tablet, 5 mg Selective Progesterone Receptor Modulator (SPRM) Allergan Pharma Co. 85 Enterprise Blvd., Suite 500 Markham, Ontario CANADA L6G 0B5 Date of Revision: January 10, 2018 Submission Control No: 209518 FIBRISTAL is a trade-mark of Allergan, Inc. under license by Allergan Pharma Co. FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 2 of 55 Table of Contents PART I: HEALTH PROFESSIONAL information ..3 SUMMARY PRODUCT information ..3 INDICATIONS AND CLINICAL USE ..3 CONTRAINDICATIONS ..3 WARNINGS AND PRECAUTIONS ..4 ADVERSE REACTIONS ..6 DRUG INTERACTIONS ..14 DOSAGE AND ADMINISTRATION ..16 OVERDOSAGE ..16 ACTION AND CLINICAL PHARMACOLOGY ..16 STORAGE AND STABILITY ..18 SPECIAL HANDLING INSTRUCTIONS.

2 19 DOSAGE FORMS, COMPOSITION AND PACKAGING ..19 PART II: SCIENTIFIC information ..20 PHARMACEUTICAL information ..20 CLINICAL TRIALS ..21 DETAILED PHARMACOLOGY ..47 TOXICOLOGY ..48 REFERENCES ..49 PART III: PATIENT medication information ..50 FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 3 of 55 PrFIBRISTAL ulipristal acetate PART I: HEALTH PROFESSIONAL information SUMMARY PRODUCT information Route of Administration Dosage Form / Strength Clinically Relevant Nonmedicinal Ingredients Oral Tablet, 5 mg For a complete listing see Dosage Forms, Composition and Packaging section. INDICATIONS AND CLINICAL USE FIBRISTAL (ulipristal acetate) is indicated for: Treatment of moderate to severe signs and symptoms of uterine fibroids in adult women of reproductive age, who are eligible for surgery. Intermittent treatment of moderate to severe signs and symptoms of uterine fibroids in adult women of reproductive age.

3 The duration of each treatment course is 3 months. Geriatrics ( 65 years of age): Safety and efficacy of FIBRISTAL have not been established in women 65 years of age. Pediatrics (< 18 years of age): Safety and efficacy of FIBRISTAL have not been established in women < 18 years of age. CONTRAINDICATIONS Women who are hypersensitive to ulipristal acetate or to any ingredient in the formulation. For a complete listing, see the Dosage Forms, Composition and Packaging section of the PRODUCT MONOGRAPH . For use during pregnancy and in women who are breastfeeding. Women with genital bleeding of unknown etiology or for reasons other than uterine fibroids. Women with uterine, cervical, ovarian or breast cancer. FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 4 of 55 WARNINGS AND PRECAUTIONS Ulipristal acetate should only be prescribed after careful diagnosis. Pregnancy should be precluded prior to treatment.

4 Hypersensitivity Hypersensitivity reactions were reported in patients taking FIBRISTAL , such as generalised edema, pruritus, rash, swelling face or urticaria. Rarely, serious cases of angioedema and drug hypersensitivity with respiratory difficulty were also reported. If hypersensitivity occurs, FIBRISTAL treatment should be discontinued and appropriate medical treatment should be initiated. Contraception Concomitant use of progestagen-only pills, a progestagen-releasing intrauterine device or combined oral contraceptive pills is not recommended. Although a majority of women taking a therapeutic dose of ulipristal acetate have anovulation, a non-hormonal contraceptive method is recommended during treatment. Hepatic Impairment Ulipristal acetate is not recommended in patients with severe hepatic impairment unless the PATIENT is closely monitored. Renal Impairment Renal impairment is not expected to significantly alter the elimination of ulipristal acetate.

5 In the absence of specific studies, ulipristal acetate is not recommended for patients with moderate and severe renal impairment unless the PATIENT is closely monitored. Concomitant Treatments No dose adjustment is recommended in patients receiving FIBRISTAL with mild CYP3A4 inhibitors. Co-administration of moderate or potent CYP3A4 inhibitors ( , clarithromycin, ketoconazole, erythromycin) and ulipristal acetate is not recommended. When prescribing ulipristal acetate to patients receiving CYP3A4 inducers, plasma levels of ulipristal acetate may be reduced. Concomitant use of ulipristal acetate and potent enzyme inducers ( , rifampicin, carbamazepine, phenytoin, St. John's wort) is not recommended. Asthma patients Use in women with severe asthma insufficiently controlled by oral glucocorticoids is not recommended. FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 5 of 55 Endometrial Changes: Endometrial Thickening/Progesterone receptor modulator Associated Endometrial Changes (PAEC) Ulipristal acetate has a specific pharmacodynamic action on the endometrium.

6 An increase in thickness of the endometrium may occur. The thickness of the endometrium decreases to baseline levels upon treatment cessation. If the endometrial thickening persists beyond 3 months following the end of treatment and return of menstruations, this may need to be investigated as per usual clinical practice to exclude underlying conditions. Changes in the histology of the endometrium may be observed in patients treated with ulipristal acetate. These changes are reversible after treatment cessation. These histological changes are denoted as Progesterone receptor modulator Associated Endometrial Changes (PAEC) and should not be mistaken for endometrial hyperplasia. In case of repeated intermittent treatment, periodic monitoring of the endometrium is recommended. This includes annual ultrasound to be performed after resumption of menstruation during off-treatment period.

7 If endometrial thickening is noted, which persists after return of menstruations during off-treatment periods or beyond 3 months following the end of treatment courses, and/or an altered bleeding pattern is noted (see bleeding pattern ), investigation INCLUDING endometrial biopsy should be performed in order to exclude other underlying conditions, INCLUDING endometrial malignancy. In case of hyperplasia (without atypia), monitoring as per usual clinical practice ( , a follow-up control 3 months later) would be recommended. In case of atypical hyperplasia, investigation and management as per usual clinical practice should be performed. Repeated intermittent treatment has been studied up to 4 intermittent treatment courses. Individual treatment courses should each not exceed 3 months as the risk of adverse impact on the endometrium is unknown if treatment is continued without interruption.

8 Bleeding Pattern patients should be informed that treatment with ulipristal acetate usually leads to a significant reduction in menstrual blood loss or amenorrhea within the first 10 days of treatment. Should the excessive bleeding persist, patients should notify their physician. Menstrual periods will generally return within 4 weeks after the end of the treatment course. If an altered persistent or unexpected bleeding pattern occurs, such as inter-menstrual bleeding, after the initial reduction in bleeding or amenorrhea during repeated intermittent treatment, investigation of the endometrium INCLUDING endometrial biopsy should be performed in order to exclude other underlying conditions, INCLUDING endometrial malignancy. FIBRISTAL Ulipristal Acetate, 5 mg tablets Page 6 of 55 Special Populations Pregnant Women: Use of FIBRISTAL is contraindicated during an existing or suspected pregnancy.

9 The extent of exposure in pregnancy during clinical trials is very limited. Nursing Women: It is not known if ulipristal acetate is excreted in human milk. However, ulipristal acetate is detected in milk of lactating rats. Because many drugs are excreted in human milk, risk to the breast-fed child cannot be excluded. Breastfeeding while taking FIBRISTAL is not recommended. Pediatrics (< 18 years of age): Safety and efficacy of FIBRISTAL have not been established in women < 18 years of age. Geriatrics ( 65 years of age): Safety and efficacy of FIBRISTAL have not been established in women 65 years of age. Monitoring and Laboratory Tests Pregnancy should be excluded before prescribing FIBRISTAL . If pregnancy cannot be excluded on the basis of history and/or physical examination, pregnancy testing should be performed. If there is any doubt concerning the general health or pregnancy status of any woman after taking FIBRISTAL , further investigation may be warranted.

10 ADVERSE REACTIONS Adverse Drug Reaction Overview The safety of ulipristal acetate has been evaluated in 1,032 women with uterine fibroids treated with 5 mg or 10 mg ulipristal acetate during Phase III studies for at least 3 months of exposure. The most common finding in clinical trials was amenorrhea, which is considered to be a desirable outcome for the patients . The most common adverse drug reactions ( 5%) in the clinical trials for women receiving FIBRISTAL 5 mg were hot flash and headache. The vast majority of adverse drug reactions were mild or moderate ( ), and did not lead to discontinuation of the medication ( ). Clinical Trial Adverse Drug Reactions Because clinical trials are conducted under very specific conditions the adverse reaction rates observed in the clinical trials may not reflect the rates observed in practice and should not be compared to the rates in the clinical trials of another drug.