Source: https://www.casewatch.net/fdawarning/prod/2009/geromatrix.shtml
Timestamp: 2019-04-24 02:16:16+00:00

Document:
This letter is in reference to your firm's marketing and distribution of "LoPain AF 15% Ibuprofen Creme," a topical cream that is labeled as containing the active ingredients Ibuprofen USP, MSM, Arnica, and Devil's Claw Root, and is sold over-the-counter (OTC) without a prescription. The labeling for this product contains therapeutic claims that cause the product to be a drug, as defined by section 201(g) of the Federal Food, Drug, and Cosmetic Act (the Act) (21 U.S.C. § 321(g)).
"REDUCES Pain, Swelling and Inflammation"
"Geromatrix LoPain AF is a topical skin cream with penetrating liposome's to carry the active ingredients directly and deep to the painful area, providing quick active relief from muscular pain, back aches, inflammatory rheumatic afflictions of the joints, sport/accident related strains, contusions and sprains."
"Geromatrix LoPain AF is a safe professional-strength homeopathic topical skin cream formulation with maximum non-prescription strength ibuprofen cream and natural enzymes MSM, Lidocaine, Arnica and Devil's Claw Root for the most powerful synergistic complex available."
Based on these claims, "LoPain AF 15% Ibuprofen Creme," is a drug under section 201(g)(1)(B) of the Act (21 U.S.C. § 321 (g)(1)(B)), because it is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man, and under section 201 (g)(1)(C) of the Act (21 U.S.C. § 321(g)(1)(C)), because it is intended to affect the structure or function of the body.
Moreover, based on 'the combination of active ingredients and the claims made for this product, "LoPain AF 15% Ibuprofen Creme" is a new drug within the meaning of section 201(p) of the Act (21 U.S.C. § 321(p)) because it is not generally recognized as safe and effective for its labeled uses; Drug products intended for indications such as those for which "LoPain AF 15% Ibuprofen Creme" is labeled are being evaluated under the Tentative Final Monograph (TFM) issued on February 8, 1983 for OTC External Analgesics. (48 Fed. Reg. 5852). The External Analgesics TFM did not include the ingredients ibuprofen, MSM, arnica, or devil's claw root,1 nor were these ingredients evaluated as part of the OTC drug review for any external use, including any of the indications found in the labeling for "LoPain AF 15% Ibuprofen Creme."2 Furthermore, indications for inflammation and inflammatory rheumatic afflictions of the joints are not included in the External Analgesics TFM. Additionally, we are not aware of a product with these ingredients, for topical application, to treat any of the conditions found in the labeling of "LoPain AF 15% Ibuprofen Creme," having been available in the U.S. market, as an OTC drug, on or before the inception of the OTC drug review. Accordingly, this product is not subject to the OTC drug review. There is no approved new drug application for "LoPain AF 15% Ibuprofen Creme." Thus, the current marketing of "LoPain AF 15% Ibuprofen Creme" violates sections 301(d) and 505(a) of the Act (21 U.S.C. §§ 331(d) and 355(a)) because it is a new drug and it is not the subject of an approved new drug application.
Furthermore, "LoPain AF 15% Ibuprofen Creme" is misbranded under section 502(o) of the Act (21 U.S.C. § 352(o)) because it is not manufactured, prepared, propagated, compounded or processed in an establishment duly registered under section 510 of the Act (21 U.S.C. § 360), nor is it included in a list required by section 510(j) of the Act (21 U.S.C. § 3600).
We recognize that the labeling for "LoPain AF 15% Ibuprofen Creme" identifies it as a homeopathic drug product. We acknowledge that many homeopathic drug products are manufactured and distributed without FDA approval under enforcement policies set out in FDA's Compliance Policy Guide entitled, "Conditions Under Which Homeopathic Drugs May be Marketed (CPG 7132.15)" (the CPG). The CPG defines a homeopathic drug as: "Any drug labeled as being homeopathic which is listed in the Homeopathic Pharmacopeia of the United States (HPUS), an addendum to it, or its supplements." The CPG additionally states that "Drug products containing homeopathic ingredients in combination with non-homeopathic active ingredients are not homeopathic drug products."
Although arnica montana is an established homeopathic active ingredient included in the HPUS, neither MSM, devil's claw root, or ibuprofen is a recognized active ingredient in the HPUS or any of its addenda or supplements. Furthermore, to our knowledge, none of these ingredients is listed in any recognized materia medica containing information on the preparation of homeopathic medicines. Therefore, neither MSM, devil's claw root, or ibuprofen is a homeopathic ingredient, and "LoPain AF 15% Ibuprofen Creme" is not considered a homeopathic drug product under the CPG. Accordingly, the policies set forth in the CPG for the marketing of homeopathic drug products do not apply to "LoPain AF 15% Ibuprofen Creme."
You should take prompt action to correct the violations cited in this letter. Failure to promptly correct these violations may result in legal action without further notice, including, without limitation, seizure, and injunction. Other federal agencies may take this Warning Letter into account when considering the award of contracts.
Additionally, if another firm manufactures the product identified above, your reply should include the name and address of the manufacturer. If the firm from which you receive the products is not the manufacturer, please include the name of your supplier in addition to the manufacturer. Address your reply to the U.S. Food and Drug Administration, Florida District Office, 555 Winderley Place, Suite 200, Maitland, FL 32751. Attention: Matthew B. Thomaston, Compliance Officer.
1 We acknowledge that homeopathic drug products were excluded from the OTC drug review. 37 F.R. 9464,9466 (May 11,1972). However, as discussed below, the Food and Drug Administration (FDA) does not consider "LoPain AF 15% Ibuprofen Creme" to be a homeopathic drug product.
2 Although ibuprofen as an active ingredient was first approved by FDA in 1974, that approval was for use as an internal analgesic available by prescription only. Oral dosage forms of ibuprofen were first available OTC in 1984. We note that on August 21, 2002, FDA proposed to amend the TFM for OTC internal analgesic, antipyretic, and antirheumatic (IAAA) drug products to include ibuprofen as a generally recognized safe and effective analgesic/antipyretic active ingredient for OTC use. (67 Fed. Reg. 54139). However, the proposal to amend the IAAA TFM does not include the topical use of ibuprofen for any indication, nor does the IAAA TFM issued on November 16, 1988 (53 Fed. Reg. 46204) include arnica montana as an active ingredient.

References: § 321
 § 321
 § 321
 § 321
 § 352
 § 360
 § 3600