FrancophonIA/ELRC3.0 huggingface dataset:
English: Paracetamol is used in various pain types such as headache, migraine, dysmenorrhoea, sore throat, musculoskeletal pain, pain after dental procedures/tooth extraction, toothache and the pain of osteoarthritis and for fever.
Slovenian: Uporablja se pri različnih vrstah bolečine, kot so glavobol, migrena, dismenoreja, boleče grlo, kostno-mišične bolečine, bolečine po posegu na zobeh/izdrtju zoba, zobobol in bolečine zaradi osteoartritisa, ter pri povišani telesni temperaturi.
English: The measures to improve the awareness on the risk of overdose (educational material, product information, labelling, DHPC) was not considered effective to prevent case of overdose, especially when intentional, as information to the patients and healthcare professionals is already extensive.
Slovenian: Ukrep izboljšanja zavedanja o tveganju prevelikega odmerjanja (izobraževalno gradivo, informacije o zdravilu, označevanje, neposredno obvestilo za zdravstvene delavce) ni bil ocenjen kot učinkovit pri preprečevanju prevelikega odmerjanja, zlasti namernega, saj so informacije za bolnike in zdravstvene delavce že zdaj obširne.
English: In this regard, the MAHs proposal to gain further experience on this proposed revised protocol by the means of a post-authorisation safety study was not endorsed.
Slovenian: Zato predlog imetnikov dovoljenj za promet z zdravilom, da bi dodatne izkušnje glede tega predlaganega pregledanega protokola pridobili s pomočjo študije varnosti po pridobitvi dovoljenja za promet z zdravilom ni bil sprejet.
English: The PRAC also considered, notwithstanding the feasibility and effectiveness concerns, that the shortcomings of such measures would not be proportionate, notably considering the modest benefits of these medicinal products.
Slovenian: Odbor PRAC je menil tudi, da ne glede na pomisleke o izvedljivosti in učinkovitosti pomanjkljivosti tovrstnih ukrepov ne bi bile sorazmerne, zlasti glede zmernih koristi teh zdravil.
English: Late crossing of the standard treatment nomogram were seen in 19% of the cases.
Slovenian: Pri 19 % primerov so opazili pozno prečkanje črte nomograma za standardno zdravljenje.
English: With regards to the small pack sizes, whilst these could have been an efficient measure to restrict availability, this would not be adequate for medicinal products mainly relevant in a chronic pain setting.
Slovenian: Kar zadeva majhne velikosti pakiranja, bi te sicer lahko bile učinkovit ukrep za omejitev razpoložljivosti, kar pa ne bi bilo primerno za zdravila, ki so večinoma pomembna pri kronični bolečini.
English: It was also noted that the FDA has recognised the dangers of the prescription combination of paracetamol and opioids and, in January 2014 implemented a fixed amount of paracetamol approved per dosage unit of combination.
Slovenian: Poudarjeno je bilo tudi, da je agencija ZDA za zdravila in prehrano (FDA) ugotovila nevarnosti kombinacije paracetamola in opioidov na recept ter je januarja 2014 uvedla točno določeno količino paracetamola, ki je odobrena na odmerno enoto kombinacije.
English: If the patient presents to emergency medical care in time following an overdose, there is an effective antidote available - N-acetylcysteine (NAC).
Slovenian: Če bolnik, po tem ko je vzel prevelik odmerek, pride na urgenco še pravočasno, obstaja učinkovit protistrup - N-acetilcistein (NAC).
English: Data published by the Swedish Poison Centre described a series of 53 patients with reported overdose with paracetamol 665mg MR (range 10-166 g).
Slovenian: Podatki, ki jih je objavil švedski center za zastrupitve, navajajo, da so pri 53 bolnikih poročali o prevelikem odmerjanju s paracetamolom 665 mg s prirejenim sproščanjem (razpon 10-166 g).
English: The main safety concern with paracetamol is hepatic toxicity following intake of high, supratherapeutic doses, which can be fatal unless adequately treated.
Slovenian: Glavni pomislek glede varnosti pri paracetamolu je toksičnost za jetra po vnosu velikih, supraterapevtskih odmerkov, ki so lahko smrtni, če se ne zdravijo ustrezno.
English: These include products with paracetamol as a single ingredient; namely modified release (MR) tablets containing 500 mg, 665 mg or 1000 mg paracetamol, and paracetamol 500 mg prolonged release tablet.
Slovenian: Mednje spadajo zdravila s paracetamolom kot edino učinkovino, in sicer tablete s prirejenim sproščanjem, ki vsebujejo 500 mg, 665 mg ali 1000 mg paracetamola, in tablete s podaljšanim sproščanjem s 500 mg paracetamola.
English: Overall, the measures proposed were considered neither sufficient nor appropriate to adequately minimise the risk of intentional and unintentional overdose.
Slovenian: Na splošno so bili predlagani ukrepi ocenjeni kot nezadostni in neprimerni za ustrezno zmanjšanje tveganja za namerno in nenamerno preveliko odmerjanje.
English: The PRAC also considered that the above proposals would have a questionable feasibility and effectiveness and would not effectively address the risk of hepatotoxicity following intentional or accidental overdose.
Slovenian: Odbor PRAC je menil tudi, da imajo zgornji predlogi vprašljivo izvedljivost in učinkovitost ter da ne bi učinkovito obravnavali tveganja za hepatotoksičnost po namernem ali nenamernem prevelikem odmerjanju.
English: Further, the feasibility of determining and implementing effective measures across EU Member States is questioned, due to the complexity of managing two specific protocols, a close monitoring (increased blood sampling) and the complexity due to the uncertainty on the ingested formulation that is prejudicial to the patient in view of the risk of not using an effective protocol and the safety concern related to the unnecessary administration of NAC.
Slovenian: Tudi izvedljivost ugotavljanja in uvajanja učinkovitih ukrepov v vseh državah članicah EU je vprašljivo, in sicer zaradi zapletenosti vodenja dveh posebnih protokolov, skrbnega spremljanja (večkratnih odvzemov krvi) in zapletenosti, ki je posledica negotovosti glede zaužitega formulacije, ki je bistvenega pomena za bolnika v smislu tveganja, da ne bo uporabljen učinkovit protokol, ter varnostnih pomislekov, povezanih z nepotrebnim dajanjem NAC.
English: Seven of the eleven patients with an ALT above the reference range were treated with NAC within 8 h of ingestion, of which three developed hepatotoxicity.
Slovenian: Sedem od enajstih bolnikov z vrednostjo ALT nad referenčnim razponom so z NAC zdravili v osmih urah po zaužitju, hepatotoksičnost pa se je pojavila pri treh.
English: On 30 June 2016, Sweden triggered a procedure under Article 31 of Directive 2001/83/EC, and asked the PRAC to assess the impact of the above concerns on the benefit-risk balance of products with modified or prolonged release properties containing paracetamol and issue a recommendation on whether the marketing authorisation(s) of these products should be maintained, varied, suspended or revoked.
Slovenian: Švedska je 30. junija 2016 sprožila postopek v skladu s členom 31 Direktive 2001/83/ES in odbor PRAC zaprosila, naj oceni vpliv zgornjih pomislekov na razmerje med tveganji in koristmi zdravil s prirejenim ali podaljšanim sproščanjem, ki vsebujejo paracetamol, ter izda priporočilo, ali naj se dovoljenje(-a) za promet z zdravilom ohrani(-jo), spremeni(-jo), začasno umakne(-jo) ali prekliče(-jo).
English: All these uncertainties and the identified disadvantages for patients having taken a paracetamol overdose, seriously question the feasibility and reliability in the recommendations proposed by the MAHs.
Slovenian: Vse navedene negotovosti in prepoznane slabosti pri bolnikih, ki vzamejo prevelik odmerek paracetamola, resno postavljajo pod vprašaj izvedljivost in zanesljivost priporočil, ki sta jih predlagala imetnika dovoljenj za promet z zdravilom.
English: Paracetamol is the most commonly reported toxic ingestion of a medical substance in the UK and some other EEA countries (e.g. Sweden) and is the most common medicinal agent of intentional self-harm.
Slovenian: Paracetamol je učinkovina, za katero v Združenem kraljestvu in nekaterih drugih državah EGP (npr. na Švedskem) najpogosteje poročajo o toksičnem zaužitju, in je najpogostejša učinkovina za namerno samopoškodovanje.
English: Due to the difference in the severity of conditions, there is a possibility of difference in the risk of suicidality between these two populations of patients using this fixed-dose combination with tramadol versus the MR paracetamol as monocomponent.
Slovenian: Zaradi razlike v resnosti stanj obstaja možnost razlike v tveganju za samomorilnost med tema dvema populacijama bolnikov, ki uporabljata kombinacijo s fiksnim odmerkom s tramadolom v primerjavi z monokomponentnim paracetamolom s prirejenim sproščanjem.
English: The shortcomings of Rumack-Matthew nomogram have already been identified thus leading to different treatment protocols in case of co-ingestion of other products (particularly those who affect gastric motility) or in cases when no information can be obtained from the patients (e.g. time of ingestion is unknown).
Slovenian: Pomanjkljivosti Rumack-Matthewovega nomograma so že bile prepoznane, zato že obstajajo nadomestni protokoli zdravljenja za primere sočasnega zaužitja drugih zdravil (zlasti tistih, ki vplivajo na želodčno gibljivost) ali primere, kadar od bolnikov ni mogoče pridobiti nobenih informacij (npr. neznan čas zaužitja).
English: It is acknowledged by PRAC that MR formulation may provide adequate control of pain and fewer dosing decreases the possibility for medication errors and improves patients' compliance.
Slovenian: Odbor PRAC je priznal, da formulacija s prirejenim sproščanjem lahko zagotovi ustrezen nadzor nad bolečino, manjše število odmerjanj pa zmanjšuje možnost za napake pri jemanju zdravila in izboljšuje bolnikovo sodelovanje pri zdravljenju.
English: Most countries have adopted guidelines which rely on a nomogram to establish whether the patient should be treated with NAC or not, relating the serum paracetamol concentration to the number of hours between ingestion and the blood test.
Slovenian: V večini držav so sprejeli smernice, ki pri ugotavljanju, ali je treba bolnika zdraviti z NAC ali ne, temeljijo na nomogramu, pri katerem so koncentracije paracetamola v serumu povezane s številom ur, ki so pretekle med zaužitjem in krvno preiskavo.
English: This included the responses submitted by the marketing authorisation holders (MAHs) in writing and during oral explanations, the grounds for the re-examination as submitted by the two concerned MAHs, as well as the advice from the two groups of experts in the management of poisoning, pain management and pharmacokinetics, published studies and spontaneous reports of overdose.
Slovenian: To je vključevalo odgovore, ki sta jih pisno in med ustno obrazložitvijo predložila imetnika dovoljenj za promet z zdravilom, razloge za ponovno proučitev, kot sta jih predložila zadevna imetnika dovoljenj za promet z zdravilom, ter nasvet dveh skupin strokovnjakov za zdravljenje zastrupitve, obvladovanje bolečine in farmakokinetiko, objavljene študije in spontana poročila o prevelikem odmerjanju.
English: This translates into different PK profiles also at overdoses which is supported by available data including published case series.
Slovenian: To pomeni, da so farmakokinetični profili tudi pri prevelikem odmerjanju drugačni, kar podpirajo razpoložljivi podatki, vključno z objavljenim nizom primerov.
English: The authors also suggest a negligible risk from modest increases in NAC dose in those with a high paracetamol ratio.
Slovenian: Avtorji navajajo tudi zanemarljivo tveganje zaradi zmernega povečanje odmerka NAC pri bolnikih z visokim razmerjem paracetamola.
English: Based on available data, the PRAC did not identify in the authorised indications any substantial clinical benefit which would be only specific to the MR formulation.
Slovenian: Na podlagi razpoložljivih podatkov odbor PRAC pri odobrenih indikacijah ni ugotovil nobene bistvene klinične koristi, ki bi bila posebna samo za formulacijo s prirejenim sproščanjem.
English: • The PRAC reviewed all the available data submitted with regard to overdose of the paracetamol containing MR products, including intentional and accidental overdose.
Slovenian: • odbor PRAC je pregledal vse razpoložljive podatke, predložene v povezavi s prevelikim odmerjanjem zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem, vključno z namernim in nenamernim prevelikim odmerjanjem.
English: The Rumack-Matthew nomogram was developed for single overdose with precise time of ingestion and cannot accurately assess risk after repeated overdoses, acute overdose of a sustained-release product, or when the time of ingestion is unknown or patients present beyond 24 hours.
Slovenian: Rumack-Matthewov nomogram je bil razvit za enkraten prevelik odmerek, z natančno znanim časom zaužitja, in ne more točno oceniti tveganja po večkratnih prevelikih odmerkih, po akutnem prevelikem odmerku zdravila s podaljšanim sproščanjem ali kadar je čas zaužitja neznan ali bolnik pride na urgenco po več kot 24 urah.
English: Tramadol/paracetamol MR tablets are indicated for treatment of moderate and severe pain conditions.
Slovenian: Tablete s tramadolom/paracetamolom s prirejenim sproščanjem so indicirane za zdravljenje zmernih in hudih bolečinskih stanj.
English: • The PRAC noted that the efficacy of MR paracetamol, as a single ingredient or in combination with tramadol, has been documented in representative acute and chronic pain models, and that the benefits of paracetamol as well as tramadol in general, are well established.
Slovenian: • odbor PRAC je ugotovil, da je bila učinkovitost paracetamola s prirejenim sproščanjem kot edino učinkovino ali v kombinaciji s tramadolom dokumentirana pri reprezentativnih modelih akutne in kronične bolečine ter da so koristi paracetamola in tramadola na splošno dobro uveljavljene.
English: Having considered the detailed grounds submitted by the MAH, the PRAC confirmed its previous position that the evidence of clinical advantage of monocomponent MR paracetamol in chronic pain is very weak.
Slovenian: Po proučitvi podrobno opisanih razlogov, ki jih je predložil imetnik dovoljenja za promet z zdravilom, je odbor PRAC potrdil svoje predhodno stališče, da so dokazi o klinični prednosti monokomponentnega paracetamola s prirejenim sproščanjem pri kronični bolečini zelo slabi.
English: During the procedure, all MAHs have recommended as part of the risk minimisation strategy that in case of poisoning the emergency medical services should promptly contact the national Poison Centres.
Slovenian: Med postopkom so vsi imetniki dovoljenj za promet z zdravilom kot del strategije zmanjševanja tveganja priporočili, da naj se nujna medicinska pomoč v primeru zastrupitve takoj obrne na nacionalni center za zastrupitve.
English: Therefore PRAC considers that in view of the sample size needed for the model to be sufficiently powered to address the current uncertainties, such mechanistic model could not be developed in a reasonable timeframe and patients would still be exposed to the risk of overdose with paracetamol MR.
Slovenian: Zato odbor PRAC meni, da glede na velikost vzorca, ki bi bila potrebna za moč modela, da bi ta zadoščal za obravnavo trenutnih negotovosti, takega mehanicističnega modela ni mogoče razviti v razumnem časovnem okviru in da bi bili bolniki še vedno izpostavljeni tveganju za preveliko odmerjanje paracetamola s prirejenim sproščanjem.
English: From the literature review two publications were the most relevant where Lasko and colleagues (2012) investigated the efficacy of MR tramadol/paracetamol formulation for acute low back pain, while Lee and colleagues (2013) for chronic low back pain.
Slovenian: Med pregledom literature sta bili najpomembnejši dve objavi, in sicer so Lasko in sodelavci (2012) proučevali učinkovitost formulacije s tramadolom/paracetamolom s prirejenim sproščanjem pri akutni bolečini v križu, Lee in sodelavci (2013) pa pri kronični bolečini v križu.
English: • The PRAC also considered the proposed risk minimisation measures to reduce the risk of overdose through education, communication and restricting availability and concluded that these measures would not be sufficient to minimise the risk of intentional and accidental overdoses to an acceptable level.
Slovenian: • odbor PRAC je obravnaval tudi predlagane ukrepe za zmanjšanje tveganja za preveliko odmerjanje, ki vključujejo izobraževanje, sporočanje in omejitev razpoložljivosti, ter zaključil, da ti ukrepi ne bi zadoščali za zmanjšanje tveganja za namerno in nenamerno preveliko odmerjanje na sprejemljivo raven.
English: Both the absorption duration and the terminal halflive were prolonged in the poisoned patients, sometimes resulting in double peaks.
Slovenian: Pri zastrupljenih bolnikih je prišlo do podaljšanega trajanja absorpcije in končne razpolovne dobe, včasih z dvojnimi vrhovi.
English: The PRAC was in agreement with the ad-hoc expert group views.
Slovenian: Odbor PRAC se je strinjal s stališči priložnostne strokovne skupine.
English: The PRAC assessed the proposed risk minimisation measures during the re-examination phase, and concluded that there are uncertainties regarding their feasibility and their effectiveness, in particular with regards to revised treatment protocols for MR overdoses across the EU, and the potential harms to patients who would be unnecessarily overexposed to NAC.
Slovenian: Odbor PRAC je med ponovno proučitvijo ocenil predlagane ukrepe za zmanjšanje tveganja in zaključil, da obstajajo negotovosti glede njihove izvedljivosti in učinkovitosti, zlasti glede pregledanih protokolov zdravljenja prevelikega odmerjanja formulacij s prirejenim sproščanjem v vsej EU in morebitnih škodljivih posledic za bolnike, ki bi bili po nepotrebnem čezmerno izpostavljeni NAC.
English: Protocol based on a systematic treatment with NAC would also lead to a number of patients unnecessarily being treated or over-treated with NAC which is not proportionate and acceptable in view of the adverse reactions cutaneous like rash, itching, flushing and gastrointestinal like nausea, vomiting) associated with treatment with NAC.
Slovenian: Protokol na podlagi sistematskega zdravljenja z NAC bi privedel do številnih primerov bolnikov, ki bi se po nepotrebnem ali čezmerno zdravili z NAC, kar ni sorazmerno in sprejemljivo glede na neželene učinke na kožo, kot so izpuščaj, srbenje, vročinski oblivi, in na prebavila, kot sta navzeja in bruhanje, povezane z zdravljenjem z NAC.
English: The vast majority of the serious cases reported with paracetamol MR formulation happened in overdoses with more than 30 g of paracetamol (considered a massive overdose by Marks et al, 2017).
Slovenian: Velika večina resnih primerov, o katerih so poročali pri formulacijah paracetamola s prirejenim sproščanje, se je zgodila pri prevelikem odmerjanju paracetamola v odmerkih, ki so presegali 30 g (kar Marks et al., 2017, obravnavajo kot znatno prevelik odmerek).
English: While no cases of overdose were reported in children below 12 years of age, the PRAC noted that the risk of unintentional overdose with Doreta SR is minimal in the patient population due to e.g. the restricted use in children, the child resistant package.
Slovenian: Pri otrocih, mlajših od 12 let, sicer niso poročali o primerih prevelikega odmerjanja, vendar je odbor PRAC opozoril, da je tveganje za nenamerno preveliko odmerjanje z zdravilom Doreta SR pri tej populaciji bolnikov zaradi npr. omejene uporabe pri otrocih in za otroke varnega pakiranja minimalno.
English: PRAC confirmed its position that in order to better characterise the risks and address uncertainties about management of overdoses, a larger sample size was needed for the model to be sufficiently powered and that such mechanistic model could not be developed in a reasonable timeframe.
Slovenian: Odbor PRAC je potrdil svoje stališče, da je za boljše opredelitev tveganj in obravnavo negotovosti pri zdravljenju prevelikega odmerjanja potrebna večja velikost vzorca, ki bi omogočila zadostno moč modela, ter da takšnega mehanicističnega modela ni mogoče razviti v razumnem časovnem okviru.
English: Therefore, pursuant to Article 116 of Directive 2001/83/EC, the CMDh recommends the suspension of the marketing authorisations for products containing paracetamol, modified and prolonged release.
Slovenian: Zato v skladu s členom 116 Direktive 2001/83/ES priporoča začasen umik dovoljenj za promet z zdravili, ki vsebujejo paracetamol s prirejenim in podaljšanim sproščanjem.
English: In addition, publications describing case series of overdose with modified-release paracetamol from Australia, such as Graudins and colleagues (2010, 2014) have been assessed as providing experience on the treatment protocol with NAC and supportive information regarding PK of paracetamol in cases of overdose with MR formulation.
Slovenian: Poleg tega so bili objavljeni nizi objav primerov prevelikega odmerjanja paracetamola s prirejenim sproščanjem iz Avstralije, npr. Graudins in sodelavci (2010, 2014), ki po oceni zagotavljajo izkušnje o protokolu zdravljenja z NAC in podporne informacije glede farmakokinetike paracetamola v primerih prevelikega odmerjanja formulacije s prirejenim sproščanjem.
English: In cases where ingested dose is unknown or time of ingestion is unknown or different substances were taken, treatment with NAC is usually promptly started.
Slovenian: Kadar zaužiti odmerek ali čas zaužitja nista znana ali ko je bolnik zaužil več različnih učinkovin, se zdravljenje z NAC običajno uvede takoj.
English: However, the feasibility such a recommendation questioned and PRAC considered that it would not result in effective risk minimisation throughout the EU, since the operations of these Centres are different in the EU Member States.
Slovenian: Vendar pa je izvedljivost tovrstnega priporočila vprašljiva in odbor PRAC je presodil, da s tem ne bi učinkovito zmanjšala tveganja po vsej EU, saj se delovanje teh centrov med državami članicami EU razlikuje.
English: At the ad-hoc expert group meeting convened during the re-examination, experts concluded that the only patient groups that might benefit from the MR tramadol/paracetamol combination product are those affected by chronic pain and sleeping interruptions due to pain.
Slovenian: Na srečanju priložnostne strokovne skupine, sklicanem v okviru ponovne proučitve, so strokovnjaki zaključili, da so edini bolniki, ki bi utegnili imeti korist od kombiniranega zdravila s tramadolom/paracetamolom s prirejenim sproščanje, bolniki, ki trpijo zaradi kronične bolečine in motenega spanja zaradi bolečin.
English: In view of the above, it is considered that this risk is not outweighed by their benefits in the approved indications.
Slovenian: Glede na navedeno se ocenjuje, da koristi pri odobrenih indikacijah tega tveganja ne odtehtajo.
English: The absence of effective measures to sufficiently prevent the cases of overdoses and the uncertainties regarding feasibility and effectiveness of revised treatment protocols for MR overdoses across the EU, and the disadvantages they would cause for patients are serious concerns.
Slovenian: Odsotnost učinkovitih ukrepov za zadostno preprečevanje prevelikega odmerjanja in negotovosti glede izvedljivosti in učinkovitost revidiranih protokolov zdravljenja prevelikega odmerjanja formulacij s prirejenim sproščanjem v vsej EU ter slabosti, ki jih to prinaša za bolnike, predstavljajo resne pomisleke.
English: To address uncertainties in the management of overdose cases with the MR formulation of paracetamol, a mechanistic model would be required taking into account other relevant parameters (e.g. solubility of paracetamol, kinetics of the toxic metabolite (NAPQUI) and of NAC administered as antidote).
Slovenian: Za obravnavo negotovosti pri zdravljenju primerov prevelikega odmerjanja formulacije paracetamola s prirejenim sproščanjem bi bil potreben mehanicističen model, ki bi upošteval druge pomembne parametre (npr. topnost paracetamola, kinetiko toksičnega presnovka (NAPQUI) in NAC, danega kot protistrup).