FrancophonIA/ELRC3.0 huggingface dataset:
English: According to the EU guideline on the implementation of the outcome of a PSUR WS procedure, the 29 EU countries have submitted, within a 4 month timeframe after the release of the CSP, a variation to implement the agreed CSP.
Slovenian: V skladu s smernicami EU o izvajanju dogovorov, sprejetih v okviru postopka delitve dela pri oceni PSUR, je 29 držav EU v 4 mesecih po objavi CSP predložilo spremembe, potrebne za izvajanje dogovorjenega CSP.
English: • Rheumatoid arthritis (RA)
Slovenian: • Revmatoidni artritis (RA)
English: At the time of the submission of the oil-based formulation of ciclosporin, Sandimmun, in 1987, a comprehensive clinical data summary on endogenous uveitis was available (Nussenblatt 1987).
Slovenian: V času predložitve pripravka ciklosporina na oljni osnovi, zdravila Sandimmun leta 1987, je bil na voljo izčrpen povzetek kliničnih podatkov o endogenem uveitisu (Nussenblatt 1987).
English: Pediatric data from controlled and uncontrolled studies were also provided.
Slovenian: Predloženi so bili tudi podatki iz nadzorovanih in nenadzorovanih študij pri pediatričnih bolnikih.
English: Renal dysfunction above the critical threshold, defined as creatinine increased by 3050% over baseline, was less of a problem when starting with a dose of 2.5 mg/kg/day.
Slovenian: Ledvična disfunkcija nad kritično mejno vrednostjo, tj. ko je kreatinin povišan za 30-50 % glede na izhodišče, je bila manj kritična, kadar so zdravljenje začeli z odmerkom 2,5 mg/kg/dan.
English: The registration of Sandimmun Neoral was based on efficacy and safety data from clinical studies performed with the oilbased formulation (Sandimmun), first registered in Switzerland in December 1982.
Slovenian: Registracija zdravila Sandimmun Neoral je temeljila na podatkih o učinkovitosti in varnosti iz kliničnih študij, izvedenih s pripravkom na oljni osnovi (Sandimmun), ki je bil prvič registriran decembra 1982 v Švici.
English: Posology:
Slovenian: Ob upoštevanju:
English: In addition, the CHMP considered that substrates for CYP3A4 and/or P-gp and for which elevated plasma levels are associated with serious safety concerns should not be combined with ciclosporin (e.g. dabigatran etexilate, bosentan, aliskiren).
Slovenian: Poleg tega je CHMP menil, da se substrati CYP3A4 in/ali P-glikoproteina, katerih zvišane plazemske koncentracije so povezane z resnimi varnostnimi tveganji, ne smejo uporabljati v kombinaciji s ciklosporinom (npr. dabigatran eteksilat, bosentan, aliskiren).
English: • Atopic dermatitis
Slovenian: • Atopijski dermatitis
English: In parallel of these 9 performed studies, 2 double-blind placebo controlled multicenter studies and 1 multicenter study comparing ciclosporin with cyclophosphamide in steroidresistant patients had to be stopped prematurely because of a lack of suitable patients consenting to receive placebo or a cytostatic agent.
Slovenian: Vzporedno s temi 9 študijami sta potekali še 2 dvojno slepi, s placebom nadzorovani multicentrični študiji in 1 multicentrična študija, v katerih so ciklosporin primerjali s ciklofosfamidom pri bolnikih, odpornih proti steroidnim zdravilom, vendar so jih morali predčasno prekiniti zaradi premajhnega števila primernih bolnikov, ki bi privolili v zdravljenje s placebom ali citostatiki.
English: • Nephrotic syndrome (NS)
Slovenian: • Nefrotski sindrom (NS)
English: • Aplastic Anemia
Slovenian: • Aplastična anemija
English: The rationale given by the MAH for the proposed indication was based on the following data: the initial pilot study in active rheumatoid arthritis used a dose of 10 mg/kg/day, half the dose used in solid organ transplantation at that time.
Slovenian: Utemeljitev, ki jo je imetnik dovoljenja za promet z zdravilom podal za predlagano indikacijo, je temeljila na naslednjih podatkih: v prvotni poskusni študiji pri bolnikih z aktivno obliko revmatoidnega artritisa so uporabili odmerek 10 mg/kg/dan, kar je polovica odmerka, ki se je takrat uporabljal pri presaditvah parenhimskih organov.
English: The MAH therefore agreed to revise the wording, recommending that Sandimmun Neoral should be administered on a consistent schedule with regard to time of day and relation to meals, as follows: “The daily doses of Sandimmun/Sandimmun Neoral always should be given in two divided doses equally distributed throughout the day, taken at the same time of the day, e.g., in the morning and in the evening.
Slovenian: Imetnik dovoljenja za promet z zdravilom se je zato strinjal s spremembo besedila in priporočil jemanje zdravila Sandimmun Neoral po ustaljenem urniku glede na čas dneva in obroke hrane, kot sledi: „Dnevne odmerke zdravila Sandimmun/Sandimmun Neoral je treba vedno dati v dveh deljenih odmerkih, enakomerno porazdeljenih čez dan, ki jih je treba vzeti ob istem času, na primer zjutraj in zvečer.
English: The CHMP is of the opinion that the available data confirms the use of ciclosporin in the following indication: “Treatment of severe, active rheumatoid arthritis.”
Slovenian: CHMP je menil, da razpoložljivi podatki potrjujejo upravičenost uporabe ciklosporina pri naslednji indikaciji: „Zdravljenje hudega aktivnega revmatoidnega artritisa. "
English: The CHMP is of the view that the indication should be limited to primary glomerulonephritis cases as specified above.
Slovenian: CHMP je menil, da bi morala biti indikacija omejena na omenjene primere primarnega glomerulonefritisa.
English: However the CHMP had concerns over the fact that current indication was too broad as use in secondary glomerulonephritis is controversial.
Slovenian: Kljub temu je CHMP izrazil zadržke v zvezi z dejstvom, da je trenutna indikacija preširoka, saj je uporaba zdravila pri sekundarnem glomerulonefritisu sporna.
English: However the statement “The daily doses of Neoral should always be given in two divided doses” was partly endorsed by the CHMP since the word “always” should be omitted (in some cases, three times daily administration may be needed).
Slovenian: Stavek „dnevne odmerke zdravila Sandimmun Neoral je treba vedno dati v dveh deljenih odmerkih“ pa je CHMP odobril le delno, saj bi bilo treba besedo „vedno“ izpustiti (v nekaterih primerih je namreč potrebno odmerjanje trikrat na dan).
English: As stated above, the MAH proposed a following wording for the above-mentioned paragraph based on the wordings used in the CDS and CSP.
Slovenian: V skladu z navedenim zgoraj je imetnik dovoljenja za promet z zdravilom za zgoraj omenjeni odstavek predlagal naslednje besedilo na podlagi besedil, uporabljenih v CDS in CSP.
English: However the CHMP considered that this paragraph should be complemented with recommendations for further controls to be made, e.g. of liver function, bilirubin, serum electrolytes and blood pressure and that it is preferred to use glomerular filtration rate determined by a reliable and reproducible method rather than serum creatinine.
Slovenian: Vendar pa je menil, da je treba ta odstavek dopolniti s priporočili za opravljanje dodatnih preverjanj, npr. delovanja jeter, bilirubina, elektrolitov v serumu in krvnega tlaka, ter z opombo, da je bolje uporabiti hitrost glomerulne filtracije, določeno z zanesljivo in ponovljivo metodo, kot serumsko koncentracijo kreatinina.
English: Other changes were also introduced including several proposed downgraded positions; justifications were requested by the CHMP and provided by the MAH subsequently.
Slovenian: Vključili so tudi nekatere druge spremembe, vključno z več predlogi za nižjo razvrstitev; CHMP je zahteval utemeljitev, ki jo je imetnik dovoljenja za promet kasneje tudi podal.
English: European controlled double-blind trials used 5 mg/kg/d that allowed a downward titration to find the maximum tolerated dose.
Slovenian: V evropskih nadzorovanih dvojno slepih preskušanjih so uporabili odmerek 5 mg/kg/dan, ki so ga lahko postopoma zmanjševali do največjega tolerančnega odmerka.
English: ciclosporin has been extensively studied in several clinical trials in patients with rheumatoid arthritis in whom conventional therapy is ineffective or inappropriate, as well as in many published studies reporting the use of ciclosporin in this indication.
Slovenian: Ciklosporin so obsežno raziskali v več kliničnih preskušanjih pri bolnikih z revmatoidnim artritisom, pri katerih običajna zdravila niso bila učinkovita ali primerna, in v številnih objavljenih študijah, v katerih so poročali o uporabi ciklosporina pri tej indikaciji.
English: The CHMP requested the MAH to compile all available data on switch to ciclosporin in case of rejection with any other immunosuppressive agent, not only tacrolimus.
Slovenian: CHMP je zahteval, da imetnik dovoljenja za promet z zdravilom zbere vse razpoložljive podatke o prehodu na ciklosporin v primeru zavrnitve pri uporabi katerega koli drugega imunosupresiva, ne samo takrolimusa.
English: Due to the divergent national decisions taken by Member States (MS) concerning the authorization of Sandimmun Neoral (and associated names), the European Commission (EC) notified the EMA/CHMP secretariat of an official referral under Article 30(2) of Directive 2001/83/EC as amended, to resolve divergences amongst the nationally authorised Sandimmun Neoral SmPCs across the EU/EEA region.
Slovenian: Zaradi različnih odločitev, ki so jih države članice sprejele na nacionalni ravni v zvezi z odobritvijo zdravila Sandimmun Neoral (in povezanih imen), je Evropska komisija obvestila sekretariat agencije EMA/odbora CHMP o uradni napotitvi po členu 30(2) Direktive 2001/83/ES z vsemi spremembami za odpravo neskladij med povzetki glavnih značilnosti zdravila Sandimmun Neoral, odobrenimi na nacionalni ravni na območju EU/EGP.
English: This approach was acceptable to the CHMP and final wordings in sections 4.2 and 4.4.were agreed accordingly.
Slovenian: CHMP se je s tem strinjal, zato je bilo besedilo poglavij 4.2 in 4.4 ustrezno usklajeno.
English: Ciclosporin has been studied in several clinical trials in atopic dermatitis, although the studies by modern standards are considered small.
Slovenian: Ciklosporin so raziskali v več kliničnih preskušanjih pri bolnikih z atopijskim dermatitisom, vendar pa je študij po sodobnih standardih malo.
English: The MAH proposed the following wording for this indication: “Sandimmun Neoral is indicated in patients with severe atopic dermatitis when systemic therapy is required.” The MAH's proposed indication wording for the Atopic dermatis is approved in 15 EU countries.
Slovenian: Imetnik dovoljenja za promet z zdravilom je za to indikacijo predlagal naslednje besedilo: „Zdravilo Sandimmun Neoral je indicirano pri bolnikih s hudim atopijskim dermatitisom, ki potrebujejo sistemsko zdravljenje.“ Besedilo za indikacijo atopijski dermatitis, ki ga je predlagal imetnik dovoljenja za promet z zdravilom, je odobreno v 15 državah EU.
English: The MAH presented respectively the clinical efficacy outcome of the US and Canada studies and then the European studies.
Slovenian: Imetnik dovoljenja za promet z zdravilom je predložil podatke o klinični učinkovitosti iz študij v Združenih državah in Kanadi ter nato še iz evropskih študij.
English: The MAH agreed to include the above mentioned contraindication.
Slovenian: Imetnik dovoljenja za promet z zdravilom se je strinjal z vključitvijo zgoraj omenjenih kontraindikacij.
English: In addition, Sandimmun Neoral produces a more uniform exposure to ciclosporin throughout the day and from day to day on a maintenance regimen.
Slovenian: Poleg tega zdravilo Sandimmun Neoral zagotavlja enakomernejšo izpostavljenost ciklosporinu čez dan in od enega do drugega dneva pri vzdrževalnem zdravljenju.
English: The MAH agreed with the CHMP that no specific organ transplantations should be mentioned in section 4.1 unless not appropriate to use.
Slovenian: Imetnik dovoljenja za promet z zdravilom se je strinjal z odborom CHMP, da v poglavju 4.1 ne bi smeli posebej opredeliti presaditve organov, razen kjer uporaba zdravila ni primerna.
English: The agreed Core Safety profile (CSP) from the last PSUR 13 work sharing procedure (EE/H/PSUR/0007/001) and the public AR from the paediatric article 45 procedure (CZ/W/04/pdWS/01, 2010) were also used.
Slovenian: Prav tako je uporabil dokument „Ključne informacije o varnostnem profilu zdravila" (Core Safety Profile - CSP), odobren v okviru zadnjega postopka delitve dela pri oceni PSUR 13 (EE/H/PSUR/0007/001), in poročilo o oceni zdravila iz postopka delitve dela za uporabo zdravil v pediatriji po členu 45 (CZ/W/04/pdWS/01, 2010).
English: Grounds for amendment of the summary of product characteristics, labelling and package leaflet
Slovenian: Podlaga za spremembo povzetka glavnih značilnosti zdravila, označevanja in navodila za uporabo
English: However, since the studies in the original Sandimmun dossier are old and the posology based on those data is therefore obsolete in comparison with the different transplantation regimens used today, the CHMP was of the view that the dosage should also be guided by monitoring of ciclosporin blood levels.
Slovenian: Ker pa so študije v prvotni dokumentaciji zdravila Sandimmun stare in ker je odmerjanje na podlagi teh podatkov zastarelo ob upoštevanju različnih načinov presaditve, ki se uporabljajo danes, je CHMP menil, da je treba pri določanju odmerkov upoštevati tudi koncentracije ciklosporina v krvi.
English: The Psoriasis is an approved therapeutic indication in all EU countries.
Slovenian: Psoriaza je terapevtska indikacija, ki je odobrena v vseh državah EU.
English: Section 5.3 - Preclinical Safety Data
Slovenian: Poglavje 5.3 - Predklinični podatki o varnosti
English: In comparison to Sandimmun (oil-based formulation of ciclosporin), Sandimmun Neoral (microemulsified formulation) provides improved dose linearity of ciclosporin exposure, a more consistent absorption profile and shows less influence from concomitant food intake and from diurnal rhythm.
Slovenian: V primerjavi z zdravilom Sandimmun (pripravkom ciklosporina na oljni osnovi) zdravilo Sandimmun Neoral (pripravek v obliki mikroemulzije) zagotavlja boljše linearno razmerje med odmerkom in izpostavljenostjo ciklosporinu ter doslednejši profil absorpcije in kaže manjšo dovzetnost za vpliv sočasnih obrokov hrane in dnevnega ritma.
English: The MAH discussed the need of a contraindication of statins for cyclosporin and the need of further contraindications for other medicinal products/herbals.
Slovenian: Imetnik dovoljenja za promet z zdravilom je preučil potrebo po kontraindikaciji statinov za ciklosporin in po dodatnih kontraindikacijah za druga zdravila/zelišča.
English: The MAH proposed wordings for the sub-sections “Food interactions, Drug interactions, Drugs that decrease ciclosporin levels, Drugs that increase ciclosporin levels, Other relevant drug interactions, Recommendations, Paediatric population and Other relevant drug interactions.”
Slovenian: Imetnik dovoljenja za promet z zdravilom je predlagal besedila za podpoglavja „Medsebojno delovanje s hrano, Medsebojno delovanje z drugimi zdravili, Zdravila, ki znižujejo koncentracije ciklosporina, Zdravila, ki zvišujejo koncentracije ciklosporina, Druge pomembne interakcije, Priporočila, Pediatrična populacija in Druge pomembne interakcije".
English: Given the fact that a harmonized label was agreed among the EU community in February 2011 through the PSUR 13 WS procedure, the MAH's position was to use the agreed CSP entirely (i.e. without any further changes).
Slovenian: Ker so se države EU v okviru postopka delitve dela pri oceni PSUR 13. februarja 2011 uspele dogovoriti o usklajenem besedilu, se je imetnik dovoljenja za promet z zdravilom odločil, da bo uporabil sprejeti CSP v celoti (tj. brez nadaljnjih sprememb).
English: General monitoring of posology.
Slovenian: Splošno spremljanje odmerjanja.
English: Furthermore, since ciclosporin from a non-clinical point of view is a well-known compound, the CHMP requested the MAH to delete the paragraph concerning clinical safety data on development of malignancy.
Slovenian: Poleg tega je zaradi dejstva, da je ciklosporin z nekliničnega vidika dobro znana spojina, zahteval, da imetnik dovoljenja za promet z zdravilom izbriše odstavek v zvezi s kliničnimi podatki o varnosti, ki se tičejo razvoja malignomov.
English: More specifically, considering data on ADRs frequencies in clinical trials the CHMP requested the MAH to state the reasons to set different frequencies comparing to the ones that have been calculated and thus, proposals were made with regards to some ADRs such as hyperglycaemia, headache, migraine, abdominal discomfort and gingival hyperplasia.
Slovenian: Natančneje je CHMP ob upoštevanju podatkov o pogostosti neželenih učinkov v kliničnih preskušanjih od imetnika dovoljenja za promet zahteval, da poda razloge za navedbo pogostosti, ki so drugačne od izračunanih, zato so bili podani predlogi v zvezi z nekaterimi neželenimi učinki, kot so hiperglikemija, glavobol, migrena, nelagodje v trebuhu in gingivalna hiperplazija.
English: • Bone marrow transplantation (BMT)
Slovenian: • Presaditev kostnega mozga (bone marrow transplantation - BMT)
English: Switching from Sandimmun to Sandimmun Neoral
Slovenian: Prehod z zdravila Sandimmun na zdravilo Sandimmun Neoral
English: In line with this agreement, the MAH did not include the indication of aplastic anemia in the harmonized label of Sandimmun and Sandimmun Neoral since this indication is approved in only one of 27 member states and is not listed in Sandimmun and Sandimmun Neoral CDSs.
Slovenian: V skladu s tem dogovorom imetnik dovoljenja za promet z zdravilom v usklajene informacije o zdravilih Sandimmun in Sandimmun Neoral ni vključil indikacije aplastična anemija, saj je ta odobrena samo v eni od 27 držav članic in ni navedena v krovnih dokumentih za zdravili Sandimmun in Sandimmun Neoral.
English: Ciclosporin is contraindicated for some HMG-CoA reductase inhibitors (statins) due to the CYP3A4 and/or Pgp inhibitory potential of ciclosporin.
Slovenian: Ciklosporin je kontraindiciran za nekatere zaviralce reduktaze HMG-CoA (statine) zaradi možnega zaviralnega učinka na CYP3A4 in/ali P-glikoprotein.
English: Overall, these properties result in lower within-patient variability in the pharmacokinetics of ciclosporin and a stronger correlation between trough concentrations and total exposure.
Slovenian: Na splošno te lastnosti povzročijo manjšo intraindividualno variabilnost farmakokinetičnih parametrov ciklosporina in tesnejšo povezavo med najnižjimi serumskimi koncentracijami in skupno izpostavljenostjo.
English: In their response the MAH confirmed that the data from these studies as well as extensive clinical experience are supportive of the indication “Prevention of graft rejection” for Ciclosporin.
Slovenian: Imetnik dovoljenja za promet z zdravilom je v odgovoru potrdil, da tako podatki iz teh študij kot tudi obsežne klinične izkušnje kažejo, da je indikacija „preprečevanje zavrnitve presadka" za ciklosporin upravičena.
English: The proposed wording was reviewed and agreed accordingly.
Slovenian: Predlagano besedilo je bilo ustrezno revidirano in usklajeno.
English: The MAH explained that shelf life periods were not harmonised and proposed to follow the safest approach to Sandimmun (to fix 36 months period) and the last reduced period for Sandimmun Neoral that is approved in EU countries via variation procedure.
Slovenian: Imetnik dovoljenja za promet z zdravilom je pojasnil, da roki uporabnosti niso bili usklajeni, in predlagal, da se za zdravilo Sandimmun izbere najvarnejša možnost (36 mesecev), za zdravilo Sandimmun Neoral pa zadnji skrajšani rok, ki je bil odobren v državah EU po postopku za spremembo.
English: In the European Union (EU), Sandimmum and Sandimmun Neoral are registered via national procedures.
Slovenian: Registracija zdravil Sandimmun in Sandimmun Neoral v Evropski uniji poteka po nacionalnih postopkih.
English: A harmonised wording was therefore agreed.
Slovenian: Nato so sprejeli usklajeno besedilo.
English: Section 6.4 - Special precautions for storage
Slovenian: Poglavje 6.4 - Posebna navodila za shranjevanje
English: In October 2010, Sandimmun Neoral was included in the list of products for Summary of Product Characteristics (SmPC) harmonization, requested by the CMD(h), in accordance with Article 30(2) of Directive 2001/83/EC, as amended.
Slovenian: Oktobra 2010 je bilo zdravilo Sandimmun Neoral vključeno na seznam zdravil za uskladitev povzetka glavnih značilnosti zdravila (SmPC), ki jo je zahtevala Usklajevalna skupina za postopek z medsebojnim priznavanjem in decentralizirani postopek - zdravila za uporabo v humani medicini (CMD(h)) v skladu s členom 30(2) Direktive 2001/83/ES z vsemi spremembami.
English: Although some patients experienced adverse reactions, mostly nephrotoxicity, hypertension and metabolic disorders, the CHMP noted that these adverse reactions are well known and could be managed in dose dependent manner.
Slovenian: Čeprav so pri nekaterih bolnikih opazili neželene učinke, zlasti nefrotoksičnost, hipertenzijo in prebavne motnje, je CHMP ugotovil, da so ti neželeni učinki že dobro znani in jih je mogoče obvladovati s prilagajanjem odmerka.
English: The wording proposed by the MAH is already approved in 24 countries and several other countries have very similar information.
Slovenian: Besedilo, ki ga je predlagal imetnik dovoljenja za promet z zdravilom, je odobreno v 24 državah in zelo podobno besedilom v več drugih državah.
English: In November 2011, a full review of the company label (CDSs for both products Sandimmun and Sandimmun Neoral) was initiated.
Slovenian: Novembra 2011 se je začel natančen pregled dokumentov družbe (krovnih dokumentov za zdravili Sandimmun in Sandimmun Neoral).
English: The studies presented at renewals of marketing authorization in EU were also screened and reviewed.
Slovenian: Poleg tega so preverili in pregledali tudi študije, predložene ob podaljšanjih dovoljenja za promet z zdravilom v EU.
English: The wording was reviewed accordingly.
Slovenian: Besedilo je bilo ustrezno revidirano.
English: The MAH confirmed that the storage conditions in the SmPCs of Sandimmun Neoral soft gelatin capsules and oral solutions are already aligned with the requirements set in the Guideline on Declaration of Storage Conditions (CPMP/QWP/609/96/Rev 2 dated 19 Nov 2007).
Slovenian: Imetnik dovoljenja za promet z zdravilom je potrdil, da so pogoji shranjevanja v povzetku glavnih značilnosti zdravila za zdravilo Sandimmun Neoral v obliki mehkih želatinastih kapsul in peroralne raztopine že usklajeni z zahtevami smernic za navajanje pogojev shranjevanja (CPMP/QWP/609/96/Rev 2 z dne 19. novembra 2007).
English: Sandimmun Neoral is a microemulsified formulation of ciclosporin.
Slovenian: Sandimmun Neoral je pripravek ciklosporina v obliki mikroemulzije.
English: Ciclosporin is also used in a variety of conditions that are known, or may be considered, to be of autoimmune origin (endogenous uveitis, nephrotic syndrome, rheumatoid arthritis, psoriasis and atopic dermatitis).
Slovenian: Poleg tega se ciklosporin uporablja tudi pri različnih boleznih, za katere je znano ali pa se lahko domneva, da so avtoimunske (endogeni uveitis, nefrotski sindrom, revmatoidni artritis, psoriaza in atopijski dermatitis).
English: The MAH considered that the information included in the proposed harmonized label provided relevant information to the prescribing physician to optimize patient management.
Slovenian: Imetnik dovoljenja za promet z zdravilom je menil, da informacije, vključene v predlagano usklajeno besedilo, vsebujejo pomembne podatke, ki omogočajo zdravnikom, ki predpisujejo zdravilo, da optimizirajo zdravljenje.
English: Whilst reviewing the MAH's proposal, in view of the SmPC guideline, the CHMP considered that the category “not known” should only be used in exceptional cases; the MAH was requested to adhere to the classification according to the CSP unless adequately justified.
Slovenian: Med pregledom predloga imetnika dovoljenja za promet z zdravilom je CHMP ob upoštevanju smernic o povzetkih glavnih značilnosti zdravila izrazil mnenje, da bi bilo treba kategorijo „ni znano“ uporabiti le v izjemnih primerih; imetnika dovoljenja za promet je pozval, naj upošteva razvrstitev v skladu s CSP, razen če so odstopanja primerno utemeljena.
English: Sections 4.3 - Contraindications
Slovenian: Poglavje 4.3 - Kontraindikacije