FrancophonIA/ELRC3.0 huggingface dataset:
English: Dispose of the syringe in the puncture-proof container as instructed.
Croatian: 15. Štrcaljku prema uputama odložite u neprobojni spremnik.
English: to w.30
Croatian: 10. do 12. tjedan
English: In addition, a number of typographical and QRD-related changes were made.
Croatian: Nadalje, učinjen je niz tipografičkih izmjena i izmjena povezanih s QRD-om.
English: In particular the contraindication statements recommended by the PRAC were deleted from sections 5.1 (where proposed) and from section 4.4 for aliskiren, as these were already proposed in section 4.3 and therefore considered redundant.
Croatian: Posebice su obrisane izjave o kontraindikacijama preporučene od strane PRAC-a u dijelovima 5.1 (gdje je predloženo) i od dijela 4.4 za aliskiren, budući da je isto već predloženo u dijelu 4.3 i stoga se smatra suvišnim.
English: 2013 Jan 28;346:f360.
Croatian: BMJ. 2013 Jan 28;346:f360. doi: 10.1136/bmj.f360.
English: The renin-angiotensin system (RAS) is a hormone system that regulates blood pressure and fluid balance.
Croatian: Renin-angiotenski sustav (RAS) je hormonski sustav koji regulira omjer krvnog tlaka i tekućine.
English: Corresponding changes were made, where relevant, to the currently approved product information.
Croatian: Izvršene su odgovarajuće promjene, na mjestima gdje ej to bilo bitno, u odnosu na trenutno odobrene informacije.
English: The PRAC therefore concluded that the product information of all RAS-acting agents should be revised to reflect the identified risks and provide guidance to prescribers and patients.
Croatian: Stoga je PRAC zaključio da se informacije o proizvodu svih lijekova koji djeluju na RAS trebaju pregledati kako bi se prikazali identificirani rizici i pružile smjernice propisivačima i bolesnicima.
English: Having reviewed the PRAC recommendation, the CHMP agreed with the overall scientific conclusions and grounds for recommendation.
Croatian: Nakon pregleda preporuke izdane od strane PRAC-a, CHMP se suglasio sa cjelokupnim znanstvenim zaključcima i razlozima za preporuku.
English: RAS-acting agents include angiotensin-converting enzyme inhibitors (ACEinhibitors) such as benazepril, captopril, cilazapril, delapril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril, spirapril, trandolapril and zofenopril), angiotensin receptor blockers (ARBs) such as candesartan, telmisartan, valsartan, irbesartan, eprosartan, olmesartan, losartan and azilsartan and direct renin inhibitors such as aliskiren.
Croatian: Lijekovi koji djeluju na RAS uključuju inhibitore enzima, koji konvertiraju angiotenzin (inhibitore ACE-a) poput benazeprila, kaptoprila, cilazaprila, delaprila, enalaprila, fosinoprila, imidaprila, lisinoprila, moeksiprila, perindoprila, kvinaprila, ramiprila, spiraprial, trandolaprila i zofenoprila), blokatore receptora angiotenzina (ARB-ovi) poput kandesartana, telmisartana, valsartana, irbesartana, eprosartana, olmesartana, losartana i azilsartana, te izravne inhibitori renina, poput aliskirena.
English: 1 - Overall summary of the scientific evaluation by PRAC
Croatian: 1 - Cjelokupan sažetak znanstvene ocjene PRAC-a
English: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2012/02/news_detail_001446.jsp&mid=WC0b01ac058004d5c1
Croatian: 2 European Medicines Agency recommends new contraindications and warnings for aliskiren-containing medicines, http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2012/02/news_detail_001446.jsp&mid=WC 0b01ac058004d5c1
English: 3 ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial 4 Veterans Affairs Nephropathy in Diabetes 5 Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints
Croatian: Trial 4 Veterans Affairs Nephropathy in Diabetes 5 Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints
English: In particular, a number of trials in heart failure patients have shown that the addition of a second RASacting agent may reduce hospital admissions for heart failure in patients with heart failure, which is considered a meaningful clinical endpoint.
Croatian: Posebice, niz ispitivanja provedenih kod bolesnika sa srčanom insuficijencijom pokazala su da dodavanje drugog lijeka koji djeluje na RAS može smanjiti stopu prijema u bolnicu uslijed srčane insuficijencije u bolesnika sa srčanom insuficijencijom, što se smatra značajnom kliničkom završnom točkom.
English: Treatment should only occur under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure.
Croatian: Liječenje mora nastupiti samo pod specijalističkim nadzorom i predmetom je učestalog praćenja funkcije bubrega, elektrolita i krvnoga tlaka.
English: Having considered the new available evidence from the scientific literature and given the seriousness of the identified safety concerns, the Italian Medicines Agency (AIFA) decided to initiate a review under Article 31 of Council Directive 2001/83/EC on 17 April 2013, referring the matter to the Pharmacovigilance Risk Assessment Committee (PRAC) and requesting the PRAC to issue a recommendation on the benefit-risk of dual RAS blockade therapy through the combined use of ACEinhibitors, ARBs or aliskiren and whether any regulatory measures should be taken on the marketing authorisations of the products involved in this procedure.
Croatian: Uzimajući u obzir nove dostupne dokaze iz znanstvene literature i ozbiljnost identificiranih razloga za zabrinutost za sigurnu primjenu, Talijanska agencija za lijekove (AIFA) odlučila je pokrenuti pregled sukladno članku 31. Direktive Vijeća 2001/83/EZ dana 17. travnja 2013., upućujući predmet Povjerenstvu za ocjenu rizika na području farmakovigilancije (PRAC) i tražeći od PRAC-a da izda preporuku o omjeru koristi i rizika dualne terapije inhibicije RAS-a putem kombinirane primjene inhibitora ACE-a, ARB-ova ili aliskirena, te je li potrebno poduzeti bilo kakve regulatorne mjere u vezi s odobrenjima za stavljanje u promet lijeka uključenog u ovaj postupak.
English: The PRAC however clearly specified, based on data from the ONTARGET3 and VA NEPHRON-D4 studies that ACE-inhibitors and ARBs should not be used concomitantly in patients with diabetic nephropathy.
Croatian: No, PRAC je jasno naveo na temelju podataka dostupnih iz ispitivanja ONTARGET3 i VA NEPHRON-D4 da se inhibitori ACE-a i ARB-a ne smiju koristiti istovremeno u bolesnika s dijabetičkom nefropatijom.
English: The PRAC was also of the opinion that the contraindication based on the ALTITUDE5 study data regarding the concomitant use of ACE-inhibitors or ARBs with aliskiren-containing products in patients with diabetes mellitus or renal impairment (glomerular filtration rate (GFR) < 60 ml/min/1.73 m2) was confirmed by the additional data reviewed and that it should also be implemented in the product information of ARBs and ACE-inhibitors.
Croatian: PRAC je također bio mišljenja da su kontraindikacije temeljene na podacima ispitivanja ALTITUDE5 u vezi s istovremenom primjenom inhibitora ACE-a ili ARB-ova s proizvodima koji sadrže aliskiren u bolesnika s dijabetesom melitusom ili oštećenjem bubrega (stopa glomerularne filtracije (GFR) < 60 ml/min/1.73 m2) potvrđenim dodatnim pregledom podataka te da se također treba uvrstiti u informacije o proizvodu za ARB-ove i inhibitore ACE-a.
English: these patients and patients with renal impaired are already particularly prone to developing hyperkalaemia.
Croatian: Ovo je razlog za posebnu zabrinutost budući da su ovi bolesnici i bolesnici s oštećenjem funkcije bubrega već posebno skloni razvijanju hiperkalemije.
English: The PRAC considered that the overall available data strongly suggests that the concerns identified with regard to safety and the lack of efficacy are a class effect and therefore considered that the conclusions of the review apply to all the active substances involved in the procedure.
Croatian: PRAC je zaključio da cjelokupni dostupni podaci pružaju značajne naznake da zabrinutosti identificirane u vezi sa sigurnošću i nedostatkom učinkovitosti su djelovanje klase te se stoga smatra da se zaključci u pregledu primjenjuju na sve djelatne tvari uključene u postupak.
English: In addition, the meta-analysis suggested that using multiple RAS-acting agents may not be more beneficial than using a single RAS-acting agent in terms of reducing overall mortality.
Croatian: Nadalje, meta analiza ukazuje da primjena višestrukih lijekova koji djeluju na RAS može imati više koristi od primjene jednog lijeka koji djeluje na RAS u smislu smanjivanja ukupne smrtnosti.
English: • The PRAC reviewed the totality of the available data, including clinical trials, meta-analysis and publications, the MAHs' responses as well as the report from the Scientific Advisory Group in Cardiovascular Issues;
Croatian: • je PRAC pregledao ukupnost dostupnih podataka, uključujući i klinička ispitivanja, meta analizu i publikacije, odgovore nositelja odobrenja kao i izvješće Znanstvene savjetodavne grupe za kardiovaskularna pitanja;
English: The PRAC reviewed the totality of the available data, including clinical trials, meta-analysis and publications, the MAHs' responses as well as the report from the Scientific Advisory Group in Cardiovascular Issues (SAG CVS).
Croatian: PRAC je pregledao ukupnost dostupnih podataka, uključujući i klinička ispitivanja, meta analizu i publikacije, odgovore nositelja odobrenja kao i izvješće Znanstvene savjetodavne grupe za kardiovaskularna pitanja (SAG CVS).
English: • The PRAC considered the procedure under Article 31 of Directive 2001/83/EC initiated by Italy following the emergence of new evidence on the efficacy and safety of dual RAS blockade therapy through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren, to determine whether any regulatory measures should be taken on the marketing authorisations of the products involved in this procedure;
Croatian: • je PRAC razmotrio postupak sukladno članku 31. Direktive 2001/83/EZ pokrenut od strane Italije nakon pojavljivanja novog dokaza o djelotvornosti i sigurnosti dualne terapije inhibicije RAS-a putem kombinirane primjene inhibitora ACE-a, inhibitora receptora angiotenzina II ili aliskirena, kako bi se utvrdilo trebaju li se poduzeti regulatorne mjere u vezi s odobrenjima za stavljanje u promet lijeka uključenog u ovaj postupak.
English: Having considered the matter, the PRAC therefore recommended the variation of the marketing authorisations for RAS-acting agents.
Croatian: Razmatrajući predmet, PRAC je stoga preporučio izmjenu odobrenja za stavljanje u promet lijekova koji djeluju na RAS.
English: The CHMP, having considered the PRAC recommendation, agrees with the overall scientific conclusions by the PRAC and is of the opinion that the marketing authorisations for RAS-acting agents should be varied.
Croatian: Nakon razmatranja preporuke PRAC-a, CHMP je suglasan sa cjelokupnim znanstvenim zaključcima donesenima od strane PRAC-a i mišljenja je da treba izmijeniti odobrenja za stavljanje u promet lijekove koji djeluju na RAS.
English: RAS-acting agents act by blocking different stages of the renin-angiotensin system, lowering blood pressure and their use in the treatment of hypertension and its complications (including acute myocardial infarction, congestive heart failure and chronic kidney disease) is recommended in many current clinical guidelines.
Croatian: Lijekovi koji djeluju na RAS djeluju blokirajući različite faze renin-angiotenskog sustava snižavajući krvni tlak, te se u mnogim aktualnim kliničkim smjernicama preporuča njihova primjena za liječenje hipertenzije i komplikacija iste (uključujući akutni infarkt miokarda, kongestivna dekompenzacija srca i kroničnu bolest bubrega).
English: Changes were made to the heart failure indication in section 4.4 for candesartan-containing products and in sections 4.2 and 4.4 for valsartan-containing products, in order to further harmonise the wording for the two substances.
Croatian: No, CHMP je smatrao da su potrebne manje dodatne izmjene u tekstu koji se predlaže za Sažetak opisa svojstava lijeka. izmjene su učinjene u indikaciji za srčanu insuficijenciju dio 4.4. za proizvode koji sadrže kandesartan i u djelu 4.2 te 4.4 za lijekove koji sadrže valsartan, kako bi se što više uskladio tekst za dvije podtvari.
English: The concept of dual RAS blockade through the combined use of several RAS-acting agents, emerged in the late 1990's based on an experimental model hypothesising that the combined use of an ARB, an ACE-inhibitor or aliskiren could provide a more complete blockade of the RAS which could translate into better control of blood pressure and nephroprotective and cardioprotective effects.
Croatian: Koncept dualne RAS inhibicije putem kombinirane primjene nekoliko lijekova koji djeluju na RAS pojavio se u kasnim 1990.-ima na temelju eksperimentalnog modela koji se temelji na hipotezi da kombinirana primjena ARB-a, inhibitora ACE-a ili aliskirena može pružiti potpuniju inhibiciju RAS-a što bi moglo rezultirati boljom kontrolom krvnoga tlaka kao i nefroprotektivnim i kardioprotektivnim djelovanjem.
English: In particular, the publication of a meta-analysis by Makani et al1 involving over 68,000 patients raised concerns that combining several RAS-acting agents may be associated with an increased risk of hyperkalaemia, hypotension and kidney failure, compared with the single use of one RAS-acting agent.
Croatian: Posebice, objava meta analize provedene od strane Makani et al1 koja je obuhvatila više od 68.000 bolesnika dala je povoda za zabrinutost da kombiniranje nekoliko lijekova koji djeluju na RAS može biti povezano s povišenim rizikom od hiperkalemije, preosjetljivosti i zatajenja bubrega, u usporedbi s jednokratnom primjenom jednog lijeka koji djeluje na RAS.
English: The PRAC therefore concluded that dual RAS blockade therapy should not be routinely used in the treatment of heart failure and is not recommended in the general population although it may benefit certain patients who remain symptomatic while receiving monotherapy or who cannot otherwise use alternative therapies, including potentially patients with diabetic nephropathy.
Croatian: Stoga je PRAC zaključio da se dualna terapija inhibicije RAS-a mora rutinski koristiti za liječenje srčane insuficijencije i ne preporuča se u opće populacije iako su koristi uočljive kod pojedinih bolesnika, koji ostaju simptomatski prilikom primanja monoterapije ili koji ne mogu na drugi način koristiti alternativne terapije, uključujući potencijalne bolesnike s dijabetičkom nefropatijom.
English: Scientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Croatian: Znanstveni zaključci i detaljno pojašnjenje znanstvenih razloga za razlike u odnosu na preporuku PRAC-a
English: For candesartan- and valsartan-containing products, which are also authorised in the treatment of heart failure, additional information was agreed upon to reflect the fact that dual RAS blockade therapy in combination with an ACE-inhibitor may be of benefit in certain patients who cannot use other heart failure treatments, provided that they are used under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure.
Croatian: U slučaju proizvoda koji sadrže kandesartan i valsartan, koji su također odobreni za liječenje srčane insuficijencije, usuglašene su dodatne informacije kako bi se prikazala činjenica da dualna terapija inhibicije RAS-a u kombinaciji s inhibitorom ACE može biti od koristi u određenih bolesnika koji ne mogu koristiti druge terapije za srčanu insuficijenciju, ukoliko se iste koriste pod specijalističkim nadzorom i predmetom su čestog pažljivog praćenja funkcije jetre, elektrolita i krvnoga tlaka.
English: However, new data has emerged in the past years, raising doubts over the efficacy and identifying safety concerns associated with dual RAS blockade therapy through the combined use of ACE-inhibitors, ARBs or aliskiren.
Croatian: No, pojavili su se novi podaci u prošlosti koji pobuđuju sumnju u djelotvornost te identificiraju razloge za zabrinutost za sigurnu primjenu povezane s dualnom terapijom inhibicije RASa pomoću kombinirane primjene inhibitora ACE, ARB-ova ili aliskirena.
English: 2 - Detailed explanation of the scientific grounds for differences from the PRAC recommendation
Croatian: 2 - Detaljno pojašnjenje znanstvenih razloga za razlike u odnosu na preporuku PRAC-a
English: The PRAC considered that the available efficacy data indicates that dual RAS blockade therapy does not provide significant benefit in the general patient population, although there is evidence to suggest that some selected patient subpopulations may benefit from this dual RAS blockade therapy.
Croatian: PRAC je zaključio da dostupni podaci o djelotvornosti ukazuju da dualna terapija inhibicije RAS-a ne pruža dovoljno značajnu korist kod opće populacije bolesnika, iako postoje dokazi koji ukazuju da određene odabrane podpopulacije bolesnika mogu imati koristi od ove dualne terapije inhibicije RAS-a.
English: • The PRAC was of the opinion that the concerns identified with regard to the safety and the lack of additional efficacy of dual RAS blockade therapy can be adequately managed through changes to the product information, without the need for additional risk minimisation measures.
Croatian: • je PRAC mišljenja da se identificiranim zabrinutostima u vezi sa sigurnošću i nedostatkom dodatne djelotvornosti dualne terapije inhibicije RAS-a može primjereno upravljati promjenama u informacijama o proizvodu, bez potrebe dodatnih mjera za smanjivanje rizika.
English: • The PRAC was of the view that there is considerable evidence, in particular from the ONTARGET, ALTITUDE and VA NEPHRON-D trials which conclusively demonstrates that dual RAS blockade therapy through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is associated with an increased risk of adverse events, including hypotension, hyperkalaemia and renal failure compared to monotherapy;
Croatian: • je PRAC mišljenja da postoji razmjeran dokaz, posebice iz ispitivanja ONTARGET, ALTITUDE i VA NEPHRON-D koji jednoznačno dokazuje da je dualna terapija blokade RAS-a putem kombinirane primjene inhibitora ACE-a, inhibitora receptora angiotenzina II ili aliskirena povezana s povećanim rizikom od nuspojava, uključujući hipotenziju, hiperkalemiju i zatajenje bubrega u usporedbi s monoterapijom;
English: The PRAC, as a consequence, concluded that the benefit-risk balance of RAS-acting agents remains favourable, provided that their product information is revised to reflect the concerns associated with dual RAS blockade therapy.
Croatian: Kao posljedicu PRAC je zaključio da omjer koristi i rizika lijekova koji djeluju na RAS ostaje povoljan ukoliko se njihove informacije o proizvodu pregledaju kako bi se prikazale zabrinutosti povezane s dualnom terapijom inhibicije RAS-a.
English: Annex IV Scientific conclusions, grounds for variation to the terms of the marketing authorisations and detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Croatian: Znanstveni zaključci, razlozi za izmjenu uvjeta odobrenja za stavljanje lijeka u promet i detaljno pojašnjenje znanstvenih razloga za razlike u odnosu na preporuku PRAC-a
English: The PRAC concluded that the benefit-risk balance of RAS-acting agents remains favourable, including in the context of dual RAS blockade therapy, subject to the agreed revisions to the product information.
Croatian: PRAC je zaključio da omjer koristi i rizika lijekova koji djeluju na RAS ostaje povoljan, uključujući i kontekst dualne terapije inhibicije RAS-a, što je predmetom usuglašenih revizija na informacije o proizvodu.
English: The PRAC was of the opinion that the concerns identified during this procedure with regard to the safety and the lack of efficacy of dual RAS blockade therapy could be adequately managed through changes to the product information, without the need for additional risk minimisation measures.
Croatian: PRAC je mišljenja da se zabrinutostima identificiranima tijekom ovog postupka u vezi sa sigurnošću te nedostatkom djelotvornosti dualne terapije inhibicije RAS-a može primjereno upravljati izmjenom informacija o proizvodu, bez potrebe dodatnih mjera za smanjivanje rizika.
English: A warning was introduced to state that dual RAS blockade therapy through the combined use of ACE-inhibitors, ARBs or aliskiren is not recommended and, if considered absolutely necessary, should only occur under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure.
Croatian: Uvršteno je upozorenje kako bi se navelo da se ne preporuča dualna terapija inhibicije RAS-a kombiniranom primjenom inhibitora ACE-a, ARB-ova ili aliskirena, te, samo ako je apsolutno neophodno, treba nastupiti uz nadzor specijalista i predmetom je čestog pažljivog praćenja funkcije bubrega, elektrolita i krvnoga tlaka.
English: • The PRAC considered that the available efficacy data indicates that dual RAS blockade therapy does not provide significant benefit in the general patient population although certain patient subpopulations may benefit from treatment, provided that it occurs only under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure;
Croatian: • je PRAC mišljenja da dostupni podaci o djelotvornosti ukazuju da dualna terapija inhibicije RAS-a ne pruža dovoljno značajnu korist kod opće populacije bolesnika, iako postoje dokazi koji ukazuju da određene odabrane podpopulacije bolesnika mogu imati koristi od ove dualne terapije inhibicije RAS-a, samo ukoliko nastupi pod specijalističkim nadzorom i predmetom je učestalog praćenja funkcije bubrega, elektrolita i krvnoga tlaka;
English: It was noted that the Committee for Medicinal Products for Human Use (CHMP) had already conducted a review2 under Article 20 of Regulation (EC) No 726/2004 for aliskiren-containing products, concluding that these products should be contraindicated in patients with diabetes mellitus or moderate to severe renal impairment who take ACE-inhibitors or ARBs.
Croatian: Uredbe (EK) br. 726/2004 za proizvode koji sadrže aliskiren te je zaključilo da ovi lijekovi trebaju biti kontraindicirani u bolesnika koji uzimaju inhibitore ACE-a ili ARB-ove i oboljeli su od dijabetes melitusa ili umjerenog do ozbiljnog oštećenja funkcije bubrega.
English: The PRAC was of the opinion that there is considerable evidence from large clinical trials and meta-analyses which conclusively demonstrates that dual RAS blockade therapy through the combined use of ACE-inhibitors, ARBs or aliskiren is associated with an increased risk of adverse events, including hypotension, hyperkalaemia and renal failure compared to monotherapy, in particular in patients with diabetic nephropathy.
Croatian: PRAC je mišljenja da postoje značajni dokazi iz velikih kliničkih ispitivanja i meta analiza koje definitivno demonstriraju da je dualna terapija inhibicije RAS-a putem kombinirane primjene inhibitora ACE-a, ARB-ova ili aliskirena povezana s povišenim rizikom od
English: • The PRAC was of the opinion that the concerns identified with regard to safety and the lack of additional efficacy of dual RAS blockade therapy are a class effect and that the conclusions of the review therefore apply to all the active substances involved in this procedure;
Croatian: • je PRAC zaključio da cjelokupni dostupni podaci pružaju značajne naznake da su zabrinutosti identificirane u vezi sa sigurnošću i nedostatkom učinkovitosti djelovanje klase te se stoga smatra da se zaključci u pregledu primjenjuju na sve djelatne tvari uključene u postupak;
English: BMJ.
Croatian: Dodatak IV
English: Sit or lie down in a comfortable position.
Croatian: Udobno sjednite ili legnite u udoban položaj.
English: • Take the dose as soon as you remember.
Croatian: • Primijenite dozu čim se sjetite.
English: Contact a doctor immediately if you get these symptoms.
Croatian: Odmah se javite liječniku ako dobijete te simptome.
English: Remove the syringe from the carton and check that:
Croatian: Izvadite štrcaljku iz kutije i provjerite: