FrancophonIA/ELRC3.0 huggingface dataset:
English: Therefore, the canagliflozin dose should be limited to 100 mg once daily in patients with eGFR < 60 mL/min/1.73 m 2 or CrCl < 60 mL/min and canagliflozin should not be used in patients with an eGFR < 45 mL/min/1.73 m 2 or CrCl < 45 mL/min (see section 4.2).
Slovenian: Zato je treba dnevni odmerek kanagliflozina pri bolnikih z ocenjeno glomerulno filtracijo < 60 ml/min/1,73 m2 ali očistkom kreatinina < 60 ml/min omejiti na 100 mg.
English: Body Weight Baseline (mean) in kg % change from baseline (adjusted mean) Difference from metformin XR (adjusted mean) (95% CI)
Slovenian: bolniki (%), ki so dosegli raven HbA1c telesna masa izhodiščna (povprečna) vrednost v kg % spremembe od izhodiščne vrednosti (prilagojena povprečna vrednost) razlika v primerjavi s sitagliptinom (prilagojena povprečna vrednost) (95% IZ)
English: * Intent-to-treat population
Slovenian: • siljenje na bruhanje
English: 100 patient-years).
Slovenian: Posebne skupine bolnikov Starostniki (≥ 65 let)
English: Patients with eGFR 45 mL/min/1.73 m 2 to < 60 mL/min/1.73 m In a pooled analysis of patients (N = 721) with a baseline eGFR 45 mL/min/1.73 m 2 to
Slovenian: Bolniki z ocenjeno glomerulno filtracijo od 45 ml/min/1,73 m2 do < 60 ml/min/1,73 m
English: Change from baseline (adjusted mean) Difference from glimepiride (adjusted mean) (95% CI)
Slovenian: % spremembe od izhodiščne vrednosti (prilagojena povprečna vrednost) razlika v primerjavi z metforminom XL (prilagojena povprečna vrednost) (95-odstotni IZ)
English: If renal function falls persistently below eGFR 45 mL/min/1.73 m2 or CrCl < 45 mL/min,
Slovenian: Če se zmanjša ocenjena glomerulna filtracija pod 45 ml/min/1,73 m2 ali očistek kreatinina < 45 ml/min, je treba zdravljenje s kanagliflozinom prekiniti.
English: Steady-state was reached after 4 days to 5 days of once-daily dosing with canagliflozin 100 mg to 300 mg. Canagliflozin does not exhibit time-dependent pharmacokinetics, and accumulated in plasma up to 36% following multiple doses of 100 mg and 300 mg.
Slovenian: Največja koncentracija kanagliflozina v plazmi (Cmax) in njegova AUC sta se povečevali sorazmerno z odmerkom v okviru odmerjanja od 50 mg do 300 mg. Navidezni končni razpolovni čas (t1/2) (izražen kot povprečna vrednost ± standardna deviacija) je bil 10,6 ± 2,13 ur oziroma 13,1 ± 3,28 ur pri odmerku 100 mg oziroma 300 mg. Do stanja dinamičnega ravnovesja je prišlo po 4 do 5 dneh odmerjanja 100 mg do 300 mg kanagliflozina enkrat na dan. Farmakokinetika kanagliflozina ni odvisna od časa odmerjanja, po večkratnih odmerkih 100 mg in 300 mg pa je prišlo do kopičenja kanagliflozina v plazmi v obsegu do 36%.
English: In patients tolerating canagliflozin whose eGFR falls persistently below 60 mL/min/1.73 m2 or CrCl 60 mL/min, the dose of canagliflozin should be adjusted to or maintained at 100 mg once daily.
Slovenian: Pri bolnikih, ki dobro prenašajo kanagliflozin, pri katerih se ocenjena glomerulna filtracija zmanjša in ostane pod 60 ml/min/1,73 m2 ali očistek kreatinina pod
English: 24 June 2013 EMA/423411/2013
Slovenian: 24. junij 2013 EMA/423411/2013
English: The review of cilostazol was initiated at the request of Spain, under Article 31 of Directive 2001/83/EC.
Slovenian: Pregled cilostazola je bil sprožen na zahtevo Španije v skladu s členom 31 Direktive 2001/83/ES.
English: In addition, the benefits of treatment were modest.
Slovenian: Poleg tega so bile koristi zdravljenja majhne.
English: Detailed recommendations for patients and healthcare professionals are available below.
Slovenian: Podrobna priporočila za bolnike in zdravstvene delavce so na voljo spodaj.
English: Treatment should be stopped in patients who have not shown clinically relevant benefit.
Slovenian: Zdravljenje je treba prekiniti pri bolnikih, pri katerih se niso izkazale klinično pomembne koristi.
English: • If you have any questions, you should contact your doctor or pharmacist.
Slovenian: • Če imate dodatna vprašanja, se posvetujte s svojim zdravnikom ali farmacevtom.
English: There was evidence that many of these patients had to stop taking the medicine.
Slovenian: Obstajali so dokazi, da so morali mnogi od teh bolnikov z jemanjem zdravila prekiniti.
English: More information on the studies and the CHMP's conclusions is available below.
Slovenian: Več informacij o študijah in zaključkih CHMP je na voljo spodaj.
English: For the full changes to information for doctors and patients, see under the ‘All documents' tab.
Slovenian: Za celotne spremembe informacij za zdravnike in bolnike glejte zavihek „Vsi dokumenti‟.
English: • The Agency has recommended some restrictions on the use of cilostazol.
Slovenian: • Agencija je priporočila določene omejitve glede uporabe cilostazola.
English: The CHMP recommendation was sent to the European Commission which endorsed it and adopted a legally-binding decision throughout the European Union (EU) on 24 June 2013.
Slovenian: Priporočilo CHMP je bilo poslano Evropski komisiji, ki ga je potrdila in dne 24. junija 2013 sprejela pravno zavezujočo odločbo, ki velja za celotno Evropsko unijo (EU).
English: The CHMP opinion was forwarded to the European Commission, which issued a final decision endorsing the opinion on 24 June 2013.
Slovenian: Mnenje CHMP je bilo posredovano Evropski komisiji, ki je dne 24. junija 2013 izdala končno odločitev, v kateri je sprejela mnenje.
English: The most common cardiovascular events reported were palpitations and tachycardia (each about 5% of total spontaneous reports).
Slovenian: Najpogostejši kardiovaskularni dogodki, o katerih so poročali, so bile palpitacije in tahikardija (vsaka v približno 5 % vseh spontanih poročil).
English: Medicines containing cilostazol have been approved in the EU through national procedures since 2000 and are available in France, Germany, Italy, Spain, Sweden and the United Kingdom under the invented names Pletal and Ekistol.
Slovenian: Zdravila, ki vsebujejo cilostazol, so bila v EU odobrena na podlagi nacionalnih postopkov od leta 2000 in so na voljo v Franciji, Nemčiji, Italiji, Španiji, na Švedskem in v Združenem kraljestvu pod imenoma Pletal in Ekistol.
English: CHMP concluded that the magnitude of benefit was clinically important in a subgroup of patients, and that response can be adequately assessed after three months of treatment.
Slovenian: CHMP je zaključil, da je bil obseg koristi klinično pomemben pri podskupini bolnikov in da je mogoče ta odziv ustrezno oceniti po treh mesecih zdravljenja.
English: Although the design and early termination of the study limit the conclusions that can be drawn, these results provide some reassurance with regard to cardiovascular safety of cilostazol.
Slovenian: Čeprav zasnova in predčasni zaključek študije omejujeta možne zaključke, rezultati dajejo določena zagotovila glede srčnožilne varnosti cilostazola.
English: If you are taking cilostazol-containing medicines, you should make a non-urgent appointment with your doctor to review your treatment.
Slovenian: Če jemljete zdravila, ki vsebujejo cilostazol, se dogovorite za nenujen obisk pri svojem zdravniku, ki bo pregledal vaše zdravljenje.
English: This corresponded to an absolute increase in walking distance of 87.4 metres and 43.7 metres respectively (from a baseline of about 133 metres).
Slovenian: To ustreza absolutnemu podaljšanju prehojene razdalje, ki je znašala 87,4 metre za cilostazol in 43,7 metrov za placebo (z izhodišča približno 133 metrov).
English: Many of the patients who were prescribed the medicine were much older, and taking more medicines, than those in whom it was originally tested before marketing, which may explain the increased risk of side effects.
Slovenian: Številni bolniki, ki so prejeli zdravilo, so bili starejši in so jemali več zdravil kot tisti, na katerih je bilo zdravilo prvotno preskušeno pred trženjem, kar lahko pojasni povečano tveganje za neželene učinke.
English: • Other healthcare professionals should refer patients to the prescribing physician as appropriate.
Slovenian: • Drugi zdravstveni delavci naj bolnike po potrebi napotijo k zdravniku, ki predpisuje to zdravilo.
English: Cilostazol-containing medicines are available in the EU under the names Pletal and Ekistol.
Slovenian: Zdravila, ki vsebujejo cilostazol, so v EU na voljo pod imenoma Pletal in Ekistol.
English: • Treatment should only be started by physicians experienced in the management of intermittent claudication, and should be reviewed after three months.
Slovenian: • Zdravljenje lahko uvede samo zdravnik z izkušnjami na področju obravnave intermitentne klavdikacije in je treba po treh mesecih o njem znova presoditi.
English: Doctors should review their patients at their next routine appointment and assess the continued suitability of cilostazol treatment.
Slovenian: Zdravniki naj pri naslednjem rutinskem pregledu preverijo zdravljenje svojih bolnikov in ocenijo nadaljnjo primernost zdravljenja s cilostazolom.
English: Although suspected adverse drug reaction reports have raised some safety concerns, these have not been substantiated in the clinical trial data (including the CASTLE study), and it remains possible to exclude high-risk patients in clinical practice.
Slovenian: Čeprav so bili zaradi domnevnih neželenih reakcij na zdravilo izraženi določeni zadržki glede varnosti, ti zadržki niso bili utemeljeni v podatkih iz kliničnih preskušanj (vključno s študijo CASTLE) in v klinični praksi je še zmeraj mogoče izločiti bolnike z visokim tveganjem.
English: However the evidence suggests that cilostazol alone, or in combination with one other antiplatelet drug, does not increase the risk of bleeding.
Slovenian: Vendar dokazi kažejo, da cilostazol v monoterapiji ali v kombinaciji z drugim antiagregacijskim zdravilom ne poveča tveganja za krvavitev.
English: The trial, which examined all-cause mortality as a primary endpoint, was terminated early (after about 3 years) because of a high drop-out rate in both groups (397 out of 721 cilostazol patients and 391 out of 718 patients taking placebo) and because of a much lower mortality rate than expected.
Slovenian: Preskušanje, katerega primarni cilj je bilo pr učevanje smrtnosti iz katerega koli razloga, so predčasno zaključili (po približno 3 letih) zaradi visoke stopnje prekinitve zdravljenja v obeh skupinah (397 od 721 bolnikov, ki so prejemali cilostazol, in 391 od 718 bolnikov, ki so prejemali placebo), in veliko nižje stopnje smrtnosti, kot so pričakovali.
English: Cases of haemorrhage represented about 8% of the spontaneous reports.
Slovenian: Približno 8 % spontanih poročil je bilo o krvavitvah.
English: • Safety data from nearly 14,000 suspected adverse drug reaction reports (in the context of over 6 million patient years' exposure worldwide) and 4,000 events in non-interventional studies confirmed the known adverse effect profile of cilostazol from clinical trials.
Slovenian: • Podatki o varnosti iz skoraj 14 000 poročil o domnevnih neželenih učinkih zdravila (pri več kot 6 milijonov bolnikov po vsem svetu, ki so zdravilu izpostavljeni leta in leta) in 4 000 dogodkov iz neintervencijskih študij so potrdili profil znanih neželenih učinkov cilostazola iz kliničnih preskušanj.
English: CHMP therefore recommended a number of measures aimed at targeting use of cilostazol to the population most likely to benefit, and in whom the risk of side effects is low.
Slovenian: CHMP je zato priporočil številne ukrepe, s katerimi se uporaba cilostazola priporoča populaciji, ki bo od njega najverjetneje imela koristi in pri kateri je tveganje za neželene učinke nizko.
English: The recommendations followed a review of current evidence which indicated that the modest benefits of these medicines, i.e. their ability to increase the distance patients are able to walk, are only greater than their risks, in particular the risks of side effects affecting the heart or serious bleeding, in a limited subgroup of patients.
Slovenian: Priporočila so izdali po pregledu trenutnih dokazov, ki kažejo, da so zmerne koristi teh zdravil, tj. njihova sposobnost podaljšanja razdalje, ki so jo lahko prehodili bolniki, večje od z njimi povezanih tveganj, zlasti tveganj za pojav neželenih učinkov, ki vplivajo na srce, ali resnih krvavitev, samo pri omejeni podskupini bolnikov.
English: References.
Slovenian: Referenčno gradivo:
English: On 22 March 2013 the European Medicines Agency's Committee on Medicinal Products for Human Use (CHMP) recommended that the use of cilostazol-containing medicines in the treatment of intermittent claudication - a condition where poor blood supply to the leg muscles causes pain and affects the ability to walk - should be restricted with a range of new measures aimed at targeting a patient population in which there are clinical benefits, and at the same time minimising important risks.
Slovenian: Odbor za zdravila za uporabo v humani medicini (CHMP) Evropske agencije za zdravila je 22. marca 2013 priporočil omejitev uporabe zdravil, ki vsebujejo cilostazol, za zdravljenje intermitentne klavdikacije (IK), tj. stanja, pri katerem šibek pretok krvi v mišice nog povzroča bolečine in vpliva na sposobnost hoje, z več novimi ukrepi za ciljno skupino bolnikov, kjer se pojavljajo klinične koristi, s katerimi se bodo obenem zmanjšala pomembna tveganja.
English: The advice will vary for each patient depending on factors such as lifestyle options that could improve your condition, whether your walking symptoms have improved since you started cilostazol, whether you have had recent heart problems, and which other medicines you are taking.
Slovenian: Priporočilo se bo med bolniki razlikovalo glede na dejavnike, kot so možnosti življenjskega sloga, s katerimi bi lahko svoje stanje izboljšali, ter na to, ali so se vaši simptomi pri hoji po jemanju cilostazola izboljšali, ali ste imeli pred kratkim težave s srcem in katera druga zdravila še jemljete.
English: • Long-term cardiovascular safety of cilostazol was examined post-marketing in the CASTLE study1, a randomised double-blind placebo controlled study involving 1,439 patients given cilostazol 100 mg twice daily (reduced to 50 mg twice daily if necessary) or placebo.
Slovenian: • Dolgoročno srčnožilno varnost cilostazola so proučevali v obdobju trženja v študiji CASTLE1, tj. randomizirani dvojno slepi študiji, nadzorovani s placebom, v katero je bilo vključenih 1 439 bolnikov, ki so prejemali 100 mg cilostazola dvakrat na dan (odmerek so po potrebi zmanjšali na 50 mg dvakrat na dan) ali placebo.
English: • Cilostazol should only be used for intermittent claudication when lifestyle changes (including smoking cessation and exercise programmes) and other appropriate interventions alone have not produced adequate benefit.
Slovenian: • Cilostazol se lahko uporablja za zdravljenje intermitentne klavdikacije samo v primeru, ko s spremembami življenjskega sloga (vključno s prekinitvijo kajenja in programi telesne vadbe) in drugimi primernimi ukrepi ustrezno izboljšanje ni bilo doseženo.
English: When a composite endpoint of cardiac morbidity (coronary and cerebrovascular events) and mortality was considered, there were 135 events with cilostazol and 153 with placebo.
Slovenian: Ob proučevanju sestavljenih opazovanih dogodkov srčnih obolenj (koronarni in cerebrovaskularni dogodki) in smrtnosti se je pri cilostazolu pojavilo 135 dogodkov, pri placebu pa 153.
English: The CHMP examined available clinical trial data on the benefits and risks of the medicines provided by the companies that market these medicines, as well as data from scientific literature, reports of suspected side effects, post-marketing studies and experimental studies before making its recommendations.
Slovenian: CHMP je pred izdajo priporočil proučil razpoložljive podatke iz kliničnih preskušanj o tveganjih in koristih zdravil, ki so jih predložila podjetja, ki ta zdravila tržijo, ter podatke iz znanstvene literature, poročila o domnevnih neželenih učinkih, študije v obdobju trženja in eksperimentalne študije.
English: • Prescribers should be aware of the risk of interactions with cilostazol; its dose should be reduced in patients also taking strong inhibitors of CYP3A4 or CYP2C19.
Slovenian: • Zdravniki, ki zdravilo predpisujejo, morajo upoštevati tveganje za medsebojno delovanje s cilostazolom; odmerek cilostazola je treba zmanjšati pri bolnikih, ki jemljejo močne zaviralce CYP3A4 ali CYP2C19.
English: In conclusion, the CHMP considered that although on average the efficacy of cilostazol is modest, there is a small group of patients in whom it is of clinical relevance, not least in helping them to begin exercise programmes.
Slovenian: CHMP je zaključil, da kljub povprečno majhni učinkovitosti cilostazola obstaja manjša skupina bolnikov, pri katerih je cilostazol klinično pomemben in jim pomaga pri začetku izvajanja programov telesne dejavnosti.
English: • Cilostazol should also not be given to patients also receiving both aspirin and clopidogrel, or any other combination of two or more additional antiplatelet or anticoagulant medicines.
Slovenian: • Uporaba cilostazola prav tako ni dovoljena pri bolnikih, ki jemljejo aspirin in klopidogrel ali katero koli drugo kombinacijo dveh ali več dodatnih antiagregacijskih ali antikoagulacijskih zdravil.
English: The request followed reports to the Spanish agency of serious adverse effects affecting the heart including fatal heart attacks, angina and arrhythmias (irregular heartbeat) as well as cases of serious bleeding including bleeding in the brain.
Slovenian: Zahteva je bila podana zaradi poročil, ki jih je prejela španska agencija o resnih neželenih učinkih, ki vplivajo na srce, vključno s primeri srčnega infarkta s smrtnim izidom, angino in aritmijami (nerednim srčnim utripom) ter primeri resnih krvavitev, vključno s krvavitvami v možganih.
English: The Spanish Agency for Medicines and Health Products (AEMPS) asked the CHMP to carry out a review of these medicines following a number of reports of serious suspected side effects, in particular affecting the heart, as well as cases of serious bleeding.
Slovenian: Španska Agencija za zdravila in medicinske pripomočke (AEMPS) je pozvala CHMP, naj izvede pregled teh zdravil zaradi številnih poročil o resnih domnevnih neželenih učinkih, zlasti vplivu na srce in primerih resnih krvavitev.
English: The Spanish Agency for Medicines and Health Products (AEMPS) asked the CHMP to carry out a full assessment of the benefit-risk balance of cilostazol and to issue an opinion on whether the marketing authorisations for products containing cilostazol should be maintained, varied, suspended or withdrawn across the EU.
Slovenian: Španska Agencija za zdravila in medicinske pripomočke (AEMPS) je prosila CHMP za izvedbo polne ocene razmerja med tveganji in koristmi za cilostazol ter za izdajo mnenja o tem, ali naj se dovoljenja za promet z zdravili, ki vsebujejo cilostazol, v EU ohranijo, spremenijo, začasno prekličejo ali umaknejo.
English: Cilostazol works by blocking an enzyme called phosphodiesterase type 3, which is found in the walls of arteries and is involved in various processes affecting circulation, including aggregation (clumping together) of blood platelets and narrowing of the arteries.
Slovenian: Cilostazol deluje tako, da zavira encim fosfodiesteraza tipa 3, ki se nahaja v stenah arterij in sodeluje pri različnih procesih, ki vplivajo na pretok, vključno z agregacijo (združevanjem) trombocitov in oženjem arterij.
English: • Cilostazol has been shown to produce modest increases in walking distance compared with placebo; meta-analysis of pooled individual patient data from nine efficacy trials involving 3,122 patients indicated a mean percentage increase from baseline of 59.4% for cilostazol, compared with 24.3% for placebo.
Slovenian: • Cilostazol je pokazal skromno podaljšanje prehojene razdalje v primerjavi s placebom; metaanaliza združenih podatkov posameznih bolnikov iz devetih preskušanj učinkovitosti, v katere je bilo vključenih 3 122 bolnikov, je pokazala 59,4-odstotno povečanje odstotka srednje vrednosti od izhodišča za cilostazol in 24,3-odstotno povečanje za placebo.
English: In addition, cilostazol-containing medicines should not be used in patients who have suffered severe tachyarrhythmia (fast, abnormal heart rhythm), or recent unstable angina, heart attack or bypass surgery, or who take two or more antiplatelet or anticoagulant medicines such as aspirin and clopidogrel.
Slovenian: Poleg tega uporaba zdravil, ki vsebujejo cilostazol, ni dovoljena pri bolnikih, ki so doživeli hudo tahiaritmijo (hiter, nenormalen srčni ritem), in pri bolnikih z nedavno nestabilno angino, srčnim infarktom ali obvodno operacijo, ki jemljejo dva ali več antiagregacijskih ali antikoagulacijskih zdravil, na primer aspirin in klopidogrel.
English: • Cilostazol is used to treat intermittent claudication, a condition where walking becomes painful and difficult because of problems with blood circulation in the arteries of the legs.
Slovenian: • Cilostazol se uporablja za zdravljenje intermitentne klavdikacije, tj. stanja, pri katerem hoja postane boleča in otežena zaradi težav s pretokom krvi v arterijah nog.
English: • Your doctor will advise you whether you should continue taking cilostazol, stop taking cilostazol, or change the dose that you are taking.
Slovenian: • Zdravnik vam bo svetoval, ali boste z jemanjem cilostazola nadaljevali, jemanje prekinili ali spremenili odmerek.
English: The Committee recommended that cilostazol should only be used in patients whose symptoms have not improved despite prior lifestyle changes such as exercise, healthy diet and stopping smoking.
Slovenian: Odbor je priporočil uporabo cilostazola samo pri bolnikih, pri katerih se simptomi kljub spremembam življenjskega sloga (npr. telesni dejavnosti, zdravi prehrani in prenehanju kajenja) niso izboljšali.
English: The Agency's recommendations are based on a review by the Committee for Medicinal Products for Human Use (CHMP), which looked at available data on the benefits and risks of cilostazol.
Slovenian: Več informacij o oceni: Priporočila agencije EMA temeljijo na pregledu, ki ga je izvedel Odbor za zdravila za uporabo v humani medicini (CHMP), ki je proučil razpoložljive podatke o tveganjih in koristih cilostazola.
English: There were 49 deaths in the cilostazol group, of which 12 were due to cardiac disorders, and 52 in the placebo group (13 cardiac).
Slovenian: V skupini bolnikov, ki so prejemali cilostazol, je bilo 49 smrtnih primerov, od katerih je bilo 12 posledica srčnih bolezni, v skupini, ki je prejemala placebo, pa 52 (13 primerov srčnih bolezni).
English: Blocking the enzyme reduces these actions and blood flow is improved, allowing patients to walk further without disabling pain.
Slovenian: Cilostazol blokira encim in tako zavira te procese ter izboljša krvni pretok, s tem pa bolnikom omogoča hojo na daljšo razdaljo brez hude bolečine.
English: • Analysis of available data suggests an increased risk of haemorrhage when cilostazol is given to patients also taking both aspirin and clopidogrel.
Slovenian: • Analiza razpoložljivih podatkov kaže na povečano tveganje za krvavitev pri bolnikih, ki cilostazol jemljejo v kombinaciji z aspirinom in klopidogrelom.
English: • Cilostazol should not be given to patients who have unstable angina or who have had myocardial infarction or a coronary intervention (PCI) within the last six months, nor to those with a history of severe tachyarrhythmia.
Slovenian: • Uporaba cilostazola ni dovoljena pri bolnikih z nestabilno angino, miokardnim infarktom ali koronarno intervencijo v zadnjih šestih mesecih in pri bolnikih, ki imajo v anamnezi hudo tahiaritmijo.
English: Cilostazol is a medicine that is used to improve walking distance in patients who have intermittent claudication due to peripheral arterial obstructive disease (obstruction and narrowing of the arteries of the limbs, leading to reduced blood flow).
Slovenian: Cilostazol je zdravilo, ki se uporablja za podaljšanje prehojene razdalje pri bolnikih z intermitentno klavdikacijo zaradi obstruktivne periferne arterijske bolezni (obstrukcija in zožitev arterij okončin, kar povzroči zmanjšan krvni pretok).
English: MA (EU) number (Invented) name Strength Pharmaceutical Form Route of Administration Immediate Packaging Pack size EU/1/16/1137/001 Granpidam 20 mg Film-coated tablet
Slovenian: Farmacevtska oblika Pot uporabe