FrancophonIA/ELRC3.0 huggingface dataset:
English: MA (EU) number (Invented) name
Danish: MF (EU)-nummer Særnavn Styrke Lægemiddelform Administrationsvej Indre emballage
English: Intravenous use vial (glass) 1 ml
Danish: Intravenøs anvendelse hætteglas (glas)
English: In addition, the Committee considered that the proposed risk minimisation activities were not able to reduce the risks to an acceptable level.
Danish: Udvalget tog desuden i betragtning, at de foreslåede foranstaltninger til risikominimering ikke gør det muligt at nedbringe risiciene til et acceptabelt niveau.
English: In addition, in some member states it had been both difficult and time-consuming to collate the relevant data for the purposes of the Article 31 referral, and it would be impractical and, in the medium term, unfeasible to monitor the effectiveness of risk minimization activities in these countries.
Danish: Desuden havde det i nogle medlemsstater været både vanskeligt og tidskrævende at sammenfatte de relevante data til brug ved indbringelsen i henhold til artikel 31, og det ville være upraktisk og på mellemlang sigt umuligt at overvåge effektiviteten af foranstaltninger til risikominimering i disse lande.
English: OVERALL SUMMARY OF THE SCIENTIFIC EVALUATION OF DEXTROPROPOXYPHENE CONTAINING MEDICINAL PRODUCTS (see Annex I)
Danish: SAMLET RESUMÉ AF DEN FAGLIGE VURDERING AF LÆGEMIDLER INDEHOLDENDE DEXTROPROPOXYFEN (se bilag I)
English: A group of MAHs disagreed with the opinion recommending the withdrawal of the Marketing Authorisations and requested a re-examination of the opinion.
Danish: En gruppe af indehaverne af markedsføringstilladelse var uenige i udtalelsen, hvori det blev anbefalet at tilbagekalde markedsføringstilladelserne, og anmodede om en revurdering af udtalelsen.
English: The overall safety profile of the dextropropoxyphene containing medicinal products is based on an extensive post-marketing experience (over 40 years).
Danish: Den generelle sikkerhedsprofil for lægemidler indeholdende dextropropoxyfen er baseret på omfattende erfaring efter markedsføring (over 40 år).
English: Therefore the CHMP recommended the withdrawal of all Marketing Authorisations for medicinal products containing dextropropoxyphene.
Danish: CHMP anbefalede derfor tilbagekaldelse af alle markedsføringstilladelser for lægemidler indeholdende dextropropoxyfen.
English: Across Member States, the authorised indications considerably vary from “moderate to severe pain”, “mild to moderate pain”, and “acute and chronic pains of different origins”.
Danish: Fra medlemsstat til medlemsstat veksler de godkendte indikationer mellem "moderate til stærke smerter", "milde til moderate smerter" og "akutte og kroniske smerter af forskellig oprindelse".
English: Since the benefit/risk reviews of dextropropoxyphene containing products were carried out in the UK, Sweden, France, and Ireland in 2005 - following which the fixed dose combination product (paracetamol + dextropropoxyphene) was withdrawn from the market in the UK, Sweden, and Ireland - a substantial body of important new safety information has become available.
Danish: Siden der blev gennemført revurderinger af benefit/risk-forholdet for lægemidler indeholdende dextropropoxyfen i Det Forenede Kongerige, Sverige, Frankrig og Irland i 2005 - hvorefter fastdosiskombinationslægemidlet (paracetamol + dextropropoxyfen) blev trukket tilbage fra markedet i Det Forenede Kongerige, Sverige og Irland - er der fremkommet omfattende nye sikkerhedsoplysninger.
English: ANNEX II SCIENTIFIC CONCLUSIONS AND GROUNDS FOR WITHDRAWAL OF THE MARKETING AUTHORISATIONS PRESENTED BY THE EUROPEAN MEDICINES AGENCY
Danish: BILAG II FAGLIGE KONKLUSIONER OG BEGRUNDELSER FOR TILBAGEKALDELSE AF MARKEDSFØRINGSTILLADELSERNE FREMLAGT AF DET EUROPÆISKE LÆGEMIDDELAGENTUR
English: Risk Minimisation Measures
Danish: Foranstaltninger til risikominimering
English: GROUNDS FOR WITHDRAWAL OF THE MARKETING AUTHORISATIONS
Danish: BEGRUNDELSER FOR TILBAGETRÆKNING AF MARKEDSFØRINGSTILLADELSERNE
English: - The Committee considered the referral made under article 31 of Directive 2001/83/EC, as amended for medicinal products containing dextropropoxyphene;
Danish: - Udvalget behandlede indbringelsen i henhold til artikel 31 i Rådets direktiv 2001/83/EF, med senere ændringer, for lægemidler indeholdende dextropropoxyfen.
English: - The Committee assessed the grounds for re-examination submitted by a group of MAHs on 15 July 2009, the information provided by the MAHs at an oral explanation on 20 October 2009 and the scientific discussion within the Committee;
Danish: - Udvalget bedømte begrundelserne for revurdering, som blev fremlagt af en gruppe af indehaverne af markedsføringstilladelse den 15. juli 2009, oplysningerne fremlagt af indehaverne af markedsføringstilladelse i forbindelse med de mundtlige redegørelser den 20. oktober 2009 og de faglige drøftelser i udvalget.
English: This means that one in every eight subjects with pain of moderate to severe intensity would experience at least 50% pain relief with dextropropoxyphene 65 mg who would not have done so with placebo.
Danish: Det vil sige, at én ud af otte forsøgspersoner med moderate til stærke smerter oplevede mindst 50 % smertelindring med dextropropoxyfen 65 mg, hvilket de ikke ville have gjort med placebo.
English: Dextropropoxyphene containing medicinal products with Marketing Authorisation in the European Union
Danish: Lægemidler indeholdende dextropropoxyfen med markedsføringstilladelse i Den Europæiske Union
English: On the basis of evidence of harm from reports of fatal overdose, of divergent safety reviews and previous regulatory action taken in several Member States, the European Commission initiated a referral under Article 31(2) of Directive 2001/83/EC, as amended, to address this public health issue for medicinal products containing dextropropoxyphene and paracetamol, and therefore referred the matter to the CHMP on 30 November 2007.
Danish: På baggrund af dokumentation for skader fra rapporter om fatale overdoser, divergerende sikkerhedsundersøgelser og tidligere indgriben fra myndighedernes side i flere medlemsstater indledte Europa-Kommissionen en indbringelsesprocedure under artikel 31, stk. 2, i direktiv 2001/83/EF, med senere ændringer, for at håndtere dette problem i forhold til folkesundheden for lægemidler indeholdende dextropropoxyfen og paracetamol, og henviste derfor sagen til CHMP den 30. november 2007.
English: Dextropropoxyphene containing medicinal products (as single component or combination with paracetamol or paracetamol/caffeine) are used in the symptomatic treatment of pain and are currently authorised in several Member States.
Danish: Lægemidler indeholdende dextropropoxyfen (som enkeltkomponent eller i kombination med paracetamol eller paracetamol/koffein) anvendes til symptomatisk behandling af smerter og er på nuværende tidspunkt godkendt i flere medlemsstater.
English: In addition, a smaller pack size is unlikely to result in smaller stocks of medication at home, since a patient being treated for chronic pain might well be given a month's supply in one go.
Danish: Desuden er det usandsynligt, at en mindre pakningsstørrelse ville resultere i mindre medicinlagre i hjemmet, da der meget vel kan udskrives en måneds forbrug på en gang til en patient, der behandles for kroniske smerter.
English: Also, research in the UK demonstrated the benefits of the withdrawal of dextropropoxyphene from the market - with clear evidence of a fall in number of deaths associated with dextropropoxyphene, but without any rise in mortality from poisoning with other common analgesics.
Danish: Forskning i Det Forenede Kongerige viste ligeledes fordelene ved at trække dextropropoxyfen tilbage fra markedet - med klar dokumentation for et fald i antallet af dødsfald forbundet med dextropropoxyfen, men uden nogen stigning i dødeligheden fra forgiftning med andre almindelige analgetika.
English: The narrow therapeutic index means that accidental overdose is a real possibility under normal conditions of use, particularly for patients on certain concomitant medications or when combined with even a small amount of alcohol.
Danish: Det snævre terapeutiske indeks betyder, at en utilsigtet overdosis er en reel mulighed under normale anvendelsesvilkår, særlig for patienter, der samtidig får anden medicin, eller når det indtages med selv små mængder alkohol.
English: Ibuprofen has also shown to be more effective, as a single dose, in the management of severe postoperative pain; tramadol being equally effective in this setting.
Danish: Ibuprofen har også vist sig at være mere effektivt som enkeltdosis til behandling af postoperative smerter, og tramadol har samme effekt under disse forhold.
English: The most frequently reported adverse reactions with fatal outcome involved hepatobiliary disorders, skin disorders, general disorders, blood and lymphatic disorders, nervous system disorders, gastrointestinal disorders and cardiac disorders.
Danish: De hyppigst rapporterede bivirkninger med dødelig udgang omfattede sygdomme i lever og galdeveje, hudsygdomme, almene sygdomme, sygdomme i blod- og lymfesystemet, sygdomme i nervesystemet, gastrointestinale sygdomme samt hjertesygdomme.
English: For a single dose of dextropropoxyphene 65 mg in postoperative pain the number needed to treat to benefit for at least 50% pain relief was 7.7 (95% confidence interval 4.6 to 22) when compared with placebo over 4-6 hours.
Danish: For en enkeltdosis dextropropoxyfen 65 mg mod postoperative smerter var det påkrævede antal til gavnlig behandling med minimum 50 % smertelindring 7,7 (95 % konfidensinterval 4,6 til 22) sammenlignet med placebo over 4-6 timer.
English: One possible risk minimisation measure, a reduced pack size (e.g. to only 10 tablets), is unlikely to be of any significant benefit in risk minimisation as the lethal dose (particularly when taken with alcohol) is under 10 tablets.
Danish: En mulig foranstaltning til risikominimering, en reduceret pakningsstørrelse (f.eks. til kun 10 tabletter) vil sandsynligvis ikke have nogen betydning for risikominimering, da den dødelige dosis (særlig ved indtagelse sammen med alkohol) er under 10 tabletter.
English: Although available meta-analyses mostly included single dose studies, these data also provided further insights in the efficacy of the dextropropoxyphene containing medicinal products.
Danish: Selv om de tilgængelige meta-analyser hovedsageligt omfattede enkeltdosisundersøgelser, gav disse data alligevel yderligere indsigt i effekten af lægemidler indeholdende dextropropoxyfen.
English: Risk Minimisation measures proposed by the MAHs included restriction of the use of the product (i.e. changes in SPC to restrict the population; pack size reduction), modification of the posology (e.g. reduction of posology in elderly population) and addition of further safety warnings (e.g. on concomitant use with alcohol, dependence and tolerance, combination with other central acting analgesics and overdose in children).
Danish: De foranstaltninger til risikominimering, som indehaverne af markedsføringstilladelsen foreslog, omfattede begrænsning af anvendelsen af lægemidlet (dvs. ændring af produktresuméet for at begrænse populationen, reduktion af pakningernes størrelse), ændring af doseringen (f.eks. nedsættelse af doseringen til ældre) og tilføjelse af sikkerhedsadvarsler (f.eks. om samtidig indtagelse af alkohol, afhængighed og tolerance, kombination med andre centralt virkende analgetika og overdosis hos børn).
English: For the equivalent dose of dextropropoxyphene combined with paracetamol 650 mg the NNT was 4.4 (3.5 to 5.6) when compared with placebo, indicating higher efficacy.
Danish: For den tilsvarende dosis dextropropoxyfen i kombination med paracetamol 650 mg var det påkrævede antal til gavnlig behandling 4,4 (3,5 til 5,6) sammenlignet med placebo, hvilket angiver, at der er tale om en højere effekt.
English: A substantial proportion of the fatal overdoses are accidental - occurring under normal conditions of use, for the licensed indication of painand there is a significant public health impact in relation to these cases alone.
Danish: En stor del af de dødelige overdoser er utilsigtede - og optræder under normale anvendelsesbetingelser ved den godkendte indikation smerte - og der er en betydelig indvirkning på folkesundheden alene i tilknytning til disse sager.
English: Apart from the strengthened warnings, and more extensive contra-indications, proposed by several MAHs, the other proposals for changes in the SPCs and PLs - for example, in relation to indication - reflected the existing variations across Europe and were often not internally consistent: for example, the proposal that chronic pain should be explicitly contra-indicated, in the context of a SPC also having instructions in relation to repeat prescriptions “which should not exceed three months”.
Danish: Ud over de kraftigere advarsler og mere omfattende kontraindikationer foreslået af adskillige indehavere af markedsføringstilladelse afspejlede de øvrige forslag til ændringer i produktresuméer og indlægssedler - f.eks. i relation til indikationen - de eksisterende variationer i Europa og var ofte ikke indbyrdes konsekvente, f.eks. forslaget om, at kroniske smerter udtrykkeligt skulle kontraindiceres, i et produktresumé indeholdende instruktioner vedrørende gentagne recepter "der ikke bør overstige tre måneder".
English: In chronic pain, other combinations of paracetamol and an opioid (such as a fixed-dose combination of paracetamol and codeine phosphate), or a combination of a non-steroidal anti-inflammatory drug (NSAID) and an opioid other than dextropropoxyphene have been shown to be at least as effective as the fixed combination of dextropropoxyphene and paracetamol.
Danish: Mod kroniske smerter har andre kombinationer af paracetamol og et opioidanalgetikum (såsom en fastdosiskombination af paracetamol og kodeinfosfat) eller en kombination af et non-steroidt antiinflammatorisk lægemiddel (NSAID) og et andet opioidanalgetikum end dextropropoxyfen vist sig at være mindst lige så effektiv som den faste kombination af dextropropoxyfen og paracetamol.
English: Similarly in Ireland, analysis in 2009 of further data from the Alcohol and Drug Research Unit of the Health Research Board revealed significant under-reporting of deaths associated with dextropropoxyphene-containing products - indicating fatality rates fifteen-fold higher than previously reported.
Danish: I Irland viste analyser af supplerende data fra Alcohol and Drug Research Unit under Health Research Board i 2009 en betydelig underindberetning af dødsfald i tilknytning til lægemidler indeholdende dextropropoxyfen - hvilket tyder på dødsrater, der er 15 gange højere end tidligere indberettet.
English: Based on the limited efficacy and the significant risk of fatal overdose (in particular accidental overdose), the CHMP was of the opinion that the benefit/risk balance of dextropropoxyphene containing medicinal products was negative.
Danish: På baggrund af den begrænsede effekt og den signifikante risiko for dødelig overdosering (særlig utilsigtet overdosering) mente CHMP, at benefit/risk-forholdet for lægemidler indeholdende dextropropoxyfen var negativt.
English: Benefit-Risk
Danish: Benefit/risk-forholdet
English: On the basis of the available data sources, the CHMP was of the opinion that spontaneous reporting was significantly underestimating the number of reported deaths associated with dextropropoxyphene.
Danish: På baggrund af de tilgængelige datakilder var CHMP af den holdning, at de spontane rapporter i betydelig grad undervurderer antallet af rapporterede dødsfald, der kan sammenkædes med dextropropoxyfen.
English: Available efficacy data are limited due to methodological shortcomings such as the absence of a sample size calculation in the majority of the double-blind studies in acute pain and the lack of long term efficacy data to support the use of the fixed combination of dextropropoxyphene and paracetamol as a prolonged treatment.
Danish: De tilgængelige data om effekt er begrænsede grundet metodologiske mangler, såsom manglende beregning af prøvestørrelsen i størstedelen af de dobbeltblindede undersøgelser af akutte smerter og manglende data om den langsigtede effekt til at understøtte anvendelsen af den faste kombination af dextropropoxyfen og paracetamol som længevarende behandling.
English: In particular, more comprehensive mortality data at a national level from France, notably forensic toxicology results, provided evidence of a significantly greater number of deaths associated with the use of dextropropoxyphene-containing products than had previously been estimated.
Danish: Navnlig har mere detaljerede mortalitetsdata på nationalt plan fra Frankrig, især retsmedicinske toksikologiresultater, givet evidens for et væsentligt højere antal dødsfald i forbindelse med anvendelse af lægemidler indeholdende dextropropoxyfen end tidligere anslået.
English: The CHMP reviewed the data submitted by the MAHs to address the above-mentioned concerns as well as the available data from Member States in relation to drug poisoning that involves dextropropoxyphene and the investigation of suspicious deaths in their countries.
Danish: CHMP vurderede de oplysninger, der var blevet indsendt af indehaverne af markedsføringstilladelsen som svar på de ovennævnte betænkeligheder, samt de tilgængelige data fra medlemsstaterne omkring forgiftninger, hvor dextropropoxyfen indgik, og undersøgelser af mistænkelige dødsfald i de pågældende lande.
English: However, the key safety concern with dextropropoxyphene is that it has a very narrow therapeutic index under normal conditions of use: following overdose, cardiac arrhythmias (which cannot be reversed using naloxone) and opioid side effects (such as respiratory depression) are rapid in onset and often fatal - there is evidence that the case fatality rate is higher than, for example, for tricyclic antidepressants.
Danish: Den vigtigste sikkerhedsmæssige betænkeligheder i forbindelse med dextropropoxyfen er, at det har et meget snævert terapeutisk indeks under normale anvendelsesvilkår: Næst efter overdosis indtræder hjertearytmi (der ikke kan reverseres ved hjælp af naloxon) og opiodbivirkninger (såsom respirationsdepression) hurtigt og er ofte dødelige - der er evidens for, at dødsraten er højere end for eksempelvis tricykliske antidepressiver.
English: Furthermore, the lack of long term efficacy data did not allow any definite conclusions to be drawn on the efficacy of the dextropropoxyphene medicinal products as a long-term treatment.
Danish: Manglen på data om den langsigtede effekt gjorde det desuden umuligt at træffe endegyldige konklusioner om effekten af lægemidler indeholdende dextropropoxyfen som langtidsbehandling.
English: In view of the complex context in which cases of fatal overdose occurred under normal conditions of use and in view of the narrow therapeutic index and the potential for rapid death, the CHMP was of the opinion that the above proposed risk minimisation activities of narrowing the indication, reducing the pack sizes and/or introducing further safety warnings and contraindications (including those beyond the Product Information) would not be able to reduce the risks to an acceptable level.
Danish: Set i lyset af den komplekse sammenhæng, hvorunder de dødelige overdoseringer under normale anvendelsesbetingelser fandt sted, samt det snævre terapeutiske indeks og risikoen for hurtig død, mente CHMP ikke, at de ovenfor foreslåede tiltag for at minimere risikoen, såsom begrænsning af indikationen, reduktion af pakningernes størrelse og/eller flere sikkerhedsadvarsler og kontraindikationer (ud over dem, der findes i produktinformationen), ville nedbringe risikoen til et acceptabelt niveau.
English: After considering the CHMP's major concerns over the toxicity of dextropropoxyphene, given its narrow therapeutic index and its adverse effects on the cardio - respiratory system as well as the lack of information in relation to the use of single component dextropropoxyphene medicinal products, the European Commission agreed on 31 March 2009 to the extension of the scope of the referral to also include authorised medicinal products containing only dextropropoxyphene.
Danish: Efter at have overvejet CHMP's vigtigste betænkeligheder omkring dextropropoxyfens toksicitet set i lyset af dets snævre terapeutiske indeks og dets bivirkninger i hjerte og luftveje samt de manglende oplysninger i forhold til brugen af enkeltkomponentlægemidler indeholdende dextropropoxyfen besluttede EuropaKommissionen den 31. marts 2009 at udvide formålet med indbringelsen af sagen til også at omfatte godkendte lægemidler, der kun indeholder dextropropoxyfen.
English: The CHMP, having considered the matter as set out in the appended referral assessment report recommended the withdrawal of all the Marketing Authorisations for all oral/rectal medicinal products referred to in Annex I to be effective within the next 15 months after Commission Decision in order to allow switching patients to safer alternatives in particular, considering the extensive clinical use of dextropropoxyphene containing medicinal products and the wide patient exposure in some Member States.
Danish: CHMP anbefaler, efter at have overvejet sagen, som den fremstår i den vedlagte vurderingsrapport, tilbagekaldelse af alle markedsføringstilladelser for alle orale/rektale lægemidler, der henvises til i bilag I, som skal gælde i en periode på 15 måneder efter Kommissionens beslutning, så patienterne får mulighed for at skifte til mere sikre alternativer, set i lyset af den udbredte brug af lægemidler indeholdende dextropropoxyfen og den store patienteksponering i visse medlemsstater.
English: ANNEX I LIST OF THE NAMES, PHARMACEUTICAL FORMS, STRENGTHS OF THE MEDICINAL PRODUCTS, ROUTE OF ADMINISTRATIONS AND MARKETING AUTHORISATION HOLDERS IN THE MEMBER STATES
Danish: BILAG I FORTEGNELSE OVER LÆGEMIDLERNES NAVNE, LÆGEMIDDELFORM(ER), STYRKE(R), INDGIVELSESVEJ(E), ANSØGER(E), INDEHAVER(E) AF MARKEDSFØRINGSTILLADELSE(R) I MEDLEMSSTATERNE
English: - The Committee concluded, in view of the available data, that the risk of accidental fatal overdose associated with the use of dextropropoxyphene containing medicinal products in the symptomatic treatment of pain outweigh the limited benefits.
Danish: - Udvalget konkluderede på baggrund af de foreliggende data, at risikoen for en utilsigtet dødelig overdosering, der kan sammenkædes med lægemidler indeholdende dextropropoxyfen til symptomatisk behandling af smerter, overstiger de begrænsede fordele.
English: Because of this, the most reliable data come from forensic analysis and national mortality statistics, and complete review of the fatal overdoses associated with dextropropoxyphene (alone and in combination with paracetamol/caffeine) supported the major concern over the fatal toxicity of dextropropoxyphene containing products under normal conditions of use due to their narrow therapeutic index.
Danish: Derfor stammer de mest pålidelige data fra retsmedicinske analyser og nationale dødsstatistikker, og en komplet gennemgang af de dødelige overdoser, der kan sammenkædes med dextropropoxyfen (alene og i kombination med paracetamol/koffein), understøttede den vigtigste betænkelighed ved den dødelige toksicitet ved lægemidler indeholdende dextropropoxyfen under normale anvendelsesbetingelser på grund af deres snævre terapeutiske indeks.
English: - The Committee also considered that a significant number of deaths have been reported in which dextropropoxyphene is present at toxic levels confirming that the risk of accidental fatal overdose associated with dextropropoxyphene containing medicinal products and their narrow therapeutic index is of major concern;
Danish: - Udvalget var desuden af den opfattelse, at der er blevet rapporteret et betydeligt antal dødsfald, hvor dextropropoxyfen fandtes på toksisk niveau, hvilket bekræfter, at risikoen for en utilsigtet dødelig overdosering, der kan sammenkædes med lægemidler indeholdende dextropropoxyfen samt deres snævre terapeutiske indeks, er et stort problem.