FrancophonIA/ELRC3.0 huggingface dataset:
English: The experts also noted that separate protocols would need to be in place for treating overdose with IR paracetamol and overdose with MR paracetamol or unknown formulation; and that the current nomograms are relevant only for IR paracetamol formulations.
Slovenian: Strokovnjaki so poudarili tudi, da bi morali biti vzpostavljeni ločeni protokoli za zdravljenje prevelikega odmerjanja paracetamola s takojšnjim sproščanjem in prevelikega odmerjanja paracetamola s prirejenim sproščanjem oziroma neznane formulacije ter da trenutni nomogrami veljajo samo za formulacije s paracetamolom s takojšnjim sproščanjem.
English: Inherent PK characteristics of these MR products; with one part of the paracetamol content being released immediately, and one (larger) part with a delayed release, differ from the immediate release (IR) formulations.
Slovenian: Inherentne farmakokinetične lastnosti teh zdravil s prirejenim sproščanjem, pri katerih se en del vsebnosti paracetamola sprosti takoj, drugi (večji) del pa z zapoznelim sproščanjem, se razlikujejo od lastnosti formulacij s takojšnjim sproščanjem.
English: As part of their risk minimisation strategy, the MAH have recommended that in case of poisoning the emergency medical services should promptly contact the national Poison Centres.
Slovenian: V okviru svoje strategije zmanjševanja tveganja sta imetnika dovoljenj za promet z zdravilom priporočila, da naj se nujna medicinska pomoč v primeru zastrupitve takoj obrne na nacionalni center za zastrupitve.
English: Although it was recognised that repeated, and patient-tailored plasma sampling for determination of paracetamol levels and liver enzymes together with tailored administration of NAC may be sufficient to avoid serious hepatic damage, if the patient presents to the medical emergency unit in time, it is currently not possible to determine an effective and proportionate overdose protocol for such overdose due to lack of evidence.
Slovenian: Čeprav je bilo ugotovljeno, da ponavljajoče se in bolniku prilagojeno vzorčenje plazme za ugotavljanje ravni paracetamola in jetrnih encimov skupaj s prilagojenim dajanjem NAC utegne zadoščati za preprečevanje resne poškodbe jeter, če bolnik pravočasno pride na urgenco, zaradi pomanjkanja dokazov trenutno ni mogoče določiti učinkovitega in sorazmernega protokola za preveliko odmerjanje pri tovrstnem prevelikem odmerjanju.
English: However, in view of the risk related to these products, PRAC could not identify an indication with substantial clinical benefit which would be only specific to the tramadol/paracetamol MR formulation.
Slovenian: Vendar pa glede na tveganje, povezano s temi zdravili, ni mogel določiti indikacije z bistveno klinično koristjo, ki bi bila značilna samo za formulacijo s tramadolom/paracetamolom s prirejenim sproščanjem.
English: The PRAC considered the other risk minimisation measures proposed within the re-examination procedure (e.g. school programmes, restriction to pack type and size, educational materials and direct communication to HCPs) but concluded that these would neither be sufficient nor appropriate to adequately minimise the risk of intentional and unintentional overdose and consequential risk of hepatotoxicity.
Slovenian: Proučil je tudi druge ukrepe za zmanjšanje tveganja, ki so jih predlagali v okviru postopka ponovne proučitve (npr. šolski programi, omejitev vrste in velikosti pakiranja, izobraževalna gradiva in neposredna obvestila za zdravstvene delavce), vendar je zaključil, da ti ukrepi ne bi bili niti zadostni niti primerni za ustrezno zmanjšanje tveganja za namerno in nenamerno preveliko odmerjanje ter posledično tveganje za hepatotoksičnost.
English: Products with modified or prolonged release properties containing paracetamol, which are intended to have a longer action, are available in several EU Member States.
Slovenian: V več državah članicah EU so na voljo zdravila s prirejenim ali podaljšanim sproščanjem, ki vsebujejo paracetamol in so namenjena dolgotrajnejšemu delovanju.
English: The PRAC concluded that the treatment recommendations of overdoses based on standard paracetamol formulations, including use of the nomogram, are inadequate after intake of toxic doses of MR formulations.
Slovenian: Odbor PRAC je zaključil, da so priporočila za zdravljenje prevelikega odmerjanja na podlagi standardnih formulacij paracetamola, vključno z uporabo nomograma, po zaužitju toksičnih odmerkov formulacij s prirejenim sproščanjem neustrezna.
English: The PRAC agreed with the outcome of an ad-hoc expert group meeting convened during the reexamination, where the experts concluded that it is not possible to extrapolate from a PK model developed for paracetamol as a single ingredient to the combination of paracetamol/tramadol.
Slovenian: Odbor PRAC se je strinjal z izidom srečanja priložnostne strokovne skupine, sklicanim v okviru ponovne proučitve, pri čemer so strokovnjaki zaključili, da farmakokinetičnega modela, pripravljenega za paracetamol kot edino sestavino, ni mogoče ekstrapolirati na kombinacijo paracetamola/tramadola.
English: Whilst adaptation of the existing guidelines on treatment of overdose could be done, PRAC considered that the development of a common protocol would result in overexposing certain patients to NAC and the subsequent risks related to the use of NAC (e.g. hypersensitivity including anaphylactic shock).
Slovenian: Obstoječe smernice zdravljenje prevelikega odmerjanja je sicer mogoče prilagoditi, vendar je odbor PRAC menil, da bi bili zaradi priprave skupnega protokola določeni bolniki preveč izpostavljeni NAC, pojavila pa bi se nadaljnja tveganja, povezana z uporabo NAC (npr. preobčutljivost, vključno z anafilaktičnim šokom).
English: These overdoses are even more unpredictable and more complex to manage than MR paracetamol alone due to the combination with tramadol.
Slovenian: Tovrstni primeri prevelikega odmerjanja so zaradi kombinacije s tramadolom še bolj nepredvidljivi in zapletenejši za obravnavo kot samo paracetamol s prirejenim sproščanjem.
English: The PRAC acknowledged the need for a better characterisation of the risk (relationship with the dose, the concentrations and the toxicity) as well as the need to address uncertainties on the handling of patients with MR paracetamol products overdose (e.g. the appropriate threshold to start NAC administration, the dose and duration of NAC treatment as well as the optimal number of paracetamol concentration that need to be determined).
Slovenian: Odbor PRAC je potrdil potrebo po boljši opredelitvi tveganja (razmerje med odmerkom, koncentracijami in toksičnostjo) ter potrebo po obravnavi negotovosti pri zdravljenju bolnikov, ki so zaužili prevelik odmerek zdravil s paracetamolom s prirejenim sproščanjem (npr. ustrezna meja za uvedbo NAC, odmerek in trajanje zdravljenja z NAC ter optimalno število določitev koncentracije paracetamola).
English: Furthermore, the role of risk factors such as co-medications or underlying diseases on the PK profile, in particular the delayed and double peak formation is not sufficiently understood to anticipate the population at risks and better manage the cases of overdose with paracetamol MR containing medicinal products.
Slovenian: Nadalje vpliv dejavnikov tveganja, kot so sočasna zdravila ali osnovne bolezni, na farmakokinetični profil, zlasti na zakasnjeno delovanje in nastanek dvojnih vrhov, ni dovolj pojasnjen, da bi lahko napovedali, katera populacija je izpostavljena tveganju, in bolje obravnavali primere prevelikega odmerjanja z zdravili, ki vsebujejo paracetamol s prirejenim sproščanjem.
English: During the re-examination a comparison of the effectiveness of revised treatment protocol to that of standard established treatment protocol used for the management of overdose with IR paracetamol in the prevention of paracetamol-related hepatotoxicity was made.
Slovenian: V okviru ponovne proučitve je bila opravljena primerjava med učinkovitostjo pregledanega protokola zdravljenja in standardnega uveljavljenega protokola zdravljenja, ki se uporablja za zdravljenje prevelikega odmerjanja paracetamola s takojšnjim sproščanjem pri preprečevanju hepatotoksičnosti, povezane s paracetamolom.
English: Furthermore, the PRAC confirmed that despite the difference in the target population and the clinical settings, the fixed-dose combination of MR paracetamol/tramadol can result in overdoses that are severe in view of the risk of hepatotoxicity of paracetamol and the toxicity of tramadol (e.g. CNS effects including high risk of seizures, and renal failure).
Slovenian: Nadalje je odbor PRAC potrdil, da lahko kljub razliki v ciljni populaciji in kliničnem okolju fiksna kombinacija odmerkov paracetamola s prirejenim sproščanjem/tramadola privede do prevelikega odmerjanja, ki je resno z vidika tveganja za hepatotoksičnost paracetamola in toksičnosti tramadola (npr. učinki na CŽS, vključno z velikim tveganjem za epileptične napade, in ledvična odpoved).
English: Therefore, in view of all the above, including the consultation with the second ad-hoc expert group, and the argumentation presented by the MAHs in the detailed grounds as well as in the oral explanations, the PRAC concluded that the benefit-risk balance of with modified release paracetamol and paracetamol/tramadol containing products is no longer favourable and recommended that the marketing authorisations of these products should be suspended.
Slovenian: Zato je odbor PRAC glede na vse navedeno, vključno s posvetovanjem z drugo priložnostno strokovno skupino, in utemeljitve, ki sta jih predstavila imetnika dovoljenja za promet z zdravilom v podrobno opisanih razlogih in ustnih obrazložitvah, zaključil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem in paracetamol/tramadol, ni več ugodno, in priporočil, da se dovoljenja za promet s temi zdravili začasno umaknejo.
English: The CMDh, as a consequence, considers that the benefit-risk balance of products containing paracetamol, modified and prolonged release is not favourable.
Slovenian: Skupina CMDh posledično meni, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim in podaljšanim sproščanjem, ni ugodno.
English: The MAH referred to the limited number of overdoses reported with the fixed-dose combination are limited.
Slovenian: Imetnik dovoljenja za promet z zdravilom se je skliceval na omejeno število primerov prevelikega odmerjanja, o katerih so poročali pri fiksni kombinaciji odmerkov.
English: Other risk minimisation measures proposed by the MAH to address the risk associated with overdose of the combination were considered by PRAC such as update of the product information to include stronger warnings related to at-risk patients and concomitant use with other paracetamol-containing products, DHPC and restriction of availability of certain type of packaging (i.e. bottles) and restriction of available pack size (max. 48 tablets).
Slovenian: Odbor PRAC je proučil tudi druge ukrepe za zmanjšanje tveganja, ki jih je predlagal imetnik dovoljenja za promet z zdravilom za obravnavo tveganja, povezanega s prevelikim odmerjanjem kombinacije, kot so posodobitev informacij o zdravilu, ki bi vključevale močnejša opozorila, povezana z ogroženimi bolniki, in sočasno uporabo drugih zdravil, ki vsebujejo paracetamol, neposredna obvestila za zdravstvene delavce ter omejitev razpoložljivosti določenih vrst pakiranja (tj. stekleničk) in omejitev razpoložljivih velikosti pakiranja (največ 48 tablet).
English: • The PRAC considered the highly variable PK-profile of overdoses with MR paracetamol formulations, and the uncertainties related to the quantity and the formulation of the product that the patient has ingested, increase the challenges in effectively minimising the risk for paracetamol toxicity.
Slovenian: • odbor PRAC je presodil, da zelo spremenljivi farmakokinetični profil prevelikih odmerkov formulacij paracetamola s prirejenim sproščanjem in negotovosti, povezane s količino in formulacijo zdravila, ki ju je bolnik zaužil, povečujejo izzive pri učinkovitem zmanjševanju tveganja za toksičnost paracetamola;
English: All MAHs proposed additional measures that would further minimise the risks associated with overdose with MR formulation for example updated package leaflet, communication to HCP (DHPC, education materials), prescription status, restriction of access to bottle packaging and large blister pack size for the patients.
Slovenian: Vsi imetniki dovoljenja za promet z zdravilom so predlagali dodatne ukrepe, ki bi nadalje zmanjšali tveganja, povezana s prevelikim odmerjanjem formulacije s prirejenim sproščanjem, na primer posodobljeno navodilo za uporabo, sporočilo za zdravstvene delavce (neposredno obvestilo za zdravstvene delavce, izobraževalno gradivo), status predpisovanja, omejitev dostopa do pakiranj v stekleničkah in večjih pretisnih omotov za bolnike.
English: A very high variability has been observed in the PK profiles of patients poisoned with MR formulations.
Slovenian: Farmakokinetični profili so se med bolniki, zastrupljenimi s formulacijami s prirejenim sproščanjem, zelo razlikovali.
English: The PRAC noted the claimed specific benefits of the MR formulations related to a reduction of daily tablet intake; from 4 to 3 times daily dosing for the single ingredient products, and the simplified regimen of 2 from 4 tablets for the combination products.
Slovenian: Upošteval je, da se navedene posebne koristi formulacij s prirejenim sproščanjem nanašajo na zmanjšanje dnevnega vnosa tablet, in sicer s štirikrat na trikrat dnevno odmerjanje pri zdravilih z eno učinkovino in poenostavljeni režim z dvema namesto štirih tablet pri kombiniranih zdravilih;
English: In conclusion, the complex PK profile after an overdose of paracetamol MR containing medicinal products, and the fact that the standard treatment protocol for paracetamol poisoning is inadequate for these products and the severe risk of hepatotoxicity related to overdose with paracetamol raises a serious risk to public health at Union level.
Slovenian: Zapleten farmakokinetični profil po prevelikem odmerjanju zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem, in dejstvo, da je standardni protokol zdravljenja zastrupitve s paracetamolom pri teh zdravilih neustrezen, ter resno tveganje za hepatotoksičnost, povezano s prevelikim odmerjanjem paracetamola, torej pomenijo resno tveganje za javno zdravje na ravni Unije.
English: • The PRAC also noted that in addition to the uncertainties on how to minimise the risk for paracetamol toxicity, the safety profile of tramadol was considered to present additional challenges for minimising the risks for toxicity (e.g. CNS effects, high-risk of seizures and renal failure) following an overdose with a prolonged release combination product of paracetamol and tramadol.
Slovenian: • odbor PRAC je opozoril tudi, da poleg negotovosti glede zmanjševanja tveganja za toksičnost paracetamola tudi varnostni profil tramadola pomeni dodatne izzive pri zmanjševanju tveganj za toksičnost (npr. učinki na CŽS, visoko tveganje za epileptične napade in ledvično odpoved) po prevelikem odmerjanju kombiniranega zdravila s podaljšanim sproščanjem, ki vsebuje paracetamol in tramadol;
English: Three overdose cases (none of which was fatal) have been identified involving tramadol/paracetamol fixed dose combination product following an inquiry to national Poison centres during this procedure, as only Doreta SR is marketed.
Slovenian: S poizvedovanjem pri nacionalnih centrih za zastrupitve v okviru tega postopka so našli tri primere prevelikega odmerjanja (od katerih nobeden ni bil smrten), ki so vključevali kombinirano zdravilo s fiksno kombinacijo tramadola/paracetamola, saj se trži samo zdravilo Doreta SR.
English: Therefore, in view of the above, the PRAC concluded that the benefit-risk balance of with modified release paracetamol containing products is no longer favourable and recommended that the marketing authorisations of these products should be suspended.
Slovenian: Z upoštevanjem zgoraj navedenega je zato zaključil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem, ni več ugodno, in priporočil, da se dovoljenja za promet s temi zdravili začasno umaknejo.
English: The PRAC concluded that the standard regimen for treatment of paracetamol poisoning, including use of the nomogram, which has been successful in preventing hepatotoxicity following IR overdoses, is inadequate for handling of an overdose with a paracetamol MR formulation.
Slovenian: Odbor PRAC je zaključil, da je standardni režim zdravljenja zastrupitve s paracetamolom, vključno z uporabo nomograma, ki je uspešen pri preprečevanju hepatotoksičnosti po prevelikem odmerjanju paracetamola s takojšnjim sproščanjem, neustrezen pri obravnavi prevelikega odmerjanja formulacije paracetamola s prirejenim sproščanjem.
English: A. Paracetamol modified release tablets
Slovenian: A. Tablete s paracetamolom s prirejenim sproščanjem
English: Arguments presented by the MAHs and views expressed by the experts during the re-examination phase did not alleviate any of the concerns by PRAC on the complex PK observed with overdose and the options for their management.
Slovenian: Utemeljitve, ki sta jih predstavila imetnika dovoljenj za promet z zdravilom, in stališča strokovnjakov med ponovno proučitvijo niso odpravili nobenega pomisleka odbora PRAC glede zapletene farmakokinetike, opažene pri prevelikem odmerjanju, in možnosti zdravljenja prevelikega odmerjanja.
English: The high variability in PK-profile of an overdose with a MR paracetamol containing product, and the continuously present uncertainties related to what formulation (IR or MR paracetamol) and the dose the patient has ingested, leads to serious safety concern in managing paracetamol overdoses.
Slovenian: Velika spremenljivost farmakokinetičnega profila pri prevelikem odmerjanju zdravila, ki vsebuje paracetamol s prirejenim sproščanjem, in stalne negotovosti, povezane s formulacijo (paracetamol s takojšnjim ali prirejenim sproščanjem) in odmerkom, ki ju je bolnik zaužil, predstavljajo resne pomisleke o varnosti pri obravnavi prevelikega odmerjanja paracetamola.
English: The experts were of the same views as the PRAC regarding the complications both in assessment and treatment of poisoning by paracetamol MR and the subsequent related potential for severe harm and this is due to the unpredictable release profile of MR paracetamol, the PK profile and the difficulty in establishing and implementing an optimal treatment protocol MR paracetamol poisoning is associated with additional complications.
Slovenian: Strokovnjaki so bili enakega mnenja kot odbor PRAC glede zapletov pri ocenjevanju in zdravljenju zastrupitev s paracetamolom s prirejenim sproščanjem in posledično povezanimi možnostmi za resne škodljive učinke, kar je posledica nepredvidljivega profila sproščanja paracetamola s prirejenim sproščanjem, farmakokinetičnega profila in težav pri ugotavljanju in uvajanju najboljšega protokola zdravljenja zastrupitev s paracetamolom s prirejenim sproščanjem.
English: This unpredictability was not sufficiently mitigated by the modelling and simulation measures submitted by the MAH GSK Consumer Healthcare.
Slovenian: Ukrepi modeliranja in simulacije, ki jih je predložil imetnik dovoljenja za promet z zdravilom, GSK Consumer Healthcare, te nepredvidljivosti niso zadostno odpravili.
English: For paracetamol MR tablets 319 spontaneous adverse event reports of overdose (OD) were identified since marketing authorisation.
Slovenian: Pri tabletah paracetamola s prirejenim sproščanjem je bilo od izdaje dovoljenja za promet z zdravilom prejetih 319 spontanih poročil o neželenih učinkih zaradi prevelikega odmerka.
English: For the suspension of products containing paracetamol, modified and prolonged release to be lifted, the marketing authorisation holders shall provide evidence in support of proportionate, feasible and effective measures to prevent the risk of overdose and minimise the risk of hepatic injury following intentional or accidental overdoses with modified release paracetamol containing products.
Slovenian: Za preklic začasnega umika zdravil, ki vsebujejo paracetamol s prirejenim in podaljšanim sproščanjem, morajo imetniki dovoljenj za promet z zdravilom predložiti dokaze v podporo sorazmernim, izvedljivim in učinkovitim ukrepom za preprečevanje tveganja za preveliko odmerjanje in zmanjšanje tveganja za poškodbo jeter po namernem ali nenamernem prevelikem odmerjanju zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem.
English: B. Tramadol/paracetamol prolonged release tablets
Slovenian: B. Tablete s tramadolom/paracetamolom s podaljšanim sproščanjem
English: The restriction of pack size, whilst not deprive of any effect, would not sufficiently restrict the access to these medicinal products and is unlikely to prevent overdose, in particular intentional ones.
Slovenian: Omejitev velikost pakiranja sicer ne bi bila čisto brez učinka, vendar ne bi dovolj omejila dostopa do teh zdravil.
English: In addition all MAHs proposed to conduct a Post-authorisation safety study (PASS) to collect details of cases of overdose with paracetamol and to optimize the management of overdose assess.
Slovenian: Poleg tega so vsi imetniki dovoljenj za promet z zdravilom predlagali izvedbo študije varnosti po pridobitvi dovoljenja za promet (PASS), s katero bi zbrali podrobnosti o primerih prevelikega odmerjanja paracetamola in optimizirali zdravljenje prevelikega odmerjanja.
English: It is considered that the serious and potentially fatal hepatic injury in case of overdose with paracetamol MR and paracetamol/tramadol MR formulations cannot be sufficiently minimised by effective risk minimisation measures to prevent this risk and to manage it once it occurs.
Slovenian: Šteje se, da resnih in možnih smrtnih okvar jeter pri prevelikem odmerjanju formulacij s paracetamolom s prirejenim sproščanjem in paracetamolom/tramadolom s prirejenim sproščanjem ni mogoče dovolj zmanjšati z učinkovitimi ukrepi za zmanjšanje tveganja, ki bi to tveganje preprečili in obvladali, kadar bi se pojavilo.
English: The proposed risks minimisations by the MAHs are not considered feasible, effective and proportionate by the PRAC.
Slovenian: Odbor PRAC je ocenil, da ukrepi za zmanjšanje tveganja, ki so jih predlagali imetniki dovoljenj za promet z zdravilom, niso izvedljivi, učinkoviti in sorazmerni.
English: Further to the review of all data submitted related to the paracetamol MR and paracetamol/ tramadol MR products, in particular the risk of intentional and accidental overdoses related to their use, PRAC considered that the severe risk of hepatotoxicity related to overdoses, the complex PK profile of these products after an overdose, which makes the standard treatment protocol for paracetamol poisoning inadequate raises a serious risk to public health at Union level.
Slovenian: Po pregledu vseh podatkov, predloženih v povezavi z zdravili s paracetamolom s prirejenim sproščanjem in paracetamolom/tramadolom s prirejenim sproščanjem, je odbor PRAC presodil, da zlasti glede tveganja za namerno in nenamerno preveliko odmerjanje, povezanega z njihovo uporabo, resno tveganje za hepatotoksičnost, povezano s prevelikim odmerjanjem, in zapleten farmakokinetični profil teh zdravil po prevelikem odmerjanju, zaradi česar je standardni protokol zdravljenja zastrupitve s paracetamolom neustrezen, pomenita resno tveganje za javno zdravje na ravni Unije.
English: Furthermore, the risk minimisation measures intended to reduce the risk for hepatic injury following an overdose with an MR formulation of paracetamol or the combination of paracetamol and tramadol were not considered to be sufficiently effective and reliable.
Slovenian: Poleg tega ukrepi za zmanjšanje tveganja za poškodbe jeter po prevelikem odmerjanju formulacije paracetamola s prirejenim sproščanjem ali kombinacije paracetamola in tramadola niso dovolj učinkoviti in zanesljivi;