natgillin/translations-raw huggingface dataset:
• tjeklister til præscreening og løbende overvågning af blodtryk, puls, vækst (vægt, højde, appetit) og opståen af psykoser 
• Checklists for pre-screening and on-going monitoring of patients' blood pressure, heart rate, growth (weight, height, appetite) and emergence of psychoses.
I andre populationer synes forfatterne yderligere at have konkluderet, at behandling af ADHD med stimulerende midler i barndommen er forbundet med nedsat risiko for stofmisbrug senere i livet (Biederman et al. 1999; Wilens et al. 2003). 
In other publications, authors seem to have further concluded that ADHD treatment with stimulants during childhood is associated with a reduction in the risk of substance use disorder later in life (Biederman et al. 1999; Wilens et al. 2003).
Dexamfetamin anvendes til behandling af narkolepsi og hyperaktiv opmærksomhedsforstyrrelse (ADHD) i flere EU-lande, herunder referencemedlemsstaten (RMS) i denne procedure. 
Dexamfetamine is currently used for treatment of narcolepsy and attention deficit hyperactivity disorder (ADHD) in several EU countries including the reference Member State (RMS) in this procedure.
Dette er acceptabelt, da ansøgninger vedrørende almindeligt anerkendte anvendelser ikke skal indeholde resultater af prækliniske og kliniske undersøgelser, og disse kan erstattes af passende videnskabelig litteratur. 
This is acceptable as in well-established use applications it is not required that applicants provide results of pre-clinical tests and clinical trials, these are to be replaced by appropriate scientific literature.
Det bemærkedes, at der kan optræde forhøjet blodtryk og takykardi. 
It was noted that increased blood pressure may occur as well as tachycardia.
De rådspurgte eksperter henviste til, at ADHD har mindre sandsynlighed for at medføre eufori hos børn, når produkterne anvendes som tilsigtet. 
The experts consulted expressed the fact that ADHD is less likely to produce euphoria in children when the products are used as intended.
Denne oversigt har metodologiske begrænsninger, men dens konklusioner bygger på relevant evidens. 
While the review has methodological limitations, the conclusions reached are based on relevant evidence.
Endelig bemærkes det, at lisdexamfetamin er et inaktivt prodrug, der optages i blodbanen, hvor det gradvis omdannes til dexamfetamin. 
Lastly, it is noted that lisdexamfetamine is an inactive prodrug which is absorbed to the bloodstream where it is gradually converted to dexamfetamine.
var CHMP af den opfattelse, at risk/benefit-forholdet for Dexamed og relaterede navne er positivt. 
Therefore, the CHMP was of the opinion that the benefit/risk ratio of Dexamed and associated names is considered to be favourable.
Begrundelse for den positive udtalelse, ændringerne af produktresuméet og indlægssedlen og betingelserne for markedsføringstilladelserne 
Grounds for positive opinion, amendments of the summary of product characteristics and package leaflet, and conditions to the Marketing Authorisations
Dets virkningsmekanisme ved ADHD kendes ikke fuldt ud, men dets virkning til behandling af ADHD er ikke blevet bestridt ved denne procedure. 
Its mechanism of action in ADHD is not fully understood, but its efficacy in treatment of ADHD has not been disputed during this procedure.
Endvidere kan præparater med hurtig udløsning tænkes at gøre det lettere at optimere behandlingen, når der behøves en initial titreringsfase til at fastlægge det korrekte doseringsniveau. 
Treatment optimisation may be also easier to achieve with immediate-release forms when an initial titration phase is needed to determine the correct dosing levels.
Disse og de øvrige foranstaltninger i risikostyringsplanen skal sikre, at dexamfetamin kun stilles til rådighed for patienter, der har et reelt behov for det og kan have fordel af det, hvorved risikoen for misbrug og ulovlig anvendelse mindskes. 
These and the other measures in the risk management plan are proposed to ensure that dexamfetamine is only made available to patients who really need it and can benefit from it, therefore mitigating the risk of misuse and diversion.
Grunden til forskellen i respons kan tænkes at være forskel i farmakologisk virkningsmekanisme. 
The reason for the different responses could be different pharmacological mechanisms of action.
• Indsættelse af en erklæring i punkt 4.4 om “Misbrug, fejlanvendelse og ulovlig anvendelse” med angivelse af, at risikoen sædvanligvis er større for korttidsvirkende end for tilsvarende langtidsvirkende stimulerende midler. 
• Introduction of a statement in section 4.4 on “Abuse, misuse, and diversion” reporting that the risk is generally greater for short acting stimulants than for corresponding long-acting products.
Efter vurdering af de forelagte oplysninger finder CHMP ovennævnte risikostyringsforanstaltninger nødvendige for sikker og effektiv anvendelse af lægemidlet. 
The CHMP, having considered the data submitted in the application is of the opinion that the above risk management activities are necessary for the safe and effective use of the medicinal product.
Under proceduren foretog markedsføringstilladelsesindehaveren yderligere online litteratursøgninger i databaser fra europæiske sundhedsmyndigheder og WHO samt virksomhedens egen sikkerhedsdatabase. 
During the procedure the MAH conducted further research in the literature, online, in databases from European Health Authorities and WHO and its own safety database.
Skønt det vedgås, at fejlanvendelse, misbrug, afhængighed og ulovlig anvendelse ikke altid vil blive indberettet til den ordinerende læge, fandtes der ved søgningen en meget lav hændelsesrate i de lande, hvor dexamfetamin er på markedet til anvendelse ved ADHD. 
Although it is acknowledged that misuse, abuse, dependence and diversion are events that will not always be reported to the prescribers, the search retrieved a very low event rate in the countries where dexamfetamine is available on the market for ADHD.
Virkningen ved andetvalgsbehandling af ADHD 
Efficacy in second line treatment of ADHD
Denne metaanalyse udpegede nogle hovedproblemer, der kan forklare forskellen i undersøgelsernes resultater, og forfatterne bemærkede, at skønt undersøgelsen var baseret på Wilens et al. (2003), omfattede den kun et forholdsvis beskedent antal undersøgelser. 
This meta-analysis identified a number of key issues that may explain the differences in outcome of the studies, and the authors noted that, while building on that of Wilens et al. (2003), is still relatively modest in terms of number of studies included.
Korttidsvirkende midler er således mindre tilbøjelige til at påvirke søvnmønsteret og appetitten end langtidsvirkende produkter. 
Indeed short acting treatments are less likely to affect sleep pattern and appetite compared to long-acting products.
Hvad angår de øvrige potentielle risici ved langtidsbrug af dexamfetamin såsom mulig hæmning af den neurokognitive udvikling og risikoen for kardiomyopati, er der ingen klinisk evidens for, at langtidsbehandling påvirker den neurokognitive udvikling negativt. 
With regards to other potential risks associated with long-term use of dexamfetamine such as possible impairment of neuro-cognitive development and risk of cardiomyopathy, there is no clinical evidence to support that long-term treatment has any negative influence on neuro-cognitive development.
Mere vigtig er den sammenlignende oversigt foretaget af Arnold LE (2000) af seks ikke-overlappende undersøgelser, hvor der beregnedes en responsrate på 66 % for dexamfetaminsulfat, 56 % for methylphenidat og 85 % når begge gives. 
More importantly, the Arnold LE (2000) comparative review analysed six non-duplicative studies, from which a response rate of 66% was calculated for dexamfetamine sulphate, 56% for methylphenidate and 85% stimulant response if both are tried.
• Ændring af punkt 4.1 med en anvisning om, at “behandlingen bør ske under opsyn af en specialist i adfærdsforstyrrelser hos børn og/eller unge”, og “dexamfetamin er ikke indiceret hos alle børn med ADHD, og afgørelsen om at anvende dexamfetamin skal baseres på en gennemgribende vurdering af sværheden og kroniciteten af barnets symptomer sammenholdt med barnets alder og potentiale for misbrug, fejlanvendelse og ulovlig anvendelse.” 
• Amendment to the section 4.1 to advise that “Treatment should be under the supervision of a specialist in childhood and/or adolescent behavioural disorders.” and that “Dexamfetamine is not indicated in all children with ADHD and the decision to use dexamfetamine must be based on a very thorough assessment of the severity and chronicity of the child's symptoms in relation to the child's age and potential for abuse, misuse or diversion.”
Det vedgås, at misbrug og afhængighed kan forekomme, men den population, der misbruger stimulerende midler, synes at adskille sig fra den generelle ADHD-population. 
It is acknowledged that abuse and dependence may occur, however there appears to be a difference between the population that abuses stimulants and the general ADHD population.
En risikostyringsplan for et dexamfetaminprodukt må derfor forventes at udgøre en væsentlig forbedring ved at skaffe oplysninger om produktets anvendelse i det virkelige liv og indføre risikostyringsforanstaltninger, der ikke er i kraft på nuværende tidspunkt. 
Therefore the introduction of a dexamfetamine product with a risk management plan is expected to provide significant improvement by collecting information about use of the product in real life setting, as well as introducing risk minimisation measures that are currently not in place.
En nyere metaanalyse foretaget af Humphreys et al. (2013) gennemgik imidlertid publicerede og upublicerede rapporter om alt 15 forskellige undersøgelser og konkluderede, at effektiv behandling af ADHD, typisk med methylphenidat, ikke synes at have virkning på stofmisbrug senere i livet. 
However, a more recent meta-analysis by Humphreys et al. (2013) investigated both published and unpublished reports on a total of 15 different studies and concluded that effective treatment of ADHD, typically using methylphenidate, does not seem to have impact of substance abuse later in life.
CHMP afgav en positiv udtalelse, der anbefaler udstedelse af markedsføringstilladelse for de produkter, for hvilke produktresumé, og indlægsseddel fremgår af bilag III, og betingelserne for markedsføringstilladelserne fremgår af bilag IV til CHMP's udtalelse for Dexamed og relaterede navne (se bilag I). 
The CHMP issued a positive opinion recommending the granting of the marketing authorisations for which the summary of product characteristics and package leaflet are as set out in Annex III of the CHMP opinion and conditions to the marketing authorisations in Annex IV of the CHMP Opinion for Dexamed and associated names (see Annex I).
Desuden anbefales dexamfetamin som førstevalgsbehandling i mindst syv evidensbaserede vejledninger for medikamentel behandling af ADHD, mens andre udtrykkelig positivt anbefaler det som behandlingsvalg til ADHD (Seixas et al., 2012). 
In addition, at least seven evidence-based guidelines for the pharmacological treatment of ADHD recommend dexamfetamine as first-line therapy; others give an explicit favourable recommendation for use as a therapeutic option in ADHD (Seixas et al., 2012).
Lisdexamfetamin og dexamfetamin kan anses for farmakodynamisk identiske, hvorfor udstedelse af markedsføringstilladelse for dexamfetamin som andetvalgsbehandling af ADHD vil være i overensstemmelse med den nylige godkendelse af lisdexamfetamin til anvendelse hos samme population. 
Lisdexamfetamine and dexamfetamine can be regarded as pharmacodynamically identical, therefore to grant a marketing authorisation for dexamfetamine as second line ADHD treatment would be consistent with the recent approval of lisdexamfetamine for use in the same population.
CHMP noterede sig, at den foreslåede risikostyringsplan er på linje med eksisterende risikostyringsplaner for andre centralt stimulerende midler (methylphenidat og lisdexamfetamin), og at produkter indeholdende dexamfetamin har været på markedet i EU i flere tiår uden en risikostyringsplan. 
The CHMP took note of the fact that the proposed RMP is in line with existing risk management plans for other stimulants (methylphenidate and lisdexamfetamine), and also that dexamfetamine-containing products have been available in the EU for several decades without a risk management plan.
Vedrørende risikoen for misbrug og ulovlig anvendelse hos ADHD-populationen konkluderedes det i en metaanalytisk gennemgang foretaget af Lee et al. (2011), at ADHD-patienter har betydeligt højere risiko for stofmisbrug end den (aldersmatchede) almindelige befolkning. 
With regards to the risk of misuse and diversion within the ADHD population, a meta-analytic review by Lee et al. (2011) concluded that ADHD patients are at a considerably higher risk for substance abuse as compared to the (age-matched) general population.
Desuden ville ansøgeren foretage en undersøgelse af lægemiddelanvendelse for at overvåge indberetninger om misbrug og/eller overdosering samt en ikke-interventionel sikkerhedsundersøgelse efter markedsføring (PASS) for at overvåge de vigtigste bivirkninger. 
In addition the applicant proposed to undertake a drug utilisation study (DUS) to monitor for reports of abuse and/or overdose, and a non-interventional post authorisation safety study (PASS) to monitor key adverse events.
Det er derfor i øjeblikket ikke klart, om behandling af ADHD-patienter med stimulerende midler ændrer risikoen for stofmisbrug senere i livet, men der synes at være evidens for, at risikoen i den ADHD-population, der er behandlet med centralt stimulerende midler, ikke er højere end i den ubehandlede ADHDpopulation. 
Therefore it is currently unclear whether treatment of ADHD patients with stimulants alters their risk of substance abuse disorder later in life, but evidence seems to indicate that the risk in the stimulant treated ADHD population is not higher than in the not treated ADHD population.
Til afhjælpning af denne risiko foreslog ansøgeren, at dexamfetamin nedgraderes til brug som andetvalgsbehandling ved ADHD og til børn og unge mellem 6 og 17 år, når andre medikamentelle og ikke-medikamentelle behandlingsmuligheder ikke har givet tilfredsstillende resultater. 
Therefore as a measure to mitigate this risk, the applicant proposed to downgrade dexamfetamine to second line use in ADHD and for children and adolescents of 6 to 17 years of age, if other medicinal and nonmedical treatment options have not achieved adequate results.
Nærværende ansøgning for Dexamed som andetvalgsbehandling af ADHD er en bibliografisk ansøgning (almindelig anerkendt anvendelse). 
The present application for Dexamed as second-line treatment of ADHD is a bibliographic (wellestablished use) application.
Lisdexamfetamin er i nogle medlemsstater for nylig godkendt som led i et fuldstændigt behandlingsprogram for ADHD hos børn over 6 år med foregående inadækvat klinisk respons på methylphenidat. 
Lisdexamfetamine was recently approved in some Member States as part of a comprehensive treatment programme for ADHD in children aged 6 years of age and over when response to previous methylphenidate treatment is considered clinically inadequate.
Desuden forventes korttidsvirkende midler at have visse fordele i forhold til langtidsvirkende. 
Moreover short acting treatments are expected to have some advantages compared to long-acting treatments.
• udvalget gennemgik alle data forelagt af ansøgeren til støtte for virkningen af dexamfetamin som andetvalgsbehandling ved ADHD samt forslagene til afbødning af risikoen for fejlanvendelse og ulovlig anvendelse. 
• The Committee reviewed all the data submitted by the applicant in support of the efficacy of dexamfetamine in second line treatment of ADHD, and the proposals for mitigation of the risk of misuse and diversion.
Ved vurderingen af ansøgningen om markedsføringstilladelse for Dexamed blev der udtrykt betænkelighed ved potentialet for misbrug og afhængighed af dexamfetamin. 
During the assessment of the marketing authorisation application for Dexamed, concerns were raised regarding the potential for abuse and dependence of dexamfetamine.
Virkningen af dexamfetamin til behandling af ADHD bestrides dog ikke. 
However the efficacy of dexamfetamine in the treatment of ADHD is not disputed.
Desuden ordineres stimulerende midler til ADHD-patienter efter forudgående ADHD-diagnose, i modsætning til aktiv opsøgning af stimulerende midler. 
In addition, ADHD patients are prescribed stimulants after an ADHD diagnosis has been made as opposed to deliberately seeking stimulants.
De kliniske undersøgelser viser, at der findes ADHD-patienter, som responderer på methylphenidat, men ikke på dexamfetamin, og omvendt. 
Clinical studies show that there are ADHD patients who respond to methylphenidate and not to dexamfetamine and vice versa.
Under behandlingen i CMDh var der enighed om, at dexamfetamin har en virkning ved ADHD, der ikke på nogen måde er ringere end af de andre stimulerende midler. 
An agreement has been reached during the CMDh procedure that dexamfetamine has efficacy in ADHD which is in no way inferior to the other stimulants.
Methylphenidat bindes reversibelt til det præsynaptiske transporterprotein med deraf følgende hæmning af genoptagelsen af katekolaminer i det præsynaptiske neuron (Volkow et al., 2002), øger udskillelsen af dopamin fra opbevaringsvesiklerne i det præsynaptiske cytoplasma og blokerer optagelsen af dopamin i opbevaringsvesiklerne i det neuronale cytoplasma, hvorved dopamin i det præsynaptiske cytoplasma lettere kan frigives til den synaptiske spalte (Sulzer et al., 2005). 
Methylphenidate reversibly binds to the presynaptic transporter protein with resultant inhibition of catecholamines re-uptake into the presynaptic neuron (Volkow et al., 2002), increases the release of dopamine from presynaptic cytoplasmic storage vesicles and blocks the uptake of dopamine into neuronal cytoplasmic storage vesicles, making dopamine more available in the presynaptic cytoplasm for release into the synaptic cleft (Sulzer et al., 2005).
Undersøgelsen af lægemiddelanvendelse udvides med aktiv indsamling af information om misbrug, fejlanvendelse, ulovlig anvendelse og afhængighed hos børn med ADHD fra giftkontrolcentre og narkotikaovervågningscentre, andre databaser og offentligt tilgængelige kilder i litteraturen og online, 
In addition, the DUS should be expanded to actively obtain reports of abuse, misuse, diversion and dependence in children with ADHD from poison centres, drug monitoring centres, other databases, publicly available information in the literature and online.
I indikationen angives det desuden, at behandlingen bør iværksættes og regelmæssigt vurderes af en læge med særlig erfaring i børns og unges psykiske helbred, efter at diagnosen ADHD er stillet ved en grundig vurdering. 
The indication also includes a statement that treatment should be initiated and regularly evaluated by a physician with specialist expertise in child and adolescent mental health after a comprehensive assessment has led to a diagnosis of ADHD.
Der er imidlertid konstateret risiko for ulovlig anvendelse og misbrug af dette lægemiddel. 
However there are perceived risks of diversion and abuse associated with this medication.
Skønt rækkefølgen af behandlingerne ikke er oplyst, er resultaterne overbevisende især på grund af undersøgelsens overkrydsningsdesign. 
While there is no information about the sequence of treatments, mainly due to its cross-over design the results are convincing.
Risikoen anses for at opvejes af alle disse foranstaltninger i tilslutning til den eksisterende nationale lovgivning om fremstilling, distribution og ordination af kontrollerede stoffer. 
All of these measures, taken together with existing national laws concerning manufacture, distribution and prescription of controlled drugs are considered to balance the risk.
I behandlingsperioden bør der jævnligt tages stilling til behandlingens nødvendighed og den eventuelle forekomst af overforbrug, afhængighed og ulovlig anvendelse. 
During treatments regular evaluations should be performed regarding treatment necessity (see below) and possible occurrence of overuse, dependence or diversion.
Amfetaminer øger koncentrationen af katekolaminer i den synaptiske spalte ved at blokere genoptagelsen af noradrenalin og dopamin i de præsynaptiske neuroner, frigive dopamin og noradrenalin fra de dopaminerge neuroner og muligvis hæmme monoaminoxidase. 
Amfetamines increase levels of catecholamine in the synaptic cleft by blocking reuptake of noradrenaline and dopamine by presynaptic neurons, by releasing dopamine and noradrenaline from dopaminergic neurons, and possibly by inhibiting monoamine oxidase.
• udvalget anser dexamfetamin for at have en anden virkningsmekanisme end methylphenidat og finder, at de foreliggende data støtter dexamfetamins virkning til behandling af ADHD, 
• The Committee is of the opinion that dexamfetamine has a mechanism of action different from that of methylphenidate, and that the available data is supportive of the efficacy of dexamfetamine in treatment of ADHD.
Indikationen indeholder desuden en angivelse af, at dexamfetamin kun bør ordineres af en speciallæge, der har stillet diagnosen ADHD efter forudgående grundig vurdering af kronicitet og sværhed i henhold til DSM- eller ICD-retningslinjerne, og kun når behandling med methylphenidat har været ineffektiv. 
The indication also includes a statement that it should only be prescribed by a specialist when the patient has been diagnosed with ADHD following comprehensive assessment of chronicity and severity according to DSM or ICD guidance and only when methylphenidate treatment has proved ineffective.
Risikostyringsplanen for produktet omfatter informationsmateriale til ordinerende læger og patienter/omsorgsgivere samt en undersøgelse af lægemiddelanvendelse, der er udvidet til at samle specifikke oplysninger om misbrug og fejlanvendelse. 
The risk management plan for the product includes educational material for both prescribers and patients/carers, as well as a drug utilisation study that has been expanded to collect information specifically on abuse and misuse.
Indikationen er blevet begrænset til andetvalg, og risikostyringsplanen for produktet omfatter oplysningsmateriale til ordinerende læger og patienter/omsorgsgivere samt en undersøgelse af lægemiddelanvendelse, der er udvidet til at samle information specifikt om misbrug og fejlanvendelse. 
The indication has been restricted to second line, the risk management plan for the product includes educational material for both prescribers and patients/carers, as well as a drug utilisation study that has been expanded to collect information specifically on abuse and misuse.
• om nedgradering af produktet til andetvalgsbehandling og de påtænkte risikominimeringsforanstaltninger er tilstrækkelige til at imødekomme betænkelighederne ved det konstaterede potentiale for misbrug og ulovlig anvendelse, og 
• Whether downgrading the product to second line treatment and the proposed RMP measures are sufficient to mitigate concerns relating to the perceived potential for misuse and diversion.
Efter at have taget alle foreliggende data i betragtning accepterede udvalget, at dexamfetamin har potentiale for misbrug, ulovlig anvendelse og desuden afhængighed. 
Taking into account all the available data, the Committee accepted that dexamfetamine has potential for misuse, diversion and also dependence.
Eksperterne fandt kun ringe evidens for en større risiko for afhængighed af dexamfetamin hos den behandlede ADHD-population end hos personer uden ADHD. 
The experts were of the opinion that there is currently little evidence to suggest that dexamfetamine is associated with a higher risk of dependence in the treated ADHD population than in those without ADHD.
• vejledning til den ordinerende læge, herunder vejledning i diagnose i henhold til DSM/ICDretningslinjerne og udpegelse og udelukkelse af patienter med tidligere misbrug, fejlanvendelse, ulovlig anvendelse og afhængighed 
• A physician's guide to prescribing including direction for diagnosis according to DSM/ICD guidelines and for recognition and exclusion of patients with a history of abuse misuse diversion and dependency;