natgillin/translations-raw huggingface dataset:
Kliniske undersøgelser og den publicerede litteratur støttede anvendelsen af bromocriptin til forebyggelse eller undertrykkelse af fysiologisk laktation i post partum-perioden. 
Clinical studies and published literature supported the use of bromocriptine in prevention or suppression of physiological lactation in post-partum.
Undersøgelsen vedrørende risikoen for hypertension viste, at bromocriptin ikke syntes at øge risikoen for post partum hypertension, men kan forværre eksisterende graviditetsbetinget hypertension. 
The study observing the risks of hypertension found that while bromocriptine did not appear to increase the risk of inducing post-partum hypertension, it may aggravate already existing pregnancy-induced hypertension.
Bromocriptin anvendes til forebyggelse eller hæmning af laktation hos kvinder efter fødsel. 
Bromocriptine is used to prevent or suppress lactation in women who have given birth.
På grundlag af en case-rapport anbefaledes det, at familiær disposition for præeklampsi er kontraindikation for post partum anvendelse af bromocriptin, og at blodtrykket overvåges tæt, navnlig ved hovedpine (Makdassi, 1991). 
Based on a case report, it was recommended that familial history of preeclampsia should be included as a contraindication of bromocriptine in post-partum and for blood pressure to be closely monitored, especially in case of headaches (Makdassi, 1991).
Herings et al. konkluderede, at de iagttagne kardiovaskulære og cerebrovaskulære hændelser snarere må antages at skyldes præeksisterende morbiditet end anvendelse af bromocriptin. 
Herings and colleagues concluded that, cardiovascular or cerebrovascular events observed could probably be explained by pre-existing morbidity rather than by the use of bromocriptine.
Skønt nogle faktorer tydede på en kausal sammenhæng mellem bromocriptin og disse hændelser, er der i post partumperioden uafhængige risikofaktorer for denne type hændelser. 
Although some factors suggested causality of the events to bromocriptine, independent risk factors for these types of events are present in the post-partum period.
I betragtning af mekanismen i reguleringen af laktationen og resultaterne af disse undersøgelser anså PRAC virkningen af bromocriptin til laktationshæmning for at være tilstrækkeligt godtgjort. 
Considering the mechanism of regulation of lactation and the results of these studies the PRAC considered the efficacy of bromocriptine in lactation inhibition sufficiently demonstrated.
PRAC fandt ikke, at denne potentielle risiko kunne afhjælpes ved at begrænse anvendelsen af bromocriptin til omstændigheder, hvor amning ikke er mulig af medicinske grunde (såsom intrapartal eller neonatal død, hivinfektion hos moderen), eller ved at indsætte kontraindikationer, advarsler og forholdsregler i produktinformationen som det allerede er tilfældet i visse medlemsstater. 
The PRAC was of the opinion that this potential risk could be mitigated through limiting the use of bromocriptine to circumstances where breastfeeding is not possible due to medical reasons (such as intrapartum loss, neonatal death, HIV infection of the mother) and inclusion of contraindications, warning and precautions in the product information, as it is already the case in some Member States.
På grundlag af disse konklusioner konkluderede PRAC, at benefit/risk-forholdet for lægemidler indeholdende bromocriptin fortsat er positivt under forudsætning af de anbefalede ændringer af produktinformationen, herunder de vedtagne begrænsninger og advarsler. 
Based on these conclusions, the PRAC concluded that the benefit-risk balance of bromocriptinecontaining medicinal products remains favourable subject to changes to the product information, including agreed restrictions and warnings.
I midten af 1990'erne blev indikationen laktation trukket tilbage i USA og i visse andre lande på baggrund af indberetninger om kardiovaskulære bivirkninger ved laktationshæmning med bromocriptin-holdige produkter. 
In the mid-1990s the indication of lactation was withdrawn in the United States and some other countries in view of reports of cardiovascular adverse events (AEs) in women treated with bromocriptine-containing products for lactation inhibition.
PRAC gennemgik sikkerhedsresultaterne fra alle kliniske undersøgelser, der er udført som led i det oprindelige udviklingsprogram, og bemærkede, at der ikke var iagttaget kardiovaskulære, neurologiske eller psykiske bivirkninger i forbindelse med post partum administration af bromocriptin. 
The PRAC reviewed the safety results from all clinical studies conducted as part of the initial development plan and noted that no cardiovascular, neurological or psychiatric adverse events in association with post-partum administration of bromocriptine were observed.
I nogle undersøgelser var bromocriptin forbundet med højere rebound-forekomst end cabergolin (i én undersøgelse) og svarede til lisurid eller andre ikke-ergot dopaminagonister. 
In some studies bromocriptine was associated with higher incidence of rebound phenomenon compared to cabergoline (in one study), and similar to lisuride or non-ergot dopamine agonist.
• PRAC anbefalede, at post partum laktationshæmning med orale lægemidler indeholdende bromocriptin i styrkerne 1 mg og 2,5 mg begrænses til tilfælde med medicinsk behov. 
• The PRAC recommended to limit the use of bromocriptine-containing medicinal products for oral use in the post-partum inhibition of lactation with strength of 1 mg and 2.5 mg to cases where medically indicated.
I henhold til doseringsanvisningen bør der ikke anvendes højere enkeltdosis end 2,5 mg. 
Indeed, as per the posology one dose given should not exceed 2.5 mg.
PRAC anbefalede tæt overvågning af blodtryk, navnlig i de første dage af behandlingen, og en advarsel om at seponere behandlingen ved hypertension, mistænkelige smerter i thorax, svær, progressiv eller ikke-remitterende hovedpine (med eller uden synsforstyrrelse) samt tegn på CNS-toksicitet, og at dette burde afspejles i produktinformationen. 
The PRAC recommended that blood pressure should be closely monitored, especially during the first days of therapy and a warning advising to discontinue treatment in case of hypertension, suggestive chest pain, severe, progressive, or unremitting headache (with or without visual disturbances), or evidence of central nervous system toxicity, and that this should be reflected in the product information.
• PRAC tog stilling til den procedure, der i medfør af artikel 31 i direktiv 2001/83/EF var foranlediget af lægemiddelovervågningsdata for produkter indeholdende bromocriptin til oral anvendelse til post partum laktationshæmning 
• The PRAC considered the procedure under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data for bromocriptine-containing medicinal products for oral use in the postpartum inhibition of lactation;
Skønt undersøgelserne ved mastitis, brystforstørrelse og smertefuld brystforstørrelse tydede på nogen virkning, giver de begrænsede foreliggende data ikke mulighed for at drage konklusioner om virkningen af bromocriptin til disse indikationer. 
However, although the studies conducted in mastitis, breast engorgement and painful breast engorgement suggested some efficacy, the limited data available does not allow concluding on the efficacy of bromocriptine in these indications.
I en del tilfælde blev der desuden beskrevet vigtige risikofaktorer (rygning, adipositas, præeklampsi, hypertension og psykiatriske episoder). 
Furthermore, in part of the cases important risk factors (smoking, obesity, pre-eclampsia, hypertension, history of psychiatric episodes) were reported.
Da enkeltdosis ved denne indikation ikke bør overstige 2,5 mg, bør indikationen forebyggelse eller undertrykkelse af laktation desuden slettes af produktinformationen for de højere styrker, så risikoen for fejlanvendelse og medicineringsfejl minimeres. 
In addition, as one dose administered should not exceed 2.5 mg in this indication, in order to minimise the risk of misuse and medication error, the indication prevention or suppression of lactation should be removed from the product information of the higher strengths.
Man må have for øje, at post partum-perioden er sårbar med baggrundsrisici for hypertension, kramper, præeklampsi, psykiatriske hændelser og kardiovaskulære/cerebrovaskulære og trombotiske hændelser. 
It should be kept in mind that the post-partum is a vulnerable period with background risks of hypertension, convulsions, pre-eclampsia, psychiatric events and cardiovascular/cerebrovascular and thrombotic events.
Det absolutte antal indberettede tilfælde efter markedsføring er lavt, navnlig i betragtning af, at bromocriptin har været på markedet i EU siden 1973, og at patienteksponeringen har været betydelig. 
The absolute number of cases reported in post-marketing is low, especially given the fact that bromocriptine has been available in the EU since 1973, with a substantial patient exposure; overall incidence rates are estimated to 0.005% to 0.04%.
Der er indberettet en række bivirkninger, herunder depression, psykose, myokardieinfarkt, apopleksi, intrakraniel blødning, trombotiske hændelser, kramper og hypertension. 
A range of adverse events have been reported, including depression, psychosis, myocardial infarction, stroke, intracranial haemorrhage, thrombotic events, convulsions, and hypertension.
Efter vurdering af de relevante data anbefalede PRAC, at bromocriptin ikke anvendes til rutinemæssig laktationssuppression eller til lindring af symptomer på post partum-smerter og brystforstørrelse, der kan behandles tilfredsstillende med ikke-medikamentel intervention (såsom fast bryststøtte og isomslag) og/eller simple analgetika. 
Following the assessment of the relevant data, the PRAC recommended not to use bromocriptine for the routine suppression of lactation or for the relief of symptoms of post-partum pain and engorgement which can be adequately treated with non-pharmacological intervention (such as firm breast support, ice application) and/or simple analgesics.
Gennemgangen af de fatale tilfælde viste, at der i mange af de tilfælde, hvor oplysninger var tilgængelige, forelå risikofaktorer såsom svær hypertension, graviditetsrelaterede hypertensive lidelser, tidligere koronararteriesygdom eller anden kardiovaskulær sygdom foruden psykiatriske episoder i anamnesen. 
The review of the fatal cases showed that risk factors were present in many of the cases where the information was available such as severe hypertension, hypertensive disorders of pregnancy, history of coronary artery disease or other cardiovascular condition as well history of psychiatric episodes.
Desuden frarådes anvendelse af disse produkter til rutinemæssig laktationssuppression og til lindring af symptomer på post partum mastalgi og brystforstørrelse, der kan behandles tilfredsstillende ved ikke-medikamentel intervention eller med analgetika. 
In addition the use of these products is not recommended for routine suppression of lactation or for relief of symptoms of post-partum pain and engorgement which can be adequately treated with non-pharmacological intervention or with analgesics.
Såvel den foreliggende evidens fra kliniske undersøgelser i det oprindelige kliniske udviklingsprogram som den publicerede litteratur tyder dog på, at bromocriptin er effektivt til den af gennemgangen omfattede indikation og syntes at være overlegent i forhold til androgener, kombinerede kontraceptiva, antiøstrogener og pyridoxin samt at have samme virkning som andre dopaminagonister, dog muligvis bedre end lisurid. 
Although most of the studies conducted with bromocriptine are conducted before 1990, the available evidence from clinical trials conducted as part of the original clinical development plan as well as from the published literature suggests that bromocriptine is efficacious in the indication currently under review and appeared superior to androgens, combined contraceptives, anti-oestrogens, pyridoxine, and of similar efficacy than that of other dopamine agonists, though possibly better than lisuride.
Ved symptomer på hypotension eller CNS-toksicitet bør bromocriptin seponeres 
If any symptoms of hypertension or evidence of central nervous system toxicity are detected, the administration of bromocriptine should be discontinued;
I forhold til den ikke-gravide tilstand er perioden 6 uger post partum forbundet med 3-9 gange forhøjet risiko for apopleksi, 3-6 gange forhøjet risiko for myokardieinfarkt og 9-22 gange forhøjet risiko for venøse tromboemboliske hændelser. 
As compared with the non-pregnant state, the 6-week post-partum period is associated with a 3 to 9-fold risk of stroke, 3 to 6-fold risk of myocardial infraction, 9 to 22-fold risk of venous thromboembolic event and depression is estimated to occur in approximately 1 in 10 women while psychosis is estimated to occur in approximately 1-2 in 1000 women.
Disse undersøgelser tydede på nogen virkning ved behandling af mastitis og smertefuld brystforstørrelse, men var af begrænset omfang og gav ikke tilstrækkelig evidens som grundlag for at medtage disse situationer som eksempler på indikationen. 
However, although some efficacy was suggested in the treatment of mastitis and painful breast engorgement, these studies were limited and did not constitute sufficient evidence to support including these situations as examples in the indication.
I nogle indberetninger er der dog faktorer, der tyder på en mulig kausal sammenhæng (ingen andre risikofaktorer eller konfunderende faktorer, kort tid til indsætten (mellem 6 timer og 17 
However in some reports, factors suggesting a possible causal association are present (no other risk factor or confounders, short time to onset (between 6 hours and 17 days after treatment initiation for the fatal cases where the information was available), positive de-challenge and re-challenge).
Langt lavere rater (hhv. 4,2 % og 4,7 %) blev imidlertid fundet ved en analyse, der blev udført på markedsføringstilladelsesindehaverens sikkerhedsdatabase for perioden siden den første markedsføringstilladelse for det oprindelige produkt, og som var fokuseret på dosis og behandlingsvarighed. 
With regards to off label use and misuse, while high rates were reported in the French surveys, the analysis of the safety database of the MAH of the originator covering the period since the first marketing authorisation, focused on the dose and treatment duration, retrieved much lower rates (4.2% and 4.7% respectively).
Efter gennemgang af PRAC's anbefaling af 10. juli 2014 og i henhold til artikel 107k, stk. 1 og 2, i direktiv 2000/83/EF tog CMDh stilling til ændringerne af betingelserne for markedsføringstilladelserne for de bromocriptin-holdige lægemidler til post partum laktationshæmning, for hvilke de relevante afsnit af produktresuméet og indlægssedlen fremgår af bilag III. 
The CMDh having considered the PRAC recommendation dated 10 July 2014 pursuant to Article 107k(1) and (2) of Directive 2001/83/EC, reached a position on the variation to the terms of the marketing authorisations of bromocriptine-containing medicinal products for oral use indicated in postpartum inhibition of lactation for which the relevant sections of the summary of product characteristics and package leaflet are set out in Annex III.
Som konklusion kan der af de foreliggende oplysninger ikke udelukkes en kausal sammenhæng mellem anvendelse af bromocriptin og alvorlige kardiovaskulære, neurologiske eller psykiatriske hændelser. 
In conclusion, based on the available information a causal association between use of bromocriptine and serious cardiovascular, neurological or psychiatric events cannot be excluded.
PRAC gennemgik data vedrørende virkning og sikkerhed efter oral behandling med bromocriptin til post partum laktationshæmning, navnlig data vedrørende risikoen for kardiovaskulære, vaskulære neurologiske og psykiatriske bivirkninger. 
The PRAC reviewed the efficacy and safety data following oral treatment with bromocriptine in postpartum inhibition of lactation, in particular data related to the risk of cardiovascular, vascular neurological and psychiatric adverse events.
• PRAC anbefalede endvidere, at alle styrker af disse produkter gøres kontraindiceret hos patienter med ukontrolleret hypertension, hypertensive graviditetsrelaterede tilstande (herunder eklampsi, præeklampsi og graviditetsbetinget hypertension), hypertension post partum og i puerperiet, koronararteriesygdom eller andre svære kardiovaskulære sygdomme i anamnesen og ved symptomer på eller anamnese med svære psykiske lidelser 
• In addition, the PRAC recommended all strengths of these products to be contraindicated in patients with uncontrolled hypertension, hypertensive disorders of pregnancy (including eclampsia, pre-eclampsia or pregnancy-induced hypertension), hypertension post-partum and puerperium as well as in patients with a history of coronary artery disease or other severe cardiovascular conditions, or symptoms/history of severe psychiatric disorders;
Samlet fandt PRAC antallet af tilfælde lavt i betragtning af den betydelige eksponering for det aktive stof. 
Overall, considering the substantial exposure to this active substance, the PRAC considered the number of cases as low.
PRAC vurderede sammenhængen mellem anvendelse af orale bromocriptin-holdige lægemidler til post partum laktationshæmning og forekomsten af alvorlige kardiovaskulære, neurologiske og psykiatriske bivirkninger. 
The PRAC considered the relation between the use of bromocriptine-containing medicinal products for oral use in post-partum inhibition of lactation and the occurrence of serious cardiovascular, neurological and psychiatric adverse events.
CMDh (koordinationsgruppen vedrørende gensidig anerkendelse og decentrale procedurer (human)) har gennemgået PRAC's (Udvalget for Risikovurdering inden for Lægemiddelovervågning) anbefaling af 10. juli 2014 for lægemidler indeholdende bromocriptin, og CMDh kan tilslutte sig anbefalingen, således som det fremgår af følgende: 
The CMDh, having considered the PRAC recommendation dated 10 July 2014 with regards to the bromocriptine containing medicinal products, agrees with the recommendation therein as stated below:
Sideløbende viste en national lægemiddelovervågningsundersøgelse i Frankrig, at kardiovaskulære bivirkninger udgjorde en betydelig del af de indberettede bivirkninger. 
Concomitantly, in France, following a first national pharmacovigilance survey that showed that cardiovascular adverse drug reactions (ADRs) accounted for an important proportion of the AEs reported, the summary of product characteristics (SmPC) had been reinforced with respect to these ADRs.
Den patogene mekanisme bag disse hændelser må antages at være vasospasme. 
From the pathogenic point of view, it is likely that vasospasm is responsible for these events.
Et rimeligt klinisk svar på disse iagttagelser kan være undgåelse af elektiv brug af dette lægemiddel hos patienter med graviditetsbetinget hypertension. 
Avoiding the elective use of this drug in patients with pregnancy-induced hypertension might constitute a reasonable clinical response to these findings.
Desuden var PRAC af den opfattelse, at samtlige medlemsstater bør indføre de kontraindikationer, der i forvejen delvis er i kraft i de fleste medlemsstater, dvs. ukontrolleret hypertension, hypertensive graviditetsrelaterede tilstande (herunder eklampsi, præeklampsi eller graviditetsbetinget hypertension), hypertension post partum og i puerperiet, koronararteriesygdom eller andre svære kardiovaskulære sygdomme i anamnesen samt symptomer på eller anamnese med svære psykiatriske lidelser. 
In addition, the PRAC was of the view that the contra-indication in patients with uncontrolled hypertension, hypertensive disorders of pregnancy (including eclampsia, pre-eclampsia or pregnancyinduced hypertension), hypertension post-partum and in the puerperium, and patients with a history of coronary artery disease or other severe cardiovascular conditions, or symptoms/history of severe psychiatric disorders, already partially in place in most member states should be implemented across all Member States.
• PRAC gennemgik alle foreliggende data vedrørende den kardiovaskulære, neurologiske og psykiatriske risiko som følge af post partum laktationshæmning med orale lægemidler indeholdende bromocriptin, idet gennemgangen omfattede spontane case-rapporter efter markedsføring, kliniske undersøgelser, den publicerede litteratur og andre foreliggende oplysninger. 
• The PRAC reviewed all available data from post-marketing spontaneous case reports, clinical trials, published literature and other available information on bromocriptine-containing medicines for oral use with regards to the cardiovascular, neurological and psychiatric risk following treatment in post-partum lactation inhibition.
På denne baggrund, og i betragtning af den udbredte anvendelse af bromocriptin til laktationshæmning, fandt den franske lægemiddelstyrelse ANSM, at benefit/risk-forholdet for produkter indeholdende bromocriptin til denne indikation er negativt, og at det er i EU's interesse, at lægemidler indeholdende bromocriptin til oral brug til indikationen post partum laktationshæmning indbringes for PRAC. 
In light of the above, and given the widespread use of bromocriptine in lactation inhibition, the ANSM considered that the benefit/risk ratio of bromocriptine-containing products in this indication is unfavourable and that it is in the interest of the Union to refer the bromocriptine-containing medicinal products for oral use indicated in post-partum inhibition of lactation to the PRAC and requested in July 2013 that it gives a recommendation under Article 31 of Directive 2001/83/EC, on whether marketing authorisations of these products should be maintained, varied, suspended or withdrawn.
Endelig fandt PRAC, at indikationen laktationshæmning bør slettes fra produktinformationen for styrkerne 5 mg og 10 mg for at undgå medicineringsfejl og fejlanvendelse. 
Finally, the PRAC considered that, to avoid medication errors or misuse, the indication for inhibition of post-partum lactation, should be removed from the product information of the 5 mg and 10 mg strengths.
PRAC fandt derfor, at indikationen laktationshæmning bør slettes af produktinformationen for styrkerne 5 mg og 10 mg for at undgå medicineringsfejl og fejlanvendelse af produkterne. 
For that reason the PRAC considered that to avoid medication errors or misuse of the products the indication of inhibition of lactation should be removed from the PI of the 5 mg and 10 mg strengths.
Ud fra de foreliggende data kunne PRAC ikke udelukke en kausal sammenhæng mellem anvendelse af bromocriptin og kardiovaskulære, neurovaskulære og psykiatriske hændelser. 
Based on the available data the PRAC could not exclude a causality between the use of bromocriptine and cardiovascular, neurovascular and psychiatric events; these are already included in many PI for these products.
• For orale lægemidler indeholdende bromocriptin i styrkerne 5 mg og 10 mg til post partum laktationshæmning anbefalede PRAC endelig, at denne indikation slettes, da udvalget var af den opfattelse, at fordelene ikke opvejer risikoen for fejlanvendelse og fejlmedicinering anbefaler PRAC i overensstemmelse med artikel 32 i direktiv 2001/83/EF ændring af markedsføringstilladelserne for alle de i bilag I omhandlede lægemidler indeholdende bromocriptin, for hvilke ændringerne i produktinformationen fremgår af bilag III til PRAC's anbefaling konkluderede PRAC, at benefit/risk-forholdet fortsat er positivt for de i bilag I nævnte orale lægemidler indeholdende bromocriptin til post partum laktationshæmning under forudsætning af de vedtagne ændringer af produktinformationen, herunder begrænsninger og advarsler. 
• Finally, for the bromocriptine-containing medicinal products for oral use in the post-partum inhibition of lactation with the strengths of 5 mg and 10 mg, the PRAC is of the opinion that the benefit does not outweigh the risks of misuse and medication error and therefore recommended this indication to be deleted.
Dato for første markedsføringstilladelse: 14. november 2007 Dato for seneste fornyelse: 23. juli 2012 
Date of first authorisation: 14 November 2007 Date of latest renewal: 23 July 2012