natgillin/translations-raw huggingface dataset:
• The PRAC considered the totality of the data submitted for methotrexate-containing products with regard to the important identified risk of medication errors when methotrexate intended for once weekly use is taken daily by mistake, the root causes for this risk and the effectiveness of the risk minimisation measures in place.
• odbor PRAC je ocenil vse predložene podatke o zdravilih, ki vsebujejo metotreksat, kar zadeva pomembno ugotovljeno tveganje za napake pri uporabi zdravila, kadar se metotreksat, ki je predviden za uporabo enkrat na teden, pomotoma jemlje vsak dan, ključne vzroke za to tveganje in vzpostavljene ukrepe za zmanjšanje tveganja.
The risks associated with inappropriate use of methotrexate daily instead of weekly make methotrexate one of the most known high-risk medications prone to medication errors.
Zaradi tveganj, povezanih z nepravilno uporabo metotreksata enkrat na dan namesto enkrat na teden, je metotreksat eno najbolj znanih zdravil z visokim tveganjem za napake pri uporabi zdravila.
The risk of medication errors due to inadvertent daily instead of once weekly dosing is an important identified risk and all methotrexate-containing products for which additional risk minimisation measures are required to address this risk (i.e. replacement of bottles/tubes by blisters, implementation of educational material and patient card), should have a risk management plan (RMP) in place listing all pharmacovigilance activities and risk minimisation measures agreed.
Tveganje za napake pri uporabi zdravila zaradi nenamernega odmerjanja enkrat na dan namesto enkrat na teden je pomembno ugotovljeno tveganje, in vsa zdravila, ki vsebujejo metotreksat, za katera so za obravnavo te težave zahtevani dodatni ukrepi za zmanjšanje tveganja (tj. nadomestitev stekleničk/epruvet s pretisnimi omoti, uvedba izobraževalnih gradiv in bolnikove kartice), morajo imeti vzpostavljen načrt za obvladovanje tveganja (RMP), v katerem so navedene vse farmakovigilančne dejavnosti in dogovorjeni ukrepi za zmanjšanje tveganja.
Similarly, the boxed warning in SmPC section 4.2 already agreed to be added to the product information of the oral formulations as outcome of the PSUSA should be also reflected in the product information of methotrexate parenteral formulations.
Podobno je treba uokvirjeno opozorilo v poglavju 4.2 povzetka glavnih značilnosti zdravila, za katero je kot izid postopka PSUSA že dogovorjeno, da bo vključeno v informacije o zdravilu za peroralne formulacije, navesti tudi v informacijah o zdravilu za parenteralne formulacije metotreksata.
For this reason, the PRAC was of the view that the visual reminder agreed for the outer packaging of the oral formulations of methotrexate should also be implemented on the outer packaging of the parenteral formulations of methotrexate with at least one indication requiring once weekly dosing, and that the shorter warning agreed for the immediate packaging of the oral formulations should be implemented on the intermediate (where applicable) and immediate packaging of the parenteral formulations.
Zato je odbor PRAC menil, da je treba vidni opomnik, dogovorjen za zunanjo ovojnino peroralnih formulacij metotreksata, uvesti tudi na zunanji ovojnini parenteralnih formulacij metotreksata z vsaj eno indikacijo, ki zahteva odmerjanje enkrat na teden, in da je treba krajše opozorilo, dogovorjeno za stično ovojnino peroralnih formulacij, uvesti tudi na vmesni (kjer je ustrezno) in stični ovojnini parenteralnih formulacij.
In order to assess the root causes and the impact of the risk of medication errors due to inadvertent daily dosing instead of weekly dosing, the PRAC considered the analyses of cases report of inadvertent daily instead of weekly usage of methotrexate-containing products, including reports without adverse events, for the period 1 January 2013 until 31 March 2018 from the EudraVigilance database as well as from the data provided by the MAHs of methotrexate-containing products which included analyses of the medication error case reports from the companies' pharmacovigilance databases and in the literature.
Da bi ocenil ključne vzroke in vpliv tveganja za napake pri uporabi zdravila zaradi nenamernega odmerjanja enkrat na dan namesto enkrat na teden, je odbor PRAC upošteval analize poročil o primerih nenamerne uporabe zdravil, ki vsebujejo metotreksat, enkrat na dan namesto enkrat na teden, vključno s poročili brez neželenih učinkov, za obdobje od 1. januarja 2013 do 31. marca 2018 iz zbirke podatkov EudraVigilance ter podatke, ki so jih predložili imetniki dovoljenj za promet z zdravilom za zdravila, ki vsebujejo metotreksat, kar je vključevalo analize poročil o primerih napak pri uporabi zdravila iz farmakovigilančnih zbirk podatkov podjetij in literature.
The day of the week methotrexate treatment should be taken should be written on the card by the patient.
Bolnik mora na kartico zapisati dan v tednu, ko mora vzeti metotreksat.
• The PRAC concluded that there is a need to further strengthen the current risk minimisation measures by adding warnings in the product information and visual reminders on the outer, intermediate and immediate packaging of methotrexate-containing medicinal products with at least one indication requiring a once weekly dosing, for both oral and parenteral use;
• odbor PRAC je zaključil, da je treba trenutne ukrepe za zmanjšanje tveganja dodatno okrepiti, in sicer z vključitvijo opozoril v informacije o zdravilu in vidnih opomnikov na zunanjo, vmesno in stično ovojnino zdravil, ki vsebujejo metotreksat in imajo vsaj eno indikacijo, ki zahteva odmerjanje enkrat na teden, za peroralno in parenteralno uporabo;
• Considering the number of reported inadvertent daily administration of methotrexate oral formulations, the PRAC concluded that for these products educational materials for healthcare professionals should be developed or updated, if already in place, in accordance with the key elements agreed, as well as a patient card to be provided with the medicinal product, to further increase awareness.
• odbor PRAC je glede na število sporočenih primerov nenamernega dajanja peroralnih formulacij metotreksata enkrat na dan presodil, da je treba za ta zdravila pripraviti ali posodobiti (če so že na voljo) izobraževalna gradiva za zdravstvene delavce v skladu s ključnimi dogovorjenimi elementi ter zdravilu priložiti bolnikovo kartico za nadaljnje povečanje ozaveščenosti.
Dispensing errors have also been reported.
Poročali so tudi o primerih napak pri izdaji zdravila.
This card was considered a necessary tool to remind patients to take the product only once weekly, inform on serious adverse effects that may be fatal, on the symptoms of overdose and steps to be taken should symptoms arise, and recommend patients to show the card and alert any healthcare professionals not familiar with their methotrexate treatment about their once weekly dosing schedule (e.g. on hospital admission, change of care).
Ocenili so, da je kartica potrebno orodje za opominjanje bolnikov, da morajo zdravilo jemati samo enkrat na teden, za obveščanje o resnih neželenih učinkih, ki so lahko usodni, o simptomih prevelikega odmerjanja in ukrepih v primeru pojava simptomov ter za opozarjanje bolnikov, naj zdravstvenim delavcem, ki niso seznanjeni z njihovim zdravljenjem z metotreksatom, pokažejo kartico in jih opozorijo na svoj urnik odmerjanja enkrat na teden (npr. ob sprejemu v bolnišnico, spremembi oskrbe).
• The PRAC noted that severe, life-threatening and fatal cases of overdose due to medication errors with methotrexate-containing medicinal products continue to be reported and that the risk minimisation measures in place have not been sufficiently effective to prevent medication errors, in particular with the oral formulations of methotrexate;
• odbor PRAC je opozoril, da pri zdravilih, ki vsebujejo metotreksat, še naprej poročajo o resnih, smrtno nevarnih in usodnih primerih prevelikega odmerjanja zaradi napak pri uporabi zdravila in da vzpostavljeni ukrepi za zmanjšanje tveganja niso dovolj učinkoviti za preprečevanje napak pri uporabi zdravila, zlasti pri peroralnih formulacijah metotreksata;
While daily instead of once weekly use of methotrexate was mainly reported with oral dosage forms in non-oncologic indications, predominantly rheumatoid arthritis and psoriasis, there were also cases with the use of parenteral formulations, as well as many reports which did not specify the route of administration.
O uporabi metotreksata enkrat na dan namesto enkrat na teden so v glavnem poročali pri peroralnih farmacevtskih oblikah pri neonkoloških indikacijah, večinoma pri revmatoidnem artritisu in psoriazi, bili pa so tudi primeri z uporabo parenteralnih formulacij ter poročila, v katerih način uporabe ni naveden.
To gain further knowledge on the reasons leading to medication errors and prevent them adequately, as well as in support of the measurement of the effectiveness of the agreed risk minimisation measures, all MAHs are requested to implement and use a targeted follow-up questionnaire, as agreed by PRAC, for all medication errors reported with methotrexate and resulting in overdose.
Za poglobitev znanja o razlogih, ki privedejo do napak pri uporabi zdravila, in njihovo preprečevanje ter kot podpora pri ugotavljanju učinkovitosti dogovorjenih ukrepov za zmanjšanje tveganja se od vseh imetnikov dovoljenj za promet z zdravilom zahteva, da uvedejo in uporabljajo namenski vprašalnik za spremljanje, dogovorjen z odborom PRAC, za vse napake pri uporabi zdravila, o katerih se poroča pri metotreksatu in ki privedejo do prevelikega odmerjanja.
In addition, although the number of cases reporting medication errors with parenteral formulations was smaller than with oral formulations, the risk of medication error by daily intake/use rather than once weekly is considered a general problem for all methotrexate-containing products with at least one indication that requires once a week dosing.
Ne glede na dejstvo, da je število primerov napačne uporabe parenteralnih formulacij manjše kot pri peroralnih formulacijah, velja, da je tveganje za napako pri uporabi zdravila enkrat na dan namesto enkrat na teden splošna težava pri vseh zdravilih, ki vsebujejo metotreksat in imajo vsaj eno indikacijo, ki zahteva odmerjanje enkrat na teden.
To minimise the risk of prescribing errors due to lack of knowledge by the prescriber of the weekly dosing schedule of methotrexate for the treatment of auto-immune diseases, the PRAC was of the view that methotrexate should only be prescribed by physicians with expertise in the use of methotrexate and a full understanding of the risks of methotrexate therapy.
Da bi zmanjšali tveganje za napake pri predpisovanju zaradi pomanjkanja seznanjenosti predpisovalca z odmerjanjem metotreksata pri zdravljenju avtoimunskih bolezni enkrat na teden, je odbor PRAC menil, da smejo metotreksat predpisovati samo zdravniki s strokovnim znanjem o uporabi metotreksata in celovitim razumevanjem tveganj zdravljenja z metotreksatom.
The CHMP, as a consequence, considers that the benefit-risk balance of methotrexate-containing medicinal products remains favourable subject to the amendments to the product information and to the conditions described above.
Odbor CHMP posledično meni, da je razmerje med tveganji in koristmi zdravil, ki vsebujejo metotreksat, še naprej ugodno, če se upoštevajo zgoraj opisane spremembe informacij o zdravilu in pogojev.
To increase awareness of HCPs on the risk of medication errors and their possible consequences, it was considered that for methotrexate oral formulations, educational materials for healthcare professionals should be developed or updated, if already in place, to inform them on the potential for fatal overdose due to medication errors (ME), including daily instead of once weekly use, highlight the need to inform patients and relatives/carers about the once weekly dosing, and provide information on the importance to fill in prescriptions with clear instructions about once weekly dosing, defined day of intake, and to not use abbreviations.
Da bi povečali ozaveščenost zdravstvenih delavcev o tveganju za napake pri uporabi zdravila in njihovih morebitnih posledicah, je bilo ocenjeno, da je treba za peroralne formulacije metotreksata pripraviti oziroma posodobiti (če so že na voljo) izobraževalna gradiva za zdravstvene delavce ter tako te seznaniti z možnostjo za usodno preveliko odmerjanje zaradi napak pri uporabi zdravila, vključno z uporabo enkrat na dan namesto enkrat na teden, poudariti potrebo po seznanjanju bolnikov in njihovih sorodnikov/negovalcev z odmerjanjem enkrat na teden ter zagotoviti informacije o odmerjanju enkrat na teden, opredeljenem dnevnem vnosu in neuporabi okrajšav.
The Committee, as a consequence, recommends the variation to the terms of the marketing authorisations for methotrexate-containing medicinal products.
Odbor posledično priporoča spremembo pogojev dovoljenj za promet z zdravili, ki vsebujejo metotreksat.
An update of the product information of all methotrexate products with at least one indication requiring a once weekly dosing schedule was recommended accordingly.
V skladu s tem je bila priporočena posodobitev informacij o zdravilu za vsa zdravila z metotreksatom, ki imajo vsaj eno indikacijo, ki zahteva odmerjanje enkrat na teden.
To increase awareness and remind healthcare professionals and patients of the weekly dosing schedule required for the treatment of some conditions, the MAHs for oral methotrexate-containing products with at least an indication requiring dosing once a week had been requested, as outcome of the PSUSA (EMEA/H/C/PSUSA/00002014/201706), to implement a visual reminder on the outer and immediate packaging to warn patients to take the product once a week for those indications requiring dosing once a week.
Da bi povečali ozaveščenost ter zdravstvene delavce in bolnike opomnili na odmerjanje enkrat na teden, ki je potrebno pri zdravljenju določenih bolezni, je kot izid pregleda PSUSA (EMEA/H/C/PSUSA/00002014/201706) od imetnikov dovoljenj za promet z zdravilom za zdravila z vsaj
Since early 1996, harmful or fatal errors with low dose oral methotrexate have been reported to the Institute for Safe Medication Practices (ISMP) and published in more than 50 of its newsletters, but in spite of this and numerous risk minimization measures, methotrexate continues to be subject in documented serious medication errors (Grissinger, 20182).
inštituta, vendar je metotreksat kljub temu in kljub številnim ukrepom za zmanjšanje tveganja še naprej predmet dokumentiranih resnih napak pri uporabi zdravila (Grissinger, 20182).
Dividing the prescribed dose in multiple intakes was reported as a risk factor for medication error and no robust evidence could be provided to support the effectiveness of this regimen or identify patient groups for whom benefits of dividing the dose would outweigh the risk of medication errors.
Robustnih dokazov v podporo učinkovitosti te sheme ali za identifikacijo bolnikov, pri katerih bi delitev odmerka odtehtala tveganje za napake pri uporabi zdravila, ni bilo mogoče zagotoviti.
• The PRAC finally agreed on targeted follow-up questionnaires should be used for all cases of medication errors reported with methotrexate and resulting in overdose.
• odbor PRAC se je dogovoril tudi, da je treba pri vseh primerih napak pri uporabi zdravila, o katerih poročajo z metotreksatom in ki privedejo do prevelikega odmerjanja, uporabljati namenske vprašalnike za spremljanje.
In addition, as understanding of the once weekly dosing schedule of methotrexate is essential to avoid dosing errors by the patients or their carer and for the adherence to this special treatment schedule, an update of the product information of methotrexate products with at least one indication requiring a once weekly dosing schedule was considered necessary to alert healthcare professionals to restrict the use of oral methotrexate to patients/carers who are able to comply with the once weekly dosing schedule.
Ker je seznanjenost z odmerjanjem metotreksata enkrat na teden ključnega pomena za preprečevanje napak pri odmerjanju in za ravnanje v skladu s tem posebnim urnikom zdravljenja, je bila posodobitev informacij o zdravilu za zdravila z metotreksatom z vsaj eno indikacijo, ki zahteva odmerjanje enkrat na teden, ocenjena kot potrebna za opozarjanje zdravstvenih delavcev, da morajo omejiti uporabo peroralnega metotreksata na bolnike/negovalce, ki so urnik odmerjanja enkrat na teden zmožni upoštevati.
The data showed that severe, life-threatening and fatal cases of overdose due to medication errors with methotrexate-containing medicinal products continue to be reported despite the risk minimisation measures in place.
Podatki so pokazali, da kljub uvedenim ukrepom za zmanjšanje tveganja še naprej poročajo o resnih, smrtno nevarnih in usodnih primerih prevelikega odmerjanja, ki so posledica napak pri uporabi zdravil, ki vsebujejo metotreksat.
Therefore the CHMP recommends the variation to the terms of the marketing authorisations for methotrexate-containing medicinal products.
Zato priporoča spremembo pogojev dovoljenj za promet z zdravili, ki vsebujejo metotreksat.
In view of the above, the Committee considers that the benefit-risk balance of methotrexatecontaining medicinal products remains favourable subject to the agreed conditions to the marketing authorisations, and taking into account the agreed amendments to the product information and other risk minimisation measures.
Glede na navedeno odbor meni, da je ob upoštevanju dogovorjenih pogojev za dovoljenja za promet z zdravilom ter dogovorjenih sprememb informacij o zdravilu in drugih ukrepov za zmanjševanje tveganj razmerje med tveganji in koristmi zdravil, ki vsebujejo metotreksat, še naprej ugodno.
The ambiguity due to the product being authorised in different indications with different dosing schedules and lacking clear and visible warnings alerting on the once weekly dosing schedule on the packaging and the use of bulk packaging were identified as root causes for medication errors.
Kot ključni vzroki za napake pri uporabi zdravila so bili ugotovljeni dvoumnost, ki je posledica dejstva, da je zdravilo odobreno za različne indikacije z različnimi urniki odmerjanja, odsotnost jasnih in vidnih opozoril na ovojnini, ki bi opozarjala na uporabo enkrat na teden, ter uporaba zbirne ovojnine.
Serious cases of overdose, sometimes fatal, have been reported in patients inadvertently receiving the product daily instead of weekly for indications that require weekly dosing.
Pri bolnikih, ki so pri indikacijah, ki zahtevajo odmerjanje enkrat na teden, zdravilo pomotoma prejemali enkrat na dan namesto enkrat na teden, so poročali o resnih primerih prevelikega odmerjanja, ki so bili včasih usodni.
1Mean antibody (Ab) obtained after vaccination of mice with a 1/20 sow dose
intramuskularno a viala iz zloženki v odmerku po 2 ml: fimbrijski adhezin F4ab (K88ab):  9,0 log titra protiteles
The use of more than one of these products concomitantly should be avoided.
Sočasni uporabi več kot enega od teh zdravil se je potrebno izogibati.
• allergic reactions
• alergične reakcije
It is recommended that consideration be given to concomitant PFMT.
Priporočamo, da razmislite o sočasnem PFMT.
Talk to your doctor if you have high blood pressure or heart disease.
Pogovorite se s svojim zdravnikom, če imate nenadzorovan visok krvni tlak ali srčno bolezen.
You should also tell your doctor if you are taking any of the following:
Svojemu zdravniku povejte tudi, če jemljete karkoli od naslednjega:
Frequency estimate: Very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000).
Ocene pogostnosti: zelo pogosti (≥ 1/10), pogosti (≥ 1/100 in < 1/10), občasni (≥ 1/1.000 in < 1/100), redki (≥ 1/10.000 in < 1/1.000), zelo redki (< 1/10.000).
In addition, long-term safety data in children and adolescents concerning growth, maturation and cognitive and behavioural development are lacking.
Poleg tega so pomanjkljivi tudi podatki o dolgoročni varnosti pri otrocih in mladostnikih glede rasti, dozorevanja in kognitivnega ter vedenjskega razvoja.
Depression, suicidal ideation and behaviour
Depresija, samomorilne misli in vedenje
Pregnancy There are no adequate data on the use of duloxetine in pregnant women.
Nosečnost Nimamo zadostnih podatkov o uporabi duloksetina pri nosečnicah.
These effects are normally mild to moderate and often disappear after a short time.
Ti učinki so običajno blagi do zmerni in pogosto po kratkem času izzvenijo.
Some patients, who suddenly stop taking YENTREVE after more than 1 week of therapy, have had symptoms such as:
Nekatere bolnice, ki se nenadoma prenehale jemati zdravilo YENTREVE po več kot 1 tednu zdravljenja, so imele simptome, kot so
If, based on clinical need, a decision to treat is nevertheless taken, the patient should be carefully monitored for the appearance of suicidal symptoms.
Če se na podlagi klinične potrebe za zdravljenje vseeno odločimo, moramo bolnika skrbno spremljati za primer pojava samomorilnih simptomov.
What YENTREVE is and what it is used for
KAJ JE ZDRAVILO YENTREVE IN ZA KAJ GA UPORABLJAMO
In these women, YENTREVE may provide no benefit beyond that afforded by more conservative behavioural interventions.
Pri teh ženskah zdravilo YENTREVE morda ne daje koristi, v primerjavi s tistimi, kot jih dosegamo z bolj konzervativnimi vedenjskimi posredovanji.
After 2-4 weeks of treatment, patients should be re-assessed in order to evaluate the benefit and tolerability of the therapy.
Po 24 tednih zdravljenja je treba bolnice ponovno pregledati, da ovrednotimo učinkovitost in prenosljivost zdravljenja.
• tinnitus (hearing sound in the ear when there is no external sound), ear pain
• tinitus (zvonjenje v ušesih, kljub temu da ni zunanjega zvoka), ušesna bolečina
A similar mechanism in women is believed to result in stronger urethral closure during urine storage with physical stress that could explain the efficacy of duloxetine in the treatment of women with SUI.
Podoben mehanizem naj bi pri ženskah povzročal močnejše zapiranje sečnice med shranjevanjem urina s fizičnim stresom, kar bi lahko pojasnilo učinkovitost duloksetina pri zdravljenju žensk s SUI.
Contents of the pack and other information
VSEBINA PAKIRANJA IN DODATNE INFORMACIJE
Differences were observed at each visit after 4 weeks (duloxetine 54% and placebo 22%), 8 weeks (52% and 29%), and 12 weeks (52% and 33%) of medication.
Razlike so opazovali ob vsakem obisku, po 4 tednih (duloksetin 54 % in placebo 22 %), 8 tednih (52 % in 29 %) in po 12 tednih (52 % in 33 %) zdravljenja.
de la Industria Nº 30, 28108 Alcobendas Madrid
Avenida de la Industria Nº 30 28108 Alcobendas Madrid
The recommended dose of YENTREVE is 40 mg twice a day (in the morning and late afternoon/evening).
Priporočen odmerek zdravila YENTREVE je 40 mg dvakrat dnevno (zjutraj in pozno popoldne/zvečer).
- are taking other medicines containing duloxetine (see ‘Other medicines and YENTREVE')
- jemljete druga zdravila, ki vsebujejo duloksetin (glejte »Druga zdravila in zdravilo YENTREVE«)
To help you remember to take YENTREVE, you may find it easier to take it at the same times every day.
Morda se boste lažje spomnili vzeti zdravilo YENTREVE, če ga boste jemali vsak dan ob istih urah.
The MAH shall perform the required pharmacovigilance activities and interventions detailed in the agreed RMP presented in Module 1.8.2. of the Marketing Authorisation and any agreed subsequent updates of the RMP.
Imetnik dovoljenja za promet z zdravilom bo izvedel zahtevane farmakovigilančne aktivnosti in ukrepe, podrobno opisane v sprejetem RMP, predloženem v modulu 1.8.2 dovoljenja za promet z zdravilom in vseh nadaljnjih sprejetih posodobitvah RMP.
YENTREVE should be used in pregnancy only if the potential benefit justifies the potential risk to the foetus.
Zdravilo YENTREVE naj se v nosečnosti uporablja le, če možna korist upravičuje možno tveganje za plod.
In an additional study limited to patients with severe SUI, all responses with duloxetine were achieved within 2 weeks.
V dodatni študiji, omejeni na bolnice s hudo SUI, so bili vsi odzivi na duloksetin doseženi v 2 tednih.