natgillin/translations-raw huggingface dataset:
In addition, early patch replacement is only advised in the rare case of a problem with patch adhesion.
Poleg tega se zgodnja zamenjava obliža svetuje le v redkem primeru težav z adhezijo obliža.
Paediatric indication
Pediatrična indikacija
The new sub heading on linearity/non linearity is justified by adequate data and also considered to be acceptable.
Novo podpoglavje o linearnosti/nelinearnosti upravičujejo zadostni podatki in se prav tako obravnava kot sprejemljivo.
The lowest available patch strength is 12.5 μg/h, which is designated as 12μg/h to distinguish it from a 125μg/h dosage that could be prescribed by using multiple patches.
Najmanjša razpoložljiva jakost obliža je 12,5 µg/h, ki je označen kot 12 µg/h, da se lažje razlikuje od odmerka 125 µg/h, ki bi ga lahko predpisali z uporabo več obližev.
The transdermal patches were developed as a non-invasive parenteral treatment option to avoid the first pass mechanism and to achieve a constant release and plasma levels.
Transdermalni obliži so bili razviti kot neinvaziven način parenteralnega zdravljenja, da bi se izognili mehanizmu prvega prehoda in da bi dosegli konstantno sproščanje in plazemsko koncentracijo.
Scientific conclusions
ZNANSTVENI ZAKLJUČKI
For safety reasons, addition of the text that the lowest effective dose should be used has been included this subsection.
Iz varnostnih razlogov je bilo v to podpoglavje dodano besedilo, da mora biti uporabljen najmanjši še učinkovit odmerek.
Since the term “intractable pain” is not properly defined, it has been replaced by ‘severe', which captures the term ‘intractable'.
Ker izraz „neobvladljiva bolečina“ ni jasno opredeljen, ga je nadomestil izraz „hud“, ki obsega tudi pojem „neobvladljiv“.
Replacing the patch before 72 hours may result in increased serum concentrations of fentanyl, which could increase the risk for adverse events.
Menjava obliža po manj kot 72 urah lahko povzroči povečanje serumske koncentracije fentanila, s čimer se poveča tveganje za neželene učinke.
The CHMP as a consequence, concluded that the benefit-risk balance of Durogesic and associated names remains favourable, subject to the agreed changes to the product information.
Posledično je odbor CHMP zaključil, da je razmerje med tveganji in koristmi zdravila Durogesic in povezanih imen še naprej ugodno, pod pogojem, da se upoštevajo dogovorjene spremembe informacij o zdravilu.
anaesthetic since the 1960s.
Fentanil se kot intravenski anestetik trži od 60. let 20. stoletja.
The scope of this procedure is limited to Durogesic transdermal patches.
Obseg tega postopka je omejen na zdravilo Durogesic transdermalni obliži.
Elderly or patients with renal or hepatic impairment should be closely observed and dose reductions made if necessary.
Starejše bolnike in bolnike z okvaro ledvic ali jeter je treba natančno opazovati in po potrebi zmanjšati odmerke.
Table 3: An alternative conversion Table from oral morphine to fentanyl transdermal therapeutic system (TTS), based on data from a clinical study of fentanyl TTS in subjects tolerant of stable regimens of sustained release (SR) morphine, was proposed in 1996 by Donner et al. (1996)1.
Preglednica 3: Alternativna preglednica za pretvorbo s peroralnega morfina na fentanilni transdermalni terapevtski sistem (TTS), osnovana na podatkih iz klinične študije fentanilnega TTS pri osebah, ki so razvile toleranco za stabilne sheme podaljšanega sproščanja morfina, je bila leta 1996 predlagana v Donner et al. (1996)1
In such a case it is recommended that the patient should be monitored closely for increased serum concentrations.
V takem primeru se priporoča natančno nadzorovanje serumskih koncentracij zdravila pri bolniku.
Due to the divergent national decisions taken by Member States concerning the authorisation of Durogesic and associated names, the European Commission (EC) notified the European Medicines Agency of an official referral under Article 30 of Directive 2001/83/EC in order to resolve divergences amongst the authorised summary of product characteristics (SmPCs) for the above-mentioned product, and thus to harmonise the SmPCs across the EU.
Zaradi različnih nacionalnih odločitev, ki so jih sprejele države članice v zvezi z izdajo dovoljenja za promet z zdravilom Durogesic in povezanimi imeni, je Evropska komisija obvestilaEvropsko agencijo za zdravila o uradni napotitvi v skladu s členom 30 Direktive 2001/83/ES, z namenom odprave neskladij in uskladitve nacionalno odobrenih povzetkov glavnih značilnosti zdravila v EU.
The proposed wording has been developed to align the populations evaluated in clinical studies and to maintain alignment between the indications for both adult and paediatric patients.
Predlagano besedilo je bilo zasnovano tako, da uskladi v kliničnih študijah vrednotene populacije in da ohrani usklajenost indikacij pri odraslih in pediatričnih bolnikih.
The analgesic action of fentanyl is thought to be mediated mainly through µopioid-receptors.
Domneva se, da je analgetični učinek fentanila posredovan predvsem prek µ-opioidnih receptorjev.
Information related to studies in the post-operative pain indication in opioid naïve subjects has not been retained since this is not in the indication of Durogesic.
Informacije, povezane s študijami pri indikaciji pooperacijske bolečine pri bolnikih, ki prej niso jemali opioidov, niso bile ohranjene, ker to ni vključeno v indikacijo o zdravilu Durogesic.
Fentanyl has high lipid solubility and potency, which make it suitable for transdermal administration.
Fentanil ima visoko lipidotopnost in jakost, zaradi česar je primeren za transdermalno uporabo.
• The committee reviewed the totality of the data submitted by the MAH in support of the proposed harmonisation of the Product Information.
• Odbor je pregledal vse podatke, ki jih je v podporo predlagani uskladitvi informacij o zdravilu predložil imetnik dovoljenja za promet z zdravilom.
These are: pharmacodynamic-related interactions with centrally-acting medicinal products and alcohol, monoamine oxidase inhibitors, serotonergic drugs and concomitant use of mixed opioid agonists/antagonists, and pharmacokinetic-related interactions with CYP3A4 Inhibitors and CYP3A4 inducers.
Te so: s farmakodinamiko povezane interakcije s centralno delujočimi zdravili in alkoholom, zaviralci monoaminske oksidaze, serotonergična zdravila ter hkratno uporabo mešanih opioidnih agonistov/antagonistov in s farmakokinetiko povezane interakcije z zaviralci CYP3A4 in induktorji CYP3A4.
If hypotension persists after naloxone administration, standard medical care for hypovolemia, including fluid management is recommended to be considered.
Če hipotenzija vztraja po aplikaciji naloksona, se priporoča premislek o priporočeni standardni medicinski oskrbi pri hipovolemiji, vključno s tekočinskim zdravljenjem.
The MAH has clarified that only at first application could a patch be replaced after 48 hours when analgesia is insufficient.
Imetnik dovoljenja za promet z zdravilom je pojasnil, da bi se obliž lahko zamenjal po 48 urah le v primeru nezadostne analgezije pri uporabi prvega odmerka.
Durogesic transdermal patch contains fentanyl, which is a potent, synthetic opioid analgesic belonging to the piperidine derivatives.
Zdravilo Durogesic transdermalni obliž vsebuje fentanil, ki je močan sintetični opioidni analgetik iz skupine piperidinskih derivatov.
Table 2: Designed for adult patients who have a need for rotation of, or conversion from, another opioid regimen (conversion ratio of oral morphine to transdermal fentanyl approximately equal to 150:1).
Preglednica 2: Zasnovana za odrasle bolnike, ki potrebujejo spremembo ali pretvorbo z drugega opioidnega načina zdravljenja (s pretvorbenim razmerjem peroralnega morfina in transdermalnega fentanila približno enakim 150 : 1).
Other warnings included in section 4.4 are: chronic pulmonary disease, drug dependence and potential for abuse, central nervous system including increased intracranial pressure, cardiac disease, hypotension, hepatic impairment, renal impairment, respiratory depression, serotonin syndrome, accidental exposure by patch transfer, use in elderly patients, gastrointestinal tract, paediatric population, lactation, and patients with myasthenia gravis.
Druga v poglavje 4.4 vključena opozorila so: kronična pljučna bolezen, zasvojenost z zdravilom in možnost zlorabe, osrednje živčevje, vključno z zvišanim intrakranialnim tlakom, bolezni srca, hipotenzija, okvara jeter, okvara ledvic, respiratorna depresija, serotoninski sindrom, naključna izpostavljenost s prenosom obliža, uporaba pri starejših bolnikih, prebavila, pediatrična populacija, laktacija in bolniki z miastenijo gravis.
Table 1 - Equianalgesic potency conversion: Due to differences in the relative potency of various opioid analgesics, guidance is necessary regarding equianalgesic doses of various medications.
Preglednica 1 - Pretvorba v odgovarjajoč analgetični učinek: Zaradi razlik v relativni učinkovitosti različnih opioidnih analgetikov je potrebna usmeritev o odgovarjajočih odmerkih različnih zdravil.
As the wording about the potential risk of serotonin syndrome has been included in sections 4.4 and 4.5 of the harmonised SmPC, section 4.8 of the harmonised SmPC has also been updated with a statement that cases of serotonin syndrome have been reported when fentanyl-containing products are administered concomitantly with highly serotonergic medicinal products.
Ker je bilo v poglavji 4.4 in 4.5 usklajenega povzetka glavnih značilnosti zdravila vključeno besedilo o možnem tveganju za serotoninski sindrom, je bil razdelek 4.8 usklajenega povzetka glavnih značilnostih zdravila posodobljen z izjavo, da so pri hkratnem dajanju zdravil, ki vsebujejo fentanil, in visoko serotonergičnih zdravil poročali o primerih serotoninskega sindroma.
The subjects (N=1667) included had chronic low back pain, osteoarthritis or rheumatoid arthritis or pain of unspecified origin.
V študijo so bile vključene osebe (N = 1 667), ki so imele kronične bolečine v križu, osteoartrozo, revmatoidni artritis ali bolečino neopredeljenega izvora.
Because there are no pharmacokinetic (PK) data available to support the safety of replacing patches at 48hour intervals, the MAH does not recommend dosing intervals of less than 72 hours.
Na voljo ni nobenih farmakokinetičnih podatkov, ki bi podprli varnost menjavanja obližev v 48-urnih intervalih, zato imetnik dovoljenja za promet z zdravilom ne priporoča intervalov odmerjanja, krajših od 72 ur.
With regard to the interactions with CYP3A4 inhibitors, although the concomitant use with Durogesic is not recommended, in cases where the benefits outweigh the increased risk of adverse effects, a washout period of 2 days before the first Durogesic patch is applied was considered to be sufficient in most cases.
Kar se tiče interakcij z zaviralci CYP3A4, hkratna uporaba z zdravilom Durogesic ni priporočena, v tistih primerih, kjer koristi odtehtajo povečano tveganje za neželene učinke, pa se je štelo za zadostno obdobje izpiranja dva dni pred uporabo prvega obliža Durogesic.
As outlined in the October 2007 Public Assessment Report regarding paediatric data, the long-term management of severe chronic pain in children from 2 years of age who are receiving opioid therapy is indicated in section 4.1 of the proposed harmonised SmPC, and also present in the majority of SmPCs.
Kot je bilo v zvezi s pediatričnimi podatki opisano v javnem poročilu o oceni zdravila oktobra 2007, je dolgotrajno zdravljenje hude kronične bolečine pri otrocih, starih dve ali več let, ki prejemajo opioidno zdravljenje, indicirano v poglavju 4.1 predlaganega usklajenega povzetka glavnih značilnosti zdravila in zapisano tudi v večini povzetkov glavnih značilnosti zdravila.
In such cases, the potential for life-threatening hypoventilation has been added as a warning.
Zaradi takih primerov je bilo dodano opozorilo o možnosti življenjsko nevarne hipoventilacije.
As there were no striking differences in the safety profile between adult and paediatric subjects, the MAH's decision not to include a separate table was considered to be acceptable.
Ker v informaciji o varnosti zdravila ni bilo bistvenih razlik med odraslimi in pediatričnimi preiskovanci, je bila odločitev imetnika dovoljenja za promet z zdravilom, da ne vključi ločene preglednice, ocenjena kot sprejemljiva.
The results of all pharmacodynamic or efficacy studies conducted in paediatric patients has been included in this section and the number of paediatric patients has been brought in line with the other sections of the harmonised SmPC.
V ta razdelek so bili vključeni rezultati vseh farmakodinamičnih študij in študij o učinkovitosti, ki so bile izvedene pri pediatričnih bolnikih, število pediatričnih bolnikov pa je bilo usklajeno z drugimi poglavji usklajenega povzetka glavnih značilnosti zdravila.
Major differences between SmPCs regarding the assigned frequencies for individual adverse reactions were discussed and resolved.
Obravnavane in odpravljene so bile glavne razlike med povzetki glavnih značilnosti zdravila v zvezi s pripisanimi pogostostmi posameznih neželenih učinkov.
The wording regarding tolerance and dependence, opioid withdrawal symptoms, and neonatal withdrawal syndrome follow exactly the wording included in the CSP and is considered to be acceptable.
Besedilo o toleranci in zasvojenosti, simptomih odtegnitve opioidov in neonatalnem odtegnitvenem sindromu natančno sledijo besedilu v ključni informaciji o zdravilu in so obravnavane kot sprejemljive.
However a warning has been added that more time would be needed for CYP3A4 inhibitors with a long half-life (such as amiodarone) or CYP3A4 inhibitors with time-dependent or mechanism-based inhibition (such as erythromycin, nicardipine, idelalisib, ritonavir), and that the product information of the CYP3A4 inhibitor must be consulted for the half-life and duration of the inhibitory effect before applying the first Durogesic patch.
Dodano pa je bilo tudi opozorilo, da bi bil pri zaviralcih CYP3A4 z dolgo razpolovno dobo (npr. amjodaronom) ali zaviralcih CYP3A4 s časovno odvisnim ali na mehanizmu temelječim zaviranjem (npr. eritromicinu, nikardipinu, idelalisibu, ritonavirju) potreben daljši čas in da je treba pred uporabo prvega obliža Durogesic v navodilih za uporabo zaviralca CYP3A4 preveriti razpolovni čas in trajanje zaviralnega učinka.
Although clinical experience is limited with Durogesic in opioid-naïve patients and in general the transdermal route is not recommended in opioid-naïve patients, the MAH recognizes that in exceptional clinical circumstances, the 12 μg/h fentanyl patch could be considered, when commencing with oral opioids is not considered appropriate.
Čeprav so klinične izkušnje z zdravilom Durogesic pri bolnikih, ki prej niso prejemali opioidov, omejene in pri njih transdermalna pot v splošnem ni priporočljiva, imetnik dovoljenja za promet z zdravilom ugotavlja, da bi se v izrednih kliničnih okoliščinah lahko pretehtala uporaba 12 μg/h fentanilnega obliža, kadar zdravljenja ni primerno začeti s peroralnimi opioidi.
Children aged 16 years and above follow adult dosage, and for children 2-16 years a table with recommended Durogesic dosages for paediatric patients based upon daily oral morphine dose has been provided.
Za otroke, stare od 2 do 16 let, je predložena preglednica s priporočenimi odmerki zdravila Durogesic na osnovi dnevnega peroralnega odmerka morfina.
The initially proposed Table 1 was simplified at the request of the CHMP, where the conversion factors from a drug to oral morphine are already provided, with the intention of reducing the risk of errors in conversion from other opioids to oral morphine, due to less calculation.
Sprva predlagana Preglednica 1 je bila z namenom zmanjšanja tveganja za napake pri pretvorbi z drugih opioidov na peroralni morfin na predlog odbora CHMP poenostavljena tako, da so faktorji za pretvorbo z zdravila na peroralni morfin že podani in je potrebnega manj računanja.
Therefore the MAH's proposal to give a common broad indication wording, not explicitly differentiating between cancer and non-cancer pain, was endorsed by the CHMP.
CHMP je zato sprejel predlog imetnika dovoljenja za promet z zdravilom za skupno besedilo s široko zastavljeno indikacijo brez izrecnega razlikovanja med bolečino pri raku in nepovezano z rakom.
The wording in this section has been amended according to the PSUR worksharing (2010), that Durogesic may impair mental and/or physical ability required for the performance of potentially hazardous tasks such as driving or operating machinery.
Dodano je bilo, da lahko zdravilo Durogesic zmanjša duševno ali fizično sposobnost, potrebno za izvajanje potencialno nevarnih nalog, kot sta vožnja in upravljanje strojev.
• The committee agreed on a harmonised summary of product characteristic, labelling, package leaflet for Durogesic and associated names.
• Odbor se je strinjal z usklajenim povzetkom glavnih značilnosti zdravila, označevanjem ter navodilom za uporabo zdravila Durogesic in povezanih imen.
The wording for the subsection ‘Fertility' has been amended to ensure consistency across the different fentanyl-containing medicinal products.
Besedilo za podpoglavje „Plodnost“ je bilo popravljeno tako, da bi bila dosežena večja usklajenost različnih zdravil, ki vsebujejo fentanil.
Overdose of an opioid such as fentanyl could lead to persistent hypotension due to peripheral vasodilation.
Poglavje 4.9 - Preveliko odmerjanje Preveliko odmerjanje opioida, kot je fentanil, bi lahko vodilo v trajno hipotenzijo zaradi periferne vazodilatacije.
The table with adverse reactions from clinical trials and post-marketing data for both adult and paediatric subjects together, in line with the current table of adverse reactions in the Core Safety Profile (CSP) was proposed.
Preglednica z neželenimi učinki iz kliničnih preizkušanj in podatkov v obdobju trženja za odrasle in pediatrične preiskovance skupaj, v skladu s trenutno preglednico neželenih učinkov v ključni informaciji o varnosti zdravila.
The wording for this subsection has been amended in line with the available information to ensure consistency across the different fentanyl-containing medicinal products.
Besedilo tega podpoglavja je bilo popravljeno v skladu z dostopnimi podatki, da bi bila dosežena usklajenost med različnimi zdravili, ki vsebujejo fentanil.
Revisions were made to the sections; use in opioid-naïve and not opioid-tolerant patients and use during fever or external heat application, and cautionary statements on interchangeability have been deleted as local guidance is required to be followed on the distribution of fentanyl patches, which may differ between Member States.
Poglavje 4.4 - Posebna opozorila in previdnostni ukrepi Poglavja so bila revidirana; uporaba pri bolnikih, ki prej niso bili zdravljeni z opioidi, in tistih, ki opioidov ne prenašajo, uporaba ob zvišani temperaturi ali zunanjem ogrevanju in previdnostne izjave o medsebojni zamenljivosti so bili izbrisani, saj so pri distribuciji fentanilnih obližev potrebna lokalna navodila, ki se med državami članicami lahko razlikujejo.
According to the EMA Guideline on the Clinical Development of Medicinal Products Intended for the Treatment of Pain (EMA/CHMP/970057/2011, Corr. 11) and the WHO Guideline on Cancer Pain Relief, pain severity can be classified as mild, moderate and severe.
Skladno s smernico Evropske agencije za zdravila o kliničnem razvoju zdravil, namenjenih zdravljenju bolečine (EMA/CHMP/970057/2011, popr.
Contraindications relating to severe respiratory depression, hypersensitivity to the active substance or to any of the excipients use in acute or postoperative pain and use in acute or postoperative pain has been included in the harmonised SmPC.
V usklajeni povzetek glavnih značilnosti zdravila so bile vključene kontraindikacije, povezane s hudo respiratorno depresijo, preobčutljivostjo na zdravilno učinkovino ali katero koli pomožno snov, ki se uporablja pri akutni in pooperacijski bolečini, in uporaba pri akutni in pooperacijski bolečini.
The use of fentanyl patches is well established as reflected by the large database, in both malignant and severe non-malignant pain conditions (eg.
Kot je razvidno iz velike podatkovne zbirke, so fentanilni obliži dobro uveljavljeni pri malignih in hudih nemalignih bolečinskih stanjih (npr. pri hudih opeklinah in popoškodbenih okvarah).
The information provided in section 4.2 is partly presented in up to three tables and are only be used to convert from other opioids to Durogesic and not vice versa:
Uporabljajo naj se le za pretvorbo z drugih opioidov na zdravilo Durogesic in ne obratno.
The wording proposed for lactation/breast-feeding that was agreed for fentanyl-containing transdermal patches during two previous PSUR-WS procedures, was endorsed by the CHMP.
o katerem je bilo v zvezi s transdermalnimi obliži, ki vsebujejo fentanil, doseženo soglasje v prejšnjih dveh postopkih PSUR-WS, je odobril odbor CHMP.
the CHMP recommended the variation to the terms of the marketing authorisations for which the summary of product characteristics, labelling and package leaflets are set out in Annex III for Durogesic and associated names.
Odbor CHMP je priporočil spremembo pogojev dovoljenj za promet z zdravilom Durogesic in povezanimi imeni, za katera so v Prilogi III navedeni povzetek glavnih značilnosti zdravila, označevanje in navodilo za uporabo.
Whereas
Odbor
In opioid-naïve elderly or patients with renal or hepatic impairment, there may be some instances in which the initiation of opioid treatment with a transdermal formulation is necessary and appropriate (e.g. in cases of difficulties swallowing).
Opioidno zdravljenje je pri opioidno naivnih starejših bolnikih in bolnikih z okvaro ledvic ali jeter v nekaterih primerih morda treba začeti s transdermalno obliko (npr. pri oteženem požiranju).
As placental passage of fentanyl is known to occur in human pregnancies and the potential risk for humans is unknown, a cautionary statement that Durogesic should not be used during pregnancy unless clearly necessary has been included.
Poglavje 4.6 - Plodnost, nosečnost in laktacija Ker je znano, da pri človeški nosečnosti lahko pride do placentarnega prehoda fentanila in potencialno tveganje za ljudi ni znano, je bila dodana previdnostna izjava, da se zdravilo Durogesic ne sme uporabljati med nosečnostjo, razen če je to nujno potrebno.
Vasodilation is effectively reversed by naloxone.
Vazodilatacijo učinkovito izniči nalokson.
The efficacy of Durogesic has been shown in six studies in adults with non-malignant pain, of which five were open-label and 3 did not have a comparator arm.
Učinkovitost zdravila Durogesic je bila dokazana v šestih študijah pri odraslih z nemaligno bolečino,
Grounds for the CHMP opinion
Podlaga za mnenje odbora CHMP Ob upoštevanju naslednjega:
A warning for renally impaired patients has been included that careful observation for signs of fentanyl toxicity is warranted (and the dose reduced if necessary) as fentanyl pharmacokinetics has not been evaluated in this patient population.
Vključeno je bilo opozorilo za bolnike z ledvično okvaro, da je upravičeno dosledno ugotavljanje znakov fentanilne toksičnosti (in da se odmerek, če je treba,
Package Leaflet (PL)
PRILOGA II
The proposed pharmacodynamic-related interactions were endorsed in the PSUR worksharings in 2010 and 2015.
Poglavje 4.5 - Medsebojno delovanje z drugimi zdravili in druge oblike interakcij Predlagane s farmakodinamiko povezane interakcije so bile sprejete v postopku razdelitve dela pri pripravi Periodičnega poročila o varnosti zdravila (PSUR) leta 2010 in 2015.
The PL has been harmonised taking into account all revisions of the SmPC that are relevant to the PL.
Navodilo za uporabo je bilo usklajeno z upoštevanjem vseh revizij povzetka glavnih značilnosti zdravila, ki so relevantne za navodilo za uporabo.
The MAH has summarised the most commonly reported adverse reactions in this section based on the pooled safety data derived from 11 clinical trials with a total of 1854 participating adult and paediatric subjects.
11 kliničnih preizkušanj, v katerih je sodelovalo skupaj 1 854 odraslih in pediatričnih preiskovancev, povzel najpogosteje poročane neželene učinke.