natgillin/translations-raw huggingface dataset:
While it may be argued that patients may use less alcohol as a self-medication strategy if they are sufficiently treated with analgesics like opioids, the results of a recently published Danish Health survey (Ekholm et al. Eur J Pain 2009; 13: 606-12) reveal a different pattern of behavior. 
Čeprav nekateri morda zagovarjajo stališče, da bi bolniki uporabljali manj alkohola kot sredstva za samozdravljenje, če bi bili ustrezno zdravljeni z analgetiki kot so opioidi, pa rezultati nedavno objavljene danske zdravstvene raziskave (Ekholm et al.. Eur J Pain 2009; 13: 606-12) kažejo drugačne vzorce vedenja.
Concurrent depression and pain have a much greater impact than either disorder alone and, in patients with pain, depression is associated to more pain sites, greater pain intensity, longer duration of pain, and greater likelihood of poor treatment response (Bair, J et al., Psychosom Med. 2008 October; 70(8): 890-897). 
Sočasno pojavljanje depresije in bolečine ima veliko večji vpliv kot vsaka motnja posebej, pri bolnikih z bolečino je depresija povezana z več bolečimi mesti, večjo intenzivnostjo bolečine, daljšim trajanjem bolečine in večjo verjetnostjo, da bo odziv na zdravljenje slab (Bair, J et al., Psychosom Med. 2008 October; 70(8): 890-897).
Clinical issues 
Klinična vprašanja
The MAH expressed the view that: 
Imetnik dovoljenja za promet z zdravilom je izrazil stališče, da:
Pain at baseline was a significant predictive factor for alcohol use in the 3-years follow-up period. 
Bolečina v izhodišču je bila pomemben napovedni dejavnik uporabe alkohola v triletnem nadaljevalnem obdobju.
It is therefore concluded that the approach is not inconsistent, firstly because in the case of alcohol, a recommendation not to take the product with alcohol will always exist regardless of the formulation. 
Na podlagi tega se sklepa, da pristop ni neskladen, prvič zato, ker bo v primeru alkohola vedno obstajalo priporočilo, naj se zdravilo ne jemlje z alkoholom, ne glede na formulacijo.
Given the type of products and patient population involved, it is acknowledged that underreporting is considerable. 
Ob upoštevanju vrste zdravil in vključene populacije bolnikov se priznava, da je neporočanje o interakcijah precejšnje.
The association between pain and drinking was evaluated by Brennan et al in a cohort of 401 elderly with different drinking behavior (Brennan, Addiction. 
Povezavo med bolečino in pitjem so ocenjevali Brennan et al. v skupini 401 starostnika z različnimi vzorci pitja (Brennan, Addiction.
A low number of cases of interaction between alcohol and opioid products have been reported, most reports involved intentional overdose or abuse in conjunction with other products and some were fatal. 
V manjšem številu primerov so poročali o interakciji med alkoholom in opioidnimi zdravili, večina poročil pa je vključevala namerno preveliko odmerjanje ali zlorabo skupaj z drugimi zdravili in nekateri primeri so bili smrtni.
In this context, the fact that the product is meant for use once or twice a day may be of importance given the higher dose usually contained in once a day formulations. 
Pri tem je lahko pomembno tudi dejstvo, da je zdravilo namenjeno uporabi enkrat ali dvakrat na dan, saj so v formulacijah za uporabo enkrat na dan načeloma večji odmerki.
Grounds for suspension of the marketing authorisation 
Podlaga za začasni umik dovoljenja za promet z zdravilom
With food the gastric emptying of alcohol is delayed, but still significant (50-60% in 1 hour, Levitt, 1997, and Cortot et al, Digestive Diseases and Sciences 1986; 31:343-48). 
S hrano se praznjenje alkohola iz želodca nekoliko upočasni, vendar je še vedno pomembno (50-60 odstotkov v eni uri; Levitt, 1997, in Cortot et al, Digestive Diseases and Sciences 1986; 31:343-48).
In addition, the CHMP agreed on the inclusion for all other products in the European market of a pharmacodynamic warning. 
Poleg tega je CHMP potrdil tudi vključitev farmakodinamičnega opozorila za vse druga zdravila na evropskem trgu.
This effect is known as ‘dose-dumping'. 
Ta učinek je znan kot „prekomerno sproščanje“.
In its initial Opinion, the CHMP did not conclude that the formulations analysed were unaffected by alcohol. 
V svojem prvotnem mnenju CHMP ni menil, da alkohol ni učinkoval na analizirane formulacije.
Gastric ethanol concentrations dropped rapidly after the consumption of alcohol by 70% in 10 min (Levitt et all, Am J Physiol Gastrointest Liver Physiol 273:951-957, 1997). 
Koncentracija etanola v želodcu se je po zaužitju alkohola hitro zmanjšala, in sicer do 70 odstotkov v 10 minutah (Levitt et al, Am J Physiol Gastrointest Liver Physiol 273:951-957, 1997).
When adopting its 22 July 2010 opinion on this procedure, CHMP was fully aware of the positions of the different working parties. 
CHMP se je pri sprejemanju mnenja o tem postopku dne 22. julija 2010 popolnoma zavedal stališč različnih delovnih skupin.
The National Competent Authorities should therefore determine, based on the modified-release mechanism of the products approved in their Member State, the appropriate actions to be taken for individual products. 
Pristojni nacionalni organi morajo zato na podlagi mehanizmov za prirejeno sproščanje zdravil, odobrenih v njihovi državi članici, določiti ustrezne ukrepe za posamezna zdravila.
Alcohol use is common in patients with chronic pain due to the fact that it reduces pain perception. 
Uporaba alkohola je pri bolnikih s kroničnimi bolečinami običajna, saj zmanjšuje zaznavanje bolečine.
A product with this dissolution profile cannot be considered to behave as an immediate release formulation. 
Za zdravilo s takim profilom raztapljanja ne more veljati, da deluje kot formulacija s takojšnjim sproščanjem.
The association between chronic pain and alcohol use is summarized in the table below. 
Povezava med kronično bolečino in uporabo alkohola je povzeta v spodnji preglednici.
Modified-release products are complex dosage forms designed to release drugs in a controlled manner to achieve desired efficacy and safety profiles. 
Zdravila s prirejenim sproščanjem imajo kompleksno farmacevtsko obliko, ki omogoča sproščanje zdravila na nadzorovan način za doseganje želene učinkovitosti in varnostnih profilov.
Both problem drinkers as non-problem drinkers reported to use alcohol to manage pain, although in the latter group to less extent (see figure 1). 
Tako problematični kot neproblematični pivci so poročali, da alkohol uporabljajo za obvladovanje bolečine, čeprav neproblematični pivci v manjšem obsegu (glejte sliko 1).
The advice of the QWP was that formulations should, if possible, be developed such that a physicochemical incompatibility with alcohol is avoided. 
Priporočilo delovne skupine za kakovost je bilo, da naj se formulacije, kadar je le mogoče, razvijejo na tak način, da ne bo prišlo do fizikalno-kemijske inkompatibilnosti z alkoholom.
Therefore, patients taking this particular formulation are exposed to a significantly greater risk of developing serious adverse reactions such as respiratory depression and death. 
Bolniki, ki jemljejo to določeno formulacijo, so tako izpostavljeni bistveno večjemu tveganju, da se pri njih pojavijo hudi neželeni učinki, kot sta depresija dihanja in smrt.
This is demonstrated by measurements of gastric-duodenal ethanol levels after consumption of alcohol in healthy volunteers. 
To je prikazano z meritvami ravni etanola v želodcu in dvanajstniku po zaužitju alkohola pri zdravih prostovoljcih.
Scientific conclusions and grounds for suspension/amendment of the summaries of product characteristics, package leaflets and labelling presented by the European Medicines Agency 
Znanstveni zaključki in podlaga za začasni umik/dopolnilo povzetkov glavnih značilnosti zdravila, navodil za uporabo in označevanja, ki jih je predstavila Evropska agencija za zdravila
The Committee also discussed the possibility of the introduction of a pharmacokinetic warning in those cases where some degree of additional formulation interaction could be suspected. 
Odbor je prav tako razpravljal o možnosti vključitve farmakokinetičnega opozorila v primerih, kadar obstaja možnost dodatnih interakcij formulacije.
For the suspension to be lifted, the Marketing Authorisation Holders need to provide evidence that the product has been reformulated, that it exhibits an acceptable release profile with the same quality, safety and efficacy profile of the currently authorised formulation but without the clinically significant interaction with alcohol. 
Za preklic začasnega umika morajo imetniki dovoljenja za promet z zdravilom predložiti dokaze, da je bila formulacija zdravila spremenjena ter da ima ustrezen profil sproščanja z enakim profilom kakovosti, varnosti in učinkovitosti, kot ga ima trenutno odobrena formulacija, vendar brez klinično pomembne interakcije z alkoholom.
Following the CHMP Opinion of 22 July 2010, one MAH submitted detailed grounds for the re-examination of the opinion. 
Ob upoštevanju mnenja CHMP z dne 22. julija 2010 je imetnik dovoljenja za promet z zdravilom predložil podrobno utemeljitev zahtevka za ponovni pregled mnenja.
The CHMP was then asked by the European Commission to determine whether there is a need to take specific measures to deal with the consequences of the interaction between strong-opioid modified-release oral products and alcohol. 
Evropska komisija je CHMP zaprosila, naj ugotovi, ali je treba sprejeti specifične ukrepe za obravnavanje posledic interakcij med močnimi opioidnimi peroralnimi zdravili s prirejenim sproščanjem in alkoholom.
The assessment within this procedure provided an overview of the modified-release systems used in the European Union in oral opioid products. 
Ocena iz tega postopka je omogočila pregled sistemov za prirejeno sproščanje, ki se uporabljajo za peroralna opioidna zdravila v Evropski Uniji.
The Committee is also of the opinion that further minimisations measures would not adequately address the concern. 
Odbor tudi meni, da nadaljnji ukrepi za zmanjševanje tveganja ne bi ustrezno obravnavali tega zadržka.
Level III of the WHO scale includes fentanyl, hydromorphone, morphine and oxycodone, however no oral modified-release products containing fentanyl are currently authorised in the EU, as due to a marked first pass effect, oral administration of fentanyl is not feasible. 
III. stopnja lestvice SZO vključuje fentanil, hidromorfon, morfin in oksikodon, vendar v EU trenutno ni odobrenih peroralnih zdravil s prirejenim sproščanjem, ki vsebujejo fentanil, saj zaradi učinka prvega prehoda peroralna uporaba fentanila ni možna.
In this respect, it was noted that the in vitro - in vivo correlation is unclear in most cases, and therefore it would be inappropriate to assume a pharmacokinetic interaction. 
V zvezi s tem je bilo navedeno, da je v večini primerov korelacija in vitro - in vivo nejasna, zato bi bilo sklepanje o farmakokinetični interakciji neprimerno.
• The Committee is also of the opinion that further risk minimisation measures would not adequately address the concern, 
• Odbor tudi meni, da nadaljnji ukrepi za zmanjševanje tveganja ne bi ustrezno obravnavali tega vprašanja.
The Opinion does not provide information on the acceptance criteria to be applied in relation to the clinical significance of pharmacokinetic interactions because there are currently no standard acceptance criteria to be applied in this context. 
Mnenje ne daje podatkov o merilih sprejemljivosti, ki bi se morali uporabljati v zvezi s kliničnim pomenom farmakokinetičnih interakcij, saj trenutno ni standardnih meril sprejemljivosti, ki bi se uporabljala v zvezi s tem.
Patients being treated with opioids tend to drink less alcohol than patients who do not use opioids at all. 
Bolniki, zdravljeni z opioidi, običajno pijejo manj alkohola kot bolniki, ki opioidov sploh ne uporabljajo.
A similar dissolution study from 2007 however, showed that at 60 minutes the dissolution rate of the reference product (considered by the MAH to be a safe product) in the absence of alcohol was actually higher that the dissolution rate of the competing product presented when exposed to 20% alcohol. 
Podobna študija raztapljanja iz leta 2007 pa je pokazala, da je stopnja raztapljanja referenčnega zdravila (imetnik dovoljenja za promet z zdravilom je menil, da je to zdravilo varno) pri 60 minutah v odsotnosti alkohola dejansko višja kot stopnja raztapljanja predstavljenega konkurenčnega zdravila pri izpostavljenosti 20-odstotnemu alkoholu.
For alcohol, the majority of the data available relates to in vitro testing only, and therefore cannot be assumed, for the reasons previously explained, to be directly reproduced in vivo. 
Večina razpoložljivih podatkov za alkohol izhaja le iz in vitro testiranja, kar pomeni, da zaradi prej navedenih razlogov ne morejo biti neposredno ponovljeni in vivo.
Therefore, the European Commission requested the CHMP to give its opinion on whether the marketing authorisations for authorised modified-release oral medicinal products of the WHO level III scale for the management of pain (intense sustained pain resistant to previous medications) (containing morphine, oxycodone, fentanyl and hydromorphone) should be maintained, varied, suspended or withdrawn. 
Evropska komisija je tako CHMP zaprosila, naj poda mnenje, ali naj se dovoljenja za promet z odobrenimi peroralnimi zdravili s prirejenim sproščanjem III stopnje po lestvici SZO za lajšanje bolečin (močne dolgotrajne bolečine, odporne na predhodna zdravljenja) (ki vsebujejo morfin, oksikodon, fentanil in hidromorfon) ohranijo, spremenijo, začasno prekličejo ali umaknejo.
The advice of the EWP was to consider the worst case scenario, including gastric residence times of 1-2 to hours and potential exposure to high concentrations of alcohol. 
Priporočilo delovne skupine za učinkovitost je bilo, da se upošteva najslabši možni scenarij, vključno s časom prisotnosti v želodcu od ene do dveh ur ter možno izpostavljenostjo visokim koncentracijam alkohola.
However, for all of these products, a pharmacodynamic interaction may occur and should be mentioned in the Product information of all products in a consistent manner. 
Kljub temu pa se pri vseh teh zdravilih lahko pojavi farmakodinamična interakcija, kar je potrebno na usklajen način omeniti v informacijah o vseh zdravilih.
As not all medicinal products concerned by this review submitted data, the National Competent Authorities should ensure, based on the modified-release mechanism of the products approved in each Member State, that the appropriate actions are taken for individual products. 
Ker predloženi podatki za ta pregled ne zadevajo vseh zdravil, morajo pristojni nacionalni organi na podlagi mehanizmov za prirejeno sproščanje zdravil, odobrenih v posamezni državi članici, zagotoviti sprejem ustreznih ukrepov za posamezna zdravila.
While a pharmacodynamic interaction with alcohol may occur irrespective of the formulation, in most cases a pharmacokinetic interaction will not be clinically significant so as to warrant measures beyond the proposed wording for the product information. 
Farmakodinamične interakcije z alkoholom se sicer lahko pojavljajo ne glede na formulacijo, v večini primerov pa farmakokinetične interakcije niso klinično pomembne v tej meri, da bi bili potrebni dodatni ukrepi, ki jih predlagano besedilo za informacije o zdravilu ne vključuje.
More than confirming that the generic and originator are bioequivalent, in this review it is important to consider whether the observed in vitro effect constitutes an unacceptable risk for patients. 
V tem pregledu je od potrditve biološke enakovrednosti generičnega in originatorskega zdravila pomembneje ugotoviti, ali opaženi in vitro učinek predstavlja nesprejemljivo tveganje za bolnike.
Having considered all the data submitted, it can be concluded that the large majority of modifiedrelease oral opioid products in the European Union do not exhibit a clinically significant interaction with alcohol. 
Ob upoštevanju predloženih podatkov se lahko potrdi, da velika večina peroralnih opioidnih zdravil s prirejenim sproščanjem v Evropski uniji ne kaže klinično pomembne interakcije z alkoholom.
In addition, as the medicinal product based on this release-mechanism is intended for once a day dosing, the content of morphine is high and therefore the risk of adverse events following dose-dumping is also higher. 
Poleg tega so zdravila, osnovana na takšnem mehanizmu sproščanja, namenjena za uporabo enkrat na dan, vsebnost morfina pa je visoka in zato je nevarnost pojavljanja neželenih učinkov zaradi prekomernega sproščanja prav tako večja.
The issue of additional risk to patients was addressed by CHMP in its initial opinion, and as a consequence a recommendation was adopted to suspend and reformulate the formulations where the interaction was of such magnitude that the products essentially resemble an immediate release formulation (while containing the opioid dose appropriate for a modified release formulation). 
Vprašanje dodatnega tveganja za bolnike je CHMP obravnaval v svojem prvotnem mnenju in posledično sprejel priporočilo, da je treba začasno umakniti in spremeniti vse formulacije, pri katerih so bile interakcije tako velike, da je bilo zdravilo v osnovi podobno formulaciji s takojšnjim sproščanjem (vsebovalo pa je odmerek opioida, primeren za formulacijo s prirejenim sproščanjem).
Secondly, because unlike alcohol, SPC information on food interactions will reflect in vivo studies and therefore have clear added value for the prescriber and the patient. 
In drugič, ker v nasprotju z alkoholom, podatki v povzetku glavnih značilnosti zdravila o interakcijah s hrano odražajo rezultate in vivo študij in imajo zato jasno dodano vrednost za predpisovalce in bolnike.
Where not possible, the QWP recommended the inclusion of differential wording in the Product Information. 
Če to ne bi bilo možno, pa je delovna skupina za kakovost priporočila, da se v informacije o zdravilu vključi drugačno besedilo.
It should be noted that, while the authors of the above mentioned paper go on to conclude that ‘in vitro dissolution may provide evidence regarding the ruggedness of formulations to ingested alcohol', no recommendations are issued to specific products given that ‘…further research is needed to understand the relationship between dosage form, product formulation and configuration and drug release in the presence of ethanol.' 
Pri tem pa je treba omeniti, da avtorji prej navedenega dela menijo, da „in vitro raztopine sicer lahko zagotovijo dokaz o odpornosti formulacije na zaužiti alkohol“, vendar pa niso dali nobenih priporočil glede posameznih zdravil, saj so „... potrebne dodatne raziskave, ki bi pojasnile razmerje med obliko odmerjanja, formulacijo zdravila, konfiguracijo in sproščanjem zdravila v prisotnosti etanola“.
This may be further aggravated by the fact that many patients with chronic pain will also suffer from depression. 
Dejstvo, da se pri velikem številu bolnikov s kronično bolečino pojavlja tudi depresija, vse le še poslabšuje.
Firstly, the Opinion does not provide any information regarding the acceptance criteria to be applied in relation to the clinical significance of pharmacokinetic interactions with alcohol. 
Prvič, mnenje ne vsebuje podatkov o merilih sprejemljivosti, ki jih je treba upoštevati v zvezi s kliničnim pomenom farmakokinetičnih interakcij z alkoholom.
In a limited number of cases, the MAH has also presented the results of in vivo studies and/or a review of adverse event reports which may have been related to the concomitant use of alcohol. 
Le v manjšem številu primerov so imetniki dovoljenja za promet z zdravilom predstavili tudi rezultate in vivo študij in/ali pregled poročil o neželenih učinkih, ki bi lahko bili povezani s sočasno uporabo alkohola.
If, however, the modified-release system is influenced by an external factor or substance (such as alcohol), it is possible that a large quantity of the active substance is released in a short timeframe so that it resembles an immediate-release dosage form. 
Če pa na sistem s prirejenim sproščanjem vplivajo zunanji dejavniki ali snovi (na primer alkohol), obstaja možnost, da se večja količina zdravilne učinkovine sprosti v krajšem časovnem obdobju, kar bi bilo podobno farmacevtski obliki s takojšnjim sproščanjem.
The anticipated increase in dissolution rate observed for modified-release products is a result of the modified release system being rendered unstable in the presence of alcohol. 
Pričakovano povečanje stopnje raztapljanja, opaženo pri zdravilih s prirejenim sproščanjem, je posledica dejstva, da sistemi za prirejeno sproščanje v prisotnosti alkohola postanejo nestabilni.
Fifty-percent of the formulations assessed are affected by alcohol solutions in vitro, but in most cases, the effect of alcohol on the dissolution rate is mild. 
Na petdeset odstotkov ovrednotenih formulacij so vplivale alkoholne raztopine in vitro, vendar pa je bil v večini primerov vpliv alkohola na stopnjo raztapljanja blag.
In the context of marketing authorisation procedures for oxycodone-containing products, possible differences in the safety profile of the originator and generic products had been raised concerning the interaction with alcohol. 
V kontekstu postopkov za pridobitev dovoljenja za promet z zdravili, ki vsebujejo oksikodon, so bili podani zadržki zaradi možnih razlik v varnostnem profilu med originatorskim in generičnimi zdravili glede interakcije z alkoholom.
The MAH mentioned in his grounds for re-examination a paper by Smith at al (In vitro dissolution of oral modified-release tablets and capsules in ethanolic media, International Journal of Pharmaceutics 398 (2010) 93-96) to illustrate that formulations should not be assumed to be unaffected by alcohol without data being evaluated. 
Imetnik dovoljenja za promet z zdravilom je v utemeljitvi zahtevka za ponovni pregled navedel tudi poročilo Smitha et al (In vitro dissolution of oral modified-release tablets and capsules in ethanolic media (In vitro raztapljanje peroralnih tablet in kapsul s prirejenim sproščanjem v etanolnem mediju), International Journal of Pharmaceutics 398 (2010) 93-96), s katerim je želel prikazati, da se brez vrednotenja podatkov ne more sklepati, da alkohol ne učinkuje na formulacije.
According to the data on a competitor product presented by the MAH requesting re-examination, this product starts to exhibit accelerated release of the active substance after approximately 30 min of exposition to alcohol, and is claimed to release 76.5% of the oxycodone dose within one hour of exposure to concentrations of alcohol around 24%. 
Podatki o konkurenčnem zdravilu, ki jih je predstavil imetnik dovoljenja za promet z zdravilom, ki je zahteval ponovni pregled, so pokazali, da je pri tem zdravilu prišlo do pospešenega sproščanja zdravilne učinkovine približno 30 minut po izpostavljenosti alkoholu, 76,5 odstotka odmerka oksikodona pa naj bi se sprostilo v eni uri po izpostavljenosti alkoholu s koncentracijo okoli 24 odstotkov.
For all other strong-opioid modified release oral products in the European market (formulations not containing polymethacrylate-triethylcitrate), no significant risk of dose-dumping due to alcohol use was identified. 
Pri nobenem drugem močnem opioidnem peroralnem zdravilu s prirejenim sproščanjem na evropskem trgu (formulacije, ki ne vsebujejo polimetakrilata-trietilcitrata) ni bilo ugotovljeno pomembnejše tveganje prekomernega sproščanja zaradi uporabe alkohola.
This is clearly demonstrated by the existing data for one specific product for which the in vitro interaction is significant but where the pharmacokinetic parameters did not differ significantly among subjects taking the product with water or with alcohol (ethylcellulose N-50, methacrylic acid copolymer type C, polyethylene glycol 6000 and diethyl phthalate product). 
To je jasno razvidno tudi iz obstoječih podatkov za določeno zdravilo, pri katerem je in vitro interakcija pomembna, farmakokinetični parametri pa se med preiskovanci, ki so zdravilo jemali z vodo ali alkoholom (zdravilo z etilcelulozo N50, kopolimerom metakrilne kisline tipa C, polietilen glikolom 6000 in dietil ftalatom), niso bistveno razlikovali.