natgillin/translations-raw huggingface dataset:
• In addition, the Committee considered that the dissolution profile of products containing a polymethacrylate-triethylcitrate coating as modified-release mechanism is significantly affected in the presence of alcohol, leading to an uncontrolled rapid release of the majority of the active substance, and therefore the product exhibits a significant interaction with alcohol with potentially significant clinical effects (e.g. respiratory depression and death), 
• Odbor je prav tako ugotovil, da je profil raztapljanja zdravil, ki vsebujejo premaz iz polimetakrilat-trietilcitrata kot mehanizem za prirejeno sproščanje, ob prisotnosti alkohola pomembno spremenjen, kar lahko povzroči nenadzorovano hitro sproščanje večine zdravilne učinkovine, kar pomeni, da zdravilo kaže pomembno interakcijo z alkoholom, pri čemer se lahko pojavijo pomembni klinični učinki (na primer depresija dihanja in smrt).
As a consequence, where accelerated drug release is seen, the EWP's recommendation was for label warnings and risk management strategies to be considered. 
Kadar je bilo opaženo pospešeno sproščanje zdravila, je tako delovna skupina za učinkovitost priporočila izdelavo opozoril na ovojnini in strategij za obvladovanje tveganja.
The results of the only study with a morphine product (ethylcellulose N-50, methacrylic acid copolymer type C, polyethylene glycol 6000 and diethyl phthalate formulation) indicate that a relatively high quantity of alcohol has almost no effect in vivo. 
Rezultati edine izvedene študije z morfinskim zdravilom (etilceluloza N-50, kopolimer metakrilne kisline tipa C, polietilen glikol 6000 in formulacija dietil ftalata) kažejo, da relativno velika količina alkohola nima skorajda nikakršnega učinka in vivo.
The Committee therefore recommended the amendment of the Marketing Authorisation for which the relevant sections of the Summary of Product Characteristics and Package Leaflet are set out in Annex III. 
Odbor je tako priporočil spremembe dovoljenja za promet z zdravilom, za katero so ustrezna poglavja povzetka glavnih značilnosti zdravila in navodila za uporabo navedena v Prilogi III.
It is of note that, in the data presented by the MAH for this competitor product, the most pronounced effect of alcohol is not at the highest alcohol concentrations tested (40%), but between 28%-32%. 
Omeniti je treba, da so predstavljeni podatki imetnika dovoljenja za promet z zdravilom o tem konkurenčnem zdravilu pokazali, da je najizrazitejši učinek alkohola pri koncentraciji alkohola med 28 in 32 odstotkov in ne pri največji testirani koncentraciji (40 odstotkov).
It follows from the above that data presented on the in vitro effects of alcohol on the dissolution profile of these products are not necessarily a reliable predictor of in vivo behaviour and therefore recommendations such as suspension and reformulation of products should only be adopted for products for which the in vitro interaction is of such magnitude that the products are considered to pose serious risks to the patients. 
Iz zgoraj navedenega izhaja, da predloženi podatki o in vitro učinkih alkohola na profil raztapljanja teh zdravil niso nujno zanesljiv napovednik in vivo delovanja, zato je treba priporočila o začasnem umiku in spremembi zdravil sprejeti samo za tista zdravila, pri katerih se pojavi tako velika in vitro interakcija, da za ta zdravila velja, da predstavljajo resno tveganje za bolnike.
The polymethacrylatetriethylcitrate based formulation is highly sensitive to alcohol with its modified release properties being destroyed shortly after exposure, making it resemble an immediate release formulation. 
Formulacija na osnovi polimetakrilat-trietilcitrata je zelo občutljiva za alkohol, njene lastnosti prirejenega sproščanja pa so bile uničene kmalu po njihovi izpostavitvi, zaradi česar je postala podobna formulaciji s takojšnjim sproščanjem.
• The Committee considered all the available data submitted by the MAHs, 
• Odbor je upošteval vse razpoložljive podatke, ki so jih predložili imetniki dovoljenja za promet z zdravilom.
• The Committee considered, however, that as a pharmacodynamic interaction with alcohol may occur, the product information of the above mentioned products should describe in a clear and harmonised manner the pharmacodynamic interaction between opioid products and alcohol, 
• Odbor je menil, da se farmakodinamična interakcija z alkoholom lahko pojavi, zato mora biti v informacijah o prej navedenih zdravilih na jasen in usklajen način opisana farmakodinamična interakcija med opioidnimi zdravili in alkoholom.
Another study conducted with a hydromorphone formulation based on cellulose acetate 398-10 and Macrogol 3350 formulation confirmed the conclusions of the in vitro studies that the effect of coadministered alcohol on PK parameters is rather limited. 
Druga študija, izvedena s formulacijo hidromorfona na osnovi celuloznega acetata 398-10 in formulacijo makrogol 3350, je potrdila ugotovitve in vitro študij, da je vpliv sočasne uporabe alkohola na farmakokinetične dejavnike precej omejen.
An important interaction following alcohol consumption becomes progressively less likely with time due to dilution effect by gastric secretions and saliva, and gastric emptying. 
Pomembna interakcija po zaužitju alkohola je po določenem času postopoma manj verjetna zaradi razredčevanja z želodčno kislino in slino ter praznjenjem želodca.
From all the above mentioned considerations, including the limitations of the existing data and the current status of scientific knowledge, it follows that general recommendations for acceptance criteria to be applied in relation to the clinical significance of pharmacokinetic interactions with alcohol can not be determined by the Committee at this time. 
Na podlagi zgoraj navedenih zadržkov, vključno z omejitvami obstoječih podatkov in trenutnim stanjem znanstvenega znanja, Odbor trenutno še ne more določiti splošnih priporočil za merila sprejemljivosti, ki naj bi se uporabljala v zvezi s klinično pomembnostjo farmakokinetičnih interakcij z alkoholom.
• The Committee therefore considered that patients exposed to the above mentioned products and concomitant intake of alcohol are at significantly greater risk of developing serious adverse reactions such as respiratory depression and death, 
• Odbor je tako ugotovil, da so bolniki, ki so izpostavljeni zgoraj navedenim zdravilom in sočasnemu vnosu alkohola, izpostavljeni bistveno večjemu tveganju, da se pri njih pojavijo hudi neželeni učinki, kot sta depresija dihanja in smrt.
In light of the existing data, including published data on the use of alcohol in patients treated with opioids, the Committee is of the opinion that the current warnings and contraindications are not sufficient to protect patients from the significant alcohol interaction observed with the polymethacrylate- triethylcitrate formulation. 
Na podlagi obstoječih podatkov, vključno z objavljenimi podatki o uporabi alkohola pri bolnikih, zdravljenimi z opioidi, Odbor meni, da obstoječa opozorila in kontraindikacije ne zadostujejo za zaščito bolnikov pred pomembno interakcijo z alkoholom, opaženo pri formulaciji s polimetakrilattrietilcitratom.
• The Committee considered that products without a polymethacrylate-triethylcitrate coating as modified-release mechanism do not suggest a significant interaction with alcohol considered to be harmful under normal conditions of use, 
• Odbor je menil, da zdravila brez premaza iz polimetakrilat-trietilcitrata kot mehanizma za prirejeno sproščanje ne kažejo pomembne interakcije z alkoholom, ki bi bila pod normalnimi pogoji uporabe škodljiva.
While most products already contain warnings and references to this interaction in the SPC, the wording should be harmonised to ensure the same level of awareness. 
V povzetkih glavnih značilnosti večine teh zdravil so že navedena opozorila in navodila v zvezi s to interakcijo, vendar je besedilo potrebno uskladiti in tako zagotoviti enako raven osveščenosti.
The in vitro data showed a release of 80% of the drug within 15 minutes in 20% of alcohol solution. 
Podatki in vitro preiskave so pokazali, da se je 80 odstotkov zdravila sprostilo v manj kot 15 minutah v 20 odstotkih alkoholne raztopine.
Having assessed the detailed grounds for re-examination provided by the MAH, the rapporteurs assessment reports, the conclusions from the ad hoc expert meeting together with the MAH's expressed concerns on the conclusions of the ad hoc expert meeting and all the information submitted during the referral procedure, the CHMP discussed each one of the grounds submitted: 
Po oceni podrobne utemeljitve zahtevka za ponovni pregled, ki jo predložil imetnik dovoljenja za promet z zdravilom, poročila o oceni poročevalcev, sklepov z ad hoc zasedanja strokovnjakov in izraženih zadržkov imetnika dovoljenja za promet z zdravilom glede sklepov ad hoc zasedanja strokovnjakov ter vseh podatkov, predloženih v napotitvenem postopku, je CHMP odgovoril na vsako točko predložene utemeljitve:
Grounds for amendment of the summaries of product characteristics, package leaflets and labelling 
Podlaga za dopolnilo povzetkov glavnih značilnosti zdravila,navodil za uporabo in označevanja
In vivo studies conducted with a hydromorphone formulation based on ammonio methacrylate copolymer type B (Eudragit RS) confirmed the existing in vitro data suggesting that alcohol affects the formulation. 
In vivo študije, izvedene s formulacijo hidromorfona na osnovi amonijevega metakrilata ko-polimera tipa B (Eudragit RS), so potrdile obstoječe in vitro podatke, ki kažejo, da alkohol učinkuje na formulacijo.
The CHMP had not addressed the issue of the additional risk to patients posed by modified release formulations of opioids which exhibit a greater vulnerability to alcohol compared with the reference product, whilst conferring no additional patient benefit. 
Odbor ni obravnaval vprašanja dodatnega tveganja za bolnike, ki ga predstavljajo formulacije opioidov s prirejenim sproščanjem, ki kažejo večjo občutljivost na alkohol v primerjavi z referenčnim zdravilom, pri tem pa ne zagotavljajo nobenih dodatnih koristi za bolnika.
• The Committee took the view that modified-release oral opioid products in the level III of the WHO scale for the management of pain containing a polymethacrylate-triethylcitrate coating as modified-release mechanism are harmful under the normal conditions of use in accordance with article 116 of Directive 2001/83/EC, as amended. 
• Odbor je podprl stališče, da so peroralna opioidna zdravila s prirejenim sproščanjem III. stopnje po lestvici SZO za lajšanje bolečin, ki vsebujejo premaz iz polimetakrilat-trietilcitrata kot mehanizem za prirejeno sproščanje, pri normalnih pogojih uporabe v skladu s členom 116 Direktive 2001/83/ES, kakor je bila spremenjena, škodljiva.
• The Committee, based on the published literature, considered that a significant percentage of the patient population using these products does not abstain from alcohol consumption despite the existing warnings and contraindications, and that therefore the existing risk minimisation measures do not adequately address the concern, 
• Odbor je na podlagi objavljene literature ugotovil, da se pomemben delež bolnikov, ki se zdravi s temi zdravili, navkljub obstoječim opozorilom in kontraindikacijam ne vzdržuje pri uporabi alkohola, zato obstoječi ukrepi za zmanjševanje tveganja tega vprašanja ne obravnavajo ustrezno.
The question of what could be considered as a clinical significant interaction with alcohol was left for the EWP to consider. 
Odgovor na vprašanje, kaj velja za klinično pomembno interakcijo z alkoholom, je morala podati delovna skupina za učinkovitost.
The Committee also reflected on the usefulness for prescribers and patients of a pharmacokinetic warning in the Product Information referring to the in vitro data. 
Odbor je ocenil tudi uporabnost farmakokinetičnega opozorila glede in vitro podatkov v informacijah o zdravilu za predpisovalce in bolnike.
In its detailed grounds for re-examination the MAH referred to statistical analysis confirming different behaviours in the presence of alcohol for a generic and its originator product. 
V podrobni utemeljitvi zahtevka za ponovni pregled je imetnik dovoljenja za promet z zdravilom navedel statistično analizo, ki je potrdila različno delovanje generičnega in originatorskega zdravila v prisotnosti alkohola.
• The Committee considered that, based on the published literature, a significant percentage of the patient population using these products does not abstain from alcohol consumption despite the existing warnings and contraindications, 
• Odbor je na podlagi objavljene literature ugotovil, da pomemben delež bolnikov, ki se zdravi s temi zdravili, navkljub obstoječim opozorilom in kontraindikacijam ne preneha z uživanjem alkohola.
Not all MAHs of modified-release oral opioid products in the level III of the WHO scale for the management of pain in the European market submitted data, and so it can not be guaranteed that all products approved in the EU have been assessed. 
Ker podatkov niso predložili vsi imetniki dovoljenja za promet s peroralnimi opioidnimi zdravili s prirejenim sproščanjem III. stopnje po lestvici SZO za lajšanje bolečin na evropskem trgu, ni mogoče potrditi, da so bila ocenjena vsa v EU odobrena zdravila.
The CHMP having assessed all the detailed grounds for re-examination and argumentation presented by the MAH and having considered the views of the Rapporteurs, the scientific discussion within the Committee and the conclusions of the ad hoc expert group as well as the concerns raised by the MAH in this respect, concluded that products with a polymethacrylate-triethylcitrate coating are harmful under the normal conditions of use and that, for the remaining products, the Product Information should be amended to include a warning and recommendation for avoiding concomitant use with alcohol. 
CHMP je proučil podrobno utemeljitev zahtevka za ponovni pregled in dokaze, ki jih je predstavil imetnik dovoljenja za promet z zdravilom, ter ob upoštevanju stališč poročevalcev, znanstvene razprave v odboru in sklepov ad hoc strokovne skupine ter zadržkov, ki jih je v zvezi s tem izrazil imetnik dovoljenja za promet z zdravilom, zaključil, da so zdravila s prevleko iz polimetakrilatatrietilcitrata v normalnih pogojih uporabe škodljiva in da je treba pri ostalih zdravilih spremeniti podatke o zdravilu tako, da bodo vključevali opozorilo in priporočilo glede izogibanja sočasni uporabi z alkoholom.
Considering that the proposed pharmacodynamic warning already advises against concomitant use with alcohol, considering also the limitations of the in vitro data and difficulties in its interpretation by prescribers, the majority of the Committee was of the opinion that the addition of a pharmacokinetic interaction warning based on a description of the in vitro data would not favour the clarity of the message to patients and prescribers regarding the need to avoid concomitant use with alcohol. 
Ob upoštevanju, da je v predlaganem farmakodinamičnem opozorilu sočasna uporaba z alkoholom že odsvetovana, ob upoštevanju omejenih in vitro podatkov in težav, ki jih imajo pri njihovi interpretaciji predpisovalci, je večina članov Odbora menila, da vključitev opozorila glede farmakokinetične interakcije na podlagi opisa in vitro podatkov ne bi prispevala k jasnosti sporočila bolnikom in predpisovalcev glede izogibanja sočasni uporabi z alkoholom.
Overall summary of the scientific evaluation of modified-release oral opioid products in the level III of the WHO scale for the management of pain (intense sustained pain resistant to previous medications) (see Annex I) 
Splošni povzetek znanstvenega vrednotenja peroralnih opioidnih zdravil s prirejenim sproščanjem III stopnje po lestvici Svetovne zdravstvene organizacije za lajšanje bolečin (močne dolgotrajne bolečine, odporne na predhodna zdravila) (glejte Prilogo I)
Food related interactions are taken into consideration and reflected in the SPC and package leaflet for the benefit of patients and prescribers. 
Interakcije, povezane s hrano, se zato upoštevajo in so v korist bolnikov in predpisovalcev navedene v povzetku glavnih značilnosti zdravila in navodilu za uporabo.
Consequently, the CHMP has recommended the suspension of the marketing authorisation for modified-release oral opioid products in the level III of the WHO scale for the management of pain containing a polymethacrylate-triethylcitrate coating as modified-release mechanism (see annex I). 
CHMP je tako priporočil začasni umik dovoljenja za promet za peroralna opioidna zdravila s prirejenim sproščanjem III. stopnje po lestvici SZO za lajšanje bolečin, ki vsebujejo premaz iz polimetakrilattrietilcitrata kot mehanizem za prirejeno sproščanje (glejte Prilogo I).
The dissolution profile of this product (80% dissolved substance within 15 min in 20% alcohol) is beyond the limit of the Ph. Eur. 
Profil raztapljanja tega zdravila (80 odstotkov raztopljene snovi v 15 minutah v 20 odstotkih alkohola) presega mejne vrednosti Evropske farmakopeje za zdravila s konvencionalnim sproščanjem (ne manj kot 75 odstotkov raztopljene zdravilne učinkovine v 45 minutah).
Further to that, the IVIV correlation is, at present time, uncertain for most products. 
Poleg tega je za večino zdravil korelacija in vitro - in vivo trenutno negotova.
Whereas 
Brez
It is however clear that, in the cases where the highest degree of in vitro interaction was observed, the high alcohol solubility of the excipients provided a clear explanation for the observation. 
V primerih, ko je bila opažena najvišja stopnja in vitro interakcije, je bilo to mogoče razložiti z visoko topnostjo pomožnih snovi v alkoholu.
This is justified on the basis that a pharmacodynamic interaction between opioid products and alcohol may occur irrespective of the formulation. 
To utemeljuje dejstvo, da se lahko farmakodinamična interakcija med opioidnim zdravilom in alkoholom pojavi neodvisno od formulacije.
The exception is one morphine formulation using polymethacrylate-triethylcitrate coating as modified-release mechanism, for which dose dumping might occur when taken together with alcohol. 
Izjema je bila le ena formulacija morfina, pri kateri je uporabljen premaz iz polimetakrilattrietilcitrata kot mehanizem za prirejeno sproščanje in pri kateri se lahko pri sočasni uporabi z alkoholom pojavi učinek prekomernega sproščanja.
It is clearly stated in the Opinion that 50% of the formulations were found to be affected by alcohol in vitro. 
V mnenju je jasno navedeno, da je alkohol in vitro učinkoval na 50 odstotkov formulacij.
• The Committee considered the procedure under Article 31 of Directive 2001/83/EC, as amended for modified-release oral opioid products in the level III of the WHO scale for the management of pain (intense sustained pain resistant to previous medications), 
• Odbor je upošteval postopek v skladu s členom 31 Direktive 2001/83/ES, kakor je bila spremenjena, za peroralna opioidna zdravila s prirejenim sproščanjem III. stopnje po lestvici SZO za lajšanje bolečin (močne dolgotrajne bolečine, odporne na predhodna zdravljenja),
In its detailed grounds for re-examination, the MAH referred to a competitor product in which the release of oxycodone is accelerated in the presence of alcohol as an example of a potentially clinically meaningful interaction. 
Imetnik dovoljenja za promet z zdravilom je v podrobni utemeljitvi zahtevka za ponovni pregled kot primer možne klinično pomembne interakcije navedel konkurenčno zdravilo, pri katerem je sproščanje oksikodona v prisotnosti alkohola pospešeno.
• The Committee considered the procedure under Article 31 of Directive 2001/83/EC, as amended for modified-release oral opioid products in the level III of the WHO scale for the management of pain (intense sustained pain resistant to previous medications) on the EU market, 
• Odbor je upošteval postopek v skladu s členom 31 Direktive 2001/83/ES, kakor je bila spremenjena, za peroralna opioidna zdravila s prirejenim sproščanjem III. stopnje po lestvici SZO za lajšanje bolečin (močne dolgotrajea bolečine, odporne na predhodna zdravljenja), ki so na trgu EU.
The MAH further considered, in its grounds for re-examination, that the CHMP opinion was inconsistent in its approach regarding alcohol versus food interactions. 
V utemeljitvi zahtevka za ponovni pregled je imetnik dovoljenja za promet z zdravilom menil, da je bilo mnenje Odbora glede pristopa do interakcije z alkoholom neskladno s pristopom do interakcije s hrano.
From the products tested, fifty percent of the formulations were found to be affected by alcohol solutions in vitro. 
Med in vitro preizkušanimi zdravili je bilo 50 odstotkov formulacij, na katere so vplivale alkoholne raztopine.
The Opinion did not take account of the earlier advice of its own working parties, namely the EWP and QWP, which had been requested by the CMD(h); nor did it provide any proper reasons for discounting that advice. 
Pri izdanem mnenju niso bili upoštevani predhodni nasveti delovnih skupin Odbora, in sicer delovne skupine za učinkovitost in delovne skupine za kakovost, ki jih je naročila Usklajevalna skupina za postopke z medsebojnim priznavanjem in decentralizirani postopek za zdravila za uporabo v humani medicini, prav tako pa niso bili navedeni ustrezni razlogi za neupoštevanje teh mnenj.
This morphine formulation with polymethacrylate- triethylcitrate coating as modified-release mechanism has been identified as a product where dose dumping might occur when taken together with alcohol. 
Ugotovljeno je bilo, da je ta morfinska formulacija s premazom iz polimetakrilat-trietilcitrata kot mehanizmom za prirejeno sproščanje zdravilo, pri katerem se lahko ob sočasnem uživanju alkohola pojavi učinek prekomernega sproščanja.
• The Committee noted that a pharmacodynamic interaction between opioid products and alcohol may occur irrespective of the formulation, 
• Odbor je ugotovil, da se farmakodinamična interakcija med opioidnimi zdravili in alkoholom lahko pojavi neodvisno od formulacije.
Further to the request from the MAH, the CHMP convened an Ad-Hoc Expert meeting including experts on technology/formulation science, pharmacokinetics and clinical/medical practice in order to deliver answers on a consultative basis to specific questions in relation to the grounds for re-examination. 
farmakokinetike in klinične/medicinske prakse, da bi s posvetovanjem prišli do odgovorov na specifična vprašanja v zvezi z utemeljitvijo zahtevka za ponovni pregled.
A product containing hydromorphone and a prolonged release system consisting of ammonio methacrylate co-polymer type B (Eudragit RS) also suffered a significant effect of high concentrations of alcohol on in vitro dissolution. 
Pomemben učinek pri visoki koncentraciji alkohola na in vitro raztopino se je pokazal tudi pri zdravilu, ki vsebuje hidromorfon, njegov sistem podaljšanega sproščanja pa je sestavljen iz kopolimera amonijevega metakrilata tipa B (Eudragit RS).
In order to assess the potential for dose-dumping of each product, MAHs of products in the level III of the WHO scale for the management of severe pain were asked to submit data on their products. 
Imetniki dovoljenja za promet z zdravili III stopnje po lestvici SZO za lajšanje hudih bolečin so bili zaprošeni, da predložijo podatke o svojih zdravilih za ocenitev možnosti prekomernega sproščanja vsakega posameznega zdravila.
• The Committee considered that a pharmacodynamic interaction between opioid products and alcohol may occur irrespective of the formulation, 
Odbor je menil, da se lahko farmakodinamična interakcija med opioidnimi zdravili in alkoholom pojavi neodvisno od formulacije.
The withdrawal letter is available here. 
Dopis o umiku vloge je na voljo tukaj.
If you are in a clinical trial and need more information about your treatment, contact the doctor who is treating you. 
Če ste vključeni v klinično preskušanje in potrebujete več informacij o zdravljenju, se obrnite na zdravnika, ki vam je predpisal zdravljenje.
It was to be available as a suspension for inhalation. 
Na voljo naj bi bilo v obliki suspenzije za inhaliranje.
What consequences does this withdrawal have for patients in clinical trials? 
Kakšne so posledice umika za bolnike, ki sodelujejo v kliničnih preskušanjih?