natgillin/translations-raw huggingface dataset:
Analyses performed in the clinical development program to assess potential interactions of daclizumab with potentially hepatotoxic medications showed no clear evidence of increased risk of liver injury with concomitant hepatotoxic medications. 
Analize, ki so bile izvedene v okviru programa za klinični razvoj zdravila, za oceno morebitnega medsebojnega delovanja med daklizumabom in potencialno hepatotoksičnimi zdravili, niso dale nobenih jasnih dokazov o povečanem tveganju poškodbe jeter zaradi sočasnega jemanja hepatotoksičnih zdravil.
Caution should also be used when medicinal products of known hepatotoxic potential are used concomitantly. 
Prav tako je potrebna previdnost pri sočasnem jemanju zdravil s hepatotoksičnim potencialom.
Patients exhibiting signs and symptoms suggestive of liver injury should be promptly referred to a hepatologist. 
Bolniki, ki kažejo znake in simptome, ki kažejo na poškodbe jeter, morajo biti nemudoma napoteni k hepatologu.
On 7 June 2017, the European Commission (EC) was informed of a fatal case of fulminant liver failure in a patient treated with daclizumab in an ongoing observational study, despite monthly liver function testing performed in accordance with recommendations in the product information. 
Evropska komisija je 7. junija 2017 prejela obvestilo o smrtnem primeru zaradi fulminantne odpovedi jeter pri bolniku, zdravljenim z daklizumabom v okviru tekoče opazovalne študije, kljub mesečnim pregledom delovanja jeter v skladu s priporočili in informacijami o izdelku.
In addition, consideration should be given to discontinue treatment if an adequate therapeutic response is not achieved. 
Poleg tega je treba razmisliti o prenehanju zdravljenja pri bolnikih, pri katerih ni bil dosežen ustrezen terapevtski odziv.
The PRAC also considered that daclizumab should be contraindicated in patients with pre-existing hepatic disease or impairment. 
Odbor PRAC prav tako meni, da je treba daklizumab kontraindicirati pri bolnikih s predhodno obstoječo boleznijo ali okvaro jeter.
In view of this and while the magnitude and nature of the risk of liver injury is being further investigated, the PRAC considered that provisional measures are needed to limit the use of daclizumab. 
Glede na navedeno in medtem ko je preiskava obsega in narave tveganja za poškodbe jeter še vedno v teku, odbor PRAC meni, da je treba uvesti začasne ukrepe za omejitev uporabe daklizumaba.
This was also noted in serious cases that occurred since the marketing authorisation, including the fatal case, therefore while the role of concomitant hepatotoxic medication is not fully elucidated, concomitant use with daclizumab should be cautious. 
To je bilo opaženo tudi pri resnih primerih, ki so se pripetili po izdaji dovoljenja za promet, vključno s smrtnim primerom, zato je kljub temu, da vloga sočasnega jemanja hepatotoksičnih zdravil ni povsem jasna, potrebna posebna previdnost pri sočasnem zdravljenju z daklizumabom.
In view of the above, the Committee considers that the benefit-risk balance of Zinbryta (daclizumab) remains favourable subject to the agreed provisional amendments to the product information. 
Odbor je glede na zgoraj navedeno menil, da je razmerje med tveganji in koristmi zdravila Zinbryta (daclizumab) še naprej ugodno, če se upoštevajo dogovorjene začasne spremembe informacij o zdravilu.
• The PRAC noted that a fatal case of fulminant liver failure occurred despite adherence to the terms of the marketing authorisation and the risk minimisation measures recommended, including the liver function monitoring. 
• Odbor PRAC je menil, da se je smrtni primer fulminantne odpovedi jeter zgodil kljub upoštevanju pogojev dovoljenja za promet in izvajanju priporočenih ukrepov za zmanjševanje tveganja, vključno s spremljanjem funkcije jeter.
Transaminases elevations and serious hepatic injury are known risks associated to treatment with Zinbryta (daclizumab) and several risk minimisation measures (RMMs) were implemented in this regard, including monthly liver function monitoring. 
Dvig ravni transaminaz in resne poškodbe jeter so znana tveganja pri zdravljenju z zdravilom Zinbryta (daklizumab), zaradi česar so bili uvedeni številni ukrepi za zmanjševanje teh tveganj (RMM), vključno z mesečnim spremljanjem delovanja jeter.
Further, the PRAC took into consideration that interrupting treatment in patients whose disease is well-controlled with daclizumab may induce relapses. 
Upošteval je tudi, da lahko prekinitev zdravljenja pri bolnikih, pri katerih je bolezen s pomočjo daklizumaba dobro nadzorovana, povzroči ponovitev bolezni.
The PRAC took under consideration the alternative treatment options for the different stages or manifestations of RMS and that limiting access to daclizumab may deny some patients a treatment option for this disease. 
Odbor PRAC je proučil alternativne možnosti zdravljenja za različne stopnje ali manifestacije multiple skleroze ter pri tem upošteval dejstvo, da omejitev dostopa do daklizumaba nekaterim bolnikom odvzema možnost zdravljenja njihove bolezni.
The efficacy of daclizumab was demonstrated in two pivotal studies in subjects with relapsing remitting multiple sclerosis that led to the indication in relapsing multiple sclerosis. 
Učinkovitost daklizumaba je bila dokazana v dveh ključnih študijah na subjektih z recidivno-remitentno multiplo sklerozo, kar je vodilo v sprejetje indikacije za zdravljenje recidivne multiple skleroze.
• The PRAC reviewed the preliminary data provided by the marketing authorisation holder on cases of serious liver injury reported since the initial marketing authorisation, in the context of available safety data from clinical trials submitted in support of the initial marketing authorisation in relation to the overall risk of liver injury with daclizumab. 
• Odbor PRAC je pregledal predhodne podatke, ki jih je posredoval imetnik dovoljenja za promet z zdravilom glede primerov resne poškodbe jeter, ki so bili zabeleženi po izdaji dovoljenja za promet, v kontekstu podatkov o varnosti iz kliničnega preskušanja, ki so bili predloženi v podporo prvotnemu dovoljenju za promet v zvezi z celokupnim tveganjem poškodbe jeter z daklizumabom.
Zinbryta (daclizumab) is a centrally authorised medicinal product indicated in adult patients for the treatment of relapsing forms of multiple sclerosis (RMS). 
Zinbryta (daclizumab) je zdravilo, odobreno po centraliziranem postopku, namenjeno za zdravljenje recidivnih oblik multiple skleroze pri odraslih bolnikih.
The RMMs implemented, in particular the monthly liver testing, have not been effective to prevent the fatal case of fulminant hepatic failure. 
Uvedeni ukrepi za zmanjšanje tveganja, zlasti mesečno testiranje funkcije jeter, niso bili dovolj učinkoviti za preprečitev smrtnega primera fulminantne odpovedi jeter.
Cases of serious liver injury occurred at any time point between early after treatment initiation to several month after discontinuation and no window of susceptibility to could be defined from cases observed in clinical trials. 
Primeri resnih poškodb jeter so se zgodili v obdobju med zgodnjo fazo po uvedbi zdravljenja in nekaj mesecev po prekinitvi zdravljenja, vendar na osnovi primerov, opazovanih v okviru kliničnega preskušanja, ni bilo mogoče določiti okna občutljivosti.
The above provisional measures should be reflected in the product information of daclizumab and communicated to HCPs via a dedicated letter. 
Zgoraj navedeni začasni ukrepi se morajo odražati tudi v informacijah o zdravilu za daklizumab, sporočiti pa jih je treba tudi zdravstvenim delavcem v obliki dopisa na to temo.
Finally, physicians should consider discontinuing daclizumab treatment if an adequate therapeutic response has not been achieved. 
Zdravniki morajo razmisliti o prekinitvi zdravljenja z daklizumabom v primerih, pri katerih ni dosežen ustrezen terapevtski odziv.
The PRAC noted that the hepatic findings observed during the clinical development program had led at time of the initial marketing authorisation to the inclusion of a warning in the product information that treatment of patients with pre-existing severe hepatic impairment is not appropriate and that those with pre-existing mild or moderate hepatic impairment should be monitored. 
Odbor PRAC je menil tudi, da so izsledki glede spremljanja jeter, ugotovljeni v okviru programa kliničnega razvoja zdravila, v času prvotnega dovoljenja za promet privedli do vključitve opozorila v informacije o zdravilu, da zdravilo ni primerno za bolnike s prej obstoječo resno okvaro jeter ter, da je treba bolnike s predhodno blago ali zmerno okvaro jeter redno spremljati.
Considering the lack of clinical data in patients with pre-existent significant hepatic diseases as these were excluded from clinical trials, the new serious hepatic cases, and that a mild elevation of serum transaminases was reported prior to treatment initiation in the patient who died of fulminant liver failure, the PRAC recommended as a provisional measure that daclizumab should be contraindicated in all patients with pre-existing hepatic disease or hepatic impairment, while the pattern of hepatotoxicity and possible mechanism of action is further investigated. 
Glede na pomanjkanje kliničnih podatkov pri bolnikih s predhodno obstoječimi resnimi boleznimi jeter, saj so bili ti izključeni iz kliničnih preizkusov, nove resne primere jetrnih obolenj ter dejstva, da je bil pri bolniku, ki je umrl zaradi fulminantne odpovedi jeter, pred začetkom zdravljenja ugotovljen blag dvig ravni transaminaz v serumu, odbor PRAC kot začasen ukrep priporoča kontraindikacijo daklizumaba pri vseh bolnikih s predhodno obstoječim obolenjem jeter ali okvaro jeter, medtem pa je treba vzorec hepatotoksičnosti in možen mehanizem delovanja nadalje raziskati.
• In addition, the PRAC recommended, as provisional measures to further minimise the risk of liver injury, to strengthen the current warnings to take due account that all patients should be monitored for signs and symptoms of hepatic injury and that liver functions testing should be performed at least monthly, to promptly refer patients to an hepatologist in case of signs or symptoms suggestive of such injury and that treatment initiation is not recommended in patients with other autoimmune conditions. 
• Poleg tega odbor PRAC kot začasni ukrep za nadaljnje zmanjšanje tveganja za poškodbe jeter priporoča okrepitev obstoječih opozoril tako, da bodo zahtevala, da je treba spremljati vse bolnike glede znakov in simptomov poškodbe jeter, da morajo biti preizkusi funkcije jeter izvedeni vsaj enkrat mesečno, da morajo biti vsi bolniki, ki kažejo znake ali simptome takšnih poškodb nemudoma napoteni k hepatologu, ter, da uvedba zdravljenja z daklizumabom ni priporočljiva za bolnike z avtoimunskimi obolenji.
• The PRAC recommended as provisional measure amendment to the indication of daclizumab to restrict its use to adult patients with highly active relapsing disease despite a previous treatment with at least one disease modifying therapy (DMT) or, with rapidly evolving severe relapsing multiple sclerosis who are unsuitable for treatment with other DMTs. 
• Odbor PRAC kot prehodni ukrep priporoča spremembo indikacije daklizumaba tako, da se njegova uporaba omeji na odrasle bolnike z visoko aktivno recidivno multiplo sklerozo, ki je prisotna kljub predhodnemu zdravljenju z vsaj enim zdravilom, ki spreminja potek bolezni (DMT), ali na odrasle bolnike s hitro napredujočo hudo recidivno multiplo sklerozo, ki niso primerni za zdravljenje z drugimi zdravili DMT.
Notable for this fatal case was the occurrence of rapid fulminant liver failure in the setting of recommended liver function monitoring and concomitant use of another medicinal product known to be associated with hepatotoxicity. 
Pomembno dejstvo pri tem smrtnem primeru je bil nastop hitre fulminantne odpovedi jeter kljub izvajanju priporočenega rednega spremljanja delovanja jeter ter ob sočasnemu jemanju drugega zdravila, ki je povezano s hepatotoksičnostjo.
The PRAC considered the preliminary new safety data from a recent fatal case of fulminant liver failure and from cases of serious liver injury that occurred since the marketing authorisation, in the context of the data generated during the clinical development of daclizumab. 
Odbor PRAC je obravnaval nove predhodne podatke o varnosti na podlagi nedavnega primera fulminantne odpovedi jeter s smrtnim izidom, ter na podlagi primerov resnih poškodb jeter, ki so se zgodili po izdaji dovoljenja za promet, v kontekstu podatkov, ki so bili pridobljeni med kliničnim razvojem daklizumaba.
The majority of findings were asymptomatic transaminases elevations, however a low incidence of serious liver events and a rare incidence of fatal liver failure (autoimmune hepatitis) were acknowledged as important risks with daclizumab. 
Večinoma so bili najdeni primeri asimptomatičnega dviga ravni transaminaz, vendar pa so bili nizka pojavnost resnih poškodb jeter in redki smrtni primeri odpovedi jeter (avtoimunski hepatitis) priznani kot pomembna tveganja v zvezi z daklizumabom.
In addition, prompt recognition of signs and symptoms of liver injury is a key component of risk minimisation for liver injury with daclizumab and these should be monitored in all patients. 
Hitro prepoznavanje znakov in simptomov poškodbe jeter je ključna sestavina ukrepov za zmanjševanje tveganja poškodbe jeter zaradi daklizumaba, zato mora zdravnik pri vsakem bolniku le-te redno spremljati.
However, a number of serious hepatic events in patients in daclizumab groups occurred in the setting of concomitant drugs with known hepatotoxic potential, including one fatal autoimmune hepatitis and one non-fatal hepatic failure assessed by an adjudication committee as probable Hy's Law (indicative of a risk of drug-induced severe liver injury). 
Vendar so se številni resni dogodki v zvezi z jetri v skupinah bolnikov, ki so prejemale daklizumab, pripetili v okoliščinah sočasnega jemanja zdravil z znanim hepatotoksičnim potencialom, in so vključevali en primer kroničnega avtoimunskega hepatitisa s smrtnim izidom in en primer odpovedi jeter brez smrtnega izida, katerega je razsodbena komisija ocenila kot možni Hyjev zakon (ki je indikativen za tveganje resnih poškodb jeter zaradi zdravil).
During the clinical development, transaminases elevations and serious hepatic injury were identified as important identified risks. 
Med kliničnim razvojem je bilo ugotovljeno, da sta dvig ravni transaminaz in resna poškodba jeter pomembni tveganji.
However, in view of the seriousness of the reactions reported, leading in one case to a fatal outcome despite adherence to the recommended RMMs, the EC considered that the impact of the risk of liver injury on the benefit-risk balance of the medicinal product and the adequacy of the related RMMs should be reviewed. 
Vendar glede na resnost zabeleženih neželenih učinkov, ki so se v enem primeru kljub izvajanju priporočenih ukrepov za zmanjšanje tveganja končali s smrtnim izidom, Evropska komisija meni, da je potrebno ponovno pregledati vpliv tveganja poškodbe jeter na razmerje med tveganji in koristmi zdravila, kot tudi primernost obstoječih ukrepov za zmanjšanje tveganja.
In view of the restricted indication and contraindication in patients with pre-existing hepatic disease or hepatic impairment, the PRAC recommended that physicians should re-evaluate promptly whether daclizumab continues to be an appropriate treatment option for each of their patients currently treated with this medicinal product, taking into account the provisional measures recommended by the PRAC. 
Glede na omejitev indikacije in kontraindikacijo pri bolnikih s predhodno obstoječim obolenjem jeter ali okvaro jeter odbor PRAC priporoča, naj zdravniki pri vseh svojih bolnikih, ki se zdravijo z daklizumabom, čim hitreje ponovno ocenijo, ali je zdravljenje z daklizumabom zanje še vedno primerno, pri čemer morajo upoštevati začasne ukrepe, ki jih priporoča odbor PRAC.
In addition 4 cases of serious liver injury were reported from clinical trials, in the first periodic safety update report (PSUR). 
Poleg tega so bili v redno posodobljenem poročilu o varnosti zdravila (PSUR) zabeleženi še štirje primeri resne poškodbe jeter v okviru kliničnega preskušanja.
It was also noted that autoimmune thyroiditis was reported in the recent fatal case as well as in one of the Hy's law adjudicated cases; therefore treatment initiation is not recommended in patients with history of concurrent autoimmune conditions. 
Opaženo je bilo tudi, da je bila tako pri smrtnem primeru, kot pri enem izmed obravnavanih primerov Hyjevega zakona zabeležena tudi avtoimunska bolezen ščitnice, zato uvedba zdravljenja ni priporočljiva pri bolnikih, ki so v preteklosti imeli sočasna avtoimunska obolenja.
Therefore, while the magnitude and nature of the risk are being reviewed in depth, having considered the seriousness of the risk and that further RMMs that would be effective in preventing with certainty any new severe cases cannot be identified at this stage, the PRAC considered that it is necessary to provisionally limit the use of daclizumab through restriction of the indication and through preventing its use in patients potentially predisposed to liver injury and provide further recommendations to healthcare professionals (HCPs) and patients in the management of this risk. 
Zato odbor PRAC meni, da je poleg temeljite raziskave glede stopnje in narave tveganja, ob upoštevanju resnosti tveganja, kakor tudi dejstva, da nadaljnjih ukrepov za učinkovito in zanesljivo zmanjšanje tveganja ob tem času ni mogoče določiti, treba začasno omejiti uporabo daklizumaba v smislu omejitve indikacije in preprečevanja uporabe zdravila pri bolnikih, ki so morebitno nagnjeni k poškodbam jeter, ter zdravstvenim delavcem in bolnikom zagotoviti nadaljnja priporočila o obvladovanju tveganj.
Thus, considering the serious risk of hepatic injury along with the benefit that daclizumab may bring to RMS patients, the PRAC recommended that the use of daclizumab should be provisionally restricted to adult patients with highly active RMS despite a full and adequate course of treatment with at least one disease modifying therapy (DMT) or, with rapidly evolving severe relapsing multiple sclerosis who are unsuitable for treatment with other DMTs. 
Zato odbor PRAC glede na resno tveganje poškodbe jeter in po drugi strani koristi daklizumaba za bolnike z recidivno multiplo sklerozo priporoča začasno omejitev uporabe daklizumaba samo na odrasle osebe z visoko aktivno recidivno multiplo sklerozo, prisotno kljub izvedbi celovitega in ustreznega zdravljenja z vsaj enim zdravilom, ki spreminja potek bolezni (DMT), ali na odrasle osebe s hitro napredujočo recidivno multiplo sklerozo, ki niso primerne za zdravljenje z drugimi zdravili DMT.
HCPs and patients should be informed of the post-marketing fatal case of fulminant liver failure, the common risk of hepatitis and the updated frequency of serious cases of hepatic injury in the light of the new cases. 
Glede na omenjene nove primere je treba zdravstvene delavce in bolnike obvestiti o smrtnem primeru fulmnantne jetrne odpovedi, ki se je zgodil v obdobju po izdaji dovoljenja za promet, splošnem tveganju za pojav hepatitisa ter posodobljeni pogostnosti resnih primerov poškodbe jeter.
¾ The need to inform patients about the risks of Libertek and the precautions for safe use. 
¾ Obveznost informiranja bolnikov o tveganjih zdravila Libertek in previdnostnih ukrepih za varno uporabo.
Libertek is contraindicated in patients with moderate or severe liver impairment (Child Pugh B or C). 
Libertek je kontraindiciran pri bolnikih z zmerno ali hudo okvaro jeter (Child Pugh B ali C).
Libertek is not recommended in patients with a history of depression associated with suicidal ideation or behaviour. 
Libertek ni priporočljiv za bolnike z anamnezo depresije, ki je bila povezana s samomorilnimi mislimi ali vedenjem.
• Copies of the patient card to be given to patients before they receive Libertek 
• Kopije kartic za bolnike, ki naj bi jih bolniki prejeli pred začetkom jemanja zdravila Libertek
¾ The potential cardiac risk: Libertek has not been studied in patients in congestive heart failure (NYHA grade 3 and 4); hence, it is not recommended in this population. 
¾ Potencialno tveganje za srce: zdravilo Libertek ni bilo raziskano pri bolnikih s kongestivnim srčnim popuščanjem (NYHA stopnje 3 in 4); za to populacijo ni priporočljiv.
¾ The lack of experience in patients with HIV infection or active hepatitis, with severe immunological diseases (e.g. multiple sclerosis, lupus erythematous, multifocal leukoencephalopathy) or treated with immunosuppressive therapy (other than short-term systemic corticosteroids) and that Libertek should not be initiated or should be stopped in these patients. 
¾ Pomanjkanje izkušenj pri bolnikih z okužbo HIV ali aktivnim hepatitisom, z resnimi imunološkimi boleznimi (npr. multiplo sklerozo, eritematoznim lupusom, multifokalno leukoencefalopatijo) ali na zdravljenju z imunosupresivnimi zdravili (razen kratkotrajnega zdravljenja s sistemskimi kortikosteroidi) in zdravila Libertek se pri teh bolnikih ne sme uvajati oz. ga je treba ukiniti.
The fact that Libertek is not indicated for the treatment of COPD patients other than those covered by the approved indication, nor for use in patients with asthma or alpha 1 anti trypsine deficiency. 
Dejstvo, da zdravilo Libertek ni indicirano za zdravljenje bolnikov s KOPB, razen tistih, ki ustrezajo odobreni indikaciji, ni primeren za uporabo pri bolnikih z astmo ali pomanjkanjem alfa-1-antitripsina.
Libertek should not be initiated or should be stopped in patients with cancers (except basal cell carcinoma). 
Zdravila Libertek se ne sme uvajati oz. ga je treba ukiniti pri bolnikih z rakom (z izjemo bazalnoceličnega karcinoma).
• The Marketing Authorisation Holder (MAH) should ensure that, at launch, all Healthcare Professionals who are expected to prescribe Libertek are provided with an Educational pack. 
• Imetnik dovoljenja za promet z zdravilom mora zagotoviti, da bodo imeli ob uvajanju vsi zdravniki, ki bodo predpisovali zdravilo Libertek, na razpolago izobraževalno gradivo.
¾ The potential risk of infections: Libertek should not be initiated, or treatment should be stopped, in patients with severe acute infectious diseases. 
¾ Potencialno tveganje za okužbe: zdravila Libertek se ne sme uvajati oz. zdravljenje je treba prekiniti pri bolnikih z resnimi oblikami akutnih infekcijskih bolezni.
¾ The risk of psychiatric disorders such as insomnia, anxiety, depression in patients receiving Libertek and the potential risk of suicide. 
¾ Tveganje za psihiatrične motnje, npr. nespečnost, tesnobo, depresijo, pri bolnikih, ki jemljejo zdravilo Libertek in potencialno tveganje za samomor.
• Summary of Product Characteristics and Patient Information Leaflet for Libertek 
• Povzetek glavnih značilnosti zdravila in Navodilo za uporabo zdravila Libertek
That Libertek may cause weight loss and patients should weigh themselves regularly and record their weight on the patient card. 
Da zdravilo Libertek lahko povzroči izgubo telesne mase in, da se morajo redno tehtati ter beležiti svojo telesno maso na kartico za bolnike.
14 January 2016 EMA/168579/2015 
14. januar 2016 EMA/168579/2015
Ambroxol and bromhexine medicines have been authorised in: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden. 
Zdravila z ambroksolom in bromheksinom so bila odobrena: v Avstriji, Belgiji, Bolgariji, na Hrvaškem, Cipru, v Češki republiki, na Danskem, v Estoniji, na Finskem, v Franciji, Nemčiji, Grčiji, na Madžarskem, v Islandiji, na Irskem, v Italiji, Latviji, Litvi, Luksemburgu, na Malti, Nizozemskem, Norveškem, Poljskem, Portugalskem, v Romuniji, na Slovaškem, v Sloveniji, Španiji in na Švedskem.
As these medicines have been authorised via national procedures, approved uses are not the same in all EU countries. 
Ker so bila ta zdravila odobrena po nacionalnih postopkih, odobrena uporaba ni enaka v vseh državah EU.