natgillin/translations-raw huggingface dataset:
• The PRAC also considered the proposed risk minimisation measures to reduce the risk of overdose through education, communication and restricting availability and concluded that these measures would not be sufficient to minimise the risk of intentional and accidental overdoses to an acceptable level. 
• odbor PRAC je obravnaval tudi predlagane ukrepe za zmanjšanje tveganja za preveliko odmerjanje, ki vključujejo izobraževanje, sporočanje in omejitev razpoložljivosti, ter zaključil, da ti ukrepi ne bi zadoščali za zmanjšanje tveganja za namerno in nenamerno preveliko odmerjanje na sprejemljivo raven.
Both the absorption duration and the terminal halflive were prolonged in the poisoned patients, sometimes resulting in double peaks. 
Pri zastrupljenih bolnikih je prišlo do podaljšanega trajanja absorpcije in končne razpolovne dobe, včasih z dvojnimi vrhovi.
The PRAC was in agreement with the ad-hoc expert group views. 
Odbor PRAC se je strinjal s stališči priložnostne strokovne skupine.
The PRAC assessed the proposed risk minimisation measures during the re-examination phase, and concluded that there are uncertainties regarding their feasibility and their effectiveness, in particular with regards to revised treatment protocols for MR overdoses across the EU, and the potential harms to patients who would be unnecessarily overexposed to NAC. 
Odbor PRAC je med ponovno proučitvijo ocenil predlagane ukrepe za zmanjšanje tveganja in zaključil, da obstajajo negotovosti glede njihove izvedljivosti in učinkovitosti, zlasti glede pregledanih protokolov zdravljenja prevelikega odmerjanja formulacij s prirejenim sproščanjem v vsej EU in morebitnih škodljivih posledic za bolnike, ki bi bili po nepotrebnem čezmerno izpostavljeni NAC.
Protocol based on a systematic treatment with NAC would also lead to a number of patients unnecessarily being treated or over-treated with NAC which is not proportionate and acceptable in view of the adverse reactions cutaneous like rash, itching, flushing and gastrointestinal like nausea, vomiting) associated with treatment with NAC. 
Protokol na podlagi sistematskega zdravljenja z NAC bi privedel do številnih primerov bolnikov, ki bi se po nepotrebnem ali čezmerno zdravili z NAC, kar ni sorazmerno in sprejemljivo glede na neželene učinke na kožo, kot so izpuščaj, srbenje, vročinski oblivi, in na prebavila, kot sta navzeja in bruhanje, povezane z zdravljenjem z NAC.
The vast majority of the serious cases reported with paracetamol MR formulation happened in overdoses with more than 30 g of paracetamol (considered a massive overdose by Marks et al, 2017). 
Velika večina resnih primerov, o katerih so poročali pri formulacijah paracetamola s prirejenim sproščanje, se je zgodila pri prevelikem odmerjanju paracetamola v odmerkih, ki so presegali 30 g (kar Marks et al., 2017, obravnavajo kot znatno prevelik odmerek).
While no cases of overdose were reported in children below 12 years of age, the PRAC noted that the risk of unintentional overdose with Doreta SR is minimal in the patient population due to e.g. the restricted use in children, the child resistant package. 
Pri otrocih, mlajših od 12 let, sicer niso poročali o primerih prevelikega odmerjanja, vendar je odbor PRAC opozoril, da je tveganje za nenamerno preveliko odmerjanje z zdravilom Doreta SR pri tej populaciji bolnikov zaradi npr. omejene uporabe pri otrocih in za otroke varnega pakiranja minimalno.
PRAC confirmed its position that in order to better characterise the risks and address uncertainties about management of overdoses, a larger sample size was needed for the model to be sufficiently powered and that such mechanistic model could not be developed in a reasonable timeframe. 
Odbor PRAC je potrdil svoje stališče, da je za boljše opredelitev tveganj in obravnavo negotovosti pri zdravljenju prevelikega odmerjanja potrebna večja velikost vzorca, ki bi omogočila zadostno moč modela, ter da takšnega mehanicističnega modela ni mogoče razviti v razumnem časovnem okviru.
Therefore, pursuant to Article 116 of Directive 2001/83/EC, the CMDh recommends the suspension of the marketing authorisations for products containing paracetamol, modified and prolonged release. 
Zato v skladu s členom 116 Direktive 2001/83/ES priporoča začasen umik dovoljenj za promet z zdravili, ki vsebujejo paracetamol s prirejenim in podaljšanim sproščanjem.
In addition, publications describing case series of overdose with modified-release paracetamol from Australia, such as Graudins and colleagues (2010, 2014) have been assessed as providing experience on the treatment protocol with NAC and supportive information regarding PK of paracetamol in cases of overdose with MR formulation. 
Poleg tega so bili objavljeni nizi objav primerov prevelikega odmerjanja paracetamola s prirejenim sproščanjem iz Avstralije, npr. Graudins in sodelavci (2010, 2014), ki po oceni zagotavljajo izkušnje o protokolu zdravljenja z NAC in podporne informacije glede farmakokinetike paracetamola v primerih prevelikega odmerjanja formulacije s prirejenim sproščanjem.
In cases where ingested dose is unknown or time of ingestion is unknown or different substances were taken, treatment with NAC is usually promptly started. 
Kadar zaužiti odmerek ali čas zaužitja nista znana ali ko je bolnik zaužil več različnih učinkovin, se zdravljenje z NAC običajno uvede takoj.
However, the feasibility such a recommendation questioned and PRAC considered that it would not result in effective risk minimisation throughout the EU, since the operations of these Centres are different in the EU Member States. 
Vendar pa je izvedljivost tovrstnega priporočila vprašljiva in odbor PRAC je presodil, da s tem ne bi učinkovito zmanjšala tveganja po vsej EU, saj se delovanje teh centrov med državami članicami EU razlikuje.
At the ad-hoc expert group meeting convened during the re-examination, experts concluded that the only patient groups that might benefit from the MR tramadol/paracetamol combination product are those affected by chronic pain and sleeping interruptions due to pain. 
Na srečanju priložnostne strokovne skupine, sklicanem v okviru ponovne proučitve, so strokovnjaki zaključili, da so edini bolniki, ki bi utegnili imeti korist od kombiniranega zdravila s tramadolom/paracetamolom s prirejenim sproščanje, bolniki, ki trpijo zaradi kronične bolečine in motenega spanja zaradi bolečin.
In view of the above, it is considered that this risk is not outweighed by their benefits in the approved indications. 
Glede na navedeno se ocenjuje, da koristi pri odobrenih indikacijah tega tveganja ne odtehtajo.
The absence of effective measures to sufficiently prevent the cases of overdoses and the uncertainties regarding feasibility and effectiveness of revised treatment protocols for MR overdoses across the EU, and the disadvantages they would cause for patients are serious concerns. 
Odsotnost učinkovitih ukrepov za zadostno preprečevanje prevelikega odmerjanja in negotovosti glede izvedljivosti in učinkovitost revidiranih protokolov zdravljenja prevelikega odmerjanja formulacij s prirejenim sproščanjem v vsej EU ter slabosti, ki jih to prinaša za bolnike, predstavljajo resne pomisleke.
To address uncertainties in the management of overdose cases with the MR formulation of paracetamol, a mechanistic model would be required taking into account other relevant parameters (e.g. solubility of paracetamol, kinetics of the toxic metabolite (NAPQUI) and of NAC administered as antidote). 
Za obravnavo negotovosti pri zdravljenju primerov prevelikega odmerjanja formulacije paracetamola s prirejenim sproščanjem bi bil potreben mehanicističen model, ki bi upošteval druge pomembne parametre (npr. topnost paracetamola, kinetiko toksičnega presnovka (NAPQUI) in NAC, danega kot protistrup).
The experts also noted that separate protocols would need to be in place for treating overdose with IR paracetamol and overdose with MR paracetamol or unknown formulation; and that the current nomograms are relevant only for IR paracetamol formulations. 
Strokovnjaki so poudarili tudi, da bi morali biti vzpostavljeni ločeni protokoli za zdravljenje prevelikega odmerjanja paracetamola s takojšnjim sproščanjem in prevelikega odmerjanja paracetamola s prirejenim sproščanjem oziroma neznane formulacije ter da trenutni nomogrami veljajo samo za formulacije s paracetamolom s takojšnjim sproščanjem.
Inherent PK characteristics of these MR products; with one part of the paracetamol content being released immediately, and one (larger) part with a delayed release, differ from the immediate release (IR) formulations. 
Inherentne farmakokinetične lastnosti teh zdravil s prirejenim sproščanjem, pri katerih se en del vsebnosti paracetamola sprosti takoj, drugi (večji) del pa z zapoznelim sproščanjem, se razlikujejo od lastnosti formulacij s takojšnjim sproščanjem.
As part of their risk minimisation strategy, the MAH have recommended that in case of poisoning the emergency medical services should promptly contact the national Poison Centres. 
V okviru svoje strategije zmanjševanja tveganja sta imetnika dovoljenj za promet z zdravilom priporočila, da naj se nujna medicinska pomoč v primeru zastrupitve takoj obrne na nacionalni center za zastrupitve.
Although it was recognised that repeated, and patient-tailored plasma sampling for determination of paracetamol levels and liver enzymes together with tailored administration of NAC may be sufficient to avoid serious hepatic damage, if the patient presents to the medical emergency unit in time, it is currently not possible to determine an effective and proportionate overdose protocol for such overdose due to lack of evidence. 
Čeprav je bilo ugotovljeno, da ponavljajoče se in bolniku prilagojeno vzorčenje plazme za ugotavljanje ravni paracetamola in jetrnih encimov skupaj s prilagojenim dajanjem NAC utegne zadoščati za preprečevanje resne poškodbe jeter, če bolnik pravočasno pride na urgenco, zaradi pomanjkanja dokazov trenutno ni mogoče določiti učinkovitega in sorazmernega protokola za preveliko odmerjanje pri tovrstnem prevelikem odmerjanju.
However, in view of the risk related to these products, PRAC could not identify an indication with substantial clinical benefit which would be only specific to the tramadol/paracetamol MR formulation. 
Vendar pa glede na tveganje, povezano s temi zdravili, ni mogel določiti indikacije z bistveno klinično koristjo, ki bi bila značilna samo za formulacijo s tramadolom/paracetamolom s prirejenim sproščanjem.
The PRAC considered the other risk minimisation measures proposed within the re-examination procedure (e.g. school programmes, restriction to pack type and size, educational materials and direct communication to HCPs) but concluded that these would neither be sufficient nor appropriate to adequately minimise the risk of intentional and unintentional overdose and consequential risk of hepatotoxicity. 
Proučil je tudi druge ukrepe za zmanjšanje tveganja, ki so jih predlagali v okviru postopka ponovne proučitve (npr. šolski programi, omejitev vrste in velikosti pakiranja, izobraževalna gradiva in neposredna obvestila za zdravstvene delavce), vendar je zaključil, da ti ukrepi ne bi bili niti zadostni niti primerni za ustrezno zmanjšanje tveganja za namerno in nenamerno preveliko odmerjanje ter posledično tveganje za hepatotoksičnost.
Products with modified or prolonged release properties containing paracetamol, which are intended to have a longer action, are available in several EU Member States. 
V več državah članicah EU so na voljo zdravila s prirejenim ali podaljšanim sproščanjem, ki vsebujejo paracetamol in so namenjena dolgotrajnejšemu delovanju.
The PRAC concluded that the treatment recommendations of overdoses based on standard paracetamol formulations, including use of the nomogram, are inadequate after intake of toxic doses of MR formulations. 
Odbor PRAC je zaključil, da so priporočila za zdravljenje prevelikega odmerjanja na podlagi standardnih formulacij paracetamola, vključno z uporabo nomograma, po zaužitju toksičnih odmerkov formulacij s prirejenim sproščanjem neustrezna.
The PRAC agreed with the outcome of an ad-hoc expert group meeting convened during the reexamination, where the experts concluded that it is not possible to extrapolate from a PK model developed for paracetamol as a single ingredient to the combination of paracetamol/tramadol. 
Odbor PRAC se je strinjal z izidom srečanja priložnostne strokovne skupine, sklicanim v okviru ponovne proučitve, pri čemer so strokovnjaki zaključili, da farmakokinetičnega modela, pripravljenega za paracetamol kot edino sestavino, ni mogoče ekstrapolirati na kombinacijo paracetamola/tramadola.
Whilst adaptation of the existing guidelines on treatment of overdose could be done, PRAC considered that the development of a common protocol would result in overexposing certain patients to NAC and the subsequent risks related to the use of NAC (e.g. hypersensitivity including anaphylactic shock). 
Obstoječe smernice zdravljenje prevelikega odmerjanja je sicer mogoče prilagoditi, vendar je odbor PRAC menil, da bi bili zaradi priprave skupnega protokola določeni bolniki preveč izpostavljeni NAC, pojavila pa bi se nadaljnja tveganja, povezana z uporabo NAC (npr. preobčutljivost, vključno z anafilaktičnim šokom).
These overdoses are even more unpredictable and more complex to manage than MR paracetamol alone due to the combination with tramadol. 
Tovrstni primeri prevelikega odmerjanja so zaradi kombinacije s tramadolom še bolj nepredvidljivi in zapletenejši za obravnavo kot samo paracetamol s prirejenim sproščanjem.
The PRAC acknowledged the need for a better characterisation of the risk (relationship with the dose, the concentrations and the toxicity) as well as the need to address uncertainties on the handling of patients with MR paracetamol products overdose (e.g. the appropriate threshold to start NAC administration, the dose and duration of NAC treatment as well as the optimal number of paracetamol concentration that need to be determined). 
Odbor PRAC je potrdil potrebo po boljši opredelitvi tveganja (razmerje med odmerkom, koncentracijami in toksičnostjo) ter potrebo po obravnavi negotovosti pri zdravljenju bolnikov, ki so zaužili prevelik odmerek zdravil s paracetamolom s prirejenim sproščanjem (npr. ustrezna meja za uvedbo NAC, odmerek in trajanje zdravljenja z NAC ter optimalno število določitev koncentracije paracetamola).
Furthermore, the role of risk factors such as co-medications or underlying diseases on the PK profile, in particular the delayed and double peak formation is not sufficiently understood to anticipate the population at risks and better manage the cases of overdose with paracetamol MR containing medicinal products. 
Nadalje vpliv dejavnikov tveganja, kot so sočasna zdravila ali osnovne bolezni, na farmakokinetični profil, zlasti na zakasnjeno delovanje in nastanek dvojnih vrhov, ni dovolj pojasnjen, da bi lahko napovedali, katera populacija je izpostavljena tveganju, in bolje obravnavali primere prevelikega odmerjanja z zdravili, ki vsebujejo paracetamol s prirejenim sproščanjem.
During the re-examination a comparison of the effectiveness of revised treatment protocol to that of standard established treatment protocol used for the management of overdose with IR paracetamol in the prevention of paracetamol-related hepatotoxicity was made. 
V okviru ponovne proučitve je bila opravljena primerjava med učinkovitostjo pregledanega protokola zdravljenja in standardnega uveljavljenega protokola zdravljenja, ki se uporablja za zdravljenje prevelikega odmerjanja paracetamola s takojšnjim sproščanjem pri preprečevanju hepatotoksičnosti, povezane s paracetamolom.
Furthermore, the PRAC confirmed that despite the difference in the target population and the clinical settings, the fixed-dose combination of MR paracetamol/tramadol can result in overdoses that are severe in view of the risk of hepatotoxicity of paracetamol and the toxicity of tramadol (e.g. CNS effects including high risk of seizures, and renal failure). 
Nadalje je odbor PRAC potrdil, da lahko kljub razliki v ciljni populaciji in kliničnem okolju fiksna kombinacija odmerkov paracetamola s prirejenim sproščanjem/tramadola privede do prevelikega odmerjanja, ki je resno z vidika tveganja za hepatotoksičnost paracetamola in toksičnosti tramadola (npr. učinki na CŽS, vključno z velikim tveganjem za epileptične napade, in ledvična odpoved).
Therefore, in view of all the above, including the consultation with the second ad-hoc expert group, and the argumentation presented by the MAHs in the detailed grounds as well as in the oral explanations, the PRAC concluded that the benefit-risk balance of with modified release paracetamol and paracetamol/tramadol containing products is no longer favourable and recommended that the marketing authorisations of these products should be suspended. 
Zato je odbor PRAC glede na vse navedeno, vključno s posvetovanjem z drugo priložnostno strokovno skupino, in utemeljitve, ki sta jih predstavila imetnika dovoljenja za promet z zdravilom v podrobno opisanih razlogih in ustnih obrazložitvah, zaključil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem in paracetamol/tramadol, ni več ugodno, in priporočil, da se dovoljenja za promet s temi zdravili začasno umaknejo.
The CMDh, as a consequence, considers that the benefit-risk balance of products containing paracetamol, modified and prolonged release is not favourable. 
Skupina CMDh posledično meni, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim in podaljšanim sproščanjem, ni ugodno.
The MAH referred to the limited number of overdoses reported with the fixed-dose combination are limited. 
Imetnik dovoljenja za promet z zdravilom se je skliceval na omejeno število primerov prevelikega odmerjanja, o katerih so poročali pri fiksni kombinaciji odmerkov.
Other risk minimisation measures proposed by the MAH to address the risk associated with overdose of the combination were considered by PRAC such as update of the product information to include stronger warnings related to at-risk patients and concomitant use with other paracetamol-containing products, DHPC and restriction of availability of certain type of packaging (i.e. bottles) and restriction of available pack size (max. 48 tablets). 
Odbor PRAC je proučil tudi druge ukrepe za zmanjšanje tveganja, ki jih je predlagal imetnik dovoljenja za promet z zdravilom za obravnavo tveganja, povezanega s prevelikim odmerjanjem kombinacije, kot so posodobitev informacij o zdravilu, ki bi vključevale močnejša opozorila, povezana z ogroženimi bolniki, in sočasno uporabo drugih zdravil, ki vsebujejo paracetamol, neposredna obvestila za zdravstvene delavce ter omejitev razpoložljivosti določenih vrst pakiranja (tj. stekleničk) in omejitev razpoložljivih velikosti pakiranja (največ 48 tablet).
• The PRAC considered the highly variable PK-profile of overdoses with MR paracetamol formulations, and the uncertainties related to the quantity and the formulation of the product that the patient has ingested, increase the challenges in effectively minimising the risk for paracetamol toxicity. 
• odbor PRAC je presodil, da zelo spremenljivi farmakokinetični profil prevelikih odmerkov formulacij paracetamola s prirejenim sproščanjem in negotovosti, povezane s količino in formulacijo zdravila, ki ju je bolnik zaužil, povečujejo izzive pri učinkovitem zmanjševanju tveganja za toksičnost paracetamola;
All MAHs proposed additional measures that would further minimise the risks associated with overdose with MR formulation for example updated package leaflet, communication to HCP (DHPC, education materials), prescription status, restriction of access to bottle packaging and large blister pack size for the patients. 
Vsi imetniki dovoljenja za promet z zdravilom so predlagali dodatne ukrepe, ki bi nadalje zmanjšali tveganja, povezana s prevelikim odmerjanjem formulacije s prirejenim sproščanjem, na primer posodobljeno navodilo za uporabo, sporočilo za zdravstvene delavce (neposredno obvestilo za zdravstvene delavce, izobraževalno gradivo), status predpisovanja, omejitev dostopa do pakiranj v stekleničkah in večjih pretisnih omotov za bolnike.
A very high variability has been observed in the PK profiles of patients poisoned with MR formulations. 
Farmakokinetični profili so se med bolniki, zastrupljenimi s formulacijami s prirejenim sproščanjem, zelo razlikovali.
The PRAC noted the claimed specific benefits of the MR formulations related to a reduction of daily tablet intake; from 4 to 3 times daily dosing for the single ingredient products, and the simplified regimen of 2 from 4 tablets for the combination products. 
Upošteval je, da se navedene posebne koristi formulacij s prirejenim sproščanjem nanašajo na zmanjšanje dnevnega vnosa tablet, in sicer s štirikrat na trikrat dnevno odmerjanje pri zdravilih z eno učinkovino in poenostavljeni režim z dvema namesto štirih tablet pri kombiniranih zdravilih;
In conclusion, the complex PK profile after an overdose of paracetamol MR containing medicinal products, and the fact that the standard treatment protocol for paracetamol poisoning is inadequate for these products and the severe risk of hepatotoxicity related to overdose with paracetamol raises a serious risk to public health at Union level. 
Zapleten farmakokinetični profil po prevelikem odmerjanju zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem, in dejstvo, da je standardni protokol zdravljenja zastrupitve s paracetamolom pri teh zdravilih neustrezen, ter resno tveganje za hepatotoksičnost, povezano s prevelikim odmerjanjem paracetamola, torej pomenijo resno tveganje za javno zdravje na ravni Unije.
• The PRAC also noted that in addition to the uncertainties on how to minimise the risk for paracetamol toxicity, the safety profile of tramadol was considered to present additional challenges for minimising the risks for toxicity (e.g. CNS effects, high-risk of seizures and renal failure) following an overdose with a prolonged release combination product of paracetamol and tramadol. 
• odbor PRAC je opozoril tudi, da poleg negotovosti glede zmanjševanja tveganja za toksičnost paracetamola tudi varnostni profil tramadola pomeni dodatne izzive pri zmanjševanju tveganj za toksičnost (npr. učinki na CŽS, visoko tveganje za epileptične napade in ledvično odpoved) po prevelikem odmerjanju kombiniranega zdravila s podaljšanim sproščanjem, ki vsebuje paracetamol in tramadol;
Three overdose cases (none of which was fatal) have been identified involving tramadol/paracetamol fixed dose combination product following an inquiry to national Poison centres during this procedure, as only Doreta SR is marketed. 
S poizvedovanjem pri nacionalnih centrih za zastrupitve v okviru tega postopka so našli tri primere prevelikega odmerjanja (od katerih nobeden ni bil smrten), ki so vključevali kombinirano zdravilo s fiksno kombinacijo tramadola/paracetamola, saj se trži samo zdravilo Doreta SR.
Therefore, in view of the above, the PRAC concluded that the benefit-risk balance of with modified release paracetamol containing products is no longer favourable and recommended that the marketing authorisations of these products should be suspended. 
Z upoštevanjem zgoraj navedenega je zato zaključil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo paracetamol s prirejenim sproščanjem, ni več ugodno, in priporočil, da se dovoljenja za promet s temi zdravili začasno umaknejo.
The PRAC concluded that the standard regimen for treatment of paracetamol poisoning, including use of the nomogram, which has been successful in preventing hepatotoxicity following IR overdoses, is inadequate for handling of an overdose with a paracetamol MR formulation. 
Odbor PRAC je zaključil, da je standardni režim zdravljenja zastrupitve s paracetamolom, vključno z uporabo nomograma, ki je uspešen pri preprečevanju hepatotoksičnosti po prevelikem odmerjanju paracetamola s takojšnjim sproščanjem, neustrezen pri obravnavi prevelikega odmerjanja formulacije paracetamola s prirejenim sproščanjem.
A. Paracetamol modified release tablets 
A. Tablete s paracetamolom s prirejenim sproščanjem