EMA对说明书中辅料聚山梨酯安全性资料的最新要求

欧洲药品局（EMA）于2018年11月发布了"人用药品辅料聚山梨酯的包装说明书资料（草案）"文件，详细评价了聚山梨酯的安全性。介绍该文件中有关药品说明书中辅料聚山梨酯安全性资料撰写的新要求，期望我国相关的药品生产厂家借鉴EMA的做法，在含有辅料聚山梨酯的药品说明书中提供聚山梨酯的安全性信息，确保用药者的安全。     

EMA对药用辅料右旋糖酐新的安全性评价

欧洲药品局（EMA）于2018年11月发布了"人用药品辅料右旋糖酐的包装说明书资料"，该文件引用大量文献全面评价了右旋糖酐的安全性，特别指出含有右旋糖酐辅料的注射和吸入制剂的疫苗与药品，应在说明书中描述有关其过敏反应信息的新要求。介绍该文件的主要内容，期望对我国这类药品说明书的撰写和监管有所帮助。     

EMA与我国不同用途制药用水质要求的对比分析

欧洲药品管理局（EMA）于2018年11月发布了"制药用水质量指导原则（草案）"，详细介绍了在人用、兽用制剂和原料药生产时，不同情况下注射用水的选择。介绍EMA该文件中对不同用途的水质要求，并与国内的相关要求进行对比，期望引起有关各方关注和思考，保障我国制药用水的质量，进而保证药品质量，保护用药者安全。     

EMA对药品说明书中儿科资料的要求

欧美国家都很重视药品说明书中的儿科资料,近年来相继发布了一些法规和指导原则。详细介绍欧洲药品管理局（EMA）对药品说明书中儿科资料的要求,期待引起相关部门的重视。建议我国药品上市许可持有人参考EMA和美国食品药品管理局（FDA）的有关要求,丰富说明书中儿科信息;同时建议监管机构重视起来,并对这些内容加强管理,从而确保儿科用药的安全有效。     

欧盟和美国对药品说明书【适应症】项目的撰写要求及启示

介绍欧盟和美国有关药品说明书[适应症]项目撰写的法规和指导原则，特别是最近欧洲药品管理局（EMA）发布的"治疗适应症的用语"。从这些管理文件得到的启示是相关法规规定不宜太粗糙，应具体、精准，应包括内容和格式的规定；而且要有指导原则伴随，以保证法规落到实处。熟悉掌握药品说明书[适应症]项目的撰写要求对规范撰写其他项目有普遍指导意义，对于药品说明书的监管也有裨益。     

FDA主动要求变更药品说明书安全性资料的法规和实施办法

2013年7月,美国食品药品监管局（FDA）发布了“说明书安全性变更——联邦食品、药品和化妆品法505（o）（4）节的实施”指导原则。介绍FDA主动要求变更药品说明书安全性资料的法规和实施办法,以期对丰富和创建我国相应的法规与指导原则、加强药政管理部门的依法监管、加速我国药品说明书安全性资料的更新提供有益的参考与启示。     

2012年药品安全信息回顾

本文选录美国食品药品监督管理局（FDA）、欧洲药品管理局（EMA）、加拿大卫生部、英国药品和健康产品管理局（MHRA）、澳大利亚治疗产品局（TGA）以及我国药物评价中心网2012年发布的部分药品安全信息,包括药品使用建议、安全评估、安全警告、修改药品说明书等信息;     

FDA主动要求变更药品说明书安全性资料的法规和实施办法

2013年7月,美国食品药品监管局（FDA）发布了“说明书安全性变更——联邦食品、药品和化妆品法505（o）（4）节的实施”指导原则。介绍FDA主动要求变更药品说明书安全性资料的法规和实施办法,以期对丰富和创建我国相应的法规与指导原则、加强药政管理部门的依法监管、加速我国药品说明书安全性资料的更新提供有益的参考与启示。     

试析药品说明书与合理用药

药品说明书是指药品生产企业印刷并提供的包含药理学、毒理学、药效学、医学等药品安全性、有效性、重要科学数据和结论,用以指导临床正确使用药品的技术性资料。药品说明书对于医、药、护治疗团队以及患者的安全合理用药有着重要的意义。国家药品监督管理局于2000年10月15日发布的《药品包装、标签和说明书管理规定（暂行）》以及2001年6月22日发布的《药品说明书规范细则（暂行）》,对药品说明书内容、格式进行了较为详尽的规范要求。     

FDA对人用处方药和生物制品说明书儿科资料的要求

欧美都很重视药品说明书中的儿科资料,近年来相继发布了一些相关法规和指导原则。介绍美国食品药品管理局（FDA）对人用处方药和生物制品说明书中儿科资料的要求,期待引起相关部门的重视。建议我国药品上市许可持有人参考FDA对人用处方药和生物制品说明书中儿科资料的要求,丰富药品说明书中儿科信息,同时建议监管机构重视该问题并加强管理,从而确保儿科用药的安全有效。     

益气活血通络方下调TGF-β/ERK信号通路对蛛网膜下腔出血大鼠的神经保护作用

目的探讨益气活血通络方对蛛网膜下腔出血大鼠TGF-β/ERK信号通路的影响及神经保护作用。方法 SD大鼠随机分为假手术组,模型组,益气活血通络方5、10、15 g/kg组和尼莫地平组,除假手术组外,其余各组建立蛛网膜下腔出血模型大鼠,分组处理后,各组大鼠进行神经功能缺损评分;以伊文思蓝染料外渗实验检测大鼠血脑屏障通透性;以TUNEL染色检测大鼠脑皮质神经细胞凋亡情况;以酶联免疫吸附法(ELISA)检测大鼠血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;以蛋白免疫印迹法检测大鼠脑皮质组织TGF-β/ERK通路相关蛋白TGF-β1、p-ERK/ERK表达情况。结果与假手术组相比,模型组大鼠神经功能缺损评分、伊文思蓝渗出量、TUNEL阳性细胞比例、血清IL-6、TNF-α水平、TGF-β1表达、p-ERK/ERK明显升高(P0.05)。与模型组相比,益气活血通络方5、10、15 g/kg组和尼莫地平组大鼠神经功能缺损评分、伊文思蓝渗出量、TUNEL阳性细胞比例、血清IL-6、TNF-α水平、TGF-β1表达和p-ERK/ERK水平明显降低(P0.05),且益气活血通络方各组呈剂量相关性,益气活血通络方15 g/kg组与尼莫地平组相比,各指标比较差异无统计学意义。结论益气活血通络方可下调TGF-β/ERK信号,保护蛛网膜下腔出血大鼠神经功能。     

药品标签和说明书中药用辅料信息的规范标注

目的 进一步规范我国药用辅料在药品标签、说明书中的标注,保障公众用药安全、促进合理用药。方法 对比国内外相关法规规定,对我国药用辅料在药品标签及说明书中的标注问题提出完善的建议。结果 我国药用辅料在标签、说明书中标注的相关法律法规及技术指南体系尚需进一步完善。结论 建议我国相关法规规定做好顶层设计和统筹谋划,明确辅料定义和标注范围,制定相应的技术指南,使生产者易遵从、监管者可执行、使用者更安全。     

The situation of OTC drugs in italy compared to the other EU states.

Even if a specific directive has been approved many years ago, the situation of self-medication products (OTC) in EU countries is still far from being harmonized. In Italy the market is lower than that of most other countries; in order to solve some of the major problems that led to this situation a guideline, concerning the criteria for the definition of an OTC product, and the characteristics of the label and the package leaflet, was recently published. In this document the characteristics of OTC, such as composition, indications and duration of the treatment are assessed. The European Commission has recently published a guideline on the readability of labels and package leaflets of medicinal products for human use. The two documents stated the same principles and the Italian document is in agreement with the European guidelines. In this paper the Italian situation of OTC products (definition and presentation) is presented and discussed.     

Excipients in medicinal products used in gastroenterology as a possible cause of side effects

Although most adverse drug reactions are caused by the active substances, excipients may sometimes affect the safety profile of a medicinal product. The aim of this review is twofold: (1) To identify the excipients most frequently contained in oral medicinal products marketed in Italy for gastrointestinal indications, and to evaluate the main safety concerns, considering both intrinsic toxicity and patient-related risk factors. (2) To analyze possible differences with medicinal products marketed in the United Kingdom and USA in terms of excipients and relevant warnings reported in the label. We identified excipients with potential impact on safety profile and calculated frequency of use of each identified excipient in 98 selected medicinal products. We discussed possible safety concerns in clinical practice. We also analyzed US and UK Summary of Products Characteristics (SmPC) of oral gastrointestinal products by searching in appropriate collections of regulatory agencies. Eleven excipients with a safety impact were identified (sucrose, saccharin, aspartame, sorbitol, mannitol, lactose, ethanol, propylene glycol, parabens, menthol and silica) and no substantial differences were found between drugs marketed in the three countries concerning excipient content. Warnings were more detailed in the SmPC of UK or USA products rather than Italian products. Information about pharmaceutical excipients with known effects is important in clinical practice, but the frequent lack of details in the related section of the SmPCs makes it difficult for health professionals to provide relevant advice. The availability of alternative products of the same therapeutic class, but lacking specific excipient(s) should be considered in selected patients.     

COMPREHENSIBILITY OF THE PACKAGE LEAFLETS OF ALL MEDICINAL PRODUCTS FOR HUMAN USE: A QUESTIONNAIRE SURVEY ABOUT THE USE OF SYMBOLS AND PICTOGRAMS

Directive 92/27EEC establishes that the package leaflet is a document, which must be included in the package of medicinal products for human use in EU countries. This informative leaflet is directed at the users and it must give full and comprehensible information. The Law suggests the use of symbols but it does not give advice about the subjects to be represented. In order to evaluate the attitude of patients towards package leaflets provided with symbols, we planned a survey interviewing 1004 patients in pharmacies. The data suggest that Italian patients usually read the package leaflet but they neither understand it easily nor find the needed information readily. Most respondents (74.3%) considered the use of symbols helpful in finding the needed information. We proposed five symbols for each heading (therapeutic indications, side effects, paediatric use, contraindications, use in pregnancy) and asked to select which symbol could be used. In the case of 'side effects', 'paediatric use', 'use in pregnancy' and 'dose', most of the respondents chose the same symbol. In the case of 'therapeutic indications' and 'contraindications' there was no uniformity in the answers. The choice depends greatly on education, age and employment of respondents.     

对EMA草药质量标准指南（第3修订版草案）的思考

草药及其产品的质量标准具有区别于化学药品或生物制品的特殊性，因此欧洲药品管理局（EMA）于2018年发布了“质量标准指南：草药物质、草药制剂和草药产品或传统草药产品的检验程序和可接受标准（第3修订版草案）”。EMA的草药及其产品的情况与我国中药有相似之处，从起始物料到成品多为活性成分未知的复杂混合物。目前我国尚未制定关于中药或中药材（饮片）质量标准相关指导原则。介绍该指南文件的主要内容，并结合中药质量监管情况进行分析，以期EMA相关质量标准制定的指导思路为制定中药质量标准提供参考。     

Quantifying the 'hidden' lactose in drugs used for the treatment of gastrointestinal conditions

Background  Lactose intolerance affects 70% of the world population and may result in abdominal and systemic symptoms. Treatment focuses predominantly on the dietary restriction of food products containing lactose. Lactose is the most common form of excipient used in drug formulations and may be overlooked when advising these patients.
Aim  To identify and quantify the amount of lactose in medications used for the treatment of gastrointestinal disorders and to identify 'lactose-free' preparations.
Methods  Medications used for the treatment of gastrointestinal disorders were identified from the British National Formulary (BNF). Their formulation including excipients was obtained from the Medicines Compendium. The lactose content and quantity in selected medications was measured using high-performance liquid chromatography (HPLC).
Results  A wide range of medications prescribed for the treatment of gastrointestinal conditions contain lactose. We have quantified the lactose content in a selection of medications using HPLC. Lactose is present in amounts that may contribute towards symptoms. Lactose-free alternatives were also identified.
Conclusions  Lactose is present in a range of medications and may contribute towards symptoms. This may not be recognized by the prescribing doctor as excipients are not listed in the BNF, and the quantity of lactose is not listed on the label or in the accompanying manufacturer's leaflet.