• Procedure started
  • Under evaluation
  • CHMP opinion
  • European Commission final decision
Current status
European Commission final decision


Cardiostad (lisinopril), which contains the active ingredient lisinopril is a highly specific, competitive inhibitor of angiotensin-I converting enzyme and therefore belongs to the group of drugs known as ACE inhibitors. Lisinopril is indicated for the treatment of hypertension, heart failure, acute myocardial infarction and, in some EU Member States, incipient nephropathy.

The Marketing Authorisation Holder (MAH) for Cardiostad (lisinopril) applied to the Reference Member State (Denmark) for a variation through the Mutual Recognition Procedure to add an indication: “treatment of incipient nephropathy in diabetes characterised by microalbuminura.” This was refused by the RMS because they would not accept an indication that was not approved for the reference product Zestril (and associated names) unless the MAH could submit sufficient clinical data of its own. In the Netherlands, Zestril does have the diabetic nephropathy indication and since Cardiostad (lisinopril) is claimed to be essentially similar to Zestril and will be used as a substitute, the Dutch Medicines Evaluation Board was of the opinion that refusal of the variation could cause a safety issue and a risk to public health because of differences in indications in the Summary of Product Characteristics and in the patient information leaflets. On 17th July 2002, the Netherlands referred the matter to the CPMP with further clarification on 23 July 2002.

The referral procedure started on 26th July 2002. The Rapporteur and Co-Rapporteur appointed were Dr. P. Nilsson and Prof R. Bass, respectively. Written explanations were provided by the Marketing Authorisation Holders on 20th November 2002, 27 May 2003 and 25 June 2003.

Based on evaluation of the currently available data and the Rapporteurs' assessment reports, the CPMP considered that the data did not support the indication in normotensive insulin dependent diabetes mellitus patients but that a revised indication: “Treatment of renal disease in hypertensive patients with type 2 diabetes melitus and incipient nephropathy” could be granted. The CPMP therefore adopted an opinion on 24 July 2003 recommending the above variation to the Marketing Authorisations together with an amended Summary of Product Characteristics.

The competent authorites of the Member States will continue to keep the product under regular review. A list of product names concerned is given in Annex I. The scientific conclusions are provided in Annex II, together with the amended Summary of Product Characteristics in Annex III.

The final opinion was converted into a Decision by the European Commission on 23 February 2004.

Key facts

About this medicine
Approved name
International non-proprietary name (INN) or common name
About this procedure
Current status
European Commission final decision
Reference number
Article 6(12) referrals (prior to January 2010)

This type of referral was triggered for a medicine that had been authorised by mutual recognition or via the decentralised procedure when there was disagreement between Member States on a variation (type II). This referral has been replaced by Article 13 referrals.

Key dates and outcomes
CHMP opinion date
EC decision date

All documents

  • List item

    Opinion following an Article 7(5) referral for Cardiostad (lisinopril) International Non-Proprietary Name (INN): Lisinopril: Background information and Annexes I, II (English) and Annex III (all languages) (PDF/247.64 KB)


    First published: 01/09/2003
    Last updated: 01/09/2003

  • Description of documents published

    Please note that some of the listed documents apply only to certain procedures.

    • Overview - lay-language summary of the stage of the procedure
    • Notification – a letter from a Member State, the European Commission or the marketing authorisation holder requesting the initiation of the procedure
    • Scientific background – further background information from the triggering Member State on the issues leading to the initiation of the procedure (if applicable)
    • List of questions – questions agreed by the Committee requesting further information from the marketing authorisation holder(s) / applicant(s) to evaluate the issues identified
    • Timetable for the procedure – agreed timeframe to respond to the list of questions, to assess the issues and to adopt a conclusion
    • List of medicines concerned by the procedure – medicine(s) / active substance(s) concerned, and marketing authorisation holder(s) / applicant(s)
    • List of questions to be addressed by the stakeholders – call for data to be submitted by stakeholders (e.g. healthcare professionals, patient organisations, individual patients) (if applicable)
    • Stakeholder submission form – form to be used by stakeholders to submit data (if applicable)
    • Scientific conclusions – scientific conclusions of the PRAC and/or CHMP and/or CMDh
    • Assessment report – PRAC or CHMP assessment and conclusions on the issues investigated, including divergent positions (if applicable)
    • Divergent positions – divergent positions of the CHMP or CMDh members for pharmacovigilance procedures (if applicable)
    • Changes to the summary of product characteristics, labelling and package leaflet (amended sections or fully revised version) (if applicable)
    • Condition(s) to the marketing authorisation(s) – condition(s) for the safe and effective use of the medicine(s) (if applicable)
    • Condition for lifting the suspension – condition to be fulfilled for the suspension of the marketing authorisation(s) to be lifted (if applicable)
    • Timetable for implementation of CMDh position – agreed timeframe to submit and finalise the variation(s) implementing the outcome of the procedure (if applicable)

    Note that older documents may have different titles.

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