Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 7-10 April 2014
PRAC recommends against combined use of medicines affecting the renin-angiotensin (RAS) system
The PRAC has advised that the combined use of two medicines of different classes acting on the renin-angiotensin (RAS) system, a hormone system that controls blood pressure and the volume of fluids in the body, should not be recommended. The affected medicines (called RAS-acting agents) are used particularly in the treatment of hypertension (high blood pressure) and congestive heart failure (a type of heart disease where the heart cannot pump enough blood around the body).
More information is provided in the table below.
Start of review of ambroxol and bromhexine
The PRAC started a review of medicines containing ambroxol and bromhexine, which are widely used as expectorants, as well as to relieve sore throat. Some formulations are used to treat breathing disorders in premature and newborn babies or to increase lung maturation before birth.
This review follows concerns about allergic reactions and severe skin adverse reactions with ambroxol. Since bromhexine gets mainly converted into ambroxol in the body, and there are some reports linking the use of bromhexine with allergic reactions, the review also covers medicines containing bromhexine.
Start of review of codeine-containing medicines when used for cough and cold in children
The Committee has also begun a review of codeine-containing medicines when used for cough and cold in children. This follows a previous review of these medicines when used for pain relief in children, which was triggered by concerns over the risk of morphine toxicity.
Review of oral methadone medicines containing povidone started
The PRAC initiated a review of oral methadone medicines that also contain povidone. Methadone-containing medicines are used in rehabilitation programs in patients dependent on opioids, such as heroin, to prevent or reduce withdrawal symptoms in order to decrease the chance of relapse. The review was started following a number of reports of kidney failure in former or current drug abusers which may be linked to the misuse of methadone oral solutions containing certain types of povidone which might have been injected into a vein.
As part of this procedure, the PRAC is inviting stakeholders such as healthcare professionals, patients' organisations and the general public to submit data relevant to the procedure so that they can be considered during the assessment of the medicines. This tool allows the Committee to actively engage stakeholders in the evaluation process, and helps to ensure that all relevant data, information and knowledge are fed into the assessment.
Review of testosterone-containing medicines started
The PRAC has started a review of testosterone-containing medicines over concerns about side effects on the heart. These medicines are mainly used in men who do not produce enough testosterone (a condition known as hypogonadism).
For an overview of all information available following the meeting of the PRAC, see the table below.
|Agenda - PRAC draft agenda of meeting 7-10 April 2014|
Start of referral procedure
|Ambroxol and bromhexine-containing medicines|
|Codeine containing medicinal products for the treatment of cough or cold in paediatric patients|
|Methadone medicinal products for oral use containing povidone|
Recommendations by PRAC
|Renin-angiotensin-system (RAS)-acting agents|