Recommendation endorsed due to the difficulty in managing overdose

The CMDh has endorsed by majority a European Medicines Agency recommendation to suspend marketing of modified- or prolonged-release products containing paracetamol (designed to release paracetamol slowly over a longer period than the usual immediate-release products). The recommendation was made by the Agency’s experts in medicines safety, the Pharmacovigilance Risk Assessment Committee (PRAC).

CMDh agreed with the Agency’s advice that the advantages of a longer-acting product did not outweigh the complications of managing an overdose of the medicine, since the treatment procedures for immediate-release products are not appropriate for modified-release paracetamol. In many cases, it may not be known whether an overdose of paracetamol involves immediate-release or modified-release products, making it difficult to decide how the overdose should be managed.

CMDh noted the PRAC conclusion that practical measures to sufficiently reduce the risk to patients had not been identified. Furthermore, it had not proved possible to agree a feasible and standardised way to adapt the management of overdose across the EU to cover both immediate- and modified-release paracetamol products. The CMDhtherefore endorsed the PRAC recommendation that the marketing authorisations for medicines containing modified-release paracetamol, alone or combined with the opioid medicine tramadol, should be suspended.

The medicines will remain suspended unless the companies that hold the marketing authorisations can provide evidence of appropriate and practical EU-wide measures to help prevent overdose with these products and adequately reduce its risks.

Immediate-release paracetamol products, which are not affected by this review, will continue to be available as before.

Because the CMDh decision was agreed by majority vote it will now be sent to the European Commission which will issue a final legally binding decision valid throughout the EU.

Posted on the EMA website on 15 December 2017