CompleteDRGDwithappendices - Jan2021
CompleteDRGDwithappendices - Jan2021
CompleteDRGDwithappendices - Jan2021
January 2021
DRUG
REGISTRATION
GUIDANCE
DOCUMENT
(DRGD)
GUIDELINE HISTORY
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PREAMBLE
This “DRUG REGISTRATION GUIDANCE DOCUMENT (DRGD)” will serve as the reference
guide for the registration process including quality control, inspection & licensing and post-
registration activities of medicinal products.
This DRGD shall be read in conjunction with the current laws and regulations together with
other relevant legislations, where applicable, governing pharmaceutical and natural products
for human use in Malaysia, which include but are not limited to the following:
The written laws shall take precedence over this guidance document in any event of
discrepancy.
The scope of this DRGD includes information relating to administrative requirements and
procedures for:
a) Submission of an application for the registration of medicinal products, which is based
on the ASEAN Common Technical Dossier/ Requirements (ACTD/ ACTR), where
applicable;
b) Submission of an application for the licensing of manufacturers, importers and
wholesalers;
c) Submission for amendments to a registered medicinal product; and
d) Post-registration activities.
This DRGD contains five (5) Main Sections and thirty-four (34) Appendices. The main sections
are :
a) Section A: General Overview
b) Section B: Product Registration Process
c) Section C: Quality Control
d) Section D: Inspection, Licensing, Certificate
e) Section E: Post-Registration Process
Applicants shall familiarize themselves with the contents of this guidance document and the
governing legislations before they submit applications for medicinal product registration.
The Authority may request for information or specify conditions not described in this
document that is deemed necessary to ensure the quality, safety and efficacy of the product.
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Ongoing review of regulatory policies will continue taking into account the global regulatory
environment, to allow for timely and pertinent changes.
For more information, please refer to Directives issued by Senior Director of Pharmaceutical
Services and NPRA Circulars.
Applicants are advised to refer to NPRA website for the latest updates of the DRGD and other
related guidelines.
Separate guidelines are available for Cosmetics and Veterinary products at NPRA website.
For cosmetics, refer to Guidelines for Control of Cosmetic Products in Malaysia
For veterinary products, refer to Registration Guideline of Veterinary Products (REGOVP)
The Authority reserves the right to amend any part of the DRGD whenever it deems fit.
Secretary,
Drug Control Authority,
National Pharmaceutical Regulatory Agency,
Ministry of Health Malaysia,
Lot 36, Jalan Universiti,
46200 Petaling Jaya, Selangor.
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TABLE OF CONTENTS
GUIDELINE HISTORY ................................................................................................... 2
PREAMBLE ...................................................................................................................... 5
TABLE OF CONTENTS .................................................................................................. 7
APPENDICES .................................................................................................................10
ABBREVIATIONS AND ACRONYMS ........................................................................12
GLOSSARY .....................................................................................................................16
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APPENDICES
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Appendix 24 Appeal
Appendix 28 Licensing
Appendix 29 Certificate
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GLOSSARY
Bulk Product: A product that has completed all processing stages up to, but not including, final
packaging
Contract Manufacturer: Any person who manufactures any product on the order of another
person to whom a manufacturer’s licence has been issued under these Regulations (as defined in
Regulation 2, CDCR 1984)
Finished Product: A product that has undergone all stages of production and quality control,
including packaging in its final container and labelling
Licensed Importer: A person to whom an import license has been issued under Regulation 12,
CDCR 1984 (as defined in Regulation 2, CDCR 1984)
Licensed Manufacturer: A person to whom a manufacturer’s licence has been issued under these
Regulations, and includes a contract manufacturer (as defined in Regulation 2, CDCR 1984)
Licensed Wholesaler: A person to whom a wholesaler's license has been issued under Regulation
12, CDCR 1984 (as defined in Regulation 2, CDCR 1984)
Manufacturer: A person carrying out one or more of the steps specified in the definition of
manufacture
Medicinal Product: The term refers to ‘product’ as stated in Regulation 2, CDCR 1984, which is
applicable to pharmaceutical and natural products
Product Owner: A person, company or entity who is the legal/ registered owner of the product
formulation and/or process with whom the marketing authorization holder has a contract
(glossary used in ACTD and ACTR)
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Product Registration Holder: The company or corporate or legal entity in the field of
pharmaceuticals who has been granted the marketing authorization. This party is responsible for
all aspects of the product, including quality and compliance with the conditions of marketing
authorization. The authorized holder must be subjected to legislation in the country that issued the
marketing authorization, which normally means being physically located in that country (glossary
used in ACTD and ACTR).
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1. INTRODUCTION
The Control of Drugs and Cosmetics Regulations (CDCR) 1984 were promulgated under the Sale of
Drugs Act 1952. The Authority (known as Drug Control Authority, DCA) established under these
Regulations, is tasked with ensuring the quality, safety and efficacy of medicinal products through
the registration, including quality control, inspection, licensing and post-registration activities. The
National Pharmaceutical Regulatory Agency (NPRA) acts as the secretariat to the Authority.
Under the CDCR 1984, Regulation 7(1): Except as otherwise provided in these Regulations, no person
shall manufacture, sell, supply, import, possess or administer any product unless:
(a) the product is a registered product; and
(b) the person holds the appropriate licence required and issued under these Regulations.
2. PRODUCT DEFINITION
Note:
In the DRGD, the term “medicinal product” refers to the term “product” as stipulated in
Regulation 2, CDCR 1984.
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3. PRODUCT CLASSIFICATION
It is important to determine the category of a product whether it meets the definition in 2. Product
Definition because different regulatory requirements may apply.
Applicant may submit a classification form, which can be downloaded from NPRA website, if
unsure of the product category.
Medicinal product shall be registered with the Authority under the following categories:
Categories of
Medicinal
Product
4.1 Products not registered with the Authority and are intended to be manufactured locally for
the purpose of clinical trial require a Clinical Trial Exemption (CTX) from the Director of
Pharmaceutical Services.
4.2 For more information pertaining to products to be used in clinical trial, please refer to The
Malaysian Guideline for Application of Clinical Trial Import License & Clinical Trial
Exemption.
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4.3 Any person who wishes to manufacture any product solely for the purpose of producing a
sample for registration should apply for an exemption for the manufacture of sample. (This
applies to locally manufactured products only)
4.4 The exemptions mentioned in 4.1 and 4.3 above is in accordance with Regulation 15(5),
CDCR 1984: “Any person who wishes to manufacture any product solely for the purpose of
producing samples for clinical trials, for registration or issuance of notification note under
these Regulation may on application be exempted by the Director of Pharmaceutical
Services from the provisions of regulation 7 (1) or regulation 18A”.
4.5 For more information on exemptions for products, refer to Regulation 15, CDCR 1984:
Exemptions & Saving.
5. APPLICATION PROCEDURES
a) The applicant for product registration, known as the Product Registration Holder (PRH),
must be a locally incorporated company, corporate or legal entity, with permanent address
and registered with the Companies Commission of Malaysia (SSM) (with business scope
related to health/ pharmaceutical product).
b) The name of the PRH, including product manufacturer, shall not reflect the following:
(i) Name of a government agency
(ii) Name of an institute of higher education/ research
(iii) Any name that reflects the quality of pharmaceutical products
e.g., “Amalan Perkilangan Baik (APB)”, Good Manufacturing Practice (GMP)
(iv) Name of a disease
(v) Name of an organ
e.g., Heart, Brain, Kidney etc.
c) If the applicant is not the product owner, the product owner shall authorize the PRH in
writing to be the holder of the product registration who is responsible for all matters
pertaining to the quality, safety and efficacy of the product. This includes the responsibility
to update any information relevant to the product / application.
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a) The PRH must ensure that all transactions with NPRA are done by their appointed
person(s).
b) Failure to make payment within thirty (30) days from the date of approved screening shall
result in rejection of the application.
c) For the purpose of product registration, the PRH shall conform to the following:
(i) The PRH shall comply with all legal provisions in Malaysia;
(ii) The government/ authority is not liable for any offence committed by the PRH as a
result of any breach of any law; and
(iii) The PRH shall indemnify the government if any claim is made against the
government as a result of any breach of any law by the applicant whether
intentionally or otherwise;
d) The PRH is responsible for all quality, safety and efficacy information submitted in support
of the product registration application; and shall inform the Authority in a timely manner
regarding any change in product information during the course of evaluation.
This is in accordance with Regulation 8(9) CDCR 1989: “Any person who knowingly
supplies any false or misleading information to the Authority with his application for the
registration of a product commits an offence”.
e) The PRH is responsible for responding and providing feedback for requested
supplementary data / information, documentation or samples by the Authority within the
specified time frame. If the applicant is unable to submit the requirements within the
specified time frame, a written request for an extension shall be submitted to NPRA.
f) The application shall be rejected if the applicant fails to submit required supplementary
data / information or documentation within six (6) months from the first correspondence
date.
g) The PRH is responsible for all matters pertaining to the quality, safety and efficacy of the
registered product, including:
(i) Data updates on product quality, safety and efficacy or current Good Manufacturing
Practice (cGMP) compliance of the manufacturers (and repackers, where
applicable).
This is in accordance with Regulation 8(5) CDCR 1984: “Any change in any
document, item, sample, particulars or information shall be notified in writing by
the applicant to the Authority within fourteen (14) days from the date of such
change”.
(ii) Any decision to withdraw the registration of the product with reasons.
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h) The PRH shall supply such documents, items, samples, particulars or information as the
Authority may require in relation to the registered product.
k) The PRH must notify the Authority of any change in correspondence details, including the
name, address, contact person, telephone number, fax number and email.
l) The PRH must notify the Authority immediately upon cessation of the applicant as the
product registration holder.
a) For registration of products, only web-based online submissions via the QUEST system at
https://quest3plus.bpfk.gov.my/front-end/login-chrome.php shall be accepted.
b) To conduct transactions via the QUEST system, the applicant must first register for a QUEST
membership with NPRA and purchase a USB Token that contains a User Digital Certificate,
from MSC Trustgate.com Sdn. Bhd., which shall be installed in the applicant’s computer.
d) For charges regarding the QUEST USB token, refer to Appendix 9: Fees.
e) The applicant is responsible for any act of fraudulence or misuse pertaining to its
authorized QUEST USB token(s).
f) The NPRA reserves the rights to approve or reject any application for QUEST membership.
5.4 Fees
a) This is in accordance with Regulation 8(3): “The Authority may charge any applicant such
costs as it may incur for the purpose of carrying out any evaluation or investigation prior to
the registration of any product”.
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d) Payment of the processing fee and any other charges shall be done online through the
QUEST system (FPX/ credit card) or in the form of bank draft/ banker’s cheque/ money
order/ postal order made payable to “Biro Pengawalan Farmaseutikal Kebangsaan”.
f) Any payment made shall NOT be REFUNDABLE once the application has been submitted
and payment confirmed.
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Pre-Submission of
application
*GMP Inspection
Data Evaluation
Meeting of the
Authority
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It is important for the applicant to consider the following when registering a product:
The applicant shall first determine the category of product as described under 3. Product
Classification because different product categories require different data.
If the applicant is unable to determine the product category, they may submit a Classification Form
to NPRA for verification.
a) Quality, safety and efficacy of any new drug product containing a New Chemical Entity
b) Safety and efficacy for a second indication of a registered drug product as a condition for
registration of any new drug product containing a New Chemical Entity; or approval for a
second indication of a registered drug product
For information pertaining to Register of Data Exclusivity Granted in Malaysia, refer to Register of
Data Exclusivity Granted in Malaysia (New Drug) and Register of Data Exclusivity Granted in
Malaysia (Second Indication). Please also refer to Appendix 10: Data Exclusivity.
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The type of application for product registration depends on the category as specified in the
respective appendix:
Appendix 3: Guideline on Registration of New Drug Products
Appendix 4: Guideline on Registration of Biologics
Appendix 5: Guideline on Registration of Generics
Appendix 6: Guideline on Registration of Health Supplements
Appendix 7: Guideline on Registration of Natural Products
Appendix 7A: Homeopathic Products
Appendix 7B: Guideline on Natural Products with Therapeutic Claim
*Note:
Refer to Appendix 11: Regulatory Control of Active Pharmaceutical Ingredients (APIs)
*Applicable for NDP and Generics
Priority review may be granted for new product application (in the category of New Drug Products,
Biologics and Generics), which fulfils the conditions. Refer to Appendix 12: Priority Review.
Combination pack:
a) refers to products that are packed together in combination for a therapeutic regimen, such
as for the treatment of Helicobacter Pylori, Hepatitis C, etc.
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Registration number for the combination Individual registration number for each product
pack OR registration number for combination pack
Name and address of manufacturer and Name and address of manufacturer and product
product registration holder registration holder
Expiry date
(according to the shortest expiry date among Individual expiry date for each product
the individual products)
a) For Export Only (FEO) product refers to locally manufactured products for exporting
purpose only and not marketed locally.
b) This does not apply to imported products meant to be packed/repacked locally and to be
re-exported. (This application falls under Regulation 7(2)(b), CDCR 1984. A separate
application form may be obtained from the NPRA website).
c) Applications for registration of FEO products are only accepted under the following
condition(s) and must be supported with evidence issued by the competent Authority of
the importing countries (self-declaration is not accepted):
(i) Countries that do not impose the same specific regulatory requirements as Malaysia
(e.g. formulation with banned/ prohibited ingredients, zone IVb stability study,
bioavailability/ bioequivalence study, API evaluation etc.); OR
(ii) Countries that have different requirements such as different formulation (e.g. colour
or strength of ingredients), shape or manufacturing process, etc. as compared to a
registered product; OR
(iii) Difference in classification category of the products (e.g. as food in the importing
country) for health supplements and natural products (Traditional and
Homeopathic Medicines).
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d) Applications for registration of FEO products are processed based on abridged evaluation.
However, the following additional requirements must be fulfilled for pharmaceutical
products. It is not applicable to health supplements and natural products (Traditional and
Homeopathic Medicines):
(i) Certificate of Analysis (CoA) of finished product for at least 1 pilot batch; AND
(ii) Minimum 6 months stability data (real time and accelerated stability study) for at
least 1 pilot batch.
f) Applicant may apply for a Certificate of Pharmaceutical Product (CPP) for registered FEO
products.
Reference: Bil (11)dlm.BPFK/07/25 Jld.2 Direktif Kaji Semula Pendaftaran Produk Untuk Tujuan Eksport
Sahaja (FEO)
6.3.5 Variants
b) The requirements to support an application for variant are based on the category of
products.
c) To register a variant:
(i) The variants should only differ in terms of fragrance/ flavour and colour
(ii) Product name of the variants shall remain the same, with the addition of an
identifying variant name
(iii) Each variant shall be registered as one (1) product with a different registration
number
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d) Variants to the registered product may be considered for the following dosage forms:
A separate application for product registration shall be required for each product for the following
conditions:
(i) Products containing the same ingredients but made to different specifications, in
terms of strength/ content of ingredient(s), dosage form, description, etc.; or
(ii) Different manufacturer.
However, different packaging (materials) or pack sizes (quantity/ volume) of a product made by
the same manufacturer to the same specifications, formulation and dosage form (including
parenteral preparations, peritoneal dialysis fluids and haemofiltration solutions introduced into
human bodies) shall require only ONE application for product registration. The product
registration shall be for the packaging and pack sizes stated in the registration documents only.
Note:
Registration application of the same product in all aspects with different product names:
a) by the same PRH is not allowed by the Authority
b) by different PRH may be considered by the Authority with acceptable justification
Product name must comply with the requirements in 7.3 Product Name.
a) It is defined as a product that is the same as the product from the first source in all aspects,
except for the site of manufacture.
b) An application for a second source may be considered by the Authority but only with
justification provided.
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c) A second source product, excluding biologic products, may differ in the following aspects:
(i) equipment/ machines;
(ii) minor manufacturing process (e.g. blending time, number of sub-parts);
(iii) batch size;
(iv) packaging materials, thickness of same packaging materials, pack sizes;
(Note: Use of different packaging materials shall be supported with stability study
report)
(v) manufacturer of API; and
(vi) source of excipients;
d) Differences in shape, embossment and thickness of tablet are NOT permitted to avoid
changes in product identity and to prevent subsequent confusion.
e) For pharmaceutical products, no third source is allowed for the same product unless in
emergency situations such as an outbreak of infectious disease.
f) The manufacturer shall declare with supporting manufacturing validation process data that
there is no change in formulation, specification of active ingredient(s) and excipient(s), and
the finished product for the second source product compared to the first source. There
should be no difference in product identity and presentation, to avoid confusion.
g) Biologics are highly sensitive to manufacturing condition. If any of the conditions outlined
below are not fulfilled, the application is automatically considered as a new application:
(i) The proposed facility is approved for manufacturing activities for the same company/
sponsor
(ii) No change in the composition, manufacturing process and drug substance as well as
drug product specifications
(iii) No change in the container/ closure system
(iv) The same validated manufacturing process is used
(v) The newly introduced product is in the same family of product(s) or therapeutic
classification as those already approved at the site and uses the same filling process/
equipment
(vi) Only one Final Release Site
The method of evaluation for the registration of a product is divided into four (4) types,
a) Full Evaluation (Standard Pathway)
b) Full Evaluation (Conditional Registration)
c) Full Evaluation via Abbreviated and Verification Review
d) Abridged Evaluation.
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7. REGULATORY REQUIREMENTS
Applicant shall comply with all of the following requirements prior to submitting a registration
application. Failure to do so shall result in the rejection of the application by the Authority.
Note: Please also refer to guidelines for the respective product category at:
Data required to be submitted for full evaluation or abridged evaluation is based on the product
category.
Refer to Appendix 15: Requirements for Full Evaluation and Abridged Evaluation.
Requirements for BA/ BE study applicable to generics products are specified in Appendix 16:
Bioequivalence (BE) Requirements.
a) Product name is defined as a name given to a product, which may either be a proprietary
name (an invented name); or a generic name (common name) or scientific name, together
with a trade mark or the name of the manufacturer.
b) Product name shall consist of dosage form and strength (for single active ingredient
product) (e.g. X Brand Paracetamol Tablet 500mg).
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c) Dosage form and strength of product would need to be entered as part of product name to
allow for multiple dosage forms (e.g. tablet, capsule) and strengths (e.g. 200mg and 400mg)
for any particular named (proprietary or generic) product.
d) The generic name is the international non-proprietary name recommended by WHO (rINN),
or if one does not exist, the usual approved name. The generic name cannot be used alone
as the product name, but can be used in combination with another name, other than the
generic name.
e) The invented name shall not pose any risk of confusion with the common name.
f) Font size of the product name on the label, including alphabets and numbers, shall be equal
in size.
i) Any product name that is the same or similar either in writing/ pronunciation with the
product name of an adulterated product or a product that has been revoked due to safety
concerns is prohibited.
j) The product name shall be shown on the product labelling, i.e. immediate label, outer unit
carton, package insert and consumer medication information leaflet.
k) Product names not permitted to be registered are listed in Appendix 17: Product Names
Not Permitted to Be Registered.
l) Additional references:
• Appendix 6: Guideline on Registration of Health Supplements 5.1.1 List of Non-
Permissible Product Name for Health Supplement Products
• Appendix 7: Guideline on Registration of Natural Products, Table 1: Non-Permissible
Product Names
7.4 Ingredients
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7.5 Indications
The registered product shall only be indicated for use as approved by the Authority. PRH may
exclude any indication(s) protected by patents or exclusivities.
Indications other than those specified and accepted at the time of registration must not be included
in any product literature, data sheets, package inserts, labels, etc. without prior permission of the
Authority.
The PRH shall ensure that the product label complies with the labelling requirements defined in:
• Appendix 19: General Labelling Requirements
• Appendix 20: Specific Labelling Requirements.
This Appendix includes the List of Substances That Requires Specific Labelling
Requirements (statement to be included in the label, package insert, RiMUP)
The importation, manufacture, sale and supply of the registered product shall comply with all
specific conditions imposed by the Authority as listed in Appendix 21: Special Conditions for
Registration of a Particular Product or Group of Products.
As part of risk minimization measures, the PRH shall provide educational materials to healthcare
professionals and patients in reducing risk(s) for a particular product.
This applies to products containing active ingredient such as:
(i) Sodium Valproate
(ii) Retinoids
Refer to Appendix 22: Educational Materials.
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7.9 Packaging
c) Justified and proven specific dosing regimen shall be demonstrated through clinical
studies.
d) Each product must be differentiated in terms of its physical description, e.g. colour,
shape/size etc. to avoid confusion during drug administration.
f) Labelling requirements specific for starter pack/ patient initiation pack/ dose
adjustment pack are shown below:
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Package insert (PI) is required for products containing scheduled poison and for injectable OTC
products. PI may also be submitted for other OTC products. The draft copy of the PI shall be
submitted for evaluation.
Sharing of PI is only allowed for products having the same active ingredient(s) but with different
strengths.
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h) Route of Administration
i) Contraindications
j) Warnings and Precautions
k) Interactions with Other Medicaments
l) Pregnancy and Lactation
m) Side Effects
n) Symptoms and Treatment of Overdose
o) Effects on Ability to Drive and Use Machine
p) Preclinical Safety Data (Not applicable for Generics)
q) Instruction for Use (e.g., Incompatibilities - For injection only)
r) Storage Conditions (may be omitted if the information is stated on the label or outer
carton labels)
s) Dosage forms and packaging available
t) Name and address of manufacturer/ product registration holder
u) Date of revision of PI
b) The draft copy of the RiMUP in both English and Bahasa Malaysia shall be submitted for
evaluation.
d) All approved RiMUP can be found in the NPRA website as reference for consumers.
Healthcare professionals can retrieve and disseminate the RiMUP to patients if necessary.
e) For OTC products: If the product is intended to be sold without a PI or RiMUP, the
information required to be included in the PI or RiMUP shall be printed on the unit outer-
carton of the product. Submission of a soft copy of the RiMUP softcopy is still compulsory as
mentioned above.
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The registered product shall be affixed with the security device approved by the Authority. The said
security device (hologram), which is serialized, shall be used to authenticate and verify that the
product is registered with the Authority, and will be affixed to each unit pack of the product,
whether locally manufactured or imported.
The security device shall be affixed onto the outer packaging of the product, (or, where there is no
outer packaging, on the immediate packaging), on the front panel of the product label. None of the
product particulars on the label shall be covered by the security device.
Refer to:
a) Appendix 19: General Labelling Requirements where the security device/ label may be
affixed on the product label;
b) FAQ on hologram; and
c) Circulars and directives pertaining to security label (hologram):
(1)dlm.BPFK/PPP/07/25 Jld. 1
Peraturan-peraturan Kawalan Dadah dan Kosmetik 1984. Arahan Pengarah Kanan
Perkhidmatan Farmasi Bil 2 Tahun 2013: Direktif Pelaksanaan dan Pengendalian Label
Keselamatan (4 April 2013)
7.13 Language
All data and information including supporting documents for product registration such as
certificates, letters and product labels shall be in English or Bahasa Malaysia.
a) Halal logo may be used voluntarily on registered product label for the following categories, for
both local and export market, provided that such products have been certified and approved
halal by the Malaysia Department of Islamic Development (Jabatan Kemajuan Islam Malaysia,
JAKIM):
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References:
Circular (95)dlm.BPFK/PPP/01/03 Jld. 2
Penggunaan Logo Halal Bagi Produk Farmaseutikal Berdaftar Kategori Produk Bukan
Racun (Over The Counter, OTC) (26 December 2012).
Directive (6)dlm.BPFK/PPP/07/25
Arahan Pengarah Kanan Perkhidmatan Farmasi Bilangan 7 Tahun 2013: Direktif
Perluasan Skop Penggunaan Logo Halal Bagi Produk Farmaseutikal Berdaftar Kategori
Produk Bukan Racun Berjadual Dalam Bentuk Parenteral (8 November 2013).
b) The logo is NOT allowed to be used on the label of registered products other than the
categories listed above.
c) Only halal logo issued by JAKIM or any Islamic Body recognized by JAKIM shall be accepted.
d) To use the halal logo on permitted product labels, which is not a mandatory requirement, the
applicant is required to submit an application for consideration by the Authority.
e) The applicant shall submit an application for product registration variation to NPRA for
approval to affix halal logo on the product label of a registered product, of which a halal
certification has been granted. A copy of the halal certificate must be submitted as a
supporting document.
7.15 Directives
The Senior Director of Pharmaceutical Services may issue written directives or guidelines to any
person or a group of persons as he thinks necessary for the better carrying out of the provisions of
these Regulations and which in particular relate to:
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8. SUBMISSION OF APPLICATION
Upon submission, the application shall be given a call number for reference, which is specific to a
particular product. The applicant shall refer to this call number during all correspondence
pertaining to the registration of the product.
9. SCREENING OF APPLICATION
After the product registration application has been submitted online, the application shall undergo
an initial evaluation (screening process), which ensures that the submitted application is complete
with the required data/ information. Further evaluation shall be done after payment for the
application has been confirmed.
9.1 Satisfactory
Only a complete application shall be accepted and approved for payment. Upon screening approval,
the applicant is requested to proceed with:
(i) payment:
Payment has to be made within thirty (30) days from the date of screening approval.
The application form will be deleted from the system if payment has not been made
within this stipulated time.
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Category of Online
No. Hard copy submission
Product Submission
Generics As requested
3. All documents
(Scheduled Poison) e.g. big file size, unable to be submitted online
As requested
5. Health Supplements All documents
e.g. big file size, unable to be submitted online
Natural Products
(Traditional and As requested
6. All documents
Homeopathic e.g. big file size, unable to be submitted online
medicines)
- A copy of CD and a copy of documents as
Natural Products All documents as
required under Part I – IV;
7. with Therapeutic required under Part
- Further documentations may be requested
Claim I – IV
as deemed necessary.
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9.2 Non-Satisfactory
If the application is found incomplete during the screening process, the application shall be rejected
and the applicant shall be notified via the system.
Upon confirmation of payment, the application with the submitted data shall be evaluated. Review
of applications shall follow a queue system. There shall be separate queues for the different
categories of products and/ or according to the level of claims (e.g. general, medium or high claim
for health supplements).
10.2 Correspondence
Correspondence via the system shall be sent to the applicant for any clarification or further
supplementary data/ information or documentation pertaining to the application, if deemed
necessary by the Authority.
The application shall be rejected if the applicant fails to respond to the correspondence from NPRA
to submit the required clarification/ supplementary data/ information or documentation within six
(6) months from the first correspondence date.
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* EVALUATION
(B) ABRIDGED EVALUATION
TIMELINE
Generics (Non-Scheduled Poison)
7. a) Single active ingredient a) 116 working days
b) Two (2) or more active ingredients b) 136 working days
Natural Products
8. a) Single active ingredient a) 116 working days
b) Two (2) or more active ingredients b) 136 working days
Health Supplements
a) ** Single active ingredient a) 116 working days
b) ** Two (2) or more active ingredients b) 136 working days
** Applicable for:
9. i) General or Nutritional Claims; and
ii) Functional Claims (Medium Claims)
*Upon payment confirmation (Processing and Analysis Fee for Product Registration)
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A regulatory decision shall be made based on the outcome of the evaluation of the submitted
documentation, and samples (if applicable). An application may be approved or rejected by the
Authority, and the Authority’s decision will be sent via email/ official letter to the PRH.
As stipulated under Regulation 11(1), CDCR 1984, , the Authority may, at any time reject, as well as
cancel or suspend the registration of any product if there are deficiencies in safety, quality or
efficacy of the product or failure to comply with conditions of registration.
Re-submission of product registration for a rejected application due to safety and efficacy reasons
shall not be accepted within two (2) years after the rejection. However, if the product is registered
in the reference countries, submission of application may be made earlier.
As stipulated under Regulation 8(8), CDCR 1984, upon registration of a product by the Authority,
the PRH shall be notified by the Authority and a product registration number (i.e. MAL number)
shall be assigned to the registered product via the QUEST system.
The registration number is specific for the product registered with the name, identity, composition,
characteristics, origin (manufacturer) and PRH, as specified in the registration documents. It shall
NOT be used for any other product.
The product registered with the registration number as stated in the Authority database shall have
the name, composition, characteristics, specifications and origin as specified in the registration
documents and Authority database.
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Alphabets/ Refers to :
symbols
MAL “Malaysia”
YYMM Refers to the year and month of registration by the Authority (e.g.
1107: July 2011)
$$$$ Serial number for a registered product (e.g. 0001)
@ Category of registered product i.e. A/ X/ N/ T/ H
## Refers to administrative code used by NPRA i.e. C/ E/ R/ S/ Y
@ and ## A Scheduled Poison
B Natural Products with Therapeutic Claim
X Non-scheduled Poisons
N Health Supplements
T Natural Products (Traditional and Homeopathic
Medicines)
H Veterinary Products
C Contract Manufactured (the product is manufactured by a
GMP certified contract manufacturer)
E For Export Only (FEO) (the product is to be sold for
export only and not for sale in the local market)
R Packed and/or repacked (the product is packed and/or
repacked by an approved GMP certified packer and/or
repacker)
S Second source (the product is from a second source/
approved second manufacturer)
Z Products gazetted as zero-rated under the Goods and
Services Tax Act 2014, Goods and Services Tax (Zero-
Rated Supplies) Order 2014
Form 1 (Certificate of Registration) for a product with the provisions, conditions, limitations and
etc. of the registration, as stipulated under Regulation 8(8) of CDCR 1984, has been deleted from
the regulation in 2006 via amendment of PU(A) 336/06. Therefore, the certificate will no longer be
issued by the Authority.
Reference:
Circular (100)dlm.BPFK/PPP/01/03 Jld. 2. Pemansuhan Pengeluaran Sijil Perakuan Pendaftaran
(SPP) (21 January 2013).
The applicant shall refer to the product registration approval notification sent by the Authority or
the Approved Product Registration List in NPRA website.
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The registration status of a product shall be valid for five (5) years or such period as specified in
the Authority database (unless the registration is suspended or cancelled by the Authority).
Upon approval for product registration by the Authority, the applicant shall fulfill all commitments
and conditions imposed with approval of the product registration and shall be responsible for the
maintenance of the product in terms of quality, safety and efficacy throughout the validity period of
registration. Failure to do so may result in rejection of future application for renewal of the product
registration.
The applicant shall notify the Authority of any changes to the product’s efficacy, quality and safety,
as described in Section E: Post-Registration Process.
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The POA and AMV shall be submitted to the Centre of Product & Cosmetic Evaluation (PPPK) via
the online QUEST system.
Documents to be submitted via online QUEST system for Active Pharmaceutical Ingredient,
API:
1. S 4.2 : Complete POA for drug substance(s)
2. S 4.3 : Complete testing methods and results for AMV for drug substance(s)
with all relevant validation parameters, including acceptance criteria
and supporting raw data (e.g. chromatograms, spectrums etc.)
This guideline consists of general and specific requirements for POA submission. The
general requirements are referred to POA content whilst details of the test methods are
illustrated in the specific requirements.
Refer to Appendix 25: Guideline for the Submission of Protocol of Analysis (POA).
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Refer to Appendix 26: Guideline for the Submission of Analytical Method Validation
(AMV) Documents.
a) In accordance with Directive No. 8 Year 2020, BPFK/PPP/07/25 (8) Jld.4. Direktif
Penerimaan Keputusan Pengujian Pra-Pendaftaran Produk Semulajadi dari Makmal Swasta
yang Telah Diiktiraf oleh Bahagian Regulatori Farmasi Negara (NPRA) dan Makmal Kawalan
Kualiti Pengilang Tempatan, starting from 1st December 2020, the applicant is no longer
required to submit samples of natural product for laboratory testing to NPRA.
b) The PRH shall submit a Certificate of Analysis (CoA) for the purpose of product registration
evaluation.
c) For further details regarding submission of the CoA, refer to Appendix 7: Guideline on
Registration of Natural Products, 2.7.7 Certificate of Analysis (Finished Product).
a) Sample shall be submitted with a cover letter containing the following information:
(i) Name and reference number of the product;
(ii) Name and address of PRH;
(iii) Name, email address and contact number of authorized person;
c) Samples submitted must be from the same manufacturing premise as stated in the
application for registration.
d) Samples submitted must have an expiry date of least one (1) year from the date of
submission and must be from the same batch.
e) An official CoA and the recent shelf-life specification from the manufacturer for the same
batch of sample must be submitted with the sample.
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g) Other materials such as HPLC columns, reagents, etc. must be submitted when requested.
h) Reference standards are required to be submitted along with the pharmaceutical products.
Requirements for these reference standards are as follows:
(i) The type and quantity of reference standards submitted must match the type and
quantity requested;
(ii) Reference standards submitted must have an expiry date of least one (1) year from the
date of submission. In special situations, an expiry date of not less than six (6) months
may be accepted;
(iii) All reference standards must be submitted with an official CoA for the same batch with
the stated purity (as is, dried, anhydrous etc.) and all other relevant information (water
content, loss on drying etc.);
(iv) All reference standards must be properly labeled with the name, batch number, purity
and expiry date;
(v) All reference standards must be submitted in small, sealed air-tight amber glass
containers.
f) The Centre of Compliance & Quality Control (PKKK) shall issue import permit for
pharmaceutical products. The applicant shall ensure that the import permit is endorsed by
the enforcement officer at the entry point.
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15. INSPECTION
Inspection of GMP and GDP are conducted to ensure the compliance of manufacturers, importers
and wholesalers with current GMP and GDP requirements besides ensuring that registered
products and notified cosmetics in the market are safe, efficacious and of quality. Refer to
Appendix 27: Inspection.
16. LICENSING
According to the Regulation 12, CDCR 1984, any company that wants to manufacture, import or
wholesale any registered products needs to have a valid Manufacturer’s License, Import License or
Wholesaler’s License. Refer to Appendix 28: Licensing.
17. CERTIFICATE
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a) The registration of a product shall be valid for five (5) years or such period as specified in
the Authority database (unless the registration is suspended or cancelled by the Authority).
c) After the expiry date, the status of product registration shall be automatically changed to
“expired”, following which the applicant will not be able to submit an application for
product re-registration. Any form of appeal shall not be considered if the re-registration
application is not submitted before the expiry date of a product registration since reminder
letter is issued 3 months prior to the expiry date. A new registration application is required
if the applicant wishes to continue to market the product.
d) After the expiry date of the product registration, the product is deemed unregistered. For
products with their re-registration on hold due to unmet requirements past their
registration expiry date, the new registration date shall be updated according to the DCA
meeting date when the re-registration application is approved by the DCA.
e) The application for product re-registration shall only be submitted when all registration
requirements have been complied with. Failure to do so shall result in the re-registration
application being rejected by the Authority.
f) The application for product re-registration shall be submitted with proof of payment via the
online QUEST system.
h) The following are requirements for product re-registration of different product categories,
where applicable:
(i) Exemption of bioequivalence study report for all registered generic products in
immediate release, oral, solid dosage form (starting 15th March 2020).
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Reference:
(2) dlm. BPFK/PPP/07/25 Jld. 4
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil. 2 Tahun 2020: Pertimbangan
Pengecualian Keperluan Data Bioekuivalens (BE) Bagi Produk Generik Dalam
Bentuk Oral Solid, Immediate Release Yang Mengemukakan Permohonan
Pendaftaran Semula (10 March 2020)
Reference:
(20) dlm. BPFK/PPP/07/25 Jld. 2
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil. 20 Tahun 2018: Direktif
Permohonan Pendaftaran Semula Produk Yang Pernah Didaftarkan secara
“Pendaftaran Hak” dan Produk “Not Commercially Viable Medicine (NCVM)” (26
June 2018)
(iii) Patient dispensing pack size for pharmaceutical product containing scheduled
poison or non-scheduled poison with tablet/ capsule dosage form, including oral
liquid preparation and dermatological preparation.
Refer to Appendix 23: Patient Dispensing Pack for Pharmaceutical Products.
(iv) Bioequivalence study report for all registered generic products containing
scheduled poison with immediate release, oral, solid dosage form (starting 1 January
2013)
Reference:
(10) dlm. BPFK/PPP/01/03 Jld.1
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil 1 Tahun 2011: Direktif
Penguatkuasaan Keperluan Kajian Bioekuivalens Bagi Semua Produk Generik
“Immediate Release, Oral, Solid Dosage Form” Yang Mengandungi Bahan Aktif Racun
Berjadual Serta Akreditasi Pusat Kajian Bioekuivalens (2 March 2011)
(v) Bioequivalence study report for all registered generic products containing
scheduled poison with effervescent, dispersible, orodispersible, sublingual, buccal
and chewable dosage form (For expiring product registrations starting 1 January
2019)
References:
(27) dlm. BPFK/PPP/07/25
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil 3 Tahun 2015: Direktif
Penguatkuasaan Keperluan Kajian Bioekuivalens (BE) Bagi Semua Produk Generik
Dalam Bentuk Dos Oral Tablet/Kapsul Yang Bersifat Effervercent, Dispersible,
Orodispersible, Sublingual, Buccal Dan Chewable Yang Mengandungi Bahan Aktif
Racun Berjadual (23 February 2015)
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(vi) Regulatory control of active pharmaceutical ingredient (API) for all dosage form of
registered pharmaceutical products containing scheduled poison (For expiring
product registrations starting from 1 January 2020)
• API information shall be submitted at least one year prior to the product
registration expiry date.
• Refer to Appendix 11: Regulatory Control of Active Pharmaceutical
Ingredients.
References:
(7) dlm.BPFK/PPP/07/25
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil 8 Tahun 2013 : Direktif Perluasan
Skop Pelaksanaan Kawalan Regulatori Ke Atas Bahan Aktif Farmaseutikal Bagi
Produk Generik Yang Mengandungi Racun Berjadual (Fasa II) (16 January 2014)
(vii) For pharmaceutical products submitted for registration before 2009, applicants
shall ensure that the Zone IVB stability study for the products have been conducted
and granted variation approval before submission of re-registration application.
References:
(1) dlm. BPFK/PPP/01/03 Jld.3
Keperluan Data Kajian Stabiliti Dalam Zon IVb Bagi Produk Farmaseutikal Berdaftar
(5 April 2013)
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(viii) Valid GMP document/ certificate for imported product (starting 1 January 2014)
To maintain the registration of an imported product, the PRH shall comply with
GMP requirements as stated in the directive issued by the Director of
Pharmaceutical Services under Regulation 29, CDCR 1984.
References:
Bil (25) dlm BPFK/PPP/01/03 Jld.1
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil 1 Tahun 2012: Syarat
Pendaftaran Produk Farmaseutikal Dari Luar Negara Berkaitan Keperluan Amalan
Perkilangan Baik (APB) (9 February 2012)
KKM/NPRA.PKP/600-2/11(7)
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil.4 Tahun 2018: Direkfit Mengenai
Penerimaan Pengesahan Pematuhan Amalan Perkilangan Baik (APB) Bagi Pengilang
Farmaseutikal Bagi Tujuan Pendaftaran Baru/ Pendaftaran Semula Produk
Farmaseutikal Berdaftar Dengan Pihak Berkuasa Kawalan Dadah (PBKD) (16 May
2018)
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(ix) Amendment of product name consisting of only generic name for registered
pharmaceutical product containing scheduled poison and non-scheduled poison
(starting 1 January 2017)
Reference:
(39) dlm. BPFK/PPP/01/03 Jld.3
Pekeliling Penggunaan Nama Generik Pada Nama Produk Bagi Produk Farmseutikal
(21 December 2015)
(x) Endorsement letter of ancillary medical device component (from Medical Device
Authority, Malaysia) for re-registration of drug-medical device combination product
(For expiring product registrations starting from 1 July 2019)
Note: Also refer to Guideline for Registration of Drug-Medical Device and Medical-
Device-Drug Combination Products.
Reference:
(9) dlm. BPFK/PPP/07/25 Jld.1
Arahan Pengarah Kanan Perkhidmatan Farmasi Bil.4 Tahun 2017: Direktif Kuatkuasa
Pemakaian Guideline for Registration of Drug-Medical Device and Medical Device-
Drug Combination Products (10 March 2017)
a) The PRH shall submit an official written request to the DCA Secretary if they decide to
withdraw the registration of a product before the end of the validity of such registration.
The PRH is required to state the reasons for the withdrawal decision in their request. The
PRH is also required to inform their manufacturer/ contract manufacturer of their
withdrawal decision.
b) The registration of a product, once withdrawn, shall not be reinstated. A new application
for product registration is required if the PRH wishes to have the product registered again
at a later date.
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Throughout the life cycle of a registered product, changes to improve product efficacy, quality and
safety are likely to occur. Therefore, the applicant shall inform the Authority of any changes or
amendments made to particulars of a registered product.
20.1 Variation
b) All supporting documents shall be submitted in accordance with the specified conditions
for each type of variation.
c) Variation applications and processing fees shall be made according to specific product
categories in the Malaysian Variation Guideline (MVG).
d) If deemed necessary, NPRA reserves the right to request for additional supporting
documents and variation approval letters from other regulatory bodies for all product
categories.
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Variation application for Health Supplement Products and Natural Products shall be
done according to the Malaysian Variation Guideline (MVG) For Natural (Traditional
Medicine & Homeopathy) And Health Supplement Products (Abridged Evaluation).
This refers to a transfer of marketing authorization from the existing PRH to another proposed new
holder. This change application allows for the same registration number of the registered product
to be maintained. Refer to Appendix 32: Change of Product Registration Holder.
New/ additional indication is defined as an indication not initially approved for a registered
pharmaceutical product. This may include new therapeutic indication or indication for new age
group, such as usage in children. This does not include changing/ rephrasing of sentences.
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Two (2) types of evaluation processes are available for a new/ additional indication application:
This applies to a new indication that has been registered in any one (1) of the eight (8)
DCA’s reference countries (United Kingdom, Sweden, France, United States of America,
Australia, Canada, Japan and Switzerland).
b) Verification Process
This applies to a new indication that has been registered in any two (2) DCA’s reference
countries (United Kingdom, Sweden, France, United States of America, Australia, Canada,
Japan, Switzerland and EMA).
Note:
The proposed new indication shall be the same as the approved new indication in the
reference countries.
An application to add a new indication deemed not feasible for submission to DCA’s reference
agencies may be considered for evaluation by NPRA on a case-by-case basis.
Other supporting documents deemed necessary shall be submitted upon request to support the
efficacy and safety of the proposed additional indication.
The supporting documents may include but are not limited to the following:
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a) Convenient pack refers to registered products packed together in a single packaging unit
for consumers, such as a confinement set or set jamu bersalin.
c) The convenient pack is applicable for registered products in the category of;
(i) Health supplements
(ii) Natural products
Or registered products from both categories (i) and (ii)
(iii) Non-Scheduled Poison (OTC)
(Only between OTC products with Abridged Evaluation category)
Contents in the labelling of each individually As per labelling requirements for registered
registered product have to be included in the products.
outer label of the convenient pack.
Note:
For the purpose of application submission: If the individually registered products are also
marketed independently, both the outer label of the packaging sold independently and the outer
label of the convenient pack are required to be submitted.
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g) The differences in a Convenient Pack from a Combination Pack (Combo Pack) and
Starter Pack/ Patient Initiation Pack/ Dose Adjustment Pack are as follows:
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21.1 Pharmacovigilance
a) In accordance with Regulation 28, CDCR 1984, the PRH or any person who possesses any
registered product shall inform immediately the Director of Pharmaceutical Services of any
adverse reaction arising from the use of the registered product.
b) All PRH must ensure that the company has a pharmacovigilance system is in place and
takes appropriate action, when necessary.
c) PRHs are required to monitor and report any product safety issues that arises locally or
internationally to the NPRA and comply with all safety-related directives issued by the
Authority.
d) The product registration status may be affected if the PRH fails to inform the Authority of
any serious adverse reactions upon receipt of such reports.
It is the prime responsibility of the PRH to ensure that products marketed are in accordance with
the standards and requirements of the Authority.
Registered products may be sampled and tested for compliance with official or pharmacopoeial
standards or specifications agreed by the manufacturer. Labels and package inserts of the samples
may also be checked to ensure compliance with the requirements approved.
The Authority shall take necessary action on products that do not conform to the standards/
specifications and requirements in the form of warnings or recalls.
The PRH has up to thirty (30) days to identify the cause of defect and actions to be taken for
improvement.
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Product Complaints
a) The PRH shall notify NPRA of any product quality related problems (with registered
products) of which the PRH is aware.
b) It is also the responsibility of the prescribers, pharmacists, as well as all other health
professionals who come into contact with the drug to report any product complaints to
NPRA by using the NPRA complaint form i.e. BPFK 419/ BPFK 418.4 with complaint sample
(if any).
c) All complaints received shall be investigated by NPRA as well as the PRH/ manufacturer. It
is the responsibility of the company to determine the appropriate corrective and preventive
action.
Product Recalls
a) The decision for recall of a product shall be made when there is actual or potential risk to
the product users. Recalls may be done voluntarily by the PRH or as directed by the
Director of Pharmaceutical Services Division, Ministry of Health Malaysia;
b) The PRH is responsible for conducting recalls of defective or unsafe products. No recall
shall take place without first consulting/ informing the Authority.
Adulteration
Punitive action shall be taken against companies who are involved in adulteration.
For any registered products found to have been adulterated, the following action shall be taken by
the Authority:
a) The registration of the related product shall be cancelled and recall of all batches of the
product shall be done immediately;
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b) The manufacturer’s license of the related manufacturer shall be revoked for six (6) months
for the first offence and one (1) year for the subsequent offence, from the date of the
revocation letter from the Authority;
c) All transactions (including application for product registration, application for change of PRH,
application for change of manufacturing site) for the adulterated PRH shall be frozen for six
(6) months for the first offence and one (1) year for the subsequent offence, from the date of
the cancellation letter from the Authority.
Reference: Bil (30) BPFK/PPP/01/03, Tindakan Punitif Ke Atas Syarikat Yang Terlibat Dengan Kes
Produk Campur Palsu (13 May 2009)
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APPENDIX 1
This guide serves to assist in determining if a product is regulated by the National Pharmaceutical
Regulatory Agency (NPRA) or by the Food Safety and Quality Division (FSQD) of the Ministry of
Health Malaysia.
1. INTRODUCTION
Malaysians are now more health conscious and there is generally greater awareness of the
importance of nutrition to overall well-being. In recent years, many consumers also rely on a
variety of “dietary supplements” to improve their health. These diverse products are freely
available through a myriad of outlets. A variety of products are available in the market, supposedly
for the maintenance, prevention and even treatment of chronic diseases. These products may range
from foods modified to have special properties or pure forms of vitamins and minerals to extracts
of various botanical or animal products.
It is important to monitor and regulate the marketing and sale of these products to protect the
interest and health of the consumer. Some of these products are not clearly defined as “food” or
“drugs” but are freely marketed. Such products include a variety of so-called health products and
have been termed as “food-drug interphase (FDI) products”.
In order to better define and regulate the FDI products, both the NPRA and the FSQD, Ministry of
Health Malaysia formed the Committee for the Classification of Food-Drug Interphase Products in
2000. The main Terms of Reference of the Committee is to assist both Divisions in classifying, in a
consistent manner, any application from the industry not clearly defined either as a food or drug
product. The Committee also serves as a platform in strengthening and updating the relevant
regulations as well as to provide scientific input on these products.
2.2 Food products with or without active ingredients (e.g.: herbs, vitamins, minerals,
etc.) such as:
i) Instant drink products containing sugar and creamer (e.g. premix coffee, tea,
chocolate, soy, cereal)
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ii) Meat essence products (liquid) (e.g. chicken essence, ostrich essence, duck
essence, fish essence, etc.)
iv) Cordial products with recommended dilution ratio (e.g. dates cordial, grape
cordial)
v) Vinegar products (powder & liquid) (e.g. apple vinegar, dates vinegar, etc.)
2.3 Isotonic drink products, sport nutrition products and special purpose food products
2.4 Products in conventional food form, e.g. biscuit, cake, confectionery, candy/sweet,
gummy, noodle
2.5 Products used for cooking and food preparation (e.g. cooking oil (olive oil, coconut
oil, sunflower oil), herbs and spices)
2.6 Herbs and spices in crude form without medicinal/ health claim
3.2 Products containing specific active ingredients, which possess high pharmacological
or therapeutic potencies. Examples of the ingredients are paracetamol,
glucosamine, tranexamic acid, aspirin, and substances listed in Poisons Act 1952
3.4 Products in pharmaceutical dosage form, such as soft gel, capsule or tablet (that is
to be directly swallowed), sublingual, buccal, spray into the mouth, etc.
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4. FDI PRODUCTS
Generally, FDI products are products with combination of food ingredients and active
ingredients for oral consumption. FDI products are not clearly defined as food or drug.
Examples of food ingredients are fruits, vegetables, meat, poultry, milk, cocoa and cereal.
Examples of active ingredients are vitamins, minerals, herbs, enzymes, probiotics,
prebiotics, amino acids, peptides, coral calcium, fatty acids, collagen, chia seed, astaxanthin,
lutein and other ingredients that are not traditionally consumed as food. FDI products may
be presented in the form of powder, liquid, semisolid forms such as gel/ jelly, chewable
tablet, drops, granule, etc.
a) Main criteria
i. Negative List for FDI as listed in Table I: Negative List For FDI:
FDI products containing ingredient(s) from Negative List for FDI shall be regulated
by NPRA; or
ii. Medicinal/ health claim refer to the term “medicinal purpose” as stipulated in
the Sales of Drug Act 1952, Section 2:
FDI products not containing ingredient(s) from Negative List for FDI and with
medicinal/ health claim shall be regulated by NPRA; or
FDI products not containing ingredient(s) from Negative List for FDI and without
medicinal/ health claim shall be regulated by FSQD.
b) Other criteria
When there is greater uncertainty regarding the safety of a FDI product, such product
shall be regulated by NPRA. This is to enable closer monitoring of such product to
safeguard the health of the consumer.
Reference: Pekeliling Kriteria Baru Pengkelasan Produk (07 August 2014) Circular
No. (19)dlm.BPFK/PPP/01/03 Jld.3)
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• Contact the relevant regulatory agencies for clarification, or seek classification service from
NPRA by submitting a classification application should there be doubt or uncertainty
pertaining to the category of the product.
• Read the governing legislations and other regulatory requirements and guidelines that
apply to the product before using this guide.
NO
2. ** Medicinal/Health Claim
Is the product indicated for medicinal purpose, or
does the product label/packaging contain any YES Drug
2. Medicinal/
statement that indicates or implies any medicinal Health Claim
purpose (e.g. body weight control; for the health
benefit of eyes specific human organs/ systems, such
as gastro-intestine and/or brain)?
NO
Food
Note: ** NPRA reserves the right to use its discretion to make decision if any issue of subjectivity
arises.
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5. ADDITIONAL NOTES
5.1 Substances listed in the prohibited/ banned ingredient list of the Drug Registration
Guidance Document (DRGD) and Schedule Poison shall not be permitted for use in
any FDI products.
5.2 Products categorized as a natural product are not allowed to contain creamer.
5.3 Food products are not allowed to be packed in blister pack/ any other form of
packaging that resembles the packaging of drug product.
5.4 Any foods or combination of foods that are regulated by FSQD shall not be in
pharmaceutical dosage form. Such products are advised to be reformulated into a
non-pharmaceutical dosage form.
5.5 Products containing only ingredient(s) such as roselle, jasmine, rose, chamomile,
chrysanthemum flower, ginger (rhizome), vanilla(stem), mint leaf, lemon peel and
cinnamon bark (with/without Camelia sinensis) will be regulated by FSQD.
5.6 Fruit ingredients that are not commonly consumed as food in Malaysia will be
considered as active ingredient.
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2 Antiaris toxicaria (Pers.) Lesch. Bark cloth tree, antiaris, false iroko, false mvule,
upas tree
7 Bile
16 Colchicum Spp. (all species) Autumn crocus, Meadow saffron, Naked lady
20 Datura Spp. (all species) Jimson weed, Devil’s apple, Green Dragon, Zombie’s
Cucumber, Moon Weed, Trumpet Lily, Stinkweed
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22 Dioscorea Hispida
30 Glucosamine
31 Glutathione
32 Gypsum Fibrosum
33 Hyaluronic acid
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45 Pearl
47 Placenta
52 Resveratrol
54 Scilla sinensis
Notes:
This list :
• is a compilation by the FDI committee.
• is not meant to be exhaustive and will be reviewed from time to time.
• shall be read in conjunction with the current laws and regulations together with other relevant
legislations, where applicable, governing pharmaceutical and natural products for human use in
Malaysia.
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Regulated by FSQD
CLASSIFICATION OF FOOD OR DRUG PRODUCTS Regulated by NPRA
PRODUCT Classification of FDI under food or drug
DRUG FOOD
APPENDIX 2
IMPORTANT NOTES:
This document shall be read in conjunction with the relevant sections of the main
guidance document: Drug Registration Guidance Document (DRGD), which is in
accordance to the legal requirements of the Sale of Drugs Act 1952 and the Control of
Drugs and Cosmetics Regulations 1984.
1. INTRODUCTION
c) Products that are excluded from the term “combination product” and will be regulated
separately:
i. A drug, device, or biological product packaged separately that according to its
investigational plan or proposed labelling is intended for use only with an approved
individually specified drug, device, or biological product where both are required to
achieve the intended use, indication, or effect and where upon approval of the
proposed product labelling of the approved product would need to be changed, e.g.,
to reflect a change in intended use, dosage form, strength, route of administration,
or significant change in dose; or
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ii. Any investigational drug or device packaged separately that according to its
proposed labelling is use only with another individually specified investigational
drug, device or cosmetic product where both are required to achieve the intended
use, indication or effect.
iii. Convenience pack product (e.g., first aid kit consists of medical device and non-
scheduled poison product)
e) The registration of drug/ medical device and notification of cosmetics that have been
classified must follow the requirements that have been set forth as follows:
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2. CLASSIFICATION CRITERIA
b) The primary mode of action/ the principal mechanism of action by which the claimed effect
or purpose of the product is achieved;
• Drug is based on pharmacological, immunological or metabolic action in/ on the
body; but
• Medical device does not achieve its primary intended action in or on the human
body by pharmacological, immunological or metabolic means, but may be assisted
in its intended function by such means;
c) Active ingredient, indication and pharmaceutical dosage form (these are the main criteria
for classification of drugs);
Applicant may verify the product classification with NPRA to determine if the product shall be
registered with the Authority or otherwise.
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Table I: MEDICAL DEVICE-DRUG-COSMETIC INTERPHASE (MDDCI) AND COMBINATION PRODUCTS CLASSIFICATION DECISION
NO PRODUCT INTENDED PURPOSE/ INDICATION AND CATEGORY CUSTODIAN
MODE OF ACTION (MOA) DIVISION
1. Aqueous Cream Product As an emollient cream with moisturizing OTC DRUG NPRA
properties to promote healing and relief to the
symptoms of skin dryness, impaired barrier
function, skin problems/ diseases.
2. Blood Bag Containing To collect and preserve blood and its MEDICAL DEVICE MDA
Anticoagulant/ Preservation Agent components (for use with cytapheresis device
only)
NOTE :
It is not for direct intravenous infusion.
3. Catheter Lock/ Flush Solutions As an anticoagulant for use as a catheter lock/ MEDICAL DEVICE MDA
(e.g., heparinised saline, sodium flush solution for flushing off catheters and
citrate solution) cannulas to maintain catheter/ cannula patency
and to prevent coagulation of blood or infection
in the catheter.
NOTE :
It is not indicated for therapeutic use.
Contraindicated for direct systemic
administration.
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ii. Root Canal Filling To seal the canal and disinfect the dentinal walls Device-Drug combination MDA
Incorporating Antibiotic by diffusing through dentine. The antibiotic product regulated as
provides ancillary actions as bactericidal MEDICAL DEVICE
antibiotic and anti-inflammatory agent to assist
in reducing pain and in maintaining a bacteria-
free environment within the root canal.
iii. Oral Wound Dressing, Non – A compound intended as a protective cover for MEDICAL DEVICE MDA
Animal/ Microbial Derived the oral mucosa to manage wounds and sores in (If it contains an active
(e.g., gel, paste, fluid, spray the mouth. It may also be used to treat mucosal substance with
solution of water/oil) irritations/ inflammation, dryness and gingivitis. pharmacological,
immunological or metabolic
primary mode of action, it will
be classified as DRUG)
6. Dialysis Products
i. Peritoneal Dialysis Dialysate It is used for the exchange of solutes across the DRUG NPRA
peritoneum of the patient (in this case, used as a For continuous ambulatory
semi-permeable membrane) peritoneal dialysis (CAPD)
products with CAPD system
(e.g., dialysate bag, drainage
bag, transfer tubing, linking
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ii. Haemofiltration Solution It is used for the exchange of solutes with blood DRUG NPRA
through a system of extracorporeal filters.
iii. Haemodialysis Dialysate It is used for the exchange of solutes with blood MEDICAL DEVICE MDA
through a semi-permeable membrane in the
dialyser of a haemodialysis system.
NOTE :
Haemodiafiltration is the combination of
haemodialysis and haemofiltration performed
either simultaneously or sequentially.
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8. Drug-Eluting Stents (DES) For use in angioplasty or coronary stenting Device-Drug combination MDA
procedures. product regulated as
MEDICAL DEVICE
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ii. Aqueous/Vitreous Humour It is used to assist in performing ophthalmic MEDICAL DEVICE MDA
Replacement Medium surgery, e.g., to maintain the shape of the eyeball
during the intervention, preserve tissue
integrity, protect from surgical trauma, or to
function as a tamponade during retinal
reattachment.
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12. General Purpose Surgical or To isolate a site of surgical incision or a surgical MEDICAL DEVICE MDA
Barrier Drapes field from contamination (e.g., microbial, (If it incorporates an ancillary
(A sterile protective covering made of substance) in various clinical settings (e.g., in an pharmacologically active
natural or synthetic materials, or operating room or catheterization laboratory). substance, it will be classified as
both) The device may also be used to protect a patient Device-Drug combination and
from heat/flame during a surgical procedure. shall be regulated as
This is a reusable or single use device. MEDICAL DEVICE)
13. General-Body Orifice Lubricant Lubricant intended to facilitate entry of a MEDICAL DEVICE MDA
diagnostic or therapeutic device into a body (If it incorporates an ancillary
orifice by reducing friction between the device pharmacologically active
and the body; substance, it will be classified as
a Device-Drug combination
Lubricant during catherisation, probing, product and shall be
endoscopy, changing fistula catheters, regulated as MEDICAL DEVICE
intubation, and prevention of iatrogenic injuries
to the rectum and colon.
14. Head Lice Products a. Acts solely by coating and/ or suffocating MEDICAL DEVICE MDA
the lice and/ or its eggs
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15. Heat Pad/ Cooling Pad To relief aches and pains. MEDICAL DEVICE MDA
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NOTE:
The device component will be
regulated on a case to case
basis.
18. Local Refrigeration Anaesthesia Used as local anaesthetic due to intense cold MEDICAL DEVICE MDA
produced by instant evaporation e.g., in minor (If it contains a
operative procedures or to alleviate pain pharmacologically active
associated muscle injuries etc; of which results substance, it will be classified as
in insensitivity of peripheral nerve endings and a DRUG)
local anaesthesia. Its principal mode of action is
not pharmacological, immunological or
metabolic.
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20. Medicinal Patch To relieve fatigue, body aches, joint pains. DRUG NPRA
21. Nail Anti-Fungal Products Treatment of onychomycosis (fungal nail MEDICAL DEVICE MDA
(e.g., pen applicator containing acetic infection) by lowering the pH of the nail bed,
acid/ lactic acid) thus creating a micro-environment that is hostile
to fungal growth.
22. Nasal Inhaler To act as a barrier against external influences by MEDICAL DEVICE MDA
formation of a moisturizing film on the nasal (If it contains a
mucosa. pharmacologically active
substance, it will be classified as
DRUG)
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Artificial Saliva/ Saliva Substitute/Solutions used to mimic and replace/ substitute MEDICAL DEVICE MDA
Replacement normal saliva in the symptomatic treatment of
dry mouth (xerostomia). Generally, contain
viscosity-increasing agents, such as mucins or
cellulose derivatives, carmellose as well as
electrolytes, including fluoride. They seldom
relieve symptoms for more than 1 or 2 hours
and does not stimulate saliva production.
24. Other Topical Antiseptics/ Disinfectants
i. Swabs/ Wipes Containing For use on human skin and intended to be used DRUG NPRA
Antiseptics/ Disinfectants/ for a medical purpose, e.g., pre/ post injection,
Antimicrobial Substances wound cleaning etc.
(e.g., chlorhexidine, iodine,
cetrimide)
ii. Preparations (Including Swabs/ Intended for the disinfection of medical devices. MEDICAL DEVICE MDA
Wipes) Containing
Antiseptics/ Disinfectants/
Antimicrobial Substances (e.g.,
alcohol, chlorhexidine, iodine,
cetrimide)
iii. Alcohol Only Wipes/ Swabs To be used for a medical purpose to wipe intact MEDICAL DEVICE MDA
skin for needles access
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NOTE:
The ingredient and intended use should comply
with the Guidelines for Control of Cosmetic
Products in Malaysia.
i. Personal Intimate Hygiene a. For female/ male intimate hygiene COSMETIC NPRA
NOTE:
The product should be rinsed off.
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iv. Personal Intimate Lubricant To use as a vaginal lubricant during the MEDICAL DEVICE MDA
climaterium (pre-menopause, menopause, post- (If it contains a
menopause) and to treat irritations in vaginal pharmacologically active
epithelium in cases of physiological decrease of substance, it may be classified
lubrication and consequent increase in vaginal as DRUG)
dryness.
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29. Synthetic Fluid Tissue As a submucosal implant in the urinary tract for MEDICAL DEVICE MDA
Reconstructive Material urinary incontinence or vesicoureteral reflux. (If it incorporates an ancillary
pharmacologically active
It may also be injected into the vocal cords to substance, such as local
treat the effects of paralysis, atrophy, or anaesthetic e.g, lidocaine, it will
scarring. After application, this device cannot be be classified as a Device-Drug
reused. combination product and
shall be regulated as
MEDICAL DEVICE)
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31. Wart Products a. Containing a caustic agent e.g., trichloroacetic DRUG NPRA
(e.g., pen applicator containing a acid (TCA) that destroys warts by chemical
caustic agent, cyryogenic kit with coagulation of proteins. NOTE:
refrigerant) If a device component is
present, it will be regulated on a
case to case basis
b. Cryotherapy which destroys warts by MEDICAL DEVICE MDA
freezing them using a very cold substance
e.g., liquid nitrogen or refrigerant made
from dimethyl ether and propane.
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ii. Comprising A Matrix, Typically To facilitate the infiltration of native skin MEDICAL DEVICE MDA
Of Living Cells (Fibroblasts) elements (e.g., fibroblasts, leukocytes, blood
And/ Or Structural Proteins vessels) for skin regeneration.
iii. Topical Preparation For To facilitate local haemostasis. It is available in MEDICAL DEVICE MDA
Application To A Skin Wound various forms (e.g., gel, spray, powder, ointment,
(e.g., abrasion, laceration, cut, plaster/gauze pad) that can be applied directly
ulcer) to the wound where it forms a seal of
transparent layer.
iv. Deep Cavity Wounds Dressing To use as the wound covering material for deep MEDICAL DEVICE MDA
For Application To A Surgical body cavity to reduce the adhesion of
Wound surrounding tissues by applying to the surgical
area.
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PRODUCT
INTERPHASE
DRUG/ (Refer Table I) MEDICAL DEVICE
COSMETIC As defined in Section 2
Categorised Categorised as
As defined in of Medical Device Act
as drug/ medical
Regulation 2, 737
cosmetic device
CDCR 1984
Product categorised in
Table I?
No
Apply for Classification to NPRA
Legend:
Submission to MDA No Refer to MDA with
Is it a drug/cosmetic based
on notification letter?
notification letter from
Submission to NPRA NPRA
Yes
Refer to NPRA
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APPENDIX 3
IMPORTANT NOTES:
This document shall be read in conjunction with the relevant sections of the main
guidance document: Drug Registration Guidance Document (DRGD), which is in
accordance to the legal requirements of the Sale of Drugs Act 1952 and the Control
of Drugs and Cosmetics Regulations 1984.
1. DEFINITION
New Drug Products (NDP) is defined as any pharmaceutical products that have not been
previously registered in accordance with the provisions of the CDCR 1984.
All other products registrable at New Drug Section which do not fall under (1.1).
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4 Selected clinical publications/ study synopsis are sent to local clinical specialists to
gather comments on product efficacy and safety.
5 Consultation with local clinical specialists is required for a product for which its
innovator has never been registered by DCA and other hybrid application, when
deemed necessary.
NOTE:
For a product in which the reference innovator product has never been registered in
Malaysia, specific requirements for Parts III and IV:
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APPENDIX 4
IMPORTANT NOTES:
This document shall be read in conjunction with the relevant sections of the main
guidance document: Drug Registration Guidance Document (DRGD), which is in
accordance to the legal requirements of the Sale of Drugs Act 1952 and the Control
of Drugs and Cosmetics Regulations 1984.
Where appropriate, the relevant WHO, EMA and ICH guidelines on biologics/
biopharmaceuticals shall be consulted.
• WHO (https://www.who.int /)
• EMA (http://www.ema.europa.eu)
• ICH (http://www.ich.org)
Every biologic is regulated as a new product and also considered ‘high risk’. Both drug
substance and drug product production must comply to Good Manufacturing Practice strictly.
Adoption of GMP as an essential tool of Quality Assurance System.
• Administrative information
• Product quality data
• Product safety data
• Clinical data, demonstrating clinical efficacy and capacity to meet therapeutic
claims, through clinical studies
Animal derived materials/ products are commonly used in the manufacture of biologics/
biopharmaceuticals. A detailed information regarding the rationale for use of such material e.g.
the source, etc. shall be provided, as per Checklist A and Checklist B; and also provide a
confirmation on the presence/ absence of the animal materials in the final product.
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This document is intended to provide guidance for the registration of biologics. However, this
document will serve as a living document that will be updated/ revised further in line with the
progress in scientific knowledge and experience.
Note: This document is not intended to apply to the control of genetically-modified live
organisms designed to be used directly in humans, e.g. live vaccines.
Outline:
1. GENERAL INFORMATION
1.1 Definitions
1.2 Introduction
2.1.3 References
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1. GENERAL INFORMATION
1.1 DEFINITIONS
The term ‘biopharmaceutical’ was coined in the 80’s to define proteins that were made by
recombinant DNA technology [which includes hybridoma technology for monoclonal antibody
(mAb) production].
Biologic/ Biological product refers to a product whose active substance is made by or derived
from a living organism (plant, human, animal or microorganism) and may be produced by
biotechnology methods and other cutting-edge technologies. This product imitates natural
biological substances in our bodies such as hormones, enzymes or antibodies.
The term ‘Biotechnology product’ and ‘Biological product’ are used to broadly refer to all
biopharmaceuticals (by the broad biotechnology view).
Note:
Today, biologics have become inextricably intertwined with biopharmaceuticals, to the point
where they are synonymous. The general consensus is that a ‘Biologic’ and ‘Biopharmaceutical’
are interchangeable terminology, but a biologic might incorporate some other products (e.g.
allergenics, somatic cells etc.).
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Unlike small-molecule generic drugs, exact copies of biologics are impossible to produce
because these are large and highly complex molecules produced in living cells. A ‘biosimilar’
medicinal product (a short designation for ‘similar biological medicinal product’) is considered
as a new biological medicinal product developed to be similar in terms of quality, safety and
efficacy to an already registered, well established, medicinal product. For details, please refer to
Guideline on Registration for Biosimilars in Malaysia.
Cell and Gene Therapy Products (CGTPs) are regulated as Biologic products. Unlike
biotechnology products which are mostly purified proteins of cells, CGTPs contain living and
functional cells. Therefore, CGTP is regulated under a separate framework.
For details, please refer to Guidance Document and Guidelines for Registration of Cell and Gene
Therapy (CGTPs). This document provides information for manufacturers, applicants,
healthcare professionals and the public on legal arrangements in Malaysia for the registration of
CGTPs. The implementation of the guideline will be compulsory on 1 January 2021 as stated in
the Directive No. 6 Year 2017. Please also refer to Directive No.18 Year 2020 regarding the
details of mechanism for registration and enforcement of CGTPs in stages.
References:
i) Directive No.18 Year 2020. NPRA.600-1/9/13(10): Direktif Berkenaan Pelaksanaan
Pendaftaran Produk Dan Penguatkuasaan Secara Berperingkat Bagi Produk Terapi Sel
Dan Gen (CGTPs) Serta Tambahan Senarai Produk Di Luar Skop Kawalan CGTPs Oleh
PBKD
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1.2 INTRODUCTION
It is acknowledged that biological substances used in the practice of medicines make a vital
contribution to health care. Nevertheless, because of their nature, biologicals demand special
attention with regard to their regulations to assure quality, efficacy and safety.
Biologicals are inherently variable due to their biological nature, produced from biological
materials, and often tested in biological test systems, themselves variable, a feature that has
important consequences for the safety and efficacy of the resulting product. Each product must
be evaluated on its own merits. A prerequisite for the use of biological is therefore to assure the
consistency of quality and safety from lot-to-lot.
Today, the biological field is one of enormous expansion and increasing diversity, most
especially in the area of new biotechnologies. The revolution of DNA-based and other cell
technologies has opened up a new and exciting vista, and in many instances, traditional
products are being replaced by equivalents derived by recombinant DNA technologies or other
cutting-edge technologies.
It is important to note that the demonstration that a product consistently possesses a desired
characteristics of safety and efficacy will depend on a multifaceted approach on the part of
manufacturer and the regulatory authority - drawing on thorough characterization of starting
materials, demonstration of consistency of production, and appropriate selection of lot release
tests - all under the stringent and documented controls imposed by good manufacturing
practices - as well as rigorous post marketing surveillance activities.
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2.1.1 Vaccines:
The antigens may be in their native state, truncated or modified following introduction of
mutations, detoxified by chemical or physical means and/or aggregated, polymerized or
conjugated to a carrier to increase immunogenicity. Antigens may be presented plain or in
conjunction with an adjuvant, or in combination with other antigens, additives and other
excipients.
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A. DESCRIPTION
Description - Information on the source materials: source materials include any
component/ unformulated active substance used in the manufacture of the product
(e.g microorganisms, cells/ cell subtrate, immunogen) including their specifications
and the tests used to demonstrate compliance with the specifications. For
combination vaccines, each active substance, which will be pooled, combined with
other antigens and formulated, shall be described.
Any chemical modification or conjugation of the drug substance shall be described in
detail.
List of inactive substances, which may be present in the drug substance.
1. Manufacturing Formula:
List of all materials (culture media, buffers, resins for peptide synthesis, chemicals,
columns etc.) and their tests and specifications, or reference to pharmacopoeia.
Complete formula inclusive of any adjuvants, diluents, preservatives, additives,
stabilisers etc.
Production of each antigen in the vaccine (i.e. fermenter or culture volumes for each
bulk batch size as applicable and typical bulk volumes per production run).
Batch formula for each batch size and final formulated bulk product.
Lot numbering system for intermediates and final product.
2. Manufacturing Process:
Flow Charts/ Diagrams be Accompanied by a Descriptive Narrative:
Ref: WHO TRS 878 (1998) Annex 1: Requirements for the use of animal cells as in vitro
substrates for the production of biologicals.
The flow chart should show the steps in production and a complete list of the in-
process controls and tests performed on the product at each step.
In-process holding steps, with time and temperature limits indicated.
Description of the manufacturing processes (flow diagram) in detail to support the
consistency of manufacture of drug substance - cell growth and harvesting.
Identification of any processes or tests performed by contract manufacturers or
testers.
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Animal cells: Cells of animal origin may harbour adventitious agents and
consequently pose a potentially greater risk to humans. Description of measures
taken to remove, inactivate, or prevent contamination of the product from any
adventitous agent present.
Information on measures to prevent any catastrophic events that could render the
cell banks unusable and to ensure continuous production of vaccines is crucial.
For recombinant vaccines: description of the construction and characterization of the
recombinant vector as well as source of master cell bank/ constructs.
C. QUALITY CONTROL
1. Starting Materials:
List of all control tests performed on raw materials, with appropriate characterisation
on starting materials.
List of raw materials meeting compendia specifications.
List of raw materials meeting in-house specifications including the tests performed
and specifications
Biological starting materials (human or animal origin) with information on the
requirements to avoid risk of transmissible spongiform encephlopathies (TSEs) and
human diseases (HIV, hepatitis,etc) in the final product including Certificate of
Suitability (CEP). Please refer Checklist A & B
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D. STABILITY
(http://www.who.int/biologicals/publications/trs/areas/vaccines/stability/en/)
Information on stability of intermediates and final product, quality control methods
and rationale for the choice of tests for determining stability.
Information on the dates of manufacture of the lots, the lot numbers, the vial and dose
size, and the scale of production.
Describe the policy for assigning the date of manufacture of each component as well
as the final product (e.g combination vaccine) and diluents, as appropriate.
In addition to final product stability data at the recommended storage temperature,
the accelerated stability data at elevated temperatures should be sufficient to justify
the choice of Vaccine Vial Monitor (VVM) for use with the product [Vaccine Vial
Monitor WHO/PQS/E06/IN05.1]
Ref:
- Guidelines for Independent Lot Release of Vaccines by Regulatory Authorities World
Health Organization 2010
- Circular Ref : (23) dlm.BPFK/PPP/07/25 Directive No. 16 Year 2014. Direktif
Pelaksanaan Vaccine Lot Release ke atas Semua Produk Vaksin Berdaftar di Malaysia
- Guidance Document for Biological Product Lot Release in Malaysia
Ref:
- WHO TRS 927 (2005) Annex 1: WHO guidelines on nonclinical evaluation of vaccines
- WHO TRS 987 (2014), Annex 2: Guidelines on the nonclinical evaluation of vaccine
adjuvants and adjuvanted vaccines
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Clinical studies designed and conducted to meet WHO and international GCP
principles.
Tabulated summary of the clinical development program of the vaccine, in which
critical parameters that may have changed during the clinical development.
Copies of publications about these trials should accompany the submission.
Clinical summary: Provide detailed summary and intepretation of the safety and
efficacy data obtained from clinical studies that supports the current prescribing
information.
Clinical Expert Report: Provide an independent clinical expert report on the clinical
studies (evidence of expertise and independence should be provided)
Ref:
- WHO TRS 924 (2004) Annex 1: WHO guidelines on clinical evaluation of
vaccines:Regulatory expectations.
- WHO TRS 850 (1995) Annex 3: Guidelines for Good Clinical Practice (GCP) for trials on
pharmaceutical products.
Provide an outline of the post marketing pharmacovigilance plan for the vaccine.
Periodic Benefit-Risk Evaluation Report (PBRER) in accordance to ICH Guideline
E2C(R2) Clinical Safety Data Management: Periodic Safety Update Reports for
Marketed Drugs.
In the case of vaccines that have recently been registered/ licensed, provide
information on any ongoing phase IV studies or on any active monitoring of the safety
profile that is taking place including adverse events following immunization(AEFI).
Risk management plan.
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(i) Definition
Biotechnological products includes the use of the new genetic tools of recombinant DNA to
make new genetically modified organisms or genetic engineering products.
Products of recombinant technology are produced by genetic modification in which DNA coding
for the required product is introduced, usually by means of a plasmid or viral vector into a
suitable microorganism or cell line, in which DNA is expressed and translated into protein. The
desired product is then recovered by extraction and purification.
I. PRODUCTION PROCESSES
K. SPECIFICATIONS
Drug substances should include assays for identity, purity, potency, physiochemical
and stability.
Identity and quantity of impurities along with analytical data which supports
impurities profile
Acceptable limits of impurities and should be included in the specifications if present
in finished products.
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L. CHARACTERISATION
M. NONCLINICAL STUDIES
N. CLINICAL STUDIES
Clinical studies designed and conducted to meet WHO and international GCP
principles.
Overall approach to the clinical developement of a medicinal product.
Overview of the clinical findings and provide an evaluation of benefits and risks
based upon the conclusions of the relevant clinical studies.
Interpretation of how the efficacy and safety findings support the proposed dose and
target indication.
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Vaccines:
WHO (http://www.who.int/biologicals/vaccines)
WHO Technical Report Series: Vaccines
Biotechnology Products:
WHO
i) WHO Technical Report Series 1991 No. 814, Annex 3. Guidelines for assuring the quality
of pharmaceutical and biological products prepared by recombinant DNA technology.
(under revision)
ii) WHO Technical Report Series 1992 No 822, Annex 3. Guidelines for assuring the quality
of monoclonal antibodies for use in humans.
iii) WHO Technical Report Series No 878, Annex 1 and Addendum. Requirements for the
use of animal cells as in vitro substrates for the production of biologicals.
iv) WHO Technical Report Series No.786, Annex 3. Requirements for human interferons
prepared from lymphoblastoid cells (Requirements for biological substances N0.42)
v) WHO Technical Report Series No.771, Annex 7 Requirements for human interferons
made by recombinant DNA techniques (Requirement for biological substance No. 41)
EMA
i) EMA/CHMP/BWP/532517/2008. Guideline on Development, Production,
Characterisation and Specification for Monoclonal Antibodies and Related Products
ii) CPMP/BWP/328/99. Development Pharmaceutics for Biotechnological and Biological
Products - Annex to Note for Guidance on Development Pharmaceutics.
iii) EMEA/410/01 Rev. 3 Minimising the Risk of Transmitting Animal Spongiform
Encephalopathy Agents via Human and Veterinary Medicinal Products.
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ICH
i) ICH Topic Q5A (R1) Quality of Biotechnological Products: Viral Safety Evaluation Of
Biotechnology Products Derived From Cell Lines Of Human Or Animal Origin.
ii) ICH Topic Q5B Quality of Biotechnological Products: Analysis of the Expression
Construct in Cell Lines Used for Production of r-DNA derived Protein Products.
iii) ICH Topic Q5D Quality of Biotechnological Products: Derivation and
Characterisation of Cell Substrates used for Production of Biotechnological/
Biological Products.
iv) ICH Topic Q5C Quality of Biotechnological products: Stability Testing of
Biotechnological/ Biological Products.
v) ICH Topic Q5D Derivation and Characterisation of Cell Substrates Used for
Production of Biotechnological/ Biological Products.
vi) ICH Topic Q5E Biotechnological/ Biological Products Subject to Changes in Their
Manufacturing Process: Comparability of Biotechnological/ Biological Products.
vii) ICH Topic Q6B Specifications: Test Procedures and Acceptance Criteria for
Biotechnological/ Biological Products.
viii) ICH Topic Q2 (R1) Validation of Analytical Procedures: Text and Methodology.
ix) ICH Topic Q8 (R2) Pharmaceutical Development.
x) ICH Topic Q11 Development and Manufacture of Drug Substances (Chemical
Entities and Biotechnological/ Biological Entities).
xi) ICH Topic S6 (R1) Preclinical Safety Evaluation of Biotechnology-Derived
Pharmaceuticals.
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Any therapeutic product derived from human blood or plasma and produced by a
manufacturing process that pools multiple units.
Plasma-derived therapies and their recombinant analogs are unique among pharmaceuticals
and biologics. Their production begins with a biological starting material, human plasma. Each
therapy has a unique biochemical profile as a result of differences in production and processing
methods that can lead to differing clinical responses and efficacy among patients.
Hence, from the starting material, through manufacturing and final distribution to patients, the
complexities of producing blood products places it in a unique class of biologics.
Blood products are regulated as medicinal product. Blood products are inherently variable due
to their biological nature, and the biological methods to test them. They are subjected to
comprehensive assessment of the quality, efficacy and safety.
Starting material: Assurance of the quality and safety of the plasma for fractionation.
Manufacturing technique: Control of the fractionation and subsequent manufacturing
procedures for isolation, purification, viral inactivation and/or removal steps.
Good manufacturing practice (GMP): Strict adherence to GMP. Adoption of GMP as an
essential tool of Quality Assurance System.
Product Compliance: Standardization of biological methods needed in characterisation
of in-process and finished products.
Plasma for fractionation and blood products that are regulated by NPRA includes:
Plasma products derived from plasma collected and fractionated in Malaysia for use in
Malaysia;
Plasma products derived from plasma collected and fractionated overseas for use in
Malaysia; and
Plasma products derived from overseas-sourced plasma fractionated in Malaysia for use
overseas.
Note: This document is applicable to all plasma-derived products containing an active and
inactive ingredient that is derived from human blood.
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Plasma Master File (PMF). It can also be a stand-alone document. Document pertaining
to the collection and controls of source materials. Key elements of PMF are:
Requirements for a formal contract governing purchase and supply of plasma.
Source plasma.
GMP status of the blood establishments/ collection centers.
Description of the quality assurance system applying to plasma supply and use.
Arrangements for donor selection, selection/exclusion criteria.
Data on population epidemiology and blood-borne infections.
Requirements for testing of samples of donations and pools. Mandatory serology on
all plasma donations. Each unit of source material tested for HBsAg, anti-HIV and
anti-HCV
Plasma bags, plasma quality and plasma specifications.
Arrangement for communication and review of post-donation information.
Plasma inventory hold.
Traceability from donor to end product and vice versa.
Ref:
- CHMP/BWP/3794/03 Rev. 1 Guideline on the Scientific Data Requirements for a
Plasma Master File (PMF)
- Checklist of Plasma Master File for Blood Products.
Documents that verify each batch of source material intended for manufacture has been
serological tested for hepatitis B (HBV), hepatitis C (HCV) and HIV. Each batch of source
material must also be tested for HCV RNA by Nucleic Acid Testing (NAT) and (increasingly
for other viruses including HIV, HBV, B19, and HAV) and exclusion of reactive donations.
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ii) Manufacturing:
Detailed description of manufacturing process and controls to demonstrate proper
quality control or prevention of possible contamination with adventitious agents.
In-process and final controls.
- Viral inactivation and/ or removal processes
- Viral validation studies and report
- Pathogen safety document inclusive of Transmissible Spongiform
Encephalopathies (TSEs) risk assessment
- Information or certification supporting the freedom of reagents, inactive
ingredients of human or animal origin from adventitious agents.
- Process consistency
- Analytical validation studies
- Process validation studies (purification, sterility etc.)
- Batch record and batch release specifications
4. CLINICAL STUDIES
Demonstrating product’s efficacy
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1. General Information
General Logistics
1.3
• Flowchart of supply chain of plasma
Plasma Origin
• Information on Collection Centers
2.1 • Information on Testing Centers
• Selection/ Exclusion Criteria for Donors
• Traceability
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Where appropriate, the relevant WHO, EMA and ICH guidelines on blood products shall be
consulted in particular the followings:
WHO (https://www.who.int/health-topics/blood-products-)
i) WHO Technical report Series 941, Annex 4, Recommendations for production, control
and regulation of human plasma for fractionation.
ii) WHO Technical report Series 924, Annex 4, Guidelines on viral inactivation and removal
procedures intended to assure the viral safety of human plasma products.
iii) WHO Guidelines on tissue infectivity distribution in Transmissible Spongiform
Encephalopathies.
EMA (http://www.ema.europa.eu)
i) EMA/CHMP/BWP/706271/2010 Committee for medicinal products for human use
(CHMP) Guideline on plasma-derived medicinal products
ii) CHMP/BWP/3794/03 Rev. 1 Guideline on the Scientific Data Requirements for Plasma
Master File (PMF)
iii) CPMP/BWP/268/95 Note for Guidance on Virus Validation Studies: The Design,
Contribution and Interpretation of Studies Validating the Inactivation and Removal of
Viruses
iv) EMEA/410/01 Rev. 3 Minimising the Risk of Transmitting Animal Spongiform
Encephalopathy Agents via Human and Veterinary Medicinal Products
v) EMA/CHMP/BPWP/144533/2009 rev. 2 Guideline on the Clinical Investigation of
Recombinant and Human Plasma-Derived Factor VIII Products
vi) EMA/CHMP/BPWP/144552/2009 Rev. 1, Corr. 1* Guideline on Clinical Investigation of
Recombinant And Human Plasma-Derived Factor IX Products
vii) EMA/CHMP/BPWP/94033/2007 rev. 2 Guideline on the Clinical Investigation of Human
Normal Immunoglobulin for Intravenous Administration (IVIg)
ICH (http://www.ich.org)
i) ICH Topic 5QC Quality of Biotechnological products: Stability Testing of
Biotechnological/ Biological Products.
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3. CHECKLISTS
3.1 CHECKLIST A
Products Containing Animal-Derived Materials WITH a valid TSE risk evaluation Certificate of
Suitability (CEP)
Source of Animals
4. • Declaration of materials of porcine origin
• Declaration of materials of other animal origin
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3.2 CHECKLIST B
Products Containing Animal-Derived Materials WITHOUT a valid TSE risk evaluation Certificate
of Suitability (CEP)
Declaration that the final product does not contain any animal-
10.
containing materials with the relevant evidence (if applicable)
Other supporting documents e.g. Halal Certification of the animal
11. derived ingredient from a competent Halal Certification
Authority.
12. Labelling of the animal derived materials.
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APPENDIX 5
IMPORTANT NOTES:
This document shall be read in conjunction with the relevant sections of the main
guidance document: Drug Registration Guidance Document (DRGD), which is in
accordance to the legal requirements of the Sale of Drugs Act 1952 and the Control of
Drugs and Cosmetics Regulations 1984.
1. DEFINITION
A generic product is a product that is essentially similar to a currently registered
product in Malaysia. However, the term generic is not applicable to Biologics.
2. GENERIC APPLICATION
The following categories of product can be processed as generic application provided
that it fulfils the definition of a generic product.
Products containing active ingredients which are not listed in the First Schedule
under Poisons Act 1952; and are excluding active ingredients which are
categorized under health supplements or natural products or cosmetics.
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3. SUBMISSION OF APPLICATION
Applicants are advised to refer to Section A (5. Application Procedures) of the DRGD
for further explanation.
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Appendix 9 Fees
Appendix 24 Appeal
Appendix 27 Inspection
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7. OTHERS
Classification of Products containing Glucosamine, Chondroitin and
Methylsulphonylmethane (MSM)
Condition on
Product Route of
No. Product Product Remark
Category Evaluation
Indication
OR No
Products
Health Abridged therapeutic
2. containing -
In supplement Evaluation claims are
Chondroitin
combination allowed
with other
supplement
ingredients
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Condition on
Product Route of
No. Product Product Remark
Category Evaluation
Indication
As single
ingredient
OR No
Health Abridged therapeutic
-
In supplement Evaluation claims are
Products combination allowed
3. containing with other
MSM supplement
ingredients
As No
combination Health Abridged therapeutic
-
with supplement Evaluation claims are
Chondroitin allowed
Reference: Circular
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APPENDIX 6
IMPORTANT NOTES:
This guideline will serve as an additional reference guide for the registration of health
supplement products, which consist of pharmaceutical active ingredients for human use as
well as ingredients derived from natural sources.
Applicants are advised to refer to main Drug Registration Guidance Document for the
common requirements for the preparation of a well-structured dossier application to be
submitted for product registration.
Contents:
1. Definition
1.1 Health Supplement (HS)
1.2 Indication
1.3 Route of Administration
1.4 Exclusion from Health Supplement
1.5 Exemption
2. Active Ingredients
3. Maximum Daily Levels of Vitamins and Minerals for Adults Allowed in
Health Supplements
4. Health Supplement Claims
4.1 Conditions
4.2 Types and Evidence of Claims
4.3 Claims Substantiation
4.4 Illustrative Substantiation Evidence
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SECTION E
5.30 Product Owner
5.31 Letter of authorization from product owner
5.32 Letter of appointment of contract manufacturer and/ or repacker
5.33 Letter of acceptance as contract manufacturer and/ or repacker
5.34 Certificate of Pharmaceutical Product (CPP), Certificate of Free Sales (CFS) and
Good Manufacturing Practice (GMP)
5.3.5 GMP/ CFS Template
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1. DEFINITION
Health Supplement (HS) refers to any product used to supplement a diet and to maintain,
enhance and improve the health function of human body. It is presented in small unit dosage
forms (to be administered) such as capsules, tablets, powder, liquids and shall not include any
sterile preparations (i.e. injectable, eye drops). It may contain one or more, or the following
combinations:
i) Vitamins, minerals, amino acids, fatty acids, enzymes, probiotics, and other bioactive
substances;
ii) Substances derived from *natural sources, including animal, mineral and botanical
materials in the forms of extracts, isolates, concentrates, metabolite;
iii) Synthetic sources of ingredients mentioned in (i) and (ii) may only be used where the
safety of these has been proven.
1.2 INDICATIONS
Oral
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2. ACTIVE INGREDIENTS
Listed active ingredients can be checked at the NPRA website https://www.npra.gov.my/ using
product search.
Condition on
Product Route of
No. Product Product Remark
Category Evaluation
Indication
OR No
Products
Health Abridged therapeutic
2. containing -
In supplement Evaluation claims are
Chondroitin
combination allowed
with other
supplement
ingredients
As single
ingredient
No
Products
Health Abridged therapeutic
3. containing OR -
supplement Evaluation claims are
MSM
allowed
In
combination
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Condition on
Product Route of
No. Product Product Remark
Category Evaluation
Indication
with other
supplement
ingredients
As No
combination Health Abridged therapeutic
-
with supplement Evaluation claims are
Chondroitin allowed
Reference: Circular
(i) Bil (66) dlm BPFK/02/5/1.3
Produk yang Mengandungi Glucosamine dan Chondroitin (14 November 2006).
(ii) Bil. (20) dlm.BPFK/PPP/01/03
Produk yang mengandungi Glucosamine, Chondroitin dan Methylsulfonylmethane (MSM)
(31 Disember 2008).
1. Vitamin A 5000 IU
2. Vitamin D 1000 IU
3. Vitamin E 800 IU
6. Vitamin B2 (Riboflavine) 40 mg
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18. Copper 2 mg
20. Iron 2 20 mg
26. Zinc 15 mg
Note:
1. Vitamin K (K1 and K2) is restricted only for combination with other vitamins and
minerals in oral preparations. Vitamin K (K1 and K2) as a single ingredient in an oral
preparation is not allowed.
2. For pre and antenatal use, as part of a multivitamin and mineral preparation, levels
higher than the 20mg limit established for adults may be permitted at the discretion of
the Authority.
3. Any form of fluoride as an ingredient is not permitted in formulation of health
supplement products.
4.1 CONDITIONS
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vii) not be medicinal or therapeutic in nature, such as implied for treatment, cure or
prevention of disease.
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For
strengthening
the body
Please refer to 4.4 Illustrative Substantiation Evidence List for the list of acceptable references,
organisations and authorities.
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Examples/
Types of HS Evidence to substantiate HS
Definition Wording of Criteria
claim Claims
claims
Functional Maintains or Acceptable For claims on 1 or more of the following
Claims enhances the claims based on established evidence:
(medium) structure or the single nutrients and
i) Standard reference e.g.
function of the ingredient ingredients such as
reference textbooks,
human body, vitamins &
e.g. pharmacopoeia, monographs
excluding minerals with daily
Vitamin A helps
disease-related recommended ii) Recommendations on usage
to maintain
claims values from reference regulatory
growth, vision
authorities or reference
and tissue
Meet the organisations
development
conditions for iii)Good quality scientific
nutrient function evidence from human
Vitamin D helps
claims as set by observational studies (refer
in normal
the Authority to ASEAN Guidelines on
development
and efficacy data requirement)
Claims have (only in the event that
maintenance of
consistent human experimental study
bones and
scientific support is not ethical, animal
teeth.
according to studies will be accepted
scientific review together with
Chondroitin
and evaluation epidemiological studies or
helps to
promote other scientific literature
In accordance to and documented traditional
healthy joints
HS principles and use)
practice in
iv) Peer-reviewed scientific data
Malaysia
or meta-analysis
Refer to 4.4 Illustrative Substantiation Evidence List for the list of acceptable references,
organisations and authorities.
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Refer to 4.4 Illustrative Substantiation Evidence List for the list of acceptable references,
organisations and authorities
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Claims must be in line with the respective HS principles and supported by adequate evidence.
To reflect the all available usage evidence (including relevant scientific evidence), the evidence
shall be summarized as part of the substantiation document for the claim presented in the
Table 4 below:
Note: Evidence not summarised and presented in the above format will not be further evaluated
Indicati Product Dosage Duratio Type Stu Study Summa Limitation Source of
on/ / and n of of dy populat ry of s of the evidence
claim Ingredi administr treatme evide des ion findings study i) Author
ent ation nt nce ign ii) Title
studied route (scien iii) Publica
tific tion
evide details
nce) iv) Year
v) Type
(text,…
)
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Reference texts
a. Martindale, latest edition. The Complete Drug. Pharmaceutical Press, 2009.
b. The ABC Clinical Guide to Herbs. American Botanical Council
c. WHO Monographs on Selected Medicinal Plants
d. British Pharmacopoeia
e. United States Pharmacopoeia
f. Indian Pharmacopoeia
g. Chinese Pharmacopoeia
h. Natural Standards (www.naturalstandard.com)
i. Office of Dietary Supplements, National Institutes of Health - Dietary Supplement
Fact Sheets (https://ods.od.nih.gov/factsheets/list-all/)
Organisations
a. American Botanical Council (www.herbalgram.org).
b. American Nutraceutical Association
c. CODEX Alimentarius
d. Global Information Hub for Integrated Medicine (http://www.globinmed.com)
e. National Centre for Complementary and Alternative Medicine
(http://nccam.nih.gov/ )
f. Office of Dietary Supplements, National Institutes of Health (USA)
(http://ods.od.nih.gov)
Notes:
1. This list is not meant to be exhaustive and will be reviewed from time to time.
2. The Authority will conduct a detailed evaluation of the evidence included in the report to
ensure that the health claim is substantiated.
3. The Authority will consider review other than those listed above, if the standards of evidence
are consistent with those of the Authority.
4. All references must be current.
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PRODUCT VALIDATION
• The product name may include product name, dosage form and strength (e.g. XYZ
Capsule 500mg)
• Dosage form and strength of product are required to be part of the product name to
allow for multiple dosage forms (e.g. tablet, capsule) and strengths (e.g. 200mg and
400mg) for any particular named (proprietary or generic) product.
• If a registered product name is found to be similar to another registered product,
NPRA reserves the rights to request for the change in the product name.
• Product with more than one (1) active ingredient should not include the strength of
active ingredients in the product name.
• The product name may include the brand name or trademark name, if applicable.
• Any product name that is the same or similar either in writing or pronunciation,
with the product name of an adulterated product is prohibited.
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7. Product name not congruent with the active The active ingredient is Evening
ingredient Primrose oil (EPO) and the product
name: “Marine tablet” is not allowed
8. Prohibited use of product names that has Words such as miracle, magic,
elements of ludicrous belief magical, miraculous, saintly, heavenly
Statements referring to ancient beliefs/ negative
spirits/ supernatural power
9. Prohibited use of product names similar to the Elegen vs L-gen vs L-jen Forte vs Fort
existing approved product names
Product name similar to the spelling and
pronunciation of words of existing product names
10. Prohibited use of product names that may cause Juice, Health drink, Beverage, Kooky
ambiguity in the nature of product (drug/ food/
beverage)
Product name similar to a food/ beverage name
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13. Product name that uses strength but formulation If the product contains multivitamins
contains more than one active ingredient and minerals.
Product name:
“XXX multivitamins and minerals
500mg” is not allowed.
14. Other prohibited product names Minda, IQ, Smart, Unique, Ultra Mega,
Detox, Defence, Immunity
Note:
1. This list is not meant to be exhaustive and will be reviewed from time to time.
2. The Authority reserves the right to disallow any other words, phrases or graphics for product
label, which in its opinion is misleading, improper or not factual.
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The applicant shall contact the following department to obtain the necessary
permit/ license. A copy of the permit/ license shall be submitted with the
application form for product registration.
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6. Pharmacological study
Note: The documentation must support the safety use and dose of new active ingredients as a
health supplement.
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Any source from animal origin must be declared and the type of animal must be
specified.
5.5 Manufacturer
The requirements for Good Manufacturing Practice (GMP) for the manufacturers are in
Table 5 below:
Table 5:
Level of claims Requirements for GMP
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Contract manufacturer is applicable when the product owner is not the product
manufacturer.
An application for a second source may be considered when deemed necessary. This
second source product shall be the same as the first product in all respects except for the
site of manufacture.
Any manufacturer involved in assembly, fill & finish, active ingredients, packing, labeling
etc.
Certificate of GMP for manufacturer/ supplier is required for the premixed ingredient(s)
in formulation. The requirements for GMP are same as in Table 5 as above.
A PRH is not allowed to register/ hold two or more products with similar formulation
(same active ingredient of raw material, strength and dosage form) at any one time,
except for product variants.
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5.15 Contraindication
State conditions for which or under which the product shall not be used.
Indicate clearly conditions that are:
- absolutely contraindicated,
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- contraindicated but may be used under special circumstances and what precautions
should be taken in such cases.
- If no information is available for this section, state “Unknown”.
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Change of formulation for active ingredient or excipient is not allowed during product
evaluation.
Cholecalciferol Active _ mg _ kg _%
Total: _ mg Total: _ kg
(Signature)
Post of authorized person
Name of authorized person
Date:
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5.25 Packaging
• Maximum pack size allowed for tablets, pills, or capsules is based on daily dosing for
a quantity not exceeding six (6) months usage.
• Maximum pack size allowed for products with disease risk reduction claim is for one
(1) month supply of products unless justified.
• Product with dosage form of soft gel with tail (twist and squeeze) shall come with
children proof cap.
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The following information shall be present on the label of a product at the outer carton,
immediate container or blister/ strips:
Health supplement products with disease risk reduction claims (high) are encouraged to be
dispensed under the supervision of pharmacists or medical practitioners. At such, the label and
package insert of health supplement products with disease risk reduction claims (high) shall
have the following statement:
“Please consult a doctor/ pharmacist before taking this product”.
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• Batch Number
• Storage Condition • Manufacturing Date
• Pack Size
• Keep out of reach • Expiry Date
of children / Jauhkan daripada • Dosage Form
capaian kanak-kanak MAL ……………………...
Note:
- Product label shall follow the standard labelling for Health Supplement.
- Information stated on the left and right panel is interchangeable.
- All information on the label must be truthful and not misleading to the consumers.
- Batch number, manufacturing date, expiration date can be stated on the label, on top of the
cap or bottom of the bottle.
- The front panel must contain the information as above. However, the information on the side
panels is interchangeable. Additional cautionary labelling relating to the safety of the
product may be imposed.
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Example:
“Money back guarantee”
Marketing strategy Such statements are
1. “Buy 1 free 1”
prohibited on labels.
“Backed by RM5 million
product Liability Insurance”
Example:
Usage guide which “After consumption of this
Prohibited on
2. promotes use of product (Product A), for better
product label
other product(s) results, it is recommended to
take Product B”
Prohibited on
3. Consumer testimonial
product label
Opinion of prominent
figure(s) on Example:
Prohibited on
6. product or its active Opinion of product/ formulation
product label
ingredient/ inventor
content
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Example:
Statement on active Allowed if proven
8. Source from the Mountains of
ingredient origin true
Alps
Prohibited on
product label
Example:
10. Logo with certification because certification
SIRIM/ ISO / GMP/ HACCP
renewal is on a
yearly basis
Indecent photographs/
Prohibited on
16. pornography/ graphics/
product label
images
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Example:
- Noted indication is for
constipation, but graphics on
Graphics which are label shows a slim-looking
Prohibited on
17. incoherent with lady which denotes indication
product label
the indication for weight loss
- Indication for urination but
label graphics contains
picture of a water hose.
Example:
Indication is for general health
Highlighting unnecessary Prohibited on
18. but graphics on label highlights
body parts product label
male and female sexual organ
parts
Example:
Graphics of plants or
Radix Ginseng which is Prohibited on
19. animal which
improvised as a male product label
may cause confusion
sexual part
Example
20. Prohibited on
Photograph of celebrities - Artiste, sports person(s),
product label
politician
Allowed on product
label provided the
product contains no
fructose, glucose,
Example
sucrose, or other
21. Statement on sugars - This product contains no
kind of sugars with a
added sugar
potential to affect
diabetics are not
included in the
formulation
Example:
- This product is blended with
Prohibited on
23. Other statements premium quality
product label
- Certified chemical residue
free
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Notes:
1. The list is not meant to be exhaustive and will be reviewed from time to time.
2. The Authority reserves the right to disallow any other words, phrases or graphics for product
label, which in its opinion is misleading, improper or not factual.
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Type of certificate
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Date:
Quantity
Test Done Stage Done Frequency Specifications Method
sample
No. of testing
taken
(example) (example) (example) (example) (example)
(example)
Before
Blue like Organoleptic
1. Appearance weight, after 2 10 gram
orange test
encapsulation
After
Uniformity of
3. tableting, 4 20 Tablets 1 gram/tab
weight
Packaging
* The above parameters are only as an example; other test may be required for specific
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a) Provide details of quality control specifications, including a list of tests for both release
and shelf life specifications (if they are different) and state the limits of acceptance.
Finished Product Quality Control (FPQC) - Finished product Specification/ Specification Sheet
Company name/Address:
Product Name:
Batch no.
Dosage form:
Packaging:
Date of manufacture:
Date of expiry:
Assay:
HPLC/ GC/ MS/
2. (All active ingredients/ To specify To specify
UV
compounds claim on label)
3. Disintegration/Dissolution To specify DRGD DRGD
4. Uniformity of weight To specify
5. Water content To specify
Microbial contamination
6. TAMC, TYMC, specified To specify DRGD DRGD
microorganism
8. Etc.:
Signature:
Name:
Designation: (At least by Quality Assurance Manager or equivalent)
Date of signature:
* The above parameters are only as an example; other test may be required for specific product.
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Effective from 1st January 2018, two (2) batches of Certificate of Analysis
(CoA) of Finished Product must be submitted for new product registration of
Health Supplement products with general claim.
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Certificate of Analysis
Company name/ Address :
Product Name :
Batch no. :
Dosage form :
Packaging :
Date of manufacture :
Date of expiry :
Test Parameter Specifications Results Method
Appearance/ Organoleptic:
Odour To describe the
Colour characteristic
Disintegration DRGD
Uniformity of weight
Assay:
(All active ingredients/ To specify
compounds claim on label)
Microbial Contamination Test
TAMC, TYMC, specified DRGD
microorganism
Heavy Metal Contamination
Lead (Pb) NMT 10 ppm
Cadmium (Cd) NMT 0.3 ppm
Mercury (Hg) NMT 0.5 ppm
Arsenic (As) NMT 5 ppm
NMT = Not More Than
Signature :
Name :
Designation : (At least by Quality Control Manager or equivalent)
Date of signature :
Note: The above parameter are only as an example, other tests may be required for specific product.
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b) Capsule
Individual weight of the capsule to be within the limit of 90-110% of the
average weight.
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TAMC TYMC
Route of Administration (CFU/g or (CFU/g or Specified micro-organisms
CFU/ml) CFU/ml)
Special Ph. Eur. provision Not more than 102 CFU of bile-
for oral dosage forms tolerant gram-negative bacteria (1 g
containing raw materials of or 1 ml or MPN)
natural (animal, vegetal or
Absence of Salmonella (10 g or 10
mineral) origin for which
ml)
antimicrobial pretreatment NMT 2 x 104 NMT 2 x 102
is not feasible and for which Absence of Escherichia coli (1 g or 1
the competent authority ml)
accepts TAMC of the raw
Absence of Staphylococcus aureus (1
material exceeding 103
g or 1 ml)
CFU/g or CFU/mL.
Notes:
TAMC : Total Aerobic Microbial Count (May be omitted for product containing probiotics)
TYMC : Total Yeasts & Molds Count
NMT : Not more than
[Reference: British Pharmacopoeia 2012]
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
General:
- The stability of the product is important to ensure the quality of health supplement
product. This is to ensure that the product specifications are maintained throughout the
shelf life of product.
- Effective from 27 Nov 2014, a shelf life of two (2) years shall be approved for both local
and imported products. Proposed shelf life exceeding this period will have to be
supported by stability study data conducted in Malaysia under Zone IVb conditions
(30±2 °C, 75±5%). For further information, refer to circular: Bil(27).dlm
BPFK/PPP/06/04Jld.7 Tempoh Hayat Simpanan (Shelf-Life) Bagi Produk Tradisional dan
Suplemen Kesihatan (27 November 2014).
Real time Time 0, 3, 6, 9, 12, 18, 24 months and annually there after
through
Accelerated 0, 3 and 6 months
Refer to the ASEAN Guidelines on Stability Study and Shelf Life of Health Supplements for
further details.
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Table 10:
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Absence of
Salmonella in 10g
or 10ml
Absence of
Escherichia coli in
1g or 1ml
Absence of
Staphylococcus in
1g or 1 ml
Heavy metal test:
Lead ≤10.0 mg/kg (≤ 10ppm)
Arsenic ≤5.0 mg/kg (≤ 5ppm)
Mercury ≤0.5 mg/kg (≤ 0.5ppm) NA
Cadmium ≤0.3 mg/kg (≤ 0.3ppm)
Conclusion ------------------------------------------------------------
Analyst name: (signature) Verified by: (signature)
Name: Name:
Designation Designation
Date: Date:
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Frequency of
For example:
testing
- 0, 3, 6, 9, 12, 18, 24 months and annually for the proposed shelf life
- All tests required for each dosage form shall be conducted, for
example:
List of relevant o Physical appearance changes
tests o Disintegration test (if applicable)
o Chemical Assays for active ingredients (if applicable)
o Microbial tests
Approval by
- Must have the name, post and signature of authorized person
authorized person
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Testing Parameters of Stability Study for each type of dosage forms are shown in Table 12
below:
Testing
organoleptic (odor,
Disintegration or
Granules/ Particle
Re-suspendability
dissolution rate
Microbial content
Parameters
Appearance/
Size variation
color, taste)
Hardness/
friability
Moisture
Assay*
Viscosity
content
pH
Dosage
Form
Oral powder √ √ √ √
Hard capsule √ √ √ √ √
Soft capsule √ √ √ √
Suspension √ √ √ √ √ √ √
Solution √ √ √ √ √
Emulsion √ √ √ √ √
Granules √ √ √ √ √
*Notes:
1. The list of tests for each product is not intended to be exhaustive, nor is it expected that every
listed test to be included in the design of the stability study protocol for a particular finished
product.
2. Justification must be given if one of the tests is not conducted for relevant dosage form.
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ATTACHMENT 1
• Depending on the level of claims, submission may follow the route outlined:
i) General/ Nutritional and Medium Claims - Abridged evaluation
ii) Disease Risk Reduction Claims - Full evaluation
General or
Functional
No. Field Nutritional
Claims
Claims
Product Validation (PV)
Brand Name
PV1 √ √
Full Product Name
Dosage Form
- COA capsule shell is required
PV2 √ √
- Colouring agent used in capsule
- Letter to verify the source of gelatin used
PV3 List of Active ingredient(s) √ √
PV4 List of excipient (s) √ √
Other information (e.g., Manufacturer,premix
PV5-17 √ √
etc., where applicable)
Part 1
Product Description
- Describe visual and physical characteristics
of the product including shape, size,
superficial markings, colour, odour, taste,
A4 √ √
type of coating, type of capsule etc. where
applicable
- Animal shape is only allowed for ‘For Export
Only’ (FEO) Products
A7 Product indication/ Usage √ √
Dose/ Use Instruction
- Target population (e.g., Adults)
A8 - Quantity and frequency √ √
- Dosing schedule must be stated
(e.g. take before/ after/ with meal)
A10 Contraindication, if applicable √ √
A11 Warning/ Precautions, if applicable √ √
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
General or
Functional
No. Field Nutritional
Claims
Claims
A12 Drug Interaction, if applicable √ √
Pack Sizes √ √
C
- Material and colour used for primary and
√ √
secondary packing should be stated
D1 Label for immediate container √ √
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
General or
Functional
No. Field Nutritional
Claims
Claims
Certificate of Free Sale (CFS)
- Applicable if CPP is not available, must be
E4 √ √
issued by the competent authority in the
country of origin/ products owner country.
E8 Importer(s) √ √
E9 Store address(s) √ √
√
- dosage form
extended/
sustained-
release/
timed-
release
√
E12 Attachment of protocol analysis dosage form
* LOC to
submit during
post
registration for
other types of
dosage form
Examples of supporting documents
Dioxin level test results (for product
containing ingredients derived from seafood)
E14 Certificate of Good Manufacturing Practice
√ √
(GMP) for premixed active ingredients
Hormone free test results
(for placenta products)
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
General or
Functional
No. Field Nutritional
Claims
Claims
Declaration letter from product manufacturer
on the hormone - free status for product
containing placenta
Manufacturing process validation report if
applicable
Letter of commitment if applicable
Etc.
Part II Section P
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Table 14: Additional Quality Data Checklist for Disease Risk Reduction Claim
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Table 15:
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- Applicable to disease risk reduction claims (for new active ingredient, new combination of
active ingredients and new dose).
Table 16:
1. Clinical overview √
Overview of Biopharmaceutics
3. √
- To include associated analytical methods
Overview of Efficiency
5. √
- Summary of clinical efficacy
Overview of Safety
6. √
- Summary of clinical safety
References
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ATTACHMENT 2
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Alphas1-Casein Tryptic • Helps in • Promotes/
Hydrolysate maintenance of Improves sleep
(Milk Protein Hydrolysate) good health quality
• Promotes
relaxation
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Chondroitin Sulphate • Helps in • Promotes healthy
maintenance of joint
good health
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Folic Acid • Helps in • Helps in formation • Helps
maintenance of of red blood cell prevent
good health • For fetal neural tube
development defects for
women who
are planning
a pregnancy
before
conception
and during
12 weeks of
pregnancy at
a dose of 400
mcg daily
Fructooligosaccharides • Helps in • Promotes the
maintenance of growth of good
good health bacteria living
inside the gut
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Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Lutein • Helps in • Supports eye
maintenance of health
good health
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Vitamin A • Maintenance of • Helps to maintain
good health growth, vision and
tissue
development
• Aids in
maintaining the
health of the skin
and mucous
membrane
• Aids in
maintenance of
eye health
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Vitamin B3 • A factor in • Helps normal
(Niacin) maintenance of growth and
good health development
• Helps the body in
utilization of
energy from food
Page 61 of 62
Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Claims
Ingredients
Reduced Risk
General Functional
Reduction Claim
Vitamin E • Maintenance of
good health
Notes:
1. The claims listed above will serve as a guide for the applicant. Other wording that bring
similar meaning may be considered
2. This list is not meant to be exhaustive and will be reviewed from time to time.
3. The Authority will nonetheless conduct a detailed evaluation of the evidence included in the
report to ensure that the health claim is substantiated.
4. The Authority will be willing to consider review other than the listed above if the standards of
evidence are consistent with those of the Authority.
5. All references must be current.
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
APPENDIX 7
IMPORTANT NOTES:
1. This part shall be read in conjunction with the relevant sections of the main
DRGD.
2. Natural products shall be evaluated based on the criteria for safety and quality of
the product, and where appropriate, efficacy/ claimed benefits.
3. This document is intended to provide guidance for the registration of natural
products. However, this is a living document that is continually updated/ revised
in the line with progress in scientific knowledge and experience.
4. The lists presented are by no means exhaustive. It may be reviewed as and when
it is deemed necessary.
Contents:
1. General Information
1.1 Definitions
1.1.1 Traditional Medicines
1.1.2 Finished Herbal Product
1.1.3 Herbal Remedy
1.1.4 Homeopathic Medicine
1.1.5 Natural Products with Therapeutic Claim
1.2 Exemption from Product Registration
1.3 Preparations which are not allowed to be registered
1.4 Classification for Specific Active Ingredients
1.4.1 Products Containing Cassia/ Senna
1.4.2 Products Containing Psyllium Husk/ Plantago Ovata
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2.3 Excipients
List of Restricted Excipients
2.4 Indications
2.4.1 Indications Acceptable for Natural Products
2.4.2 Non-Permissible Indications (Table 7)
2.5 Particulars of Packing
2.6 Labelling Requirement (Table 8)
2.6.1 Statements to be stated on Product Label
2.6.2 Specific Labelling Statements/ Warning & Precautions
2.6.3 Cautionary Statement for Products Specially Used in Women
Table 9 : List of Prohibited Ingredients in Pregnancy
Table 10: Restricted in Pregnancy
2.6.4 Prohibited Visual/ Graphics/ Statement on Label of Natural Products
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1. GENERAL INFORMATION
1.1 DEFINITIONS
Natural products include traditional medicines, herbal products, homeopathic
medicines and natural products with therapeutic claim.
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a) If the product owner wishes to use a *formulary name, any amendments made to the
product formulation such as the addition of active ingredients, removal of active
ingredients or change in strength of active ingredients will not be permitted.
* The name of the Chinese/ Ayurvedic proprietary medicine as stipulated in the
reference such as Taiwan Pharmacopoeia, The Chinese Herbal Medicine Materia
Medica, and Ayurvedic Pharmacopeia
b) A brand name added in front of the formulary name shall be required, in order to
differentiate the product from products with the same formulary name.
c) Any product name that is the same or similar either in writing or pronunciation with the
product name of an adulterated product is prohibited.
d) For a product name that is the name of active ingredient or a common name, e.g. Kapsul
Kacip Fatimah; Misal Kucing Tea; Ortosiphon Capsule; Herbal Rub; Natural Herb Capsule,
a brand name shall be added to the product name in order to differentiate and identify
this specific product.
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e) For single-ingredient products, in cases where the product name bears the name of the
active ingredient, the strength should be added to the product name. E.g.: Sunsky
Tongkat Ali 500 mg Capsule.
f) The dosage form is required to be added to the product name in the system (i.e in
section A1)
g) Justification will be required to prove the “claim” made in the product name. E.g.:
“Double Strength/ Acticoat/ WaterSol”.
h) Product name supported by a registered trademark certificate will not be accepted if
deemed inappropriate by the Authority or if it does not follow the regulations stated in
this Appendix.
i) The replacement product may use the same product name as a previously registered
product provided that the formulation (strength of active ingredient), product
registration holder and dosage form of the product remain the same.
j) The name of the active ingredient is not allowed to be used as brand name.
k) The name of active ingredient combined with the product indication are not allowed to
be used as product name.
l) Product names not permitted to be registered are specified in Table 1 below:
Example:
Power/ Kuasa, Superior, Pure,
Mustajab, Safe, Healthy/ Sihat,
Prohibited use of superlative - Names that Penawar/ Shifa, VIP, Good, Heal/
3.
indicates superiority in efficacy Sembuh, Premium, Mustajab, Men/
Women/ Children Complete, Men/
Women/ Children Enriched, Paradise/
Syurga, Menawan, Booster
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Example:
SENXBIG=SEnXBIG(label), Sexy, Enjoy,
Prohibited use of names that may be
6. Paradise, Heavenly, Blue boy,
offensive or indecent
Casanova, Desire (Dezire), Sensual
(Xenxual), Asmara, Syok
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Example:
14. Name of internal organ
Liver, Brain, Kidney, etc.
Example:
Minda, IQ, Smart, Genius, Ultra Mega,
16. Other prohibited product names
Detox, Immune, Phase 2, Defense,
Prime
Note:
1. This list is not meant to be exhaustive and will be reviewed from time to time.
2. The Authority reserves the right to disallow any other words or phrases for product names,
which in its opinion, is misleading, improper or not factual.
2.2 INGREDIENTS
a) Active ingredients are substances that have a therapeutic role in the formulation.
Substances included in the formulation as active ingredients must make a contribution
to the proposed indications for the product. Where a claim links the presence of an
ingredient to the product indication, that ingredient must contribute to that indication.
The evidence may be scientific and or traditional.
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d) For new active ingredients or new combination products, the following information
shall be required:
• Product containing new single ingredient:
i) Extract form
- Information on the taxonomy of the ingredient;
- Techniques and methods in preparing/ processing the extract and subsequently
the product;
- Information on the use and safety of the ingredient and the product quality
standard.
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2.2.2 Premix
Effective from 1 December 2007, premixed ingredient(s) shall not be used in natural product
(traditional) formulation,
Reference: Circular Bil (71) dlm BPFK/02/5/1.3, 1 Jun 2007
B. Table 3 : Botanicals (and botanical ingredients) banned due to reported adverse event
C. Table 6 : Ingredients (botanicals and substance derived from animals) banned due to
safety reasons
Part of
plant
prohibited
Common/ Local (whole Constituent(s) of
Genus Species
Name plant concern
unless
otherwise
specified)
Asidospermine,
Asidosperma quebracho White quebracho
yohimbine
Atropine, hyoscine
Atropa belladonna Deadly nightshade (scopolamine),
hyoscyamine
Cannabis
(controlled under All species Marijuana Cannabinoids
Dangerous Drug Act
1952)
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Part of
plant
prohibited
Common/ Local (whole Constituent(s) of
Genus Species
Name plant concern
unless
otherwise
specified)
Periwinkle
Madagascar, Old
Maid, Vinca rosea,
Myrtle
Syn: Vinca Vinca, Vincristine,
Catharanthus roseus balcanica, Vinca Vinblastine
difformis, Vinca
heracea, Vinca
major, Vinca
minor, Vincae
minoris herba
Autumn Crocus/
Colchicum autumnale Meadow Saffron/ Colchicine
Naked Lady)
Devil’s Trumpet,
Metel, J California
Jimson Weed Atropine,
Datura metel
Scopolamine
Syn.: Datura
wrightii
Lice bane,
Delphinium staphysagria Delphinine
Stavesacre
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Part of
plant
prohibited
Common/ Local (whole Constituent(s) of
Genus Species
Name plant concern
unless
otherwise
specified)
Common
Foxglove, Purple
Digitalis purpurea Leaf Glycoside
Foxglove,
Kecubung
Squill
Syn.:Urginea
maritima, Scilla
maritima
Drimia maritima Glycoside
Related substance:
Urginea indica,
Urginea
pancreatium,
Urginea scilla
Ephedrine,
Ephedra All species Ma Huang
Pseudoephedrine
Yellow
Jessamine,Evening
Gelsemium sempervirens Gelsemine
Trumpet,Carolina
Jessamine
Hyoscyamine-
Hyoscyamus niger Black henbane
atropine
Lobelia,
pokeweed, Indian
tobacco, gagroot,
Lobelia inflata asthma weed, Lobeline
vomitwort,
bladderpod,rapun
tium inflatum.
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Part of
plant
prohibited
Common/ Local (whole Constituent(s) of
Genus Species
Name plant concern
unless
otherwise
specified)
Morphine,
codeine,
hydrocodone,
Papaver somniferum Opium poppy
meperidine,
methadone,
papaverine
Yohimbe, Johimbe
Pilocarpus
Pilocarpus microphyllus jaborandi, Pilocarpine
jaborandi
Indian snakeroot,
Rauwolfia serpentina Reserpine
Serpentine root
African
Rauwolfia vomitoria Reserpine
serpentwood
Veratrum Sabadilla,
Schoenocaulon officinale
officinale Veratrine
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Part of
plant
prohibited
Common/ Local (whole Constituent(s) of
Genus Species
Name plant concern
unless
otherwise
specified)
Poison nut,
Quaker button,
Strychnos nux-vomica strychnine tree, Strychnine
ma qian
zi/maqianzi
All parts
Valerian All species except for Valepotriates
root part
Table 3: Botanicals (and botanical ingredients) banned due to reported adverse event
Contain Aristolochic
Acid reported to
Aristolochia All species cause kidney toxicity
(**Please refer to
footnote below)
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
Berberine
*Other herbs
containing naturally-
occuring berberine
are allowed to be
registered with
Berberis All species specific
requirements. Please
refer to Appendix
20.
Notes: Only
prohibited for oral
preparation.
Contain dioscorine
Ubi gadong,
and dioscorinine
Gadong, Gadog,
reported to cause
Gadong Lilin,
burning sensation in
Gadong Mabok,
the throat, giddiness,
Ubi Arak, Ubi
followed by
Dioscorea hispida Akas, Taring All parts
haematemesis,
Pelanduk,
sensation of
Susur Gadong,
suffocation,
Gadongan,
drowsiness and
Kedut dan Ubi
exhaustion
Bekoi
Not allowed for oral
preparation
Borneo/
Malay/ Contain camphor- not
Drybalanops aromatica Sumatra Whole herb allowed for oral
Camphor, preparation
Pokok Kapur
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tridenata
Reported to cause
Larrea Chapparal liver toxicity
mexicana
Houpu,
Magnolia officinalis
Magnolia Reported to cause
kidney toxicity
Stephania tetrandra
Piper
Kava-kava
methysticum
officinale
asperum
Symphytum Comfrey
x. uplandicum
Tansy ragwort,
jacobaea Tansy Reported to cause
Butterweed liver toxicity
Alpane
nemorensis ragwort, Wood
ragwort
Common
Senecio groundsel, Reported to cause
vulgaris Groundsel, Old- liver toxicity
man-in the-
spring
longilobus Threadleaf
-syn .with groundsel,
douglasii, Threadleaf
filifolius ragwort
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
German/Africa
Scandens Buch.- n/Cape Ivy,
Ham Climbing
Groundsel
** To identify the botanicals that may contain Aristolochic Acid besides the
Aristolochia genus, refer to:
a. List A - Botanicals Known or Suspected to contain Aristolochic Acid
(Table 4)
b. List B - Botanicals that may be Adulterated with Aristolochic Acid
(Table 5)
Notes:
Products containing any of the listed herbs (EXCEPT for Aristolochia spp. that is totally
banned) will have to be sent to any governmental doping centre for testing and the result shall
be attached with the registration form.
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Asarum splendens (F. Maek.) C.Y. Cheng & C.S. Yang Do-saishin
(Japanese)
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Menispernum dauricum
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Table 6: Ingredients (Botanicals and Substance Derived from Animals) banned due to
safety reasons:
Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
Cardiac
glycoside
(antiarin),
- Latex is highly poisonous
Cardenolides &
Antiaris toxicaria Latex, sap alkaloids with - Paralyze heart muscle and
cardiac arresting cause death
potential
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Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
- Resistance of malarial
vector
- Use of bark is
contraindicated in
pregnancy and ulcers,
intestinal or gastric, and if
taken concomitantly with
anticoagulants can
Quinine and increased their effects
Cinchona All species
derivatives
- Can elicit
thrombocytopenia with
purpura
- Cinchona alkaloids are
toxic. Can cause symptoms
such as blindness,
deafness, convulsions and
paralysis
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Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
- Carcinogenic effects,
induce infertility in both
Seed, sexes
Citrullus Colocynthis Curcubitacin
fructus
- Enterohepatonephro-
toxicity
Gelsemine &
Root, leaf, gelseminine Paralysis, shortness of
Gelsemium elegans breath, muscle
rhizome (Gelsemium
indole alkaloid) stiffeningcoma,
hypocyclosis
Difficulty in swallowing
and talking, transient
Hyoscyamine, bradycardia followed by
Hyoscyamus muticus atropine, tachycardia with
hyoscine palpitation and
arrhythmias, CNS
depression, coma
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Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
Phytotoxin
Nausea, vomiting, serious
Jatropha multifida Fruit, seed (toxalbumin -
purgative action
Curcin
- Excessive salivation,
abdominal pain, swelling of
kidney and urogenital
system, headache, vomiting
and diarrhea accompanied
by bleeding
Whole body,
Lytta vesicatoria Cantharidin - Burning of the mouth,
tincture
dysphagia, nausea,
hematemesis, gross
hematuria and dysuria
- Renal dysfunction and
related to acute tubular
necrosis and glomerular
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Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
destruction
- Potential abuse
- Dependence, palpitation,
hallucination, euphoric
Morphine and activities, CNS depression
Papaver All species derivatives,
codeine - Nervous system toxicity
- Possible death from
circulatory and respiratory
failure
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Part of
Plant/
Animal
Prohibited Constituent of
(whole Concern
Genus Species Reasons for Prohibition
plant/ Reasons for
animal Prohibition
unless
otherwise
specified)
The applicant shall contact the following department to obtain the necessary
permit/ license. A copy of the permit/ license shall be attached with the
application form for product registration.
2.3 EXCIPIENTS
a) Excipients are substances used to assist in the manufacture of active substance into
dosage forms suitable for administration. Each excipient ingredient included in a
formulation must have a justifiable excipient role and shall be controlled by
specifications. The intended use of an excipient shall be appropriate.
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b) New excipient will require safety and/or other additional data to support the
function in the product prior to addition into the Quest database.
2.4 INDICATIONS
General note: The indications listed below will serve as a guide for the applicant. For
traditional/ homeopathic medicines, only low level claim(s) will be accepted. Other
indication with the same level of claims may be considered if supported with traditional/
homeopathic use.
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1. For strengthening muscle and bone/ untuk menguatkan otot dan tulang.
2. For relieving muscular ache/ untuk melegakan sakit otot.
3. For relieving waist ache and backache/ untuk melegakan sakit pinggang dan
sakit belakang.
4. For relief of joints and muscular pain/ untuk melegakan sakit sendi dan otot.
5. For relieving muscles sprain/ untuk melegakan terseliuh/ terkehel.
1. For relief of fever, cough and cold/ untuk melegakan demam, batuk dan selsema.
2. For relief of sore throat/ untuk melegakan sakit tekak.
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3. For reducing phlegm and relief of cough, sore throat and body heatiness/ untuk
mengurangkan kahak dan melegakan batuk, sakit tekak dan panas badan.
4. For relief of throat irritations and cough/ untuk melegakan sakit tekak dan batuk.
5. For relief of nasal congestion/ untuk melegakan hidung tersumbat.
6. For relief of sore throat and cough/ untuk melegakan sakit tekak dan batuk.
7. For relief of mouth ulcers due to heatiness/ untuk melegakan sakit mulut akibat
panas badan.
8. To relieve sinusitis/ untuk melegakan resdung.
1. For relief of stomach ache, mild diarrhoea/ untuk melegakan sakit perut, cirit-
birit ringan.
2. For relief of flatulence, stomach ache, mild diarrhoea, and loss of appetite/ untuk
melegakan kembung perut, sakit perut, cirit-birit ringan dan kurang selera makan.
3. For relief of mild diarrhoea, vomiting and improve appetite/ untuk melegakan
cirit-birit, muntah ringan dan menambah selera makan.
4. For relief of mild constipation/ untuk melegakan sembelit ringan.
5. To improve appetite and digestion/ untuk menambah selera makan dan
pencernaan.
6. For relieving abdominal pain and flatulence/ untuk melegakan sakit perut dan
kembung perut.
7. For relief of stomach ache, constipation, mild vomiting and indigestion/ untuk
melegakan sakit perut, sembelit, muntah ringan dan makanan tidak hadam.
8. Aid in digestion/ untuk membantu penghadaman.
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7. For symptomatic relief of vaginal discharge and mild itch/ untuk melegakan
keputihan dan gatal-gatal ringan.
8. To improve menstrual flow, for relief of menstrual pain, vaginal discharge and
flatulence/ untuk melancarkan haid, melegakan senggugut, keputihan dan
kembung perut.
9. For strengthening body muscle and reducing body weight/ untuk menguatkan
otot-otot tubuh dan mengurangkan berat badan.
10. For general health of women after childbirth/ untuk menyihatkan rahim selepas
melahirkan anak.
11. To relieve symptoms of menopause/ untuk melegakan simptom menopause.
[Note: For specific active ingredient only supported by established reference,
examples: red clover (trifolium pratense) and black cohosh (cimicifuga racemosa)]
1. For men’s health and energy/ for vitality/ untuk memulihkan tenaga dan
kesihatan lelaki.
1. For symptomatic relief of pain and itch associated with insect bites/ untuk
melegakan sakit dan gatal-gatal digigit serangga.
2. For relief of minor burns/ untuk melegakan lecur ringan.
3. For relief minor cuts/ untuk melegakan luka-luka ringan.
4. For relief of minor bruises/ untuk melegakan lebam yang ringan.
5. For reducing pimples/ untuk mengurangkan jerawat.
6. To help maintaining healthy skin, nail and hair/ untuk kesihatan kulit, kuku dan
rambut.
7. For reducing pimples and mild itch/ untuk melegakan jerawat dan gatal-gatal
ringan.
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5. Kelumpuhan / Paralysis
6. Tibi / Tuberculosis
7. Asma / Asthma
8. Kusta / Leprosy
9. Kanser / Cancer
18. Lemah fungsi seks atau impoten / Impairment of sexual function or impotency
Lemah urat saraf atau aduan atau kelemahan lain timbul daripada atau
20. berhubung kait dengan perhubungan seks / Nervous debility or pother
complaint of infirmity arising from or relating to sexual intercourse.
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1. Product name √ √ √ √
2. Dosage Form √ √ √ √
5. Indication √ √ √
6. Batch number √ √ √
7. Manufacturing date √ √
8. Expiry date √ √ √
Storage condition(s)
- state temperature used in
the stability study
10. - state “Protect from light and √ √ √
moisture” (If product is not
packed in moisture resistant
container)
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√ √
At least name At least name
Name and address of
of town/ city of town/ city
13. manufacturer √
and country and country
(Example: Manufacturer: XXXXX)
of of
manufacturer manufacturer
Additional statement
19. √ √ √
(if applicable)
Contraindication/ Precaution
20. √ √ √
(if any)
Security Label (Hologram)
# In products without an outer
carton, the security label shall be
21. √#
applied onto the immediate
label. The security label shall not
be applied onto the outer shrink
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b) All labels and package inserts must be in Bahasa Malaysia or English. Additional
translation to another language will be allowed.
c) Font size of the product name on the label, including alphabets and numbers, should be
equal in size.
d) For a product containing two (2) or more active ingredients, the font size of each active
ingredient highlighted on the inner/ outer carton must be of equal size and equal
prominence (Note: This does not refer to the product name, but the statement made on
the label). Justification for highlighting certain ingredients only on the product name/
label must be provided and is subject to approval by the Drug Evaluation Committee.
e) All the following requirements must be stated on the labels and package inserts:
• State the weight per dosage form
• State the quantity/ content of active ingredients per dosage form
• For products in liquid form (syrup), content of active ingredients shall be stated as
follows:
“Each ____ml (per dosage) product contains extract of the following ingredients”
Herb X = ___mg
Herb Y = ___mg
• Check and correct all spelling/ grammar and translations.
g) For products meant for traditional practitioner/ physician use, state its primary use by
the related traditional physician/ practitioner on the label.
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• For product with an indication “To relieve symptoms for…. (any illness)” or
“untuk mengurangkan tanda-tanda/ simptom….”:
- “Please consult your pharmacist/ doctor if symptoms persist/ worsen or Sila
merujuk kepada ahli farmasi/ doktor jika simptom berlarutan/ bertambah
teruk.”
• For product with indication ‘To reduce body weight’, state these statements,
(unless proven otherwise):
- “Balanced diet and regular exercise are essential.”
- “Safety on long term use has not been established.”
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• Unless otherwise supported, all natural products label shall state the following
general cautionary statement, EXCEPT for products with indication for men’s
health or product for children use only:
• For product with an indication to be taken/ used specially for women, refer to
2.6.3 Cautionary Statement for Products Specially Used in Women.
• “Keep out of reach of children & Jauhkan daripada capaian kanak-kanak” (in
both Bahasa Malaysia and English).
• State the storage condition according to the temperature stated in stability data.
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• Labels with the picture/ graphic of the herb/ animal should not have the
picture/ graphic of only one (1) particular active ingredient if the product
formulation contains more than one (1) ingredient. For multiple ingredients
exceeding two (2), the label should have picture/ graphics of at least two (2)
ingredients on the label.
• Any special/ specific name of active ingredient/ extract stated on the label
should be positioned away from name of the active ingredient in the product
formulation.
• Any picture of the founder placed on the label must be decent and should not
exceed 1/10th of the panel.
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PRECAUTION:
It is dangerous to place any camphor –
containing product into the nostril of
children. A small amount applied this way
may cause immediate collapse.
- Avoid contact with the eyes.
- Do not apply to wounds or damaged
skin.
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Special precaution shall be given to ingredients taken during pregnancy. The Authority
urges pregnant women to consult their medical/ traditional health care providers prior
to taking any natural products.
Unless otherwise supported, all natural products label shall state the following general
cautionary statement:
“Pregnancy and breastfeeding: Insufficient reliable data”
However, for products containing any ingredients as listed in the following lists, i.e. List
of Prohibited Ingredients in Pregnancy and List of Restricted Ingredients in Pregnancy,
the following cautionary statement shall be stated in the product label:
The following list has been compiled based on well documented information as an aid to
the industry to comply with the labelling requirement for products used during
pregnancy.
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Common/ Chinese
Latin Compendium Name Remarks
Name
A Acorus Calamus Calamus
Bupleurum chinense,
Bupleurum
Bupleurum falcatum
Chamaemelum nobile
Roman Chamomile When taken orally
(Anthemis nobilis)
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Common/ Chinese
Latin Compendium Name Remarks
Name
Croton tiglium Ba dou
Glycyrrhiza glabra/
Licorice
Glycyrrhiza uralensis
Juniper (Juniperus
Juniper Berries
communis)
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Common/ Chinese
Latin Compendium Name Remarks
Name
Nepeta cataria Catnip
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Common/ Chinese
Latin Compendium Name Remarks
Name
Semen Strychnos nux-vomica.
Ma Qian Zi
L.
Semen Prunus Persica Tao Ren
Note: The list is not to be exhaustive and will be reviewed from time to time.
Note: The list is not to be exhaustive and will be reviewed from time to time.
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2.6.4 Prohibited Visual/ Graphics/ Statement on Packaging Materials (Label, Box, Package Insert or Consumer Medication Information
Leaflet)
General requirements:
• The label should not contain any statement or visual presentation which, whether directly or by implication, is likely to mislead the consumer
about any product.
• The graphics printed on the outer and inner labels have to be standardized to avoid confusion to the customers.
Table 11:
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4. Clinical Trial results or any information on Example: Such statements are prohibited on labels.
clinical trial done on product
“Clinically Tested”
“Randomized Double-Blind Placebo
Control Clinical Study”
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12. Nutritional claims with analysis certificate Example: Prohibited on product label
attached
Calorie, Fat, Protein and others This is not a food supplement.
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17. Graphics incoherent with the indication Example: Prohibited on product label
- Noted indication is for constipation,
but graphics on label shows a slim-
looking lady which denotes indication
for weight loss
- Indication for urination but label
graphics contains picture of a water
hose.
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20. Statement on sugars in traditional Example: Allowable on product label provided the product
products contains no fructose, glucose, sucrose or other
- This product contains no added sugar
kind of sugars with a potential to affect diabetics
are not included in the formulation
Notes:
1. This list is not meant to be exhaustive and will be reviewed from time to time.
2. The Authority reserves the right to disallow any other words, phrases or graphics for product label, which in its opinion, is misleading, improper or
not factual.
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iv) Enteric-coated tablets : Does not disintegrate for 120 minutes in acid solution
but to disintegrate within 60 minutes in buffer solution
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2.7.4 Test for Uniformity of Weight (For Tablets and Capsules Only)
i) Tablet
- For tablet with average weight of 130mg or less: Not more than 2 tablets differ from
the average weight by more than 10% AND no tablets differ from the average weight
by more than 20%
- For tablet with average weight between 130-324mg: Not more than 2 tablets differ
from the average weight by more than 7.5% AND no tablet differs from the average
weights by more than 15%
- For tablets with average weight more than 324mg: Not more than 2 tablets differ
from the average weight by more than 5% AND no tablet differs from the average
weight by more than 10%
ii) Capsule
Individual weight of the capsule to be within the limit of 90 - 110% of the average
weight.
B. Herbal medicinal products containing, e.g. extracts and/or herbal drugs, with or
without excipients, where the method of processing (e.g., extraction) or, where
appropriate, in the case of herbal drugs, of pre-treatment reduces the levels of
organism to below those stated for this category
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C. Herbal medicinal products containing, e.g. extracts and/or herbal drugs, with or
without excipients, where it can be demonstrated that the method of processing
(e.g. extraction with low strength ethanol or water that is not at boiling or low
temperature concentration) or, in the case of herbal drugs, of pre-treatment, would
not reduce the level of organisms sufficiently to reach the criteria required under B.
D. Special Ph. Eur. provision for oral dosage forms containing raw materials of natural
(animal, vegetal or mineral) origin for which antimicrobial pretreatment is not
feasible and for which the competent authority accepts TAMC of the raw material
exceeding 103 CFU/g or CFU/mL.
Microbiological Quality Acceptance Criteria
TAMC NMT 2 x 104 CFU/g or CFU/mL
TYMC NMT 2 x 102 CFU/g or CFU/mL
Bile-tolerant gram-negative
NMT 1 x 102 CFU/g or CFU/mL
bacteria
Salmonella Absence (10 g or 10 mL)
Escherichia coli Absence (1 g or 1 mL)
Staphylococcus aureus Absence (1 g or 1 mL)
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TAMC TYMC
Route of
(CFU/g or (CFU/g or Specified micro-organisms
Administration
CFU/ml) CFU/ml)
Oromucosal use
Gingival use Absence of Staphylococcus aureus
(1 g or 1 ml)
Cutaneous use NMT 2 x 102 NMT 2 x 101
Nasal use Absence of Pseudomonas
aeruginosa (1 g or 1 ml)
Auricular use
Transdermal
Absence of Staphylococcus aureus
patches (limits for
(1 patch)
one patch
NMT 2 x 102 NMT 2 x 101
including adhesive
Absence of Pseudomonas
layer and backing
aeruginosa (1 patch)
layer)
Notes:
TAMC : Total Aerobic Microbial Count
TYMC : Total Yeasts & Molds Count
NMT : Not more than
[Reference: British Pharmacopoeia 2012]
b) CoA for one (1) batch of local or imported product to be submitted during product
evaluation with NPRA’s product reference number from QUEST 3+ system.
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c) CoA from multiple laboratories for different tests may be accepted, provided that the
same batch of the products is submitted to the laboratories.
Disintegration √ X
Uniformity of weight √ X
Microbial Contamination Test √ X
Heavy Metal Contamination √ X
Lovastatin (product containing √ √
Red Yeast Rice; Monascus
purpureus)
Microcystin (product containing √ √
Aphanizomenon flosaquae)
Assay (for all standardize √ √
compounds claimed on label)
v) For imported products, applicants are required to submit CoA from panel
laboratories. Import permit issued by the Centre of Product & Cosmetic Evaluation
is required to bring in samples for the purpose of laboratory testing. The applicant
should ensure that the import permit is endorsed by the enforcement officer at the
entry point.
Reference : Directive No. 8 Year 2020, BPFK/PPP/07/25 (8) Jld.4. Direktif Penerimaan
Keputusan Pengujian Pra-Pendaftaran Produk Semulajadi dari Makmal Swasta yang Telah
Diiktiraf oleh Bahagian Regulatori Farmasi Negara (NPRA) dan Makmal Kawalan Kualiti
Pengilang Tempatan.
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Certificate of Analysis
Company name/ Address :
Product Name :
Batch no. :
Dosage form :
Packaging :
Date of manufacture :
Date of expiry :
Test Parameter Specifications Results Method
Appearance/ Organoleptic:
Odour To describe the
Colour characteristic
Disintegration DRGD
Uniformity of weight
Assay:
(All standardize compounds To specify
claimed on label)
Microbial Contamination Test
TAMC, TYMC, specified DRGD
microorganism
Signature :
Name :
Designation : (At least by Quality Control Manager or equivalent)
Date of signature :
Note: The above parameter are only as an example, other tests may be required for specific product.
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General:
- The stability of the product is important to ensure the quality of natural product (traditional
and homeopathic medicines). This is to ensure that the product specifications are maintained
throughout the shelf life of product.
- Effective from 27 Nov 2014, a shelf life of two (2) years shall be approved for both local and
imported products. Proposed shelf life exceeding this period will have to be supported by
stability study data conducted in Malaysia under Zone IVb conditions (30±2 °C, 75±5%). For
further information, refer to circular: Bil (27).dlm BPFK/PPP/06/04Jld.7 Tempoh Hayat
Simpanan (Shelf-Life) Bagi Produk Tradisional dan Suplemen Kesihatan (27 November 2014).
- Should the applicant wish to declare the percentage or content of the isolated compound of a
standardized extract, the stability study should state the results of the assay of the isolated
compound conducted along the proposed shelf-life. If results of the assay are not provided,
the shelf life period approved will not be more than two (2) years.
Refer to the ASEAN Guidelines on Stability Study and Shelf Life of Traditional Medicines for
further details.
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Stability data as shown in the following example shall be submitted for evaluation.
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The tabulated list of parameters for each dosage form is presented as a guide for the following types
of tests to be included in a stability study.
Testing Parameters
Granules/ Particle
Microbial content
Resuspendability
Seize variation
characteristics
Disintegration
Water content
Adhesiveness
Organoleptic
Dissolution/
Hardness/
Viscosity
friability
Dosage Form Assay
pH
Oral powder √ √ √ √
Hard capsule √ √ √ √ √
Soft capsule √ √ √ √
Coated and
√ √ √ √ √ √
Uncoated Tablet
Coated and
√ √ √ √ √
Uncoated Pill/ Pellet
Suspension √ √ √ √ √ √ √
Solution √ √ √ √ √
Emulsion √ √ √ √ √
Semi Solid
Preparations
√ √ √ √ √
(Ointment/ Cream/
Gel/ Lotion/ Paste)
Plaster √ √ √ √
Granules √ √ √ √ √
Herbal Infusion
√ √ √ √
Bag/ Herbal Tea Bag
Pastilles √ √ √ √
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A foot patch that contains herbs with a health claim needs to be registered with the Authority.
a) Product Indication
- If there are other indications other than those mentioned above, the applicant is required to
submit clinical study data to support the proposed indication.
- The product may only contain active ingredient classified under the category of Natural
Products (Traditional).
- Pharmaceutical ingredients with dual function as an active ingredient and excipient, e.g.
Vitamin C can be used as excipient.
- However, the maximum allowable amount for the excipient in the traditional product has to
follow the pharmacopoeia limits established. If, for example, in the case where the amount of
Vitamin C is more than 0.1%, the product shall be classified as an OTC product. The product
will then have to fulfill the requirement for the registration of an OTC product.
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APPENDIX 7A
HOMEOPATHIC PRODUCTS
The following guidance notes are published as First Edition in October 2010 and the latest revision
is in October 2012.
This guidance notes serve as an additional reference on the requirements for the registration of
homeopathic products. Other aspects of registration requirements are covered in the Drug
Registration Guidance Document. Applicants for product registration are also requested to refer to
the latest edition on the Guidelines on Good Manufacturing Practice for Traditional Medicines and
Health Supplements.
2nd Revision
Acknowledgements
The National Pharmaceutical Regulatory Agency acknowledges its indebtedness to the Malaysia
Homeopathic Medical Council and the Traditional & Complementary Medicine Division, Ministry of
Health who provided comments and advice during the preparation of these guidelines.
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Active substance: Active substances are considered to be source materials processed by one or
a sequence of homeopathic manufacturing procedures listed in pharmacopoeias in official use
and other officially recognized documents (e.g. mother tinctures, dilutions or triturations).
Diluent: Substance used for the preparation of a stock/ starting material or the potentisation
process and which may also represent the substance of the dosage form. Liquid diluents usually
consist of purified water, aqueous solution, glycerol or ethanol of a suitable concentration or for
which there is an appropriate monograph. The commonest solid diluent is usually lactose
monohydrate.
Dosage form: a dosage form in homeopathy complies with any relevant specifications for that
dosage form for which an appropriate characterization exists in a pharmacopoeia in official use,
or in other officially recognized documents. The most commonly encountered homeopathic
dosage form, the globule (pillule or pellet), is a solid spherule which consists of lactose, sucrose
or any other suitable vehicle. Usually, preformed globules are impregnated with a dilution or
directly by a mother tincture. The homeopathic dosage form tablet is a solid preparation which
complies with any relevant characterization in the pharmacopoeia in official use (or in other
officially recognized documents) for tablets. Homeopathic medicines in tablet form are either
prepared by impregnation of preformed tablets or by compression of triturations with the
vehicle. The most commonly used liquid homeopathic medicines are either alcoholic solutions or
oral liquids.
Excipient: Substance needed for manufacturing a dosage form (used after potentisation) such
as wheat starch and magnesium stearate for tablets. It may also represent the substance of the
dosage form.
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Mother tincture (also called tincture): The initial homeopathic preparation made from
source material that can be further potentised (also called “liquid stock”), sometimes used as
homeopathic medicines, is regarded as the most concentrated form of a finished homeopathic
medicine. Mother tinctures are obtained classically by maceration or percolation (sometimes
also by digestion, infusion, decoction or fermentation) techniques from source materials
according to a procedure prescribed by a recognized homeopathic pharmacopoeia. Sometimes a
mother tincture corresponds to the first decimal dilution, “1D” or “1X” (10-1), mostly when dry
plant material is used as starting material.
Nosodes: Homeopathic medicines prepared from disease products from humans or animals;
from pathogenic organisms or their metabolic products; or from decomposition products of
animal organs.
Potency: The denominated degree of serial trituration or dilution and succession that is
reached for each homeopathic medicine. The degrees of dilution or potencies are normally
indicated by the letters D, DH or X for successive 1 to 10 (decimal) dilutions, the letters C, CH or
K or CK for successive 1 to 100 (centesimal) dilutions while Q or LM denote successive 1 to 50
000 (Hahnemannian quinquagintamillesimal) dilutions. Dilution by 1 to 10 denotes 1 part
processed with 9 parts of diluent (Hahnemannian decimal), dilution by 1 to 100, 1 part
processed with 99 parts (Hahnemannian or Korsakovian centesimal), and so on. The number
preceding the letters (e.g. D, C or LM) normally indicates the number of dilution steps employed
(Table 1).
Potentisation (also called dinamization): The combined process of serial dilution and
succussion or trituration at each step in the manufacture of homeopathic medicines from stocks.
(According to the tenet of homeopathy, potentisation represents the process by which the
activity of a homeopathic medicine is developed.)
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aFor 1:10 and 1:50 000 dilution ratios only the Hahnemannian method of manufacture (multi-
flask method) is used.
bFor1:100 dilution ratios a C potency is assumed to use the Hahnemannian method of
manufacture (multi-flask method) and can also be denoted as CH. When the Korsakovian
method of manufacture (single-flask method) is used, the potency is designated as CK or K.
Sarcodes: Homeopathic medicines made from healthy animal tissues or secretions. In Greek,
sarcode means fleshly.
Source material (raw material, starting material, mother substance): Source material is the
original raw material used for the production of homeopathic medicines. This material is
obtained from natural sources, e.g. of botanical, zoological, microbiological, mineral, chemical,
animal and human origin, or synthetic procedures. Source materials may undergo preliminary
treatment in order to be further processed.
Stock: Substances or preparations made from the source materials (e.g. by maceration,
succussion or trituration) used as starting points for the production of homeopathic medicines.
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Outline:
1. Introduction
2. Exemptions
4. Ingredients
5. Quality
7. Labelling
Attachments:
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1. INTRODUCTION
Regulation 7(1)(a) of the Control of Drugs and Cosmetics Regulations (CDCR) 1984 requires all
products to be registered with the Authority prior to being manufactured, sold, supplied,
imported or possessed for sale, unless the product is exempted under the specific provisions of
the regulations.
Under Regulation 2, CDCR 1984, “Homeopathic medicine” means any pharmaceutical dosage
form used in the homeopathic therapeutic in which diseases are treated by the use of minute
amounts of such substances which are capable of producing in healthy persons symptoms
similar to those of the disease being treated. This would include preparations that are to be
chewed, sucked, swallowed whole and applied topically.
Applicants are reminded that it is their responsibility to ensure that their products comply with
these regulations and also other related legislations namely:
(i) Sale of Drugs Act 1952
(ii) Dangerous Drugs Act 1952
(iii) Poisons Act 1952
(iv) Medicines (Advertisement & Sale) Act 1956
(v) Protection of Wildlife Act, 1972
2. EXEMPTION
All homeopathic products are registrable under the Control of Drugs and Cosmetics Regulations
1984. Exemption to this are:
i) single homeopathic potentised dilution;
ii) extemporaneous preparation for an individual patient by a registered/ licensed
homeopathic practitioner;
iii) All Mother Tinctures;
iv) Unmedicated sugar globules and tablets.
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The Authority will only register homeopathic products used for oral administration, nasal or
mouth sprays and external application only. The following dosage forms will not be considered
for registration.
- Sterile preparations such as eye-drops and injectables;
- Suppositories and vaginal tablets;
- Transdermal patch;
- Sublingual preparations;
- Preparation in combination with non-homeopathic active ingredient, such as vitamins,
minerals and herbs.
- Preparations containing substance listed in the Poison List (except Attachment 1).
4. INGREDIENTS
Homeopathic products are prepared from natural or synthetic sources that are referenced in
pharmacopoeia monographs or other recognized documents. Not considering imponderable,
the source materials for homeopathic medicines may consist of the following:
- Plant material such as: roots, stems, leaves, flowers, bark, pollen, lichen, moss, ferns and
algae;
- Microorganisms such as: fungi, and plant parasites;
- Animal materials such as: whole animals, animal organs, tissues, secretions;
- Minerals and chemicals.
For each medicinal ingredient, a copy of the monograph from the pharmacopoeia to which the
applicant attests must be provided. Also for homeopathic medicines with a specific claim, it
must be supported by the same level of evidence as for traditional products.
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5. QUALITY
A certificate of analysis (CoA) for raw material potentised dilution and finished product must be
provided as proof on the dilution used.
The requirements for Good Manufacturing Practice of the premises as outlined in the Guidelines
on Good Manufacturing Practice for Traditional Medicines and Health Supplements apply to all
homeopathic products.
7. LABELLING
The labelling of homeopathic products is the same as for traditional products in DRGD with the
following additional requirements:
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Indications allowed for homeopathic product is the same as those allowed for traditional
products in the DRGD.
Recommended use or indications for specific claims must be supported by evidence for the
multi ingredient homeopathic products.
No indication will be allowed for single homeopathic potentised dilution in the form of raw
material and finished homeopathic product. No indications are also allowed for mother
tinctures.
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ATTACHMENTS
Attachment 1:
No. Ingredient
1. Aconite
2. Amyl nitrite
3. Antimony
4. Apomorphine
5. Arsenic
6. Barium
7. Belladonna
8. Bismuth
9. Boric Acid
10. Caffeine
11. Cantharidin
12. Colchinine
13. Coniine
14. Creosote
15. Curare
16. Digitalis
17. Ephedra
18. Ergot
19. Gelsemium
20. Hydrogen Cyanide
21. Hyoscine
22. Iodine
23. Jaborandi
24. Lead Acetate
25. Lobelia Inflata
26. Mercury
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No. Ingredient
27. Morphine
28. Nicotine
29. Nux Vomica
30. Phosphorus
31. Physostigmine
32. Picric Acid
33. Piper Methysticum (Kava-kava)
34. Quebracho
35. Quinine
36. Radium
37. Rauwolfia
38. Sabadilla
39. Santonin
40. Sparteine
41. Stavesacre
42. Strophanthus
43. Thallium
44. Veratrum
45. Vinca
46. Yohimba
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Attachment 2:
Negative List
NO. SUBSTANCES
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Attachment 3:
NO. COUNTRIES
1. Germany (GHP)
2. Britain
3. France (Phf)
4. USA (HPUS)
5. Pakistan
6. India (HPI)
7. European Pharmacopoeia
Attachment 4:
Notes:
These lists are not exhaustive and will be amended from time to time as and when the need arises
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REFERENCES
b) Homeopathic Products:
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APPENDIX 7B
Guidance documents are meant to provide assistance to industry and healthcare professionals
on how to comply with governing statutes and regulations. They also serve to provide guidance
to National Pharmaceutical Regulatory Agency (NPRA) officers, thereby ensuring transparency,
fairness, and consistency in assessment of quality, safety and efficacy of a product.
Guidance documents are tools to assist stakeholders and do not have the force of law and, as
such, allow for flexibility in approach. Alternate approaches to the principles and practices
described in this document will be acceptable if they support an equivalent outcome resulting in
high quality of natural products.
This document should be read in conjunction with the current laws and regulations, and with
other relevant legislation as outlined in the current guidance document (Drug Registration
Guidance Document, DRGD), which include ASEAN Common Technical Dossier/ Requirements
(ACTD/ ACTR), Malaysian Guideline for Application of Clinical Trial Import Licence and Clinical
Trial Exemption, Malaysian Guideline for Good Clinical Practice (GCP), Pharmaceutical
Inspection Co-Operation Scheme (PIC/S) Guide to Good Manufacturing Practice for Medicinal
Products, as well as relevant sections of any other applicable guidance documents.
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ACKNOWLEDGEMENTS
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1.0 INTRODUCTION
Natural products with therapeutic claims are required to be registered with the Drug Control
Authority (DCA) before they can be marketed in Malaysia. This guideline aims to provide the
requirements to support the quality, safety and efficacy of the natural product with therapeutic
claims.
All therapeutic claims made for natural products should have adequate evidence to support all
indications, and all claims made must be demonstrated to be true, valid and not misleading. The
quality, safety and efficacy of the product should be proven, and the relevant data should be
submitted to the DCA.
This guideline aims to provide guidance on making unbiased and truthful claims, supported by
adequate evidence in order to protect the consumers from misleading claims.
3.0 DEFINITION
The efficacy of a product and its ingredient(s) shall be based on the totality of the substantiation
evidence provided including human study, non-clinical and empirical or historical data, as well
as other documented evidence, where applicable on the end product. The study must show a
consistent association between the active ingredient/herbal ingredient(s) and the therapeutic
effect claimed.
The products with therapeutic claims must be manufactured in a Good Manufacturing Practice
(GMP) compliant premises which follows the Pharmaceutical Inspection Co-Operation Scheme-
Guide to Good Manufacturing Practice for Medicinal Products (PIC/S) guideline.
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Non-clinical safety studies for therapeutic claims must be conducted in a facility which complies
to Organisation for Economic Cooperation and Development (OECD) Good Laboratory Practice
(GLP) requirement as mentioned in circular (40) dlm.BPFK/PPP/07/25 Bil. 9 Tahun 2016
Keperluan Good Laboratory Practice (GLP) bagi Kajian Keselamatan Bukan Klinikal Untuk
Tujuan Pendaftaran Produk New Chemical Entity (NCE), Biologik dan Produk Herba Dengan
Tuntutan Terapeutik Tinggi.
The Authority may request for further information or specify conditions not described in this
document that is deemed necessary to ensure the quality, safety and efficacy of the product.
Primary purpose: To provide a general introduction to the product. The Administrative Data is
where required specific documentation in detail is put together such as application forms, label,
package insert etc. Product Information contains necessary information which includes
prescribed information, mode of action, side effects etc.
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Primary purpose: The product and its ingredient(s) is determined by the quality of the starting
material, development, in-process controls and process validation, and by specifications applied
to them throughout development and manufacture.
4.2.1.2 The botanical identity such as the scientific name (genus, species, sub-
species/ variety, author and family) - of each medicinal plant should be
verified by qualified experts from government agencies or other qualified
agencies.
4.2.1.4 The botanical source, plant part used and its state (e.g.: whole, reduced,
powdered, fresh, dry) should be defined.
4.2.1.5 Requested tests are listed as below, while specifications should be supported
by established monographs/ pharmacopeia:
Appearance/Organoleptic characteristics
Qualitative Test:
Identification/
Macroscopic/Microscopic/
Chemical fingerprint
Loss on drying / Water content
Purity tests
• Foreign Matter
• Total Ash Content
• Acid insoluble ash*
Extractive values*
• Water Soluble
• Ethanol Soluble
Microbial Contamination Test: -
• Total Aerobic Microbial Count
(TAMC)
• Total Yeast and Mold Count (TYMC)
• Bile tolerant gram-negative bacteria
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• Salmonella
• Escherichia coli
• Staphylococcus aureus
• Pseudomonas aeruginosa
Heavy metal limits: -
• Arsenic
• Mercury
• Lead
• Cadmium
Other Tests
(any required testing)
* These tests might not apply to all medicinal plant/ingredient and must be justified by
the applicant.
4.2.2.1 To state the botanical source and type of preparation (e.g.: dry or liquid
extract). Ratio of herbal substance to the genuine herbal preparation must
be stated.
4.2.2.3 Methods used for both identification and quantitative analysis need to be
validated
4.2.2.4 Applicants shall refer to Checklist for Protocol Analysis and Analytical
Method Validation available in NPRA website for details of the test methods.
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Appearance/ Organoleptic
characteristics
Qualitative Test:
Identification
Quantitative Assay
Impurities
• Related/ degraded substance
• Pesticide residues
• Solvent residues
Adventitious Toxins
• Aflatoxins
Other Tests
(any required testing)
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(i) Introduction
(ii) Specificity
(iii) Repeatability
(iv) Linearity
(v) Range
(vi) Accuracy
(vii) Precision
(viii) Precision (intermediate precision/ruggedness)
(ix) System suitability testing
(x) Detection Limit (if applicable)
(xi) Quantitation Limit (if applicable)
(xii) Conclusions
Applicant shall refer to Checklist for Protocol Analysis and Analytical Method Validation
available in NPRA website for details of the data to be submitted.
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In vitro studies as well as animal studies (in vivo) are intended to generate the non-clinical data.
Data from animal study should be derived from animal model which can represent human
condition related to claim. The methodology should be an acceptable and valid procedure to
measure the parameter. Data from animal studies are important to give the preliminary efficacy
and safety data prior to the conduct of human study. When data from animal (in vivo) and in
vitro studies are submitted as substantiation of claims, an explanation on its relevance to
humans should be included.
Requirements:
4.3.2 Relevant scientific literature of related active ingredient(s) of product can be considered
as an additional supporting document.
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Primary purpose: The clinical section addresses the requirements for pharmacokinetic,
pharmacodynamic, efficacy and safety studies.
Scientific data should be derived from intervention human studies, that are well designed in
accordance with recognized scientific principles, with statistically and clinically significant
outcomes addressing the specific traditional claim. The acceptable principles for human studies
can be referred to internationally accepted guidelines, for example, ICH-GCP Guidelines.
Requirements:
4.4.1 Should describe and explain the overall approach to the clinical development of a
product.
4.4.2 Assess the quality of the design and performance of the studies, and to include a
statement regarding GCP compliance.
4.4.6 Relevant scientific literature of related active ingredient(s) of product can be considered
as an additional supporting document. Any deviation should be discussed and justified.
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Where there are differences between the ingredient and reported therapeutic benefit, a
justification will be required in your evidence package to address the discrepancy.
Non-clinical studies, cellular or pharmacological studies, these alone are not considered
sufficient evidence to support a scientific indication. However, such studies can be used to
provide secondary support to human data.
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5.0 GLOSSARY
Active ingredient - The therapeutically active component in a medicine's final formulation that
is responsible for its physiological action
Clinical Trial/ Study - Any investigation in human subjects intended to discover or verify
the clinical, pharmacological and/or other pharmacodynamic effects of an investigational
product(s) and/or to identify any adverse reactions to an investigational product(s) and/or to
study absorption, distribution, metabolism, and excretion of an investigational product(s) with
the object of ascertaining its safety and/or efficacy. The terms clinical trial and clinical study are
synonymous.
Product - a drug in a dosage unit or otherwise, for use wholly or mainly by being administered
to one or more human beings or animals for a medicinal purpose; or a drug to be used as an
ingredient of a preparation for a medicinal purpose.
Scientific evidence – a quantifiable data and usually includes reports of clinical trials in
humans, human epidemiological studies, animal studies and other cellular or pharmacological
studies. Due to the quantifiable nature of scientific evidence, scientific indications can imply
clinical efficacy where the indication is supported by such data.
6.0 REFERENCES
1. Final concept paper on the implementation of different levels of scientific evidence in core-
data for herbal drugs. EMEA/CPMP/ HMPWP/1156/03
2. Guidelines on the evidence required to support indications for listed complementary
medicines, Therapeutic Good Administration (TGA), Version 3.0, January 2019.
3. General guidelines for methodologies on research and evaluation of traditional medicine,
WHO/EDM/TRM/2000.1
4. Malaysian Guideline for Application of Clinical Trial Import Licence and Clinical Trial
Exemption (Appendix D5: Pharmaceutical Data Format for Herbal/ Natural Products in
Clinical Trials),
5. Drug Registration Guidance Document (DRGD) – available at website www.npra.gov.my
6. ASEAN Common Technical Dossier/ Requirements (ACTD/ ACTR)
7. Malaysian Standard Guideline on Good Agricultural Practice (GAP) – Part 8: Herbs MS:
1784-8:2009
8. Annex VII ASEAN guidelines on claims and claims substantiation for traditional medicines
(Version 2.0)
9. Guideline on specifications: test procedures and acceptance criteria for herbal substances,
herbal preparations and herbal medicinal products/traditional herbal medicinal products.
EMA/HMPC/162241/2005 Rev. 2
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APPENDIX 8
SUPPLEMENTARY DOCUMENTATION
(PARTICULARS OF PRODUCT OWNER AND MANUFACTURER)
Product Owner
• All applications for registration shall be accompanied with Letter of Authorization from
product owner.
(Not applicable if the Product Registration Holder is Product Owner).
• Letters of Authorization (LOA) shall be valid and current at the time of submission.
• The LOA shall be on the product owner’s original letterhead and be dated and signed by
the Managing Director, President, CEO or an equivalent person who has overall
responsibility for the company or organization.
• The LOA shall state the name of the product concerned and also the name and actual
plant address of the manufacturer(s) involved in the manufacture of the product.
• Applicable for product which is contract manufactured by a manufacturer who is not the
product owner.
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• The letter of acceptance from the manufacturer shall be on the manufacturer’s original
letterhead and be dated and signed by the Managing Director, President, CEO or an
equivalent person who has overall responsibility for the company or organization.
• The letter of acceptance shall state the name of the product concerned and also the
name and actual plant address of the manufacturer(s) involved in the manufacture of
the product.
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APPENDIX 9
FEES
Outline:
Appendix 9: Fees
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Validity Period
No. Type 1 year 2 years
(RM) (RM)
Renewal
4. 48 95
(Digital Certificate only – using
existing MSC USB Token)
Appendix 9: Fees
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Every application for registration shall be submitted with the appropriate processing and
analysis fees, as specified below (effective 1st January 2007):
Pharmaceutical
Appendix 9: Fees
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Processing Fees
License Timeline Validity
(RM)
4 working days upon receipt
1. Manufacturer’s 1,000.00 1 year
of complete application
4 working days upon receipt
2. Import 500.00 1 year
of complete application
4 working days upon receipt
3. Wholesaler’s 500.00 1 year
of complete application
Processing Fees
Types of Amendment
Pharmaceutical (RM) Natural Product (RM)
Appendix 9: Fees
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Processing Fees
3. Additional Indication
1000.00 Not applicable
“The Director of Pharmaceutical Services may issue such certification on any matter relating to
any product where such certification is required by any country importing such a product.”
Appendix 9: Fees
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Appendix 9: Fees
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APPENDIX 10
DATA EXCLUSIVITY
1. INTRODUCTION
Data exclusivity refers to protection of undisclosed, unpublished and non-public domain
pharmaceutical test data, the origination of which involves considerable effort, submitted as
required to the Director of Pharmaceutical Services for the purpose of scientific assessment in
consideration of the:
a) Quality, safety and efficacy of any new drug product containing a New Chemical Entity
b) Safety and efficacy for a second indication of a registered drug product as a condition for
registration of any new drug product containing a New Chemical Entity; or approval for a
Second Indication of a registered drug product.
2. HOW TO APPLY
An application for Data Exclusivity (DE) can be made via a Letter of Intent (LOI) in conjunction
with the:
a) Application for registration of a new drug product containing a New Chemical Entity; or
b) Application for a Second Indication of a registered drug product.
The LOI shall be addressed and submitted manually to the Director of NPRA.
The application must comply with all terms and conditions stated in the directive Arahan Bagi
Melaksanakan Data Eksklusiviti Di Malaysia, Bilangan 2 Year 2011.
The following details are extracted from the Directive on Data Exclusivity (DE) issued by the
Director of Pharmaceutical Services under Regulation 29, Control of Drugs and Cosmetics
Regulations 1984, Bil (11) dlm BPFK/PPP/01/03 Jld 1, 28 February 2011.
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Applicable to:
i) New drug product containing a new chemical entity; and
ii) Second indication of a registered drug product.
New drug product containing any new chemical entity means a product that contains an 1active
moiety that has not been registered in accordance with the provisions of the CDCR 1984.
1An active moiety is defined as the molecule or ion, excluding those appended portions of the
molecule that cause the drug to be an ester, salt (including a salt with hydrogen or coordination
bonds) or other non-covalent derivative (such as a complex, chelate or clathrate) of the
molecule, responsible for the physiological or pharmacological action of the drug substance.
Second indication for a registered drug product means a single or cluster of therapeutic
indications applied subsequent to the first indication(s) approved at the point of registration of
the product. The application for approval of the second indication contains reports of new
clinical investigations other than bioavailability studies.
Any person may apply for Data Exclusivity. Such application shall be made upon submission of
documents to the Director of Pharmaceutical Services for the:
a) Registration of a new drug product containing a new chemical entity; or
b) Approval for second indication of a registered drug product.
An application for Data Exclusivity shall only be considered if the application in Malaysia for:
a) New drug product containing a new chemical entity is made within eighteen (18)
months from the date the product is first registered or granted marketing
authorization; AND
Granted Data Exclusivity/ Test Data Protection in the country of origin or in any
country, recognized and deem appropriate by the Director of Pharmaceutical
Services.
b) Second indication of a registered drug product is made within twelve (12) months
from the date the second indication is approved; AND
Granted Data Exclusivity/ Test Data Protection in the country of origin or in any
country, recognized and deemed appropriate by the Director of Pharmaceutical
Services.
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b) The applicant for a second indication of a registered drug product shall provide to
the Director of Pharmaceutical Services, the reports of new clinical investigations
other than bioavailability studies, conducted in relation to the second indication and
the origination of which has involved considerable effort.
The Director of Pharmaceutical Services shall decide on whether the application will be granted
the Data Exclusivity. The period of the Data Exclusivity granted shall be made on a case to case
basis.
b) For a second indication of a registered drug product, the period of Data Exclusivity
shall be calculated from the date the second indication is first approved AND granted
Data Exclusivity/ Test Data Protection in the country of origin or in any country
recognized and deemed appropriate by the Director of Pharmaceutical Services.
For a registered new drug product containing a new chemical entity, registration of any other
drug product where the active moiety is in all respect the same as the active moiety in the
registered drug product which has been granted Data Exclusivity in Malaysia can be considered
if:
a) The applicant provides undisclosed, unpublished and non-public domain
pharmaceutical test data, the origination of which involves a considerable effort to
demonstrate the quality, safety and efficacy if the drug product submitted for
registration; OR
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b) The applicant has obtained consent in writing for right of reference or use of the test
data from a person authorised by the owner of the registered new drug product
containing a new chemical entity.
7. APPEAL
Any person aggrieved by the decisions of the Director of Pharmaceutical Services may make a
written appeal to the Minister within fourteen (14) days from the date the decision is made
known to him and any decision of the Minister made on an appeal shall be final.
A person making an appeal may submit any supporting data or documents to the Director of
Pharmaceutical Services not later than:
a) 120 days for application of new drug products containing any new chemical entity;
or
b) 90 days for the application for second indication of a registered drug product.
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APPENDIX 11
CONTENT:
1. INTRODUCTION
2. DEFINITION
2.1 Definition of Active Pharmaceutical Ingredient (API)
2.2 Definition of main API manufacturer
3. SCOPE
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1. INTRODUCTION
1.1. A significant part of the quality of a finished product is dependent on the quality of the
Active Pharmaceutical Ingredient (API) used for its formulation. Thus, a proper system of
qualification of suppliers is necessary to ensure a constant sourcing of API of appropriate
quality and to safeguard the public health interests. This will be done through
standardized quality assessment and inspection procedures.
1.2. The National Pharmaceutical Regulatory Agency (NPRA) under the purview of the
Ministry of Health Malaysia has introduced mandatory control of API as part of the
requirements in the product registration application.
1.3. The implementation began with voluntary submission for New Drug Product in April 2011
and followed by:
Reference:
i) Bil (12) dlm BPFK/PPP/01/03 Jld1 dated 17 March 2011
ii) BPFK/PPP/07/25 (7) dated 16 January 2014
iii) Bil (11) dlm BPFK/PPP/01/03 Jld3 dated 27 June 2014
1.4 The procedure for control of API established by the NPRA is based on the following
principles:
• A general understanding of the production and quality control activities of the
manufacturer;
• Assessment of API data and information, including changes and variations, submitted by
the product registration holder (PRH)/API Manufacturer. These data should include the
manufacturing process, material specifications and test data and results;
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1.5. This document is intended to provide guidance regarding the requirements to be included
for API in the quality part of the product dossier (Part II-S).
2. DEFINITION
Main API Manufacturer refers to the manufacturer involved in the final API manufacturing
process and responsible for batch release.
3. SCOPE
3.1. This guideline encompasses the final API of new products for registration and
current/existing registered products. This is applicable to all pharmaceutical products
(excluding biologic products, traditional products, veterinary products, health supplement
products and products for export only (FEO)) both locally manufactured and imported.
3.2. For biological active substances, refer to the relevant guidelines available for Biologics.
3.3. Premixing of API is part of the product manufacturing process; therefore, information on
premixed API should be submitted under Part II-P. Submission for Part II-S solely includes
information on API only.
3.4. Separate registration of the API is not a requirement for the purpose of product
registration. However, the required technical documentation pertaining to each API
should be submitted with the new product registration application.
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4.1.1 Document required for each option of API Information submission are summarized in
table 1:
Table 1:
Summary of Document Required for API Information Submission:
• Part II-S (Open Part) via the online system (as deemed
Option 2 appropriate)
(CEP) • CEP with written statement
• See Section 6 for details
4.1.2 Separate API information must be provided for each API for:
• Finished product containing more than one (1) API
• API from different manufacturing site
• API from different synthesis route
4.1.3 The NPRA reserves the right to request for any additional information about the API
when deemed appropriate.
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4.2.1 All Part II-S information should be submitted through the online QUEST system [except
for Closed part of Drug Master File (DMF) for DMF option]. Refer to ‘Help Button’ in
QUEST for assistance during online submission.
4.2.2 Separate Part II-S information (in the same product registration application form) shall
be submitted when:
• A finished product contains more than one (1) API
• An API is manufactured from more than one (1) manufacturing site
• An API is manufactured using more than one (1) synthesis route
4.2.3 Select the correct API manufacturer (with the exact name & address) from QUEST
database and ascertain your selection. Changes to the name or address of an API
manufacturer are NOT possible once a saved form is created.
4.2.4 There are three options for Part II-S information submission. Refer to No.5 of this
document.
4.2.5 Change of submission option or change or addition of API manufacturer is NOT allowed
once the screening approval is obtained.
Fees are not required as the API application is already incorporated in the application for
product registration.
5.1.1 The Drug Master File (DMF) is a document that may be used to provide confidential
detailed information about facilities, processes, or articles used in the manufacturing,
processing, packaging, and storing of one or more API.
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5.1.2 DMF is generally created to allow an authorized party other than the holder of the DMF
to refer the DMF without disclosing the contents of the file to any other party.
5.1.3 The ICH M4Q Technical Guideline and ASEAN Common Technical Requirements
(ACTR)/ ACTD provide details on the information to be included in the API sections of
an application dossier.
5.1.4 The DMF is divided into two parts, namely the Open (or PRH’s) part and the Closed (or
restricted) part.
5.1.5 The documents required for an online application making a reference to a DMF are as
follows:
S1 General Information
1.1 Nomenclature
1.2 Structure
1.3 General Properties
S2 Manufacture
2.1 Manufacture(s)/Site of Manufacture
*ALL manufacturers involved in manufacturing process of API,
including intermediate manufacturers and milling/
micronisation sites.
S3 Characterisation
3.1 Elucidation of Structure and other Characteristics
3.2 Impurities
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S7 Stability
Refer No. 6 of this document
5.1.7 The PRH is responsible to ensure that the complete DMF (i.e. both the Open part and the
Closed part) is submitted to NPRA via electronic copy (e.g. CD/DVD/e-DMF) together
with a Letter of Access (LOA):
The Letter of Access from API Manufacturer/ holder of the DMF authorizes the NPRA to
refer to the DMF, in support of the application for a finished product. Thus, the Letter of
Access must state the following:
• The name of the finished product (product name, dosage form and product strength)
to be registered
• DMF version number (Open part & Closed part)
• Contact person for DMF correspondence (name and email address)
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5.1.8 The information contained in the closed part of the DMF will be regarded as confidential
and will only be evaluated in support of the applications mentioned in the Letter of
Access. The confidential information will not be disclosed to any third party without a
written authorization from the API Manufacturer.
5.1.9 A BPFK/NPRA DMF number will be assigned to the DMF during product registration
evaluation. For future correspondences, the PRH and the API Manufacturer should make
a reference to the BPFK/NPRA DMF number. The NPRA will directly contact API
Manufacturer for any correspondence pertaining to API information in closed part.
5.1.10 API Manufacturer is responsible to maintain and update the DMF. The PRH should file a
variation once they are notified with the changes to the DMF.
• Any change or addition, including a change in authorization related to specific PRH,
shall be submitted to the NPRA in duplicate and adequately cross-referenced to
previous submission(s). The reference should include the date(s), volume(s),
section(s), and/or page number(s) affected.
• Should any change to a DMF is necessary, the API Manufacturer shall notify each
affected PRH who has referenced the DMF of the pertinent change. Such notice
should be provided well before making the change in order to permit the PRH to
supplement or amend any affected application(s) as needed.
5.2.2 The CEP is a document that used to demonstrate the purity of a given API produced by a
given manufacturer is suitably controlled by the relevant monograph(s) of the European
Pharmacopoeia. By demonstrating grant a CEP for given API, the suppliers of the API can
prove such suitability to their pharmaceutical industry clients and the NPRA.
5.2.3 The PRH should submit a copy of the most current CEP including all annexes, together
with the following:
• A written assurance that no significant changes in the manufacturing methods or
processing have taken place following the granting of the certificate or its last
revision and;
• A declaration from the API Manufacturer that the PRH and the NPRA shall be
notified of any future change in the API specifications or in the manufacturing
process that will likely affect the product’s quality or safety.
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Note: All such written statements must state the name of the finished product (product
name, dosage form and product strength) to be registered and the PRH shall responsible
for finished product registration.
5.2.4 The PRH should provide the following information in the online submission:
S1 General Information
1.1 Nomenclature
1.2 Structure
1.3 General Properties
Discussions on any additional applicable physicochemical and other
relevant API properties that are not controlled by the CEP and Ph.Eur.
monograph, e.g. solubilities and polymorphs as per guidance in this
section
S2 Manufacture
2.1 Manufacture(s)/Site of Manufacture
*ALL manufacturers involved in manufacturing process of API, including
intermediate manufacturers and milling/micronisation sites.
2.5 Process Validation and/or Evaluation
In the case of sterile API, data on the sterilization process of the API,
including validation data, should be included in the product dossier (S 2.5)
S3 Characterisation
3.1 Elucidation of Structure and other Characteristics
Studies to identify polymorphs (exception: where the CEP specifies a
polymorphic form) and particle size distribution, where applicable, as per
guidance in this section
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Note: Specification should include all tests and limits of the CEP and
Ph.Eur. monograph and any additional tests and acceptance criteria that
were not controlled in the CEP and Ph.Eur. monograph, such as
polymorphs, impurities and/or particle size distribution.
4.2 Analytical Procedures*
4.3 Validation of Analytical Procedures*
4.4 Batch Analysis-minimum three batches
4.4.1 Certificate of Analysis (COA)-minimum two batches.
4.5 Justification of Specification
*for any methods used by the API manufacturer and in addition to those in the
CEP and Ph.Eur. monograph.
S7 Stability
Exception: where the CEP specifies a re-test period that is the same as or of
longer duration, and storage conditions which are the same or higher
temperature and humidity as proposed by the PRH.
5.2.6 The NPRA reserves the right to request for any additional information about the API
when deemed appropriate.
5.2.7 The PRH is responsible to submit the latest CEP updates, with annexes, as soon as it is
available from the API Manufacturer.
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5.3.1 Information on the API sections (ACTD Part II-S: S1-S7), including full details of
chemistry, manufacturing process, quality controls during manufacturing and process
validation for the API, shall be submitted in the product dossier.
5.3.2 The ICH M4Q Technical Guideline and ASEAN Common Technical Requirements
(ACTR)/ ACTD provide details on the information to be included in the online
submission:
S1 General Information
1.1 Nomenclature
1.2 Structure
1.3 General Properties
S2 Manufacture
2.1 Manufacture(s)/ Site of Manufacture
*ALL manufacturers involved in manufacturing process of API, including
intermediate manufacturers and milling/micronisation sites.
2.2 Description of Manufacturing Process and Process Controls
2.3 Control of Materials
2.4 Controls of Critical Steps and Intermediates
2.5 Process Validation and/or Evaluation
2.6 Manufacturing Process Development
S3 Characterisation
3.1 Elucidation of Structure and other Characteristics
3.2 Impurities
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S7 Stability
Refer No. 6 of this document
6.1.1 Current stability test data for an API shall be provided, for at least three (3) primary
batches. These data shall include:
• The type of stability study and stability protocol
• API name, API manufacturer, packaging particular
• Batch details (e.g., batch number, date of manufacture, batch size)
• The general test methodology (e.g., duration of study, storage conditions of
temperature and humidity, list of relevant testing, testing frequency, etc.);
• Proposed retest period or shelf-life;
• Proposed storage condition;
A storage temperature must be specified, e.g.:
- Do not store above 25 °C
- Do not store above 30 °C
- Store in a refrigerator (2 °C to 8 °C)
- Store in freezer
Other special storage condition, e.g.:
- Protect from light
- Protect from moisture
• The analytical test methods (e.g., assay method of quantitation, determination of
degradation products, moisture etc.) with reference;
• Validation of test methods;
• Specification;
• Results of tests; and,
• Conclusions.
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6.1.2 In circumstances where an API retest period has not been established and complete
long-term stability data is not available at the time of submission, the minimum stability
data required are as follows:
• At least twelve (12) months of long-term data and six (6) months of accelerated
data on at least three (3) primary batches of the API;
• The batches should be at least pilot scale-sized and manufactured by a method that
simulates the final commercial process.
* In view of this, the re-test date may be extended beyond the end of long-term
studies, which can be extrapolated not more than twelve (12) months covered by
the long term data.
A letter of commitment (to provide complete long-term stability data when study is
completed/when requested) shall be submitted.
6.1.3 Where the API is sourced from multiple sites or from different route of synthesis,
stability data from each source shall be provided.
6.1.4 The NPRA may request for additional stability data if deemed necessary for the
evaluation of the application.
6.1.5 Stability data is not required where the CEP specifies a re-test period and storage
condition that is the same as stated in the online submission.
6.2.1 The GMP compliance evidence accepted for main API manufacturer (refer definition at
No.2 of this document) are:
a) GMP Certificate or GMP Inspection Report issued by:
i. Pharmaceutical Inspection Co-Operation Scheme (PIC/S) Participating
Authorities or;
ii. World Health Organization (WHO) or;
iii. Drug Regulatory Authority
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6.2.3 When an atypical API (e.g. excipient, food additive or cosmetic ingredient) is used as an
active ingredient in pharmaceutical products, the GMP compliance evidence accepted
are:
a) GMP Certificate or GMP Inspection Report issued by:
i. PIC/S Participating Authorities or;
ii. World Health Organization (WHO) or;
iii. Drug Regulatory Authority or;
6.2.4 NPRA reserves the right to determine the acceptability of any GMP compliance evidence.
6.3.1 Atypical API is excipient, food additive or cosmetic ingredient used as an active
ingredient in pharmaceutical products. These substances are known to have lower risk
and widely used outside of the pharmaceutical industry, which have meet recognized
quality standards, as atypical API for the purpose of this guidance.
6.3.2 A list of Atypical API and its regulatory requirement are outlined in Guidance Notes for
API Information (refer 8.1). This list is not meant to be exhaustive and will be reviewed
by NPRA from time to time. Should a risk to health be identified, NPRA shall take
appropriate compliance and enforcement action proportional to the risk.
6.3.3 It is important to note that each lot or batch of the atypical API shall be, prior to its use in
manufacturing process of the finished pharmaceutical products, be tested against and
comply with the specifications established by the finished product manufacturer for that
atypical API.
6.3.4 Finished product manufacturer (and PRH) are responsible for ensuring products in
domestic commerce are safe, suitable and of purported quality.
6.4 New Product Registration Application Using Same Source of Approved API
6.4.1 Approved API refers to an API (in a registered product) regulated and approved
following the implementation of Directive on Regulatory Control of API in Malaysia
dated 17 Mar 2011.
6.4.2 Same Source of Approved API means the new product registration application is using
the same API, which is manufactured by the same API Manufacturer, with the same API
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synthetic route as the approved API. This new submission shall be made by the same
PRH through the same Part II-S submission option.
6.4.3 The PRH should keep the content of their dossier updated with respect to the actual
synthesis/manufacturing process. The quality control methods should be kept in line
with the current regulatory and scientific requirements. Where there are changes
affecting an approved API in a registered product that requires variation application, the
variation application shall be made and approved for every affected registered product
prior to submission of a new product registration containing an Approved API.
6.4.4 The PRH is required to declare that the quality of the API, with respect to the methods of
preparation and control, has been regularly updated by variation procedure to take
account of technical and scientific progress. The PRH shall also declare that no changes
have been made to the API other than those approved by the NPRA.
6.4.5 In cases where some minor textual changes have been introduced, and without affecting
the major content of the dossier, the PRH shall be able to provide a summary of changes
made to previously approved dossier compared to current dossier. NPRA will review the
changes introduced and may consider to accept or reject the dossier as an Approved API.
6.4.6 Template for Declaration Letter for An Approved API in New Product Registration
Application is available on NPRA website.
6.5.1 A Drug Master File (DMF) is a submission used to provide confidential detailed
information about facilities, processes, or articles used in the manufacturing, processing,
packaging, and storing of an API, in support of a product registration application.
6.5.2 A complete DMF (containing both closed part & open part information) shall be
submitted by DMF Holder to NPRA in an electronic copy (CD/DVD/USB/e-DMF) with a
Letter of Access (LoA) permitting NPRA and local product registration holder (PRH) to
reference the DMF.
6.5.3 DMF holders should send a copy of complete DMF in CD/DVD/USB together with a LoA
directly to Head of New Drug Product Section / Generic Medicine Section, Centre of
Product and Cosmetic Evaluation, NPRA.
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f. A declaration that the local PRH and NPRA shall be notified of any changes in the
API specification or in the manufacturing process that will likely affect the
product’s quality or safety
g. Name and email address of person(s) to be contacted for additional information
h. Signature of authorizing official
6.5.5 The DMF holder should send a copy of the LoA and the open part of DMF to the
dedicated PRH, who is authorized to incorporate by reference the API information
contained in the DMF. The PRH is required to upload the API information (open part) on
QUEST3+ during registration application.
6.5.6 DMFs received will be kept safe at NPRA. The information in a DMF will only be
reviewed when a PRH submit a product registration application referencing to the DMF
(with a LoA). If there are deficiencies found in the confidential information provided in a
DMF, NPRA will send a letter describing the deficiencies to the DMF holder. At the same
time, NPRA will notify the PRH that additional closed part information is needed in the
supporting DMF. Deficiencies related to open part of the DMF will be requested via
QUEST3+.
6.5.7 In situations where the DMF holder has previously submitted a complete DMF to NPRA
and wished to reference the same version of DMF with another PRH, DMF holder is
only required to supplement with a LoA. The new LoA shall be sent to NPRA via email to
[email protected]. Information below shall be provided as reference:
a. Indication for submission: new product application/ renewal/ variation
b. Name of Product
c. Name of API
d. Name of PRH
e. Name of DMF Holder
f. Name and Address of API Manufacturer
g. DMF Version Number (shall be the same as previously submitted and shall not
more than 3 years from last submission)
6.5.8 In situations where the DMF holder has previously submitted a complete DMF to NPRA
and wished to reference an updated version of the DMF** with another PRH, DMF
holders should provide information in addition to above:
a. Declaration of no change; or
b. Table of comparison to describe changes / differences between the previous and
current version
**newer version of the DMF (with minor changes) for the same API salt/ form/
grade/ standard with the same API manufacturing process and synthesis route,
at the same manufacturing site
6.5.9 The list of DMF received by NPRA will not be disclosed to PRH for confidentiality
concerns. The action of referencing a DMF with more than one PRH shall be initiated
by the DMF holder and as noted, the incorporation by reference must be accompanied
by a copy LoA.
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7.1 This section is applicable for registered products containing Scheduled Poison in ALL
dosage forms with the expiration of the registration period starting 1 January 2020.
7.2 At the point of writing, NPRA has identified anti-infective API as the selected category
for assessment purposes. This category was selected based on current public health
needs and risk-based approach, which may be extended to other categories from time to
time.
7.3 The PRH shall prepare all required Part II-S document. This information shall be
uploaded to QUEST between 12 to 15 months prior to expiry of product registration.
a. Submission by DMF option- complete DMF (both open & closed part) shall be
submitted in electronic copy (preferably in compact disc) together with a Letter of
Access and Cover Letter. This document shall reach NPRA before submission of
Form RegA2. Open part information shall also be uploaded to QUEST.
b. Submission by ACTD or CEP option- all documents shall be uploaded to QUEST.
7.5 Once all required Part II-S document are ready for updating, PRH shall fill and submit
Application Form for Section S Revision for Products (Anti-Infectives) Registered Before the
Implementation of Directive on Regulatory Control of API (Form RegA2). Form RegA2 is
an online form available on NPRA’s website.
7.6 All submissions will be screened for eligibility based on product registration expiration
date and category of API.
7.7 NPRA will enable “Product Editing” function in QUEST 3+ for the indicated product. PRH
will be given strictly 30 calendar days to upload all required Part II-S document. Failure
to update complete Part II-S information by the end of the given timeframe will affect
product renewal status.
7.8 During assessment, additional information may be requested via email, if necessary.
7.9 For registered products not containing anti-infective API, Part II-S document shall be
kept by the PRH. It is not necessary to upload to QUEST.
7.10 For non-anti-infective API, NPRA reserves the right to request for Part II-S documents
for full assessment (if deemed necessary). If the outcome of the assessment is
unsatisfactory or if there is any doubt in the submitted document, appropriate
regulatory action may be taken against the relevant product and/or the status of the
product registration will be reviewed for product recall, suspension or revoking of
registration status.
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8.1 Guidance Note for Active Pharmaceutical Ingredient (API) Information published on
NPRA website: https://npra.gov.my/index.php/en/active-pharmaceutical-ingredient-api-
main-page.html
The technical requirements related to the quality of API have already been addressed
elsewhere, (such as in the ASEAN, WHO, ICH, EDQM and EMA guidelines), and the PRH are
advised to refer to these guidelines available at the relevant website such as:
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APPENDIX 12
PRIORITY REVIEW
1. Priority review may be granted for new product application (in the category of New
Drug Products, Biologics and Generics) which fulfils either one of the following
conditions;
c) New application for products that have been registered with the same active
ingredient for which the registration has been cancelled/ withdrawn due to
issues other than safety issues. Priority review will be considered based on
individual/ case to case basis and involves product that is crucial for treatment
purpose.
d) Product which is the first *generic/ biosimilar product, or the first locally
manufactured generic/ biosimilar product.
*The priority review status granted based on condition c) shall be cancelled during
the duration of product application evaluation, in the event that a same/ similar
first generic/ biosimilar product or first locally manufactured generic/ biosimilar
product has been approved for registration.
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2. An application for Priority Review should be submitted via a formal letter addressed to
the Director of NPRA once the screening has been approved.
3. The approval of Priority Review is subjected to the decision of the Drug Evaluation
Committee Meeting upon submission of complete product registration documentation
and does not exempt applicant from any product registration requirements.
4. The timeline for evaluation for product granted Priority Review is as below;
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APPENDIX 13
Note: This part shall be read in conjunction with other parts of the DRGD that apply to
orphan medicines (where applicable), e.g. re-registration procedure, withdrawal of
registration, labeling requirements, post-market surveillance, etc.
Please also refer to Malaysian Orphan Medicines Guideline, FAQ and documents
related to orphan medicines which available at www.pharmacy.gov.my
1 Rare disease refers to the diseases listed in the latest Malaysian Rare Disease List.
2 As defined by European Medicines Agency (EMA), significant benefit means that a medicine produces a
clinically relevant advantage or makes a major contribution to patients’ care, compared with existing
methods to treat the condition. Thus, orphan designation is given to a product that will improve patients’
current treatment, having considered what else is available.
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a) The applicant may submit an application for such designation to the NPRA using
the Orphan Medicine Designation Application Form.
Product Information
i) Product name
ii) Active ingredient
iii) Strength
iv) ATC Code
v) Pharmaceutical form
vi) Route of administration
vii) Manufacturer name and address
viii) Worldwide regulatory status
ix) Worldwide orphan medicine designation status
Scientific rationale for the orphan medicine use (The scientific rationale should
support a medical plausible basis for the orphan medicine to be effective in
treating disease/ condition
i) Please briefly describe the scientific evidence to support safety and
efficacy of this product to treat/ prevent/ diagnose the proposed
indication related to the rare disease
ii) Tabulated pre-clinical data and clinical data
iii) A brief safety update report
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e) The same medicinal product may also have multiple orphan medicine
designations for different rare diseases.
f) NPRA may seek advice/ opinion from relevant experts or representatives from
the rare disease society/ patient groups or other key opinion leaders pertaining
to the application of orphan medicine designation when deemed necessary.
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No
Rejection of application
Complete?
Yes
45 working days During the evaluation stage, the section may
seek advice from relevant specialists or
Evaluation of application
expert panel pertaining to the application of
orphan medicine designation (when deemed
necessary).
Decision-making by NPRA
(through input from DEC)
No
Approved
by DEC? Rejection of application
Yes
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3. Evaluation of application
• The section may seek advice from relevant specialists or expert panel when
deemed necessary. A timeframe of two weeks is allocated for the reply.
• The section shall prepare an evaluation report to be tabled in the DEC
meeting.
4. DEC Meeting
• The DEC shall make the decision to grant the designation of orphan medicine
or otherwise.
3.2 Timeline
The decision of the DEC to grant the designation of orphan medicine or otherwise will be made
within 45 working days upon receipt of application.
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The registration requirements, conditions and fees outlined shall be applicable only to
new medicinal products that have not been registered before.
a) The PRH may proceed to submit an application for the registration of a medicinal
product designated as an orphan medicine via the NPRA QUEST online system.
b) The orphan medicine designation letter issued by NPRA shall be submitted as part of
the registration dossier via Quest3+ under Part I- Section E (E14. Other Supporting
Documents)
c) The medicinal product that has been granted designation as an orphan medicine will
be automatically granted priority review. Please refer to Appendix 12: Priority
Review.
The timeline shall commence after payment has been confirmed by the PRH (i.e.,
post-screening approval).
d) Fee for the registration of orphan medicine shall follow the fees stated in the DRGD,
according to product category.
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This part shall be read in conjunction with the other parts in the DRGD that apply to the registration of orphan medicine, e.g., labelling requirement, etc.
For medicinal products (i.e. new chemical entities and biologics), certain flexibilities are permitted for their registration as orphan medicine as
follows:
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3. Protocol of analysis, analytical Protocol of analysis, analytical method Protocol of analysis, analytical method validation and
method validation and Certificate of validation and Certificate of Analysis for Certificate of Analysis for at least 1 batch
Analysis 3 batches
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A list of orphan medicine registered with the DCA shall be published on the NPRA
website. The list will be updated regularly as and when updates have been made to it.
4.4 Re-registration
a) The DCA may, cancel any registered orphan medicine that no longer meets the
criteria for registration. Cancellation shall only be done during the re-registration of
orphan medicine.
b) The cancellation procedure/ details throughout DRGD shall apply to the cancellation
of a registered orphan medicine.
5. POST-MARKETING ACTIVITIES
The PRH shall appoint a responsible person in handling post-marketing issues in Malaysia.
The details of the current responsible person, such as name, postal address, e-mail
address, telephone, and fax numbers shall be provided to the NPRA and are required to be
promptly informed if there is any change.
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5.2 Pharmacovigilance
The PRH is responsible to ensure that an appropriate system of pharmacovigilance is in
place. The PRH shall continuously monitor and determine whether benefits continue to
outweigh risks, and to consider the necessity of steps to improve the benefit-risk
balance through risk minimization activities. The PRH is responsible and liable for their
products on the market and must take appropriate action, when necessary.
For full details on the requirements related to pharmacovigilance, please refer to the
Malaysian Pharmacovigilance Guidelines.
The PRH shall have in place written procedures describing the handling of all
adverse drug reactions (ADRs) related to their products. The system and
procedures in place must be adequate for receipt, handling, evaluation and
reporting of ADRs to the NPRA within the stipulated timelines stated in the
Malaysian Pharmacovigilance Guidelines.
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Any emerging safety issue shall be notified to the NPRA within the stipulated
timeline stated in the Malaysian Pharmacovigilance Guidelines.
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E-mail address:
3. Product Information
Product Name: Strength: ATC Code:
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Brief description of the product (details on active ingredient(s), medicines type/class, structure,
physical-chemical properties):
5. Scientific rationale for the orphan medicine use (the scientific rationale should support a
medical plausible basis for the orphan medicine to be effective in treating
disease/condition)
Please briefly describe the scientific evidence to support safety and efficacy of this product to
treat/prevent/diagnose the proposed indication related to the rare disease:
Tabulated pre-clinical trial and clinical studies(Please enclose together with this form):
6. Declaration of Applicant
i) I hereby declare that all the information and attachment(s) provided are true.
ii) I am fully aware of the consequences of rejection of this application if this form is
incomplete.
………………………………………………………
Name:
Company Stamp:
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APPENDIX 14
EVALUATION ROUTES
There are four (4) types of methods of evaluation for product registration.
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Reference: Directive No. 7 Year 2019. Ref. BPFK/PPP/07/25 (7) Jld 3: Direktif
Untuk Melaksanakan Guidelines On Facilitated Registration Pathway:
Abbreviated And Verification Review
4) Abridged Evaluation.
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Method of Evaluation
Generics
3. √ Not Applicable
(Scheduled Poison)
Includes, but not limited to the
following:
• Antiseptics/ skin disinfectants;
• Locally acting lozenges/
pastilles;
• Topical analgesic/ counter-
irritants;
Generics * All products from
• Topical nasal decongestants;
(Non-Scheduled this category, unless
4. • Emollient/ demulcent/skin
Poison) stated in Abridged
protectants;
[or known as OTC] Evaluation
• Keratolytics;
• Anti-dandruff;
• Oral care;
• Anti-acne;
• Medicated plasters/patch/pad;
and
• Topical antibacterial.
Health Supplements
a) General or Not Applicable √
Nutritional Claims
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APPENDIX 15
IMPORTANT NOTES:
1. This appendix is for reference purpose only, where applicable. It may not follow
the sequence in the online product registration application forms (in QUEST
system).
2. Online application forms are available for different product categories.
3. Applicant shall follow and comply with all requirements in the online application
forms as well as any supplementary documentation requested by the Authority.
Refer Refer
2. New Drug Products (Hybrid) √ √
Appendix 3 Appendix 3
3. Biologics √ √ √ √
Health Supplements:
6. Disease Risk Reduction √ √ √ √
Claims (High)
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1. Product name
2. Dosage Form
3. Active Ingredient(s)
a) Active Ingredient Name
b) Strength of Active Ingredient (Quantity unit/ dose)
c) Source of Active Ingredient (Animal – e.g. Bovine, Porcine, Ovine or Others/ Plant/
Others)
d) Form of Active Ingredient
e) Remarks (if any)
4. Excipient(s)
a) Excipient name
b) Strength of Excipient (Quantity unit/ dose)
c) Function of excipient (e.g. absorbent, diluents, bulking agent, coating agent, anti-
caking agent etc.)
d) Source of excipient
e) Remarks (if any)
5. Is there any source of ingredients derived from animal origin, including active ingredient?
(Yes/ No)
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c) Grant date
d) Patent statement
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Step II:
1. Active Ingredient
2. Excipient
3. Dosage Form
4. Product Description
5. Pharmacodynamics
6. Pharmacokinetics
7. Indication
8. Recommended Dose
9. Route of Administration
10. Contraindication
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Step II:
1. Pack Size
(Fill details by weight/ volume/ quantity)
1. Product Owner
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Step II:
9. Is this product licensed to be placed on the market for use in the exporting country?
(Yes/ No)
(If no, please state the reason)
10. Is the product on the market in the exporting country? (Yes/ No)
(If no, please state the reason)
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Step II:
2. Pharmaceutical Development
a) Information on Development Studies
b) Components of the Drug Product
c) Finished Products
d) Manufacturing Process Development
e) Container Closure System
f) Microbiological Attributes
g) Compatibility
3. Manufacturer
a) Batch Formula
b) Manufacturing Process and Process Controls
Manufacturing Process Flowchart
c) Control of Critical Steps & Intermediates
d) Process Validation and/or Evaluation
4. Control of Excipients
a) Specifications
b) Analytical Protocol
c) Validation of Analytical Protocol
d) Justification of Specifications
e) Excipient of Human or Animal Origin
f) Novel Excipients
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Step II:
e) Characterization of impurities
f) Justification of Specifications
g) Viral Inactivation/Removal Studies (applicable to biologics)
h) Plasma Master File (PMF) (applicable to biologics)
i) Certificate of Fitness for Purpose/ Compliance Certificate/ Plasma Quality/
Certificate (applicable to biologics)
j) Batch Release Certificates (2 batches) (applicable to biologics)
k) Summary Lot Protocol (2 batches) (applicable to biologics)
6. Reference Standards or Materials
8. Stability
1. General Information
a) Nomenclature
b) Structure and Attachment for Structure of Drug Substance
c) General Properties
2. Manufacturer
a) Manufacturer Name and Address
b) Description of Manufacturing Process and Process Controls
c) Controls of Materials
d) Controls of Critical Steps and Intermediates
e) Process Validation and/or Evaluation
f) Manufacturing Process Development
3. Characterisation
a) Elucidation of Structure and Characteristics
b) Impurities
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Step II:
7. Stability
2. Pharmacology
3. Pharmacokinetics
4. Toxicology
2. Overview of Biopharmaceutics
4. Overview of Efficacy
5. Overview of Safety
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Section F:
List of Key Literature References, Published Clinical Papers, Latest Periodic
Benefit-Risk Evaluation Report (PBRER) and Risk of Management Plan (RMP)
2. Overview of Biopharmaceutics
4. Overview of Efficacy
5. Overview of Safety
Section F:
List of Key Literature References, Published Clinical Papers, Latest Periodic
Benefit-Risk Evaluation Report (PBRER) and Risk of Management Plan (RMP)
PART IV: CLINICAL DOCUMENT
2. Overview of Biopharmaceutics
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4. Overview of Efficacy
5. Overview of Safety
Section F:
List of Key Literature References, Published Clinical Papers, Latest Periodic
Benefit-Risk Evaluation Report (PBRER) and Risk of Management Plan (RMP)
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2. ABRIDGE EVALUATION
* Generics
1.
(Non-Scheduled Poison)
Health Supplements:
3. Natural Products
* Generics (non-scheduled poison) that are evaluated under abridged evaluation include, but
are not limited, to the following:
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1. Product Name
Please provide brand name and full product name
2. Dosage Form
3. Active Ingredient(s)
a) Active Ingredient name
b) Strength of Active Ingredient (Quantity unit per dose)
c) Source of Active Ingredient (Animal – e.g. Bovine, Porcine, Ovine or Others/ Plant/
Others)
d) Form of Active Ingredient
e) Remarks (if any)
4. Excipient(s)
a) Excipient name
b) Strength of Excipient (Quantity unit per dose)
c) Function of excipient (e.g. absorbent, diluents, bulking agent, coating agent, anti-
caking agent etc.)
d) Source of excipient
e) Remarks (if any)
5. Is there any source of ingredients derived from animal origin, including active ingredient?
(Yes/ No)
If yes, please declare the origin
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Step II:
1. Active Ingredient
2. Excipients
3. Dosage Form
c) Coloring agent used in capsule shell (Please attach CoA of the capsule shell)
4. Product Description
5. Indication
6. Recommended Dose
7. Route of Administration
8. Contraindication
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Step II:
1. Batch Size
2. Batch Manufacturing Formula
3. Attachment of Batch Manufacturing Formula Documentation
1. Pack Size
(Fill details by weight/ volume/ quantity)
Measurement Type
No. Section D: Label (Mock-up) For Immediate Container, Outer Carton, Proposed
Package Insert, Consumer Medication Information Leaflet (RiMUP)
Please refer:
Appendix 19: General Labelling Requirements
Appendix 20: Specific Labelling Requirements
1. Product Owner
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Step II:
9. Is this product licensed to be placed on the market for use in the exporting country?
(Yes/ No)
(If no, please state the reason)
10. Is the product on the market in the exporting country? (Yes/ No)
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Step II:
2. Stability
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APPENDIX 16
Applicants are advised to refer to and be familiar with the latest ASEAN Guideline for The
Conduct of Bioequivalence Studies regarding the recommendation for establishing the
interchangeability of generic product with comparator product. In addition, other relevant and
latest international guidelines e.g. by EMA, USFDA, ICH should also be referred to complement
the ASEAN Guidelines .These guidelines are to be read in conjunction with pertinent directives,
circulars and updates regarding implementation of bioequivalence requirements in Malaysia,
which will be updated periodically on the NPRA website.
Currently, this requirement is applicable to all generic products in the form of oral solid dosage
forms with systemic actions. The following Table 1 summarizes types of dosage forms that are
required to submit BE data for new application of generic product registration or product
registration renewal. The scope of implementation is not exhaustive and will be reviewed
accordingly from time to time upon scientific judgement and patient risk assessment by the
National Drug Authority. As for now, dosage forms that are not covered within the scope are not
required to submit BE data during product registration or product registration renewal.
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Bioequivalence study report (i) Arahan Pengarah Kanan Perkhidmatan Farmasi Bil 3 Tahun
for all registered generic 2015: Direktif Penguatkuasaan Keperluan Kajian
products containing Bioekuivalens (BE) Bagi Semua Produk Generik Dalam
scheduled poison with Bentuk Dos Oral Tablet/Kapsul Yang Bersifat Effervescent,
effervescent, dispersible, Dispersible, Orodispersible, Sublingual, Buccal dan
orodispersible, sublingual, Chewable Yang Mengandungi Bahan Aktif Racun Berjadual,
buccal and chewable Bil (27) dlm BPFK/PPP/07/25 (23 February 2015)
dosage forms
(ii) Lanjutan Tarikh Penguatkuasaan untuk Memenuhi Keperluan
Kajian Bioekuivalens (BE) bagi Produk Generik dalam Bentuk
Dos Oral Tablet/Kapsul yang Bersifat Effervescent,
Dispersible, Orodispersible, Sublingual, Buccal dan
Chewable yang Mengandungi Bahan Aktif Racun Berjadual,
Bil (45) dlm BPFK/PPP/01/03 Jld 03 (31 May 2016)
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For BE studies that were conducted outside the period of facility listing on the NPRA BE Centre
Compliance Programme; or were conducted at facilities not listed on the Programme, the
applicant may apply for the “Evaluation on the Need for BE Study Inspection” to the Centre of
Compliance & Quality Control (PKKK). Successful applications would allow the BE studies to be
accepted for product registration review. If the applications were not successful, a study specific
inspection would be required. The application form, additional details and procedure on how to
apply for the “Evaluation on the Need for BE Study Inspection” and study specific inspections can
be obtained from the NPRA website.
Applicable directive & circulars regarding the requirements above are as below:
Direktif Penguatkuasaan Keperluan Kajian Bioekuivalens bagi Semua Produk Generik
'Immediate Release, Oral, Solid Dosage Form' yang Mengandungi Bahan Aktif Racun Berjadual
Serta Akreditasi Pusat Kajian Bioekuivalens Bil (10) dlm BPFK/PPP/01/03 Jld 1
Makluman susulan berkaitan BE Bil(6)dlm.BPFK/PPP/01/03 Jld 3
Direktif Penguatkuasaan Keperluan Kajian Bioekuivalens (BE) Bagi Produk Generik Dalam
Bentuk Dos Oral Tablet/ Kapsul Yang Bersifat Effervescent, Dispersible, Orodispersible,
Sublingual, Buccal dan Chewable Yang Mengandungi Bahan Aktif Racun Berjadual
Bil(27)dlm.BPFK/PPP/07/25
Malaysia Guideline for Bioequivalence Inspection (First Edition)
Direktif Pelaksanaan Penilaian Keperluan Pemeriksaan Kajian Bioekuivalens (BE) NPRA.600-
1/9/13 (3)
2. Investigational Products
2.1 Test Product
The test product used in the BE study should be manufactured at the same drug product
manufacturing site by the same manufacturing process and manufactured with the same drug
substance and formula as the generic product proposed for registration in Malaysia. The batch
size of test product used in the BE study should also be at least 100,000 units or 1/10 of
production scale, whichever is greater, unless otherwise justified. Any deviation from this
requirement should be justified with additional documentation to ensure the sameness of both
test product and product proposed for registration. Applicants are advised to refer to FAQ on
the NPRA website for the additional documentation required.
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product for which its innovator has never been registered in Malaysia will be classified under
Hybrid application.
For purpose of product registration in Malaysia, applicants are advised to use Malaysia
comparator product (MCP) to conduct the BE studies. The list of Malaysia comparator product is
available on NPRA website.
Applicant should provide a copy of the outer carton label which clearly showing batch number,
manufacturer address, expiry date and the prescribing information (product leaflet) of the
reference product used in the BE study for verification purposes.
Should the reference product use in the BE study was manufactured at a different site from the
MCP, or manufacturer address was not stated on the outer carton, the applicant should justify
and prove that the BE reference product is identical with the MCP in the following aspects:-
(i) The ingredients in the BE reference product are qualitatively identical to the Malaysia
comparator product except minor differences in excipient (e.g. colouring & ink) that will
not affect bioavailability of the reference product.
(ii) Comparative dissolution profile of the BE reference product is similar with the Malaysia
comparator product. The CDP should be conducted as per requirement in Appendix I of
ASEAN Guideline for the Conduct of Bioequivalence Study. It is highly recommended to
conduct the CDP between reference product and MCP simultaneously to reduce potential
variabilities and avoid comparison and compilation of historical data.
(iii) The drug substance does not have a narrow therapeutic index
Should the MCP no longer available or could not be found on the list of comparators, kindly
contact [email protected] for further assistance.
3. Study Design
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The in vitro dissolution test should be conducted at three different buffers (normally pH1.2, 4.5,
6.8) and the media intended for product release (QC media, if applicable and available).
A statement that the API is not soluble in any of the media is not sufficient, and profiles in the
absence of surfactant should be provided. The rationale for the choice and concentration of
surfactant should be provided. The concentration of the surfactant should be such that the
discriminatory power of the test will not be compromised.
At least 12-unit of each investigative products should be used in CDP testing to enable statistical
evaluation. The products should originate from batch of at least 1/10 of production scale or
100,000 units, whichever is greater, unless otherwise justified.
(iii) Agitation
Selection of speed of agitation should be properly justified. Stirrer used in paddle apparatus is
usually at 50rpm for tablets and basket apparatus at 100rpm for capsules.
Sampling time points should be sufficient to obtain meaningful dissolution profiles, and at least
every 15 minutes. More frequent sampling during the period of greatest change in the
dissolution profile is recommended. For rapidly dissolving products, where complete
dissolution is within 30 minutes, generation of an adequate profile by sampling at 5- or 10-
minute intervals may be necessary.
Dissolution similarity may be determined using suitable statistical procedure e.g the f2
similarity factor as described in ASEAN guideline or other international guidelines.
(vi) Documentation
5. Biowaiver considerations
Generic products should demonstrate the bioequivalence evidence by in-vivo equivalence
testing. Nevertheless, exemption on the submission of an in-vivo BE study can be considered in
certain circumstances for generic products of oral solid dosage forms. Applicants should
provide adequate data and justifications for not submitting the in-vivo data.
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(a) the different strengths of the generic product are manufactured by the same
manufacturing process,
(c) the composition of the strengths are quantitatively proportional, i.e. the ratio between the
amount of each excipient to the amount of active substance(s) is the same for all strengths
(for immediate release products coating components, capsule shell, colour agents and
flavours are not required to follow this rule)
(i) the amount of the active substance(s) is less than 5 % of the tablet core weight or
the weight of the capsule content;
(ii) the amounts of the different core excipients or capsule content are the same for the
concerned strengths and only the amount of active substance is changed;
(iii) the amount of a filler is changed to account for the change in amount of active
substance. The amounts of other core excipients or capsule content should be the
same for the concerned strengths
(d) appropriate comparative dissolution profile testing should confirm the adequacy of
waiving additional in-vivo bioequivalence testing. Similarity of the dissolution profiles
across the physiological pH range between additional strengths of the generic products
and the strength of the generic product used in the BE study should be demonstrated. In
addition, CDP testing demonstrating similar profiles at the same dose (e.g. two 10mg
tablets versus one 20mg tablets) may be required.
If the data and justifications are considered not adequate, applicant will be required to provide
relevant biopharmaceutics data, e.g. in-vivo BE study.
Applicants are advised to refer to the checklist “Application For A Biowaiver: Additional
Strength” and submit relevant documents when requesting for biowaiver for additional
strength.
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(i) BCS-based biowaivers are applicable for immediate-release oral solid dosage forms with
systemic action.
(ii) For immediate release product in fixed dose combination, all the drug substances in the
combination should meet the BCS-based biowaiver criteria.
(iii) Biowaiver may also be applicable if test and reference products contain different salts
provided that both belong to BCS Class I (high solubility and high permeability).
(iv) Drug products with buccal or sublingual absorption are not eligible for a BCS-based
biowaiver application
(v) Drug products having a narrow therapeutic index are excluded from consideration for a
BCS-based biowaiver
(vi) Biowaiver is not applicable when the test product contains a different ester, ether,
isomer, mixture of isomers, complex or derivative of a drug substance from that of the
reference product, since these differences may lead to different bioavailabilities not
deducible by means of experiments used in the BCS-based biowaiver concept.
Currently NPRA allows only BCS-based class 1 biowaiver application. Applicants are advised to
prove that the generic product and drug substances are highly soluble and highly permeable
with sufficient data and documentation as per requirement on the checklist Application For
Biopharmaceutics Classification System (BCS) Biowaiver.
BCS-based class 1 application should be product specific and should not based on list of
substance in the particular BCS class. If a generic product is to be marketed in several
strength(s) and the submission is based on a BCS-based biowaiver approach, a complete set of
documents is required for each strength, as it will be evaluated independently.
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In situation where the applicant is unable to provide satisfactory documents to support BCS-
based class 1 biowaiver application, biowaiver request may not be considered and BE study
should be conducted.
However, biowaiver may be considered as a surrogate to in-vivo BE study for the second source
product, provided that all the following conditions are fulfilled:
(a) BE study conducted using the registered first source product has been evaluated by NPRA
and found satisfactory.
(b) Comparative Dissolution Profile (CPD) data between the second source product against
the registered first source product is submitted
(c) The second source product is the same as registered first source product used in the BE
study in terms of:
• Product formulation.
• Equipment used in the manufacturing process.
• Source and supplier of raw material.
• Quality control and specifications of raw material.
• Manufacturing process of product and standard operating procedures.
• Environmental conditions during the manufacturing process of product.
• Quality control and specifications of finished product.
(d) CDP must be conducted in accordance to ASEAN Guidelines for The Conduct of
Bioequivalence Studies including the calculation of similarity factor (f2) to prove the
similarity of these two products.
(e) Process validation has been conducted on three pilot or commercial batches of the second
source product and found satisfactory by the NPRA.
This exemption is not applicable for any new submission of application for registration of a first
source product. BE study must be conducted for this product which is manufactured at the
actual manufacturing site submitted for registration.
Disclaimer: NPRA reserves the right to request for any additional information required for
evaluation if deemed appropriate, to determine the product interchangeability of the
generic product to the MCP.
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6. References
a. ASEAN Guideline for the Conduct of Bioequivalence Studies
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APPENDIX 17
Note:
1. This list is not meant to be exhaustive and is subject to review from time to time
2. The Authority reserves the right to disallow any other words or phrases for product names,
which in its opinion is misleading, improper or not factual.
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SENXBIG=SEnXBIG(label)
Sexy, Enjoy, Paradise,
Use of names that may be offensive or
6. Heavenly, Blue boy, Casanova, Desire
indecent
(Dezire),Sensual
(Xenxual),Asmara,Syok
Use of product names representing weight Slim, Langsing, Trim, Trimnfit, Sleen,
12. loss/ slimming properties/ names that can be Kurus, Susut perut, Xlim, Weight
associated with weight loss/ slim watcher
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APPENDIX 18
IMPORTANT NOTE:
The following lists are by no means exhaustive.
Contents:
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1. 1,3-dimethylamylamine (DMAA)
2. Aristolochic Acid
3. Aminopyrine/ Amidopyrine
4. Astemizole
5. Bacillus Coagulans
6. Berberine
7. Butobarbitone
8. Chlormezanone
9. Cisapride
12. Danthron
13. Dipyrone
16. Ethenzamide
17. Euflavine
18. Furazolidone
20. Gadodiamide
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25. Haloquinol
26. Hexachlorophene
27. Mercurochrome
28. Nimesulide
29. Novobiocin
31. Oxyphenbutazone
32. Pergolide
33. Phenacetin
35. Phenylbutazone
36. Phenylpropanolamine
37. Piperazine
38. Prenylamine
39. Quinalbarbitone
40. Salicylamide
41. Sibutramine
42. Stanozolol
43. Sulphaguanide
44. Thioridazine
45. Tegaserod
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46. Terfenadine
b) Prohibited Combinations
1. Ampicillin + Cloxacillin
3. Antacid + Charcoal
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1. Colouring Agents (Including in Amaranth (CI= 16185, FD & C Red No. 2, E123)
Capsule Shells)
2. Others Chlorofluorocarbons (CFC)
Excipients Restrictions
a) Tartrazine (CI= 19140, FD & C Yellow Not allowed in the following preparations:
No.5, E102)
− Oral;
− Rectal;
− Vaginal or
− Nasal Preparations
b) Red 2G
Not allowed in the following preparations:
− Oral Preparations; and
− Preparations Used for Mucosa Membrane
3. Preservatives
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4. Others
a) Phthalates Variant Maximum Limit of Daily Exposures
(mg/kg body weight/day)
Dibutyl 0.01mg/ kg/ day
Phthalate
(DBP)
Diethyl 4mg/ kg/ day
Phthalate
(DEP)
Polyvinyl 2mg/ kg/ day
Acetate
Phthalate
(PVAP)
b) Cetrimide Limited to less than 0.1% w/v (topical
preparations for Natural Products)
* For other preparations, the warning specified in Appendix 20: Specific Labelling
Requirements shall be included in the package insert and product literature of products
containing thiomersal.
Additional Information
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COLOUR
NO. COLOURING AGENTS INDEX
NUMBER (CI)
5. Calcium Carbonate
7. Caramel
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COLOUR
NO. COLOURING AGENTS INDEX
NUMBER (CI)
a. Flavoxanthin 40850
b. Lutein
c. Cryptoxanthin (Kryptoxanthin)
d. Violoxanthin
e. Rhodoxanthin
f. Canthaxanthin
21. The Following Colouring Matters Natural to Edible Fruits or 75530
Vegetables:
a. Alkannin
b. Annatto (including eye)
c. Carotene (including eye)
d. Chlorophyll
e. Flavine
f. Indigo
g. Osage
h. Orange
i. Persian Berry
j. Safflower
k. Saffron
l. Sandalwood
m. Turmeric
n. or their pure coloring principles whether isolated from such
natural colors or produced synthetically
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COLOUR
NO. COLOURING AGENTS INDEX
NUMBER (CI)
24. Talc
26. Brilliant Blue FCF Ammonium Salt/ D & C Blue No. 4 42090
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The following colouring agents are ALLOWED in preparations as stated in the parentheses:
Dihydroxyacetone
1.
(external use with specific drugs only)
Bismuth Oxychloride
2. 77163
(external use only, including eye)
Ferric Ferrocyanide
4.
(external eye only)
Guanine
7. 75170
(external use only)
Prophyllite
8.
(external use only)
Mica
9. 77019
(external use only, including eye)
Mica coated with titanium dioxide and/or iron oxide
(internal use only)
• for solid dosage form, not more than 3% of the
10.
preparation (in the case where the preparation was
made using iron oxides, the preparation shall not
contain more than 55% iron oxides)
Bronze
11.
(external use only, including eye)
Copper
12.
(external use only, including eye)
Zinc Oxide
13. 77947
(external use only, including eye)
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APPENDIX 19
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The following information in Table 1 below shall be present on the label of a product at the
outer carton, immediate container or blister/ strips:
1. Product Name
2. Dosage Form * NA
5. Batch Number
6. Manufacturing Date * NA
7. Expiry Date
8. Route of Administration NA
9. Storage Condition * NA
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* Exempted for small labels (i.e. 5ml and less) used for ampoules/ cartridge, vials, eye
drops, ear drops, and nose drops.
# i. If the product does not have an outer carton, the security label shall be affixed
onto the immediate label.
ii. The security label shall, however, not be affixed to the outer shrink wrap of the
product.
iii. The following are exempted from the security label requirement:
- Small labels (i.e. volume of 5mL and less). E.g. ampoules/ cartridges/
vials.
- Temperature sensitive and “cold chain” products. E.g. vaccines and
biologicals.
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No. 15, 20, 22& 23 of the above are country specific requirements for Malaysia.
Additional Requirements:
a) All labels and package inserts must be in Bahasa Malaysia or English. In addition to this,
translation to another language is allowed.
b) If the product is without an outer carton, the inner label shall bear all the required
information.
c) The link to the official company website or website for any purpose of product promotion
by the PRH/ product owner/ manufacturer is not allowed to be printed on the product
label (applicable to all product categories, including imported products). However, the
company email address is permitted on the label.
d) The label colours shall differentiate the different strengths of the product as well as
products containing different active ingredients that belong to the same PRH.
e) Only a single label artwork is permitted for all pack sizes of a registered product.
f) No stick-on label is permitted. Any usage of stick-on label shall have prior approval by the
Authority. The label shall be made from good quality material and not easily torn or
peeled off. The Authority will only consider the following situations:
g) The registration number shall be printed permanently on the product (inkjet) and it is not
allowed to be printed on the stick-on label.
h) Use of QR code is permitted only for the purpose of monitoring inventory of the product,
such as batch number, expiry date and manufacturing date, BUT NOT for linkage to any
website. The addition of QR code on registered product labels without variation approval
from NPRA may be considered only if that is the only proposed change to the currently
approved labels.
i) The label of a registered product containing any Scheduled Poison shall not have colourful
artwork or graphics that can be misleading or will adversely influence
caregivers’/patients'/children's perceptions of the appropriateness of the medication.
j) Font size of the product name on the label, including alphabets and numbers, shall be
equal.
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k) For a product containing two (2) or more active ingredients, the font of each active
ingredient that is highlighted on the inner/outer carton must be of equal size and
prominence.
• This does not refer to the product name, but the statement made on the label.
l) Declaration of nutrition information per serving (e.g. energy, carbohydrate, protein and
fat) is not permitted on a health supplement product label.
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APPENDIX 19A
PROHIBITED VISUAL/ GRAPHICS/ STATEMENTS ON LABEL
Notes:
1. This list is not meant to be exhaustive and is subject to review from time to time.
2. The Authority reserves the right to disallow any other words, phrases or graphics for
product label, which in its opinion is misleading, improper or not factual.
3. Consumer testimonial - -
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Opinion of prominent
figure(s) on the
Opinion of product/formulation
6. product or its active -
inventor
ingredient/
content
Introduction of founder/
9. - -
manufacturer
Prohibited on
product label
10. Logo with certification SIRIM/ ISO / GMP/ HACCP because certification
renewal is on a
yearly basis
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Graphics or picture of
14. Kidney, Heart, Nerves. -
internal organs
Gender symbol
15. (
� and/or
�) -
(male or female)
Indecent photographs/
16. pornography/ graphics/ - -
images
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APPENDIX 20
NO. SUBSTANCES
2. ABIRATERONE
3. ACE INHIBITORS
4. ACETAZOLAMIDE
5. ACETYLCYSTEINE
10. ALLOPURINOL
11. AMBROXOL
12. AMIODARONE
13. AMOXICILLIN
14. ANTIDEPRESSANTS
15. ANTIEPILEPTICS
17. ARGININE
18. ARIPIPRAZOLE
19. ASPARTAME
20. ATORVASTATIN
21. AZITHROMYCIN
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23. BENZODIAZEPINE
31. BROMHEXINE
32. BROMPHENIRAMINE
33. CAMPHOR
34. CARBAMAZEPINE
36. CARBOCISTEINE
37. CEFTRIAXONE
38. CETIRIZINE
40. CHITOSAN
41. CHLORHEXIDINE
42. CHLORPHENIRAMINE
44. CLEMASTINE
45. CLARITHROMYCIN
46. CLINDAMYCIN
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47. CLOPIDOGREL
48. CLOZAPINE
49. COBICISTAT
50. CODEINE
51. COLCHICINE
52. CORTICOSTEROID
57. DEXBROMPHENIRAMINE
58. DEXTROMETHORPHAN
62. DICYCLOMINE
63. DIPHENHYDRAMINE
64. DIPHENOXYLATE
65. DOMPERIDONE
67. DOXYCYCLINE
68. EFAVIRENZ
69. EPHEDRINE
70. ERYTHROMYCIN
71. ETHINYLESTRADIOL
72. ETORICOXIB
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73. FAMOTIDINE
74. FIBRATES
75. FILGRASTIM
76. FLUCLOXACILLIN
77. FLUCONAZOLE
78. FLUORIDE
79. FLUOROQUINOLONE
80. GABAPENTIN
86. GINSENG
87. GLUCOSAMINE
89. HYDROCHLOROTHIAZIDE
90. HYDROQUINONE
91. HYOSCINE
92. IMMUNOSUPPRESANTS
93. INSULIN
98. ISONIAZID
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100. KETOCONAZOLE
102. LAMOTRIGINE
103. LENOGRASTIM
104. LEVETIRACETAM
105. LEVONORGESTREL
106. LINCOMYCIN
108. LOPERAMIDE
109. LOVASTATIN
110. MEFLOQUINE
112. MESALAZINE
113. METFORMIN
117. METOCLOPRAMIDE
118. METRONIDAZOLE
119. MICONAZOLE
120. MIDAZOLAM
121. MINOCYCLINE
122. MINOXIDIL
124. MONTELUKAST
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126. NEVIRAPINE
127. NIFEDIPINE
128. NITRATES
129. NORADRENALINE
130. NORFLOXACIN
132. NOSCAPINE
134. OLANZAPINE
135. ONDANSETRON
136. OPIOID
137. OSELTAMIVIR
138. PALIPERIDONE
139. PARACETAMOL
144. PEMETREXED
145. PENICILLIN
146. PHENIRAMINE
147. PHENYLEPHRINE
148. PIROXICAM
149. PRAVASTATIN
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152. PROPAFENONE
153. PROPOFOL
156. PROPYLTHIOURACIL
157. PSEUDOEPHEDRINE
165. RISPERIDONE
166. ROSIGLITAZONE
167. ROSUVASTATIN
168. ROXITHROMYCIN
171. SALBUTAMOL
SENNA (CASSIA SPP.) – fruit/ pod/ semen and leaf and Rhubarb/ Radix et
175.
Rhizoma Rhei/ Rheum Palmatum/ Rheum Officinalis – root part
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176. SIMVASTATIN
181. STATINS
184. SULFASALAZINE
188. TEMOZOLAMIDE
189. TERBUTALINE
190. TESTOSTERONE
192. THIOMERSAL
195. TOPIRAMATE
196. TRAMADOL
197. TRIMETAZIDINE
198. TRIPROLIDINE
199. VARENICLINE
200. VITAMIN K
201. WARFARIN
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In men aged 50 to 75 years with a prior negative biopsy for prostate cancer and a
baseline PSA between 2.5 ng/mL and 10.0 ng/mL taking AVODART in the 4-year
Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, there was an
increased incidence of Gleason score 8-10 prostate cancer compared with men
taking placebo (AVODART 1.0% versus placebo 0.5%). In a 7-year placebo-
controlled clinical trial with another 5-alpha reductase inhibitor (finasteride 5
mg, PROSCAR), similar results for Gleason score 8-10 prostate cancer were
observed (finasteride 1.8% versus placebo 1.1%).
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2. ABIRATERONE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Abiraterone;
Package Insert
b) Interactions:
In a CYP2C8 drug-drug interaction trial in healthy subjects, the AUC of
pioglitazone was increased by 46% and the AUCs for M-III and M-IV, the active
metabolites of pioglitazone, each decreased by 10% when pioglitazone was given
together with a single dose of 1000mg abiraterone acetate. Patients should be
monitored for signs of toxicity related to a CYP2C8 substrate with a narrow
therapeutic index if used concomitantly. Examples of medicinal products
metabolized by CYP2C8 include pioglitazone and repaglinide.
Reference: Directive No. 2 Year 2021. NPRA.600-1/9/13 (12). Direktif Untuk Semua Produk Yang
Mengandungi Abiraterone: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Hypoglycaemia Akibat Interaksi
Ubat
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3. ACE INHIBITORS
USE IN PREGNANCY
4. ACETAZOLAMIDE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Acetazolamide;
Package Insert
a) Side Effects:
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• severe skin reaction: skin reddening, blisters, rash, fever, sore throat or eye
irritation
Reference: Directive No. 16 Year 2018. BPFK/PPP/07/25 ( 16 ) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Acetazolamide : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat
Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Severe Cutaneous Adverse
Reactions (SCARs)
5. ACETYLCYSTEINE
5.1 The following warning shall be included in the package inserts of products
containing Acetylcysteine :
CONTRAINDICATIONS
Reference: Circular Bil (7) dlm BPFK/PPP/01/03 Jld 1: Kemaskini Kenyataan Amaran
“Contraindicated In Children Under 2 Years Of Age” Yang Wajib Dimuatkan Pada Sisip Bungkusan Semua
Produk Carbocysteine, Acetylcysteine Dan Methylcarbocysteine (Mecysteine)
5.2 The following statements shall be included in the label, package insert and
Consumer Medication Information Leaflet (RiMUP) for products containing
acetylcysteine;
Package Insert
Hypersensitivity Reactions
Serious acute hypersensitivity reactions during acetylcysteine administration
including rash, hypotension, wheezing, and/or shortness of breath, have been
observed in patients receiving intravenous acetylcysteine for paracetamol
overdose and occurred soon after initiation of the infusion (see Adverse
Effects/ Undesirable Effects). If a severe hypersensitivity reaction occurs,
immediately stop the infusion of acetylcysteine and initiate appropriate
treatment.
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5.2.2 All other products (not include Injectable products for treatment of
paracetamol overdose)
Label
[Product name] may cause severe allergy and serious skin reactions. Stop using
[Product name] and seek medical assistance immediately if you experience any
of the following symptoms:
• Severe allergy: breathing difficulties, light headedness, skin swellings or rash.
• Severe skin reaction: skin reddening, blisters, rash, fever, sore throat or eye
irritation.
Package Insert
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Side Effects:
[Product name] may cause severe allergy and serious skin reactions. Stop
using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
• Severe allergy: breathing difficulties, light headedness, skin swellings or rash.
• Severe skin reaction: skin reddening, blisters, rash, fever, sore throat or eye
irritation.
Reference: Directive No. 14 Year 2018. BPFK/PPP/07/25 ( 14 ) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Carbocisteine Dan Acetylcysteine : Pengemaskinian Label, Sisip Bungkusan Dan
Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan
Anaphylactic/ Anaphylactoid Reaction Dan Severe Cutaneous Adverse Reactions (SCARs)
For products containing Acetylsalicylic acid, the following warning shall be included
on the labels in two languages (Bahasa Malaysia and English):
AMARAN
TIDAK BOLEH DIBERI KEPADA KANAK-KANAK BERUMUR KURANG DARIPADA 16
TAHUN.
WARNING
NOT TO BE GIVEN TO CHILDREN UNDER 16 YEARS OF AGE.
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7.1 The following boxed warning shall be included on the labels of products
containing Activated charcoal/ attapulgite:
NOT RECOMMENDED FOR TREATMENT OF DIARRHOEA
IN CHILDREN UNDER 6 YEARS OF AGE
7.2 The following statements shall be included in the package inserts of products
containing Activated charcoal/ attapulgite:
The following statement shall be included on the labels and in the package inserts of
products containing Albendazole or Benzimidazole antihelmintics:
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10. ALLOPURINOL
11. AMBROXOL
The following warning shall be included in the package insert, label and Consumer
Medication Information Leaflet (RiMUP) of products containing Ambroxol:
Package Insert
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a) Side Effects
[Product name] may cause severe allergy and serious skin reactions. Stop
using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
1) severe allergy: breathing difficulties, light headedness, skin swellings
or rash
2) severe skin reaction: skin reddening, blisters, rash, fever, sore throat or
eye irritation
Reference: Directive No. 1 Year 2018. BPFK/PPP/07/25 (1) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Ambroxol Dan Bromhexine : Pengemaskinian Label, Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Amaran Kesan Advers Anafilaksis Dan Severe
Cutaneous Adverse Reactions (SCARs)
12. AMIODARONE
The following boxed warning shall be included on the package inserts of products
containing Amiodarone:
13. AMOXICILLIN
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Amoxicillin
(including combination products);
Package Insert
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a) Side Effects:
Stop taking [product name] and contact your doctor immediately if you
experience any of the following:
• Serious allergic reactions such as Drug Reaction with Eosinophilia and
Systemic Symptoms (DRESS). DRESS appears initially as flu-like
symptoms with a rash on the face and then with an extended rash, high
temperature and enlarged lymph nodes.
Reference: Directive No. 8 Year 2018. BPFK/PPP/07/25 ( 8 ) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Amoxicillin Termasuk Kombinasi: Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Memperkukuhkan Maklumat Berkaitan Severe
Cutaneous Adverse Reactions (SCARs) Pada Bahagian Warnings & Precautions Dan Amaran Berkaitan
Drug Reaction With Eosinophilia And Systemic Symptoms (DRESS) Pada Bahagian Side Effects
14. ANTIDEPRESSANTS
The following statement shall be included in the package inserts of products used as
antidepressants:
• Patients who are started on therapy should be observed closely for clinical
worsening, suicidality, or unusual changes in behavior.
• Families and caregivers should be advised to closely observe the patient and to
communicate with the prescriber.
• The indication(s) approved in paediatric for the particular drug should be clearly
stated / included.
Reference: Circular Bil(41)dlm BPFK/02/5/1.3: Keputusan Pihak Berkuasa Kawalan Dadah (PBKD)
Berhubung Tambahan Amaran Berkaitan Dengan 'Suicidality In Children And Adolescents Treated With
Antidepressants'
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15. ANTIEPILEPTICS
The following statement shall be included in the package inserts of products used as
antiepileptics:
Reference: Circular Bil (16) dlm BPFK/PPP/01/03 Jld 1: Directive Kenyataan Amaran Berkaitan
Dengan Risiko Extrapyrimidal And/or Withdrawal Symptoms Bagi Neonat Yang Terdedah Kepada
Produk Antipsikotik Semasa Trimester Ketiga Kehamilan Pada Sisip Bungkusan Semua Produk
Antipsikotik
Package Insert
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b) Side Effects:
Reference: Directive No. 26 Year 2018. BPFK/PPP/07/25 ( 26 ) Jld 2.Direktif Untuk Semua
Produk Yang Mengandungi Atypical Antipsychotic Agent: Pengemaskinian Sisip Bungkusan Dan
Risalah Maklumat Ubat Untuk Pengguna (RIMUP) Dengan Maklumat Berkaitan Risiko Restless Legs
Syndrome, Sleep Apnoea, Urinary Retention, Hyperglycaemia Dan Diabetes Mellitus
17. ARGININE
The following statement shall be included on the labels and in the package inserts of
oral preparations containing Arginine for health supplement products:
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18. ARIPIPRAZOLE
The following statements shall be included in the package insert and RiMUP of
products containing Aripiprazole:
Package Insert
Psychiatric disorders
Pathological gambling, hypersexuality, impulse-control problems (See Section
Warnings and Precautions).
Consumer Medication Information Leaflet (RiMUP)
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Reference: Directive No. 22 Year 2017. BPFK/PPP/07/25 ( 27 ) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Aripripazole : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Kesan Advers Pathological Gambling Dan
Impulse-Control Problems
19. ASPARTAME
The following statement shall be included on the labels and in the package inserts of
products containing Aspartame:
WARNING
20. ATORVASTATIN
In patients with HIV taking lopinavir plus ritonavir, caution should be used when
prescribing [Product Name] and the lowest dose necessary employed.
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All generic products containing Atorvastatin should update their package inserts
respectively according to the innovator’s information such as parts for Interactions,
Pharmacokinetics and other parts deemed relevant.
Reference: Directive Bil 10 Year 2014. Circular Bil (17) dlm BPFK/PPP/07/25. Direktif Untuk
Semua Produk Atorvastatin: Mengehadkan Dos Penggunaan Atorvastatin Untuk Mengurangkan Risiko
Kecederaan Otot
21. AZITHROMYCIN
20.1 The following statement shall be included in the package insert and RIMUP of
all products containing Azithromycin:
Package Insert
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Side Effects
[Product name] may cause severe allergy and serious skin reactions.
Stop using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
• skin reddening, blisters, rash, fever, sore throat or eye irritation
20.2 The following statement shall be included in the package insert and RiMUP of
products containing azithromycin (except topical/ external and
ophthalmic preparations);
Package Insert
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Postmarketing Experience:
Side Effects
If you notice that the child vomits and/or irritability with feeding occurs, contact
doctor immediately as it may be due to the Infantile Hypertrophic Pyloric Stenosis
(IHPS).
References:
Directive Bil 3 Year 2016. Bil (34) dlm BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Azithromycin (Formulasi Sistemik): Pengemaskinian Sisip Bungkusan Dengan Maklumat
Keselamatan Berkaitan Kesan Advers QT Prolongation Dan Drug Reaction With Eosinophilia And
Systemic Symptoms (DRESS)
Directive No. 28 Year 2017. BPFK/PPP/07/25 ( 33 ) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Bahan Aktif Azithromycin Dan Erythromycin Kecuali Persediaan Topikal/ Eksternal Dan
Ubat Untuk Kegunaan Mata : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Amaran Berkaitan Risiko Infantile Hypertrophic Pyloric Stenosis (IHPS)
Directive Bil 22 Year 2018. Bil (22) dlm BPFK/PPP/07/25 Jld.2 Direktif Untuk Semua Produk Yang
Mengandungi Azithromycin, Clarithromycin, Erythromycin Dan Roxithromycin: Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan
Berkaitan Severe Cutaneous Adverse Reactions (SCARs)
The following statement shall be included on the labels and in the package inserts of
products containing bee pollen:
This product contains Bee Pollen and may cause severe allergic reactions,
including fatal anaphylactic reactions in susceptible individuals.
Asthma and allergy sufferers may be at greater risks.
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23. BENZODIAZEPINE
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing benzodiazepine:
Package Insert
Profound sedation, respiratory depression, coma, and death may result from
the concomitant use of [product name] with opioids. Observational studies
have demonstrated that concomitant use of opioids and benzodiazepines
increases the risk of drug-related mortality compared to use of opioids alone.
Because of these risks, reserve concomitant prescribing of these drugs for use
in patients for whom alternative treatment options are inadequate.
Follow patients closely for signs and symptoms of respiratory depression and
sedation. Advise both patients and caregivers about the risks of respiratory
depression and sedation when [product name] is used with opioids. Advise
patients not to drive or operate heavy machinery until the effects of
concomitant use of the opioid have been determined. Screen patients for risk
of substance use disorders, including opioid abuse and misuse, and warn them
of the risk for overdose and death associated with the use of opioids (See Drug
Interactions).
b) Interactions:
Opioids
Due to additive pharmacologic effect, the concomitant use of opioids with
benzodiazepines increases the risk of respiratory depression, profound
sedation, coma and death.
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Reserve concomitant prescribing of these drugs for use in patients for whom
alternative treatment options are inadequate (see Warnings and Precautions).
Taking [product name] with an opioid medicine (medicine to relieve pain) can
depress your central nervous system. Inform your doctor if you are currently
taking any opioid medicine.
Reference: Directive No. 23 Year 2017. BPFK/PPP/07/25 ( 28 ) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Opioid Dan Benzodiazepin : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
The following statement shall be included on the labels and in the package inserts of
products containing Benzoyl peroxide:
WARNING
Do not use this medication if you have sensitive skin or if you are sensitive to benzoyl
peroxide. This product may cause irritation, characterized by redness, burning,
itching, peeling, or possible swelling.
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The following statement shall be included on the label and in the package insert of
products containing berberine alkaloid:
WARNING
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing beta-lactam
antibiotics (including combination products);
Package Insert
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a) Side Effects:
[Product name] may cause severe allergy and serious skin reactions.
Stop using [product name] and seek medical assistance immediately if you
experience any of the following symptoms:
• skin reddening, blisters, rash, fever, sore throat or eye irritation
Reference: Directive No. 2 Year 2019. BPFK/PPP/07/25 ( 2 ) Jld 3 Direktif Untuk Semua Produk
Antibiotik Kumpulan Beta-Lactam Termasuk Kombinasi: Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Severe Cutaneous
Adverse Reactions (SCARs)
The following statement shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Bisphosphonate
(Alendronate, Clodronate, Ibandronic acid, Pamidronate, Risedronate, Zoledronic
acid):
Package Insert
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SIDE EFFECTS:
Very rare
• Talk to your doctor if you have ear pain, discharge from the ear, and/or an ear
infection. These could be signs of bone damage in the ear.
Reference: Directive No.7 Year 2016. BPFK/PPP/07/25 ( 38 ). Direktif Bagi Semua Produk Yang
Mengandungi Bisphosphonate (Alendronate, Clodronate, Ibandronic Acid, Pamidronate, Risedronate,
Zoledronic Acid) Dengan Risiko Kesan Advers Berkaitan Osteonecrosis Of The External Auditory Canal
The following statement shall be included on the labels and in the package inserts of
products containing Black Cohosh (Cimicifuga Racemosa):
WARNING
Stop taking this product if signs and symptoms suggestive of liver injury develop
such as tiredness, loss of appetite, yellowing of the skin and eyes or severe upper
stomach pain with nausea and vomiting or dark urine and consult your doctor
immediately.
Patients using herbal medicinal products should tell their doctor about it.
Reference: Circular Bil (61) dlm BPFK/02/5/1.3: Pernyataan Amaran Produk Mengandungi 'Black
Cohosh'
The following statement shall be included on label and package inserts of oral
products containing Boswellia spp:
WARNING:
Please consult your doctor/pharmacist before using this product if you are on other
medicines.
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31. BROMHEXINE
The following warning shall be included in the package insert, label and Consumer
Medication Information Leaflet (RiMUP) of products containing Bromhexine :
Package Insert
b) Side Effects
[Product name] may cause severe allergy and serious skin reactions. Stop
using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
1) severe allergy: breathing difficulties, light headedness, skin swellings
or rash
2) severe skin reaction: skin reddening, blisters, rash, fever, sore throat or
eye irritation
Reference: Directive No. 1 Year 2018. BPFK/PPP/07/25 (1) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Ambroxol Dan Bromhexine : Pengemaskinian Label, Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Amaran Kesan Advers Anafilaksis Dan Severe
Cutaneous Adverse Reactions (SCARs)
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32. BROMPHENIRAMINE
The following statement shall be included on the labels and in the package inserts of
liquid oral products containing Brompheniramine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
33. CAMPHOR
2. The following warnings and precautions shall be included in the package insert of
products containing Camphor:
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34. CARBAMAZEPINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing carbimazole or
methimazole (thiamazole):
Package Insert
a) Contraindications:
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Pregnancy
Carbimazole or methimazole (thiamazole) crosses the placenta but, provided the
mother's dose is within the standard range and her thyroid status is monitored; there
is no evidence of neonatal thyroid abnormalities. Studies have shown that the
incidence of congenital malformations is greater in the children of mothers whose
hyperthyroidism has remained untreated than in those who have been treated with
carbimazole or methimazole (thiamazole).
However, cases of congenital malformations have been observed following the use of
carbimazole or its active metabolite, methimazole (thiamazole) during pregnancy.
The blocking-replacement regimen should not be used during pregnancy since very
little thyroxine crosses the placenta in the last trimester.
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Reference: Directive No.19 Year 2019. BPFK/PPP/07/25 (19) Jld. 3. Direktif untuk semua produk
yang mengandungi carbimazole atau methimazole (thiamazole): Pengemaskinian sisip bungkusan dan
risalah maklumat ubat untuk pengguna (RIMUP) dengan maklumat keselamatan berkaitan risiko
pankreatitis akut (acute pancreatitis) dan pengukuhan maklumat keselamatan berkaitan risiko
kecacatan kongenital (congenital malformation).
36. CARBOCISTEINE
The following statements shall be included in the label, package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing carbocisteine:
Label
[Product name] may cause severe allergy and serious skin reactions. Stop using
[Product name] and seek medical assistance immediately if you experience any of
the following symptoms:
• Severe allergy: breathing difficulties, light headedness, skin swellings or rash.
• Severe skin reaction: skin reddening, blisters, rash, fever, sore throat or eye
irritation.
Package Insert
b) Contraindications
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a) Side Effects:
]Product name] may cause severe allergy and serious skin reactions. Stop
using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
• Severe allergy: breathing difficulties, light headedness, skin swellings or
rash.
• Severe skin reaction: skin reddening, blisters, rash, fever, sore throat or
eye irritation.
Reference: Directive No. 14 Year 2018. BPFK/PPP/07/25 (14) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Carbocisteine Dan Acetylcysteine : Pengemaskinian Label, Sisip Bungkusan Dan
Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan
Anaphylactic/ Anaphylactoid Reaction Dan Severe Cutaneous Adverse Reactions (SCARs)
37. CEFTRIAXONE
CONTRAINDICATION
Ceftriaxone is contraindicated in neonates (≤28 days of age) if they require (or are
expected to require) treatment with calcium-containing intravenous solutions,
including calcium-containing infusions such as parenteral nutrition, because of the
risk of precipitation of ceftriaxone-calcium.
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38. CETIRIZINE
WARNING
This product may cause adverse reaction to the liver.
AMARAN
Produk ini mungkin boleh menyebabkan kesan sampingan pada hepar (hati).
Reference: Circular (bil 17) dlm bpfk02/5/1.3: Label Amaran Tentang Penggunaan Bahan
Chelidonium majus
40. CHITOSAN
The following statement shall be included on the labels and package inserts of
products containing chitosan.
41. CHLORHEXIDINE
The following statements shall be included in the package insert, label and RiMUP of
pharmaceutical products containing Chlorhexidine:
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[Product Name] contains chlorhexidine. Inform your healthcare provider if you have
a known allergy to chlorhexidine.
Stop using this product and seek immediate medical assistance if you experience
rash, itching, swelling, breathing difficulties, light-headedness or rapid heartbeat.
Reference: Directive No. 8 Year 2017. BPFK/PPP/07/25 (13) Jld 1. Direktif Untuk Semua Produk
Farmaseutikal Yang Mengandungi Chlorhexidine : Pengemaskinian Sisip Bungkusan, Label Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Reaksi
Hipersensitiviti
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42. CHLORPHENIRAMINE
The following statement shall be included on the labels and package inserts of liquid
oral products containing Chlorpheniramine:
WARNING
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
44. CLEMASTINE
The following statement shall be included on the labels and package inserts of liquid
oral products containing Clemastine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
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45. CLARITHROMYCIN
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Clarithromycin:
Package Insert
c) Contraindications:
d) Interactions:
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a) Side Effects:
[Product name] may cause severe allergy and serious skin reactions.
Stop using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
• skin reddening, blisters, rash, fever, sore throat or eye irritation
Do not take [product name] if you are taking any of the following medicines:
domperidone (used for nausea & vomiting)
References:
Directive Bil 22 Year 2018. BPFK/PPP/07/25 (22) Jld.2. Direktif Untuk Semua Produk Yang
Mengandungi Azithromycin, Clarithromycin, Erythromycin Dan Roxithromycin : Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan
Berkaitan Severe Cutaneous Adverse Reactions (SCARs)
Directive No. 32 Year 2018. BPFK/PPP/07/25 ( 32 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Clarithromycin: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Berkaitan Interaksi Ubat Yang Mengakibatkan Peningkatan
Risiko Qt Interval Prolongation
46. CLINDAMYCIN
The package insert must include the following boxed or emphasized statements/
warning:
• Clindamycin therapy has been associated with severe colitis which may end
fatally.
• It should be reserved for serious infections where less toxic antimicrobial
agents are inappropriate.
• It should not be used in patients with nonbacterial infections, such as most
upper respiratory tract infections.
• Its use in newborns is contraindicated.
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47. CLOPIDOGREL
INTERACTION
Since clopidogrel is metabolised to its active metabolite by CYP2C19, use of drugs
that inhibit the activity of this enzyme would be expected to result in reduced drug
levels of the active metabolite of clopidogrel and a reduction in clinical efficacy.
Concomitant use of drugs that inhibit CYP2C19 (e.g proton pump inhibitors) should
be discouraged.
PHARMACOKINETIC PROPERTIES
The oxidative step is regulated primarily by Cytochrome P450 ISOENZYMES 2B6,
3A4, 1A1, 1A2 and 2C19.
Reference: Circular Bil (42) dlm. BPFK/PPP/01/03: Kenyataan Amaran Berkaitan Dengan “Possible
Interaction Between Clopidogrel and Proton Pump Inhibitors” yang Perlu Dimuatkan Pada Sisip
Bungkusan Produk Clopidogrel
48. CLOZAPINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Clozapine;
Package Insert
a) Contraindications
Paralytic ileus
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d) Interactions
Due to the possibility of additive effects, caution is essential when substances
possessing anticholinergic effects are given concomitantly with [product name].
Do not take [product name] if you suffer or have ever suffered from severe
constipation, obstruction of the bowel or any other condition which has affected
your large bowel.
Tell your doctor or pharmacist if you are taking or have recently taken medicines
which cause constipation (such as anticholinergic, which are used to relieve
stomach cramps, spasms and travel sickness).
d) Side effects:
Abdominal pain, cramping, swollen abdomen, vomiting, constipation and failure to
pass gas which may be signs and symptoms of bowel obstruction.
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Reference: Directive No. 3 Year 2021. NPRA.600-1/9/13 (13). Direktif Untuk Semua Produk Yang
Mengandungi Clozapine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Komplikasi Usus Yang Serius
Akibat Sembelit
49. COBICISTAT
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Cobicistat:
Package Insert
a) Interactions:
Medicinal Effects on Recommendation concerning co-administration
product by medicinal with [product name]
therapeutic product levels.
areas
All corticosteroids excluding cutaneous products
Corticosteroids Interaction not Concomitant use of [product name] and
primarily studied with any of corticosteroids that are metabolised by CYP3A (e.g.
metabolised by the components of fluticasone propionate or other inhaled or nasal
CYP3A (including [product name]. corticosteroids) may increase the risk of
betamethasone, development of systemic corticosteroid effects,
budesonide, Plasma including Cushing's syndrome and adrenal
fluticasone, concentrations of suppression.
mometasone, these medicinal
prednisone, products may be Co-administration with CYP3A-metabolised
triamcinolone). increased when co- corticosteroids is not recommended unless the
administered with potential benefit to the patient outweighs the risk,
[product name], in which case patients should be monitored for
resulting in systemic corticosteroid effects. Alternative
reduced serum corticosteroids which are less dependent on CYP3A
cortisol metabolism e.g. beclomethasone for intranasal or
concentrations. inhalational use should be considered, particularly
for long-term use.
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Reference: Directive No. 2 Year 2018. BPFK/PPP/07/25 ( 2 ) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Cobicistat Dan Kortikosteroid (Kecuali Produk Untuk Kegunaan Luar) :
Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan
Maklumat Berkaitan Interaksi Ubat
50. CODEINE
The following safety information/ statements shall be included in the package inserts
of products containing Codeine:
Indications
[Product name] is indicated for the relief of painful disorders such as headache,
dysmenorrhea, conditions involving musculoskeletal pain, myalgias and neuralgias. It
is also indicated as an analgesic and antipyretic in conditions accompanied by
discomfort and fever, such as the common cold and viral infections. [Product name] is
an effective analgesic after dental work and tooth extractions.
Codeine is indicated in patients older than 12 years of age for the treatment of acute
moderate pain which is not considered to be relieved by other analgesics such as
paracetamol or ibuprofen (alone).
Contraindications
• In children below the age of 12 years for the symptomatic treatment of colds
due to an increased risk of developing serious and life-threatening adverse
reactions.
• In all paediatric patients (0-18 years of age) who undergo tonsillectomy
and/or adenoidectomy for obstructive sleep apnoea syndrome due to
increased risk of developing serious and life-threatening adverse reactions.
• In women who are breastfeeding.
• In patients for whom it is known they are CYP2D6 ultra-rapid metabolisers.
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CYP2D6 metabolism
Codeine is metabolised by the liver enzyme CYP2D6 into morphine, its active
metabolite. If a patient has a deficiency or is completely lacking this enzyme an
adequate analgesic effect will not be obtained. Estimates indicate that up to 7% of the
Caucasian population may have this deficiency. However, if the patient is an
extensive or ultra-rapid metaboliser there is an increased risk of developing side
effects of opioid toxicity even at commonly prescribed doses. These patients convert
codeine into morphine rapidly resulting in higher than expected serum morphine
levels.
General symptoms of opioid toxicity include confusion, somnolence, shallow
breathing, small pupils, nausea, vomiting, constipation and lack of appetite. In severe
cases this may include symptoms of circulatory and respiratory depression, which
may be life-threatening and very rarely fatal. Estimates of prevalence of ultra-rapid
metabolisers in different populations are summarised below:
Population Prevalence %
African/Ethiopian 29%
African American 3.4 to 6.5%
Asian 1.2 to 2.0%
Caucasian 3.6 to 6.5%
Greek 6.0%
Hungarian 1.9%
Northern European 1.0 to 2.0%
Pregnancy
Careful consideration should be given before prescribing the product for pregnant
patients. Opioid analgesics may depress neonatal respiration and cause withdrawal
effects in neonates of dependent mothers.
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Breastfeeding
[Product name] is contraindicated in women during breastfeeding.
At normal therapeutic doses codeine and its active metabolite may be present in
breast milk at very low doses and is unlikely to adversely affect the breast fed infant.
However, if the patient is an ultra-rapid metaboliser of CYP2D6, higher levels of the
active metabolite, morphine, may be present in breast milk and on very rare
occasions may result in symptoms of opioid toxicity in the infant, which may be fatal.
Reference: Directive No. 16 Year 2016. BPFK/PPP/07/25 (2) Jld 1. Direktif Bagi Semua Produk Yang
Mengandungi Codeine Dengan Maklumat Keselamatan Berkaitan Risiko Kesan Advers Respiratory
Depression
51. COLCHICINE
INTERACTIONS
Potential risk of severe drug interactions, including death, in certain patients treated
with colchicine and concomitant P-glycoprotein or strong CYP3A4 inhibitors such as
clarithromycin, cyclosporin, erythromycin, calcium channel antagonists (e.g
Verapamil and Diltiazem), telithromycin, ketoconazole, itraconazole, HIV protease
inhibitors and nefazodone.
P-Glycoprotein or strong CYP3A4 inhibitors are not to be used in patients with renal
or hepatic impairment who are taking colchicine.
Reference: Circular Bil (45) dlm. BPFK/PPP/01/03: Kenyataan Amaran Berkaitan Dengan “Severe
Drug Interaction Between Colchicine and P-Glycoprotein or Strong CYP3A4 Inhibitors” Yang Perlu
Dimuatkan Pada Sisip Bungkusan Produk Colchicine
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52. CORTICOSTEROID
52.1 The following statements shall be included in the package insert and RiMUP of
inhaled corticosteriod used for treatment of Chronic Obstructive Pulmonary
Disease (COPD) such as budesonide and fluticasone (product containing
single active ingredient and in combination) and beclomethasone (only for
combination product):
Package Insert
Risk factors for pneumonia in patients with COPD include current smoking status,
older age, low body mass index (BMI) and severe COPD.
a) Side Effects
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52.2 The following statements shall be included in the package insert and RiMUP
of products containing corticosteroid (except products for external use):
Package Insert
Some medicines may increase the effects of [product name] and your doctor
may wish to monitor you carefully if you are taking these medicines (including
some medicines for HIV such as cobicistat).
Package Insert
a) Interactions:
Some medicines may increase the effects of [product name] and your doctor
may wish to monitor you carefully if you are taking these medicines (including
some medicines for HIV such as cobicistat).
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Reference: Circular Bil (46) dlm BPFK/02/5/1.3: Keputusan Mesyuarat PBKD - Tindakan-tindakan
regulatori terhadap Cox-2 Inhibitors: Celecocib dan Etoricoxib
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INDICATIONS
- Vascular Disorders
- Rare: Thromboembolism
The following boxed statement shall be included on the label of products containing
Cytotoxic agents:
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57. DEXBROMPHENIRAMINE
The following statement shall be included on the labels and package inserts of liquid
oral products containing Dexbrompheniramine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
58. DEXTROMETHORPHAN
The following statement shall be included on the labels and package inserts of liquid
oral products containing Dextromethorphan:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
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DOSAGE
As a general recommendation, the dose should be individually adjusted. Adverse
effects may be minimized by using the lowest effective dose for the shortest duration
necessary to control symptoms (see section WARNINGS AND PRECAUTIONS).
CONTRAINDICATIONS
Severe cardiac failure (see section WARNINGS AND PRECAUTIONS).
Cardiovascular Effects
Treatment with NSAIDs including diclofenac, particularly at high dose and in long
term, maybe associated with an increased risk of serious cardiovascular thrombotic
events (including myocardial infarction and stroke).
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Patients should remain alert for the signs and symptoms of serious arteriothrombotic
events (e.g. chest pain, shortness of breath, weakness, slurring of speech), which can
occur without warnings. Patients should be instructed to see a physician immediately
in case of such an event.
Cardiac Disorders
Uncommon*: Myocardial infarction, cardiac failure, palpitations, chest pain.
* The frequency reflects data from long-term treatment with a high dose (150
mg/day).
Arteriothrombotic events
Meta-analysis and pharmacoepidemiological data point towards an increased risk of
arteriothrombotic events (for example myocardial infarction) associated with the use
of diclofenac, particularly at a high dose (150 mg daily) and during long-term
treatment (see section WARNINGS AND PRECAUTIONS).
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Diclofenac (except
products for cutaneous use);
Package Insert
Gastrointestinal effects
NSAIDs, including diclofenac, may be associated with increased risk of
gastrointestinal anastomotic leak. Close medical surveillance and caution are
recommended when using diclofenac after gastrointestinal surgery.
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Cardiac disorders:
Kounis syndrome: Frequency “not known”
Tell your doctor if you recently had or you are going to have a surgery of the
stomach or intestinal tract before receiving/taking/using [product name], as
[product name] can sometimes worsen wound healing in your gut after surgery.
b) Side Effects:
Frequency “not known”: Chest pain, which can be a sign of a potentially serious
allergic reaction called Kounis syndrome.
Reference: Directive No. 4 Year 2020. Ref. BPFK/PPP/07/25 ( 4 ) Jld 4. Direktif Untuk Semua Produk
Yang Mengandungi Diclofenac (Kecuali Sediaan Untuk Kegunaan Pada Kulit): Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Penambahan Maklumat
Keselamatan Berkaitan Risiko Anastomotic Leakage Dan Kounis Syndrome
62. DICYCLOMINE
The following boxed warning shall be included on the labels and in the package
inserts of products containing Dicyclomine:
WARNING
Dicyclomine is not recommended for use in infants
under the age of six month
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63. DIPHENHYDRAMINE
The following statement shall be included on the labels and in the package inserts of
products containing Diphenhydramine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
64. DIPHENOXYLATE
WARNING
PRECAUTION
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65. DOMPERIDONE
The following statement shall be included on the package inserts and RiMUP of
products containing Domperidone:
Package insert
INDICATIONS
Domperidone is indicated for the relief of the symptoms of nausea and vomiting.
This includes:
• Nausea and vomiting of functional, organic, infectious or dietary origin.
• Nausea and vomiting induced by:
- radiotherapy or drug therapy.
- dopamine agonists (such as L-dopa and bromocriptine) used in the treatment
of Parkinson’s disease.
It is recommended to take [product name] 15-30 minutes before meals. If taken after
meals, absorption of the drug is somewhat delayed.
Adults and adolescents ≥ 12 years of age and weighing ≥35 kg & children <12 years
of age and weighing ≥ 35 kg
The dose of [product name] should be the lowest effective dose for the individual
situation (typically 30 mg/day) and can be increased if necessary to a maximum daily
oral dose of 40 mg.
Usually, the maximum treatment duration should not exceed one week for the
treatment of acute nausea and vomiting. If nausea and vomiting persists for longer
than one week, patients should consult their physician. For other indications, the
initial duration of treatment is up to four weeks. If treatment exceeds four weeks,
patients should be re-evaluated and the need for continued treatment reassessed.
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The dose of [product name] should be the lowest effective dose. The total daily dose
is dependent on weight (see table below).
Usually, the maximum treatment duration should not exceed one week for the
treatment of acute nausea and vomiting. For other indications, the initial duration of
treatment is up to four weeks. If treatment exceeds four weeks, patients should be
reevaluated and the need for continued treatment reassessed. Due to the need for
accurate dosing, tablets are unsuitable for use in adults and adolescents weighing
less than 35 kg.
The efficacy of [product name] has not been established in infants and children < 12
years of age and weighing < 35 kg.
Renal impairment
Hepatic impairment
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INTERACTIONS
The main metabolic pathway of domperidone is through CYP3A4. In vitro and human
data show that the concomitant use of drugs that significantly inhibit this enzyme
may result in increased plasma levels of domperidone. Co-administration of
domperidone with potent CYP3A4 inhibitors which have been shown to cause QT
interval prolongation is contraindicated (See Section Contraindications).
Cardiovascular effects
Domperidone has been associated with prolongation of the QT interval on the
electrocardiogram. During post-marketing surveillance, there have been very rare
cases of QT-prolongation and torsades de pointes in patients taking domperidone.
These reports included patients with confounding risk factors, electrolyte
abnormalities and concomitant treatment which may have been contributing factors
(see Adverse Reactions).
Domperidone should be used at the lowest effective dose in adults and children.
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Treatment with domperidone should be stopped if signs or symptoms occur that may
be associated with cardiac arrhythmia, and the patients should consult their
physician.
Do not take [product name] if you are taking any of the following medicines:
clarithromycin (antibiotic)
You should always take the lowest amount of [product name] that works for you
and you should not take it for longer than is necessary. Although the amount of
[product name] you should usually take is described below, your doctor may
adjust your dose to your personal needs.
Adults and adolescents (12 years of age and over) weighing 35 kg or more;
children weighing 35kg or more:
Tablets: Take 1 tablet 3 to 4 times a day. Do not take more than 4 tablets per day
(40 mg/day).
Oral suspension: Take 10mL of oral suspension 3 or 4 times a day. Do not take
more than 40mL per day (40 mg/day).
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Oral suspension: Give 0.25 milliliters of the oral suspension per kilogram of body
weight 3 or 4 times a day. The maximum dose per day is 1 mg/kg but do not
exceed 35 mg per day.
Infants and children less than 12 years of age and weighing less than 35kg:
The effectiveness of [product name] has not been established in infants and
children under 12 years of age with a body weight of <35 kg.
References:
Directive No.4 Year 2015 (28)dlm.BPFK/PPP/07/25. Direktif Untuk Semua Produk Domperidone
Untuk Mengehadkan Penggunaan Berikutan Risiko Kesan Advers Jantung
Directive No. 31 Year 2018. BPFK/PPP/07/25 ( 31 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Domperidone: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Berkaitan Interaksi Ubat Yang Mengakibatkan Peningkatan
Risiko Qt Interval Prolongation
Directive No. 6 Year 2020. BPFK/PPP/07/25 ( 6 ) Jld 4. Direktif Untuk Semua Produk Yang
Mengandungi Domperidone: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Berkaitan Penggunaan Dalam Kalangan Golongan Pediatrik
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Reference: Circular (bil 14) dlm bpfk02/5/1.3: Keluaran yang mengandungi bahan aktif
dopaminergik- tanda amaran berkaitan dengan ' sudden sleep onset'
67. DOXYCYCLINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Doxycycline;
Package Insert
a) Side Effects:
Reference: Directive No. 19 Year 2018. BPFK/PPP/07/25 (19) Jld 2. Direktif Untuk Semua
Produk Yang Mengandungi Doxycycline : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Jarisch-Herxheimer
Reaction
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68. EFAVIRENZ
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Efavirenz:
Package Insert
- QTc prolongation has been observed with the use of efavirenz (see Section
Pharmacodynamics and Section Interaction with Other Medicaments).
Consider alternatives to [Product name] when coadministered with a drug
with a known risk of Torsade de Pointes or when administered to patients at
higher risk of Torsade de Pointes.
b) Pharmacodynamics:
Cardiac Electrophysiology
The effect of [Product name] on the QTc interval was evaluated in an open-label,
positive and placebo controlled, fixed single sequence 3-period, 3-treatment
crossover QT study in 58 healthy subjects enriched for CYP2B6 polymorphisms.
The mean Cmax of efavirenz in subjects with CYP2B6 *6/*6 genotype following
the administration of 600 mg daily dose for 14 days was 2.25-fold the mean
Cmax observed in subjects with CYP2B6 *1/*1 genotype. A positive relationship
between efavirenz concentration and QTc prolongation was observed. Based on
the concentration-QTc relationship, the mean QTc prolongation and its upper
bound 90% confidence interval are 8.7 ms and 11.3 ms in subjects with
CYP2B6*6/*6 genotype following the administration of 600 mg daily dose for 14
days. (see Section Warnings and Precautions & Section Interaction with Other
Medicaments).
c) Interactions:
QT Prolonging Drugs
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b) Side effects:
Some nervous system symptoms [e.g. confusion, slow thoughts and physical
movement and delusions (false beliefs) or hallucinations (seeing or hearing
things that others do not see or hear)] may occur months to years after beginning
[product name] therapy. Always notify your doctor or pharmacist if you have
these symptoms or any side effects while taking [product name].
References:
Directive No. 18 Year 2018. BPFK/PPP/07/25 ( 18 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Efavirenz : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna
(RiMUP) Dengan Maklumat Keselamatan Berkaitan QTc Prolongation
Directive No. 4 Year 2021. NPRA.600-1/9/13 (14). Direktif Untuk Semua Produk Yang Mengandungi
Efavirenz (Termasuk Produk Kombinasi): Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat
Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Late Onset Neurotoxicity
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69. EPHEDRINE
The following statement shall be included on the labels and in the package inserts of
products containing Ephedrine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
70. ERYTHROMYCIN
1. The following statement shall be included in the package insert and RiMUP of
products containing erythromycin;
Package Insert
Side Effects
[Product name] may cause severe allergy and serious skin reactions.
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Reference: Directive Bil 22 Year 2018. Bil (22) dlm BPFK/PPP/07/25 Jld.2. Direktif Untuk Semua
Produk Yang Mengandungi Azithromycin, Clarithromycin, Erythromycin Dan Roxithromycin:
Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan
Maklumat Keselamatan Berkaitan Severe Cutaneous Adverse Reactions (SCARs)
2. The following statement shall be included in the package insert and RiMUP of
products containing erythromycin (except topical/ external and ophtalmic
preparations);
Package Insert
There have been reports of infantile hypertrophic pyloric stenosis (IHPS) occurring
in infants following erythromycin therapy. In one cohort of 157 newborns who were
given erythromycin for pertussis prophylaxis, seven neonates (5%) developed
symptoms of non-bilious vomiting or irritability with feeding and were subsequently
diagnosed as having IHPS requiring surgical pyloromyotomy. Since erythromycin
may be used in the treatment of conditions in infants which are associated with
significant mortality or morbidity (such as pertussis or chlamydia), the benefit of
erythromycin therapy needs to be weighed against the potential risk of developing
IHPS. Parents and caregivers should be informed to contact their physician if
vomiting and/ or irritability with feeding occurs.
Postmarketing Experience:
Side Effects
If you notice that the child vomits and/or irritability with feeding occurs, contact
doctor immediately as it may be due to the Infantile Hypertrophic Pyloric Stenosis
(IHPS).
Reference: Directive No. 28 Year 2017. BPFK/PPP/07/25 (33) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Bahan Aktif Azithromycin Dan Erythromycin Kecuali Persediaan Topikal/ Eksternal
Dan Ubat Untuk Kegunaan Mata : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Amaran Berkaitan Risiko Infantile Hypertrophic Pyloric Stenosis (IHPS)
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71. ETHINYLESTRADIOL
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing ethinylestradiol;
Package Insert
a) Contraindications:
ALT elevations
During clinical trials with patients treated for hepatitis C virus infections
(HCV) with the medicinal products containing ombitasvir / paritaprevir /
ritonavir and dasabuvir with/without ribavirin, transaminase (ALT)
elevations higher than 5 times the upper limit of normal (ULN) occurred
significantly more frequent in women using ethinylestradiol-containing
medications such as combined hormonal contraceptives (CHCs). Patients who
are taking ethinylestradiol-containing medicinal products must switch to an
alternative method of contraception (e.g. progestin only contraception or non-
hormonal methods) prior to initiating ombitasvir / paritaprevir/ ritonavir
and dasabuvir therapy (See Section Contraindications and Section
Interactions with Other Medicaments).
c) Interactions:
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Reference: Directive No. 13 Year 2018. BPFK/PPP/07/25 ( 13 ) Jld 2. Direktif Untuk Semua Produk
Yang Mengandungi Ethinylestradiol : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat
Untuk Pengguna (RiMUP) Dengan Risiko Peningkatan Paras Alanine Transaminase (ALT) Akibat
Interaksi Dengan Produk Kombinasi Ombitasvir / Paritaprevir / Ritonavir Dan Dasabuvir
72. ETORICOXIB
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing Etoricoxib:
Package Insert
Rheumatoid arthritis
The recommended dose is 60 mg once daily. In some patients with insufficient
relief from symptoms, an increased dose of 90 mg once daily may increase efficacy.
Once the patient is clinically stabilised, down-titration to a 60 mg once daily dose
may be appropriate. In the absence of an increase in therapeutic benefit, other
therapeutic options should be considered.
Ankylosing spondylitis
The recommended dose is 60 mg once daily. In some patients with insufficient
relief from symptoms, an increased dose of 90 mg once daily may increase efficacy.
Once the patient is clinically stabilised, down-titration to a 60 mg once daily dose
may be appropriate. In the absence of an increase in therapeutic benefit, other
therapeutic options should be considered.
Rheumatoid arthritis
The recommended dose is 60 mg once a day, and may increase to 90 mg once a day
if needed.
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Reference: Directive No. 13 Year 2017. BPFK/PPP/07/25 (18) Jld 1. Direktif Untuk Semua Produk
Farmaseutikal Yang Mengandungi Etoricoxib : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Berkaitan Perubahan Dos Permulaan Bagi Rawatan
Rheumatoid Arthritis Dan Ankylosing Spondylitis
73. FAMOTIDINE
DOSAGE
Dosage adjustment is required for patients with moderate to severe renal
insufficiency. Since CNS adverse effects have been reported in patients with
moderate to severe renal insufficiency, to avoid excess accumulation of the drug, the
dose of famotidine may be reduced to half the recommended dose or the dosing
interval may be prolonged to 36 - 48 hours as indicated by the patient’s clinical
response.
As elderly patients are more likely to have decreased clearance of famotidine, care
should be taken in dose selection and it may be useful to monitor renal function.
74. FIBRATES
INTERACTION
Concurrent use of fibrates with HMG-CoA reductase inhibitors may cause severe
myositis and myoglobinuria.
75. FILGRASTIM
The following statement shall be included in the package inserts of ALL biosimilar
products containing FILGRASTIM
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Aortitis has been reported after G-CSF administration in healthy subjects and in
cancer patients. The symptoms experienced included fever, abdominal pain, malaise,
back pain and increased inflammatory markers (e.g. C-reactive protein and white
blood cell count). In most cases aortitis was diagnosed by CT scan and generally
resolved after withdrawal of G-CSF.
Clinical Trials
In Cancer Patients
Capillary Leak Syndrome, which can be life-threatening if treatment is delayed, has
been reported uncommonly (≥1/1000 to < 1/100) in cancer patients undergoing
chemotherapy following administration of granulocyte colony stimulating factors.
Post Marketing
Vascular disorders
Cases of capillary leak syndrome have been reported in the post marketing setting
with granulocyte colony stimulating factor use. These have generally occurred in
patients with advanced malignant diseases, sepsis, taking multiple chemotherapy
medications or undergoing apheresis.
References:
Directive No. 13 Year 2014. Bil (20) dlm. BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Filgrastim Dan Pegfilgrastim: Amaran Berkaitan Risiko Capillary Leak Syndrome (CLS)
Bagi Pesakit Kanser Dan Healthy Donor (Filgrastim) Dan Bagi Pesakit Kanser (Pegfilgrastim)
Directive No. 30 Year 2018. Bil (30) dlm. BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Filgrastim, Pegfilgrastim Dan Lenograstim: Pengemaskinian Sisip Bungkusan Dengan
Maklumat Keselamatan Berkaitan Aortitis
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76. FLUCLOXACILLIN
The following warning shall be included in the package insert of products containing
Flucloxacillin:
WARNING
Liver Toxicity
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77. FLUCONAZOLE
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing Fluconazole:
Package Insert
Case reports describe a distinctive and a rare pattern of birth defects among
infants whose mothers received high dose (400-800mg/day) fluconazole
during most or all of the first trimester of pregnancy. The features seen in
these infants include brachycephaly, abnormal facies, abnormal calvarial
development, cleft palate, femoral bowing, thin ribs and long bones,
arthrogryposis, and congenital heart disease.
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• Breast-feeding
[Product name] is excreted in human breast milk, hence its use in
nursing mothers is not recommended.However, breast-feeding may be
maintained if you took a single dose of [product name] 150mg. Breast-
feeding is not recommended after a high dose (more than 150 mg) or
repeated use of [product name].
Reference: Directive No. 24 Year 2017. BPFK/PPP/07/25 (29) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Fluconazole: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Baharu Berkaitan Risiko Spontaneous Abortion
Serta Memperkukuhkan Maklumat Keselamatan Berkaitan Multiple Congenital Abnormalities Dan
Penggunaan Dalam Kalangan Ibu Menyusu
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78. FLUORIDE
All toothpastes containing Fluorides should be labeled with the following additional
information:
a. DIRECTIONS ON USE
• Do not swallow – spit and rinse after use.
d. GRAPHICS AS SHOWN
• Child’s use
• Adult’s use
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Package Insert
a) Indication:
• Acute bronchitis
• Laryngitis
• Pharyngitis-tonsillitis
• Prophylaxis of infectious gastroenteritis / traveller's diarrhoea
• Selective decontamination of gastrointestinal tract in patients with
compromised immune system
• Vaginal infections
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(iv) The following text should be added after the restricted indications in
part (iii):
The use of [INN] should be avoided in patients who have experienced serious adverse
reactions in the past when using fluoroquinolones containing products (see section
Adverse Effects/Undesirable Effects). Treatment of these patients with [INN] should
only be initiated in the absence of alternative treatment options and after careful
benefit/risk assessment.
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At the first sign of tendinitis (e.g. painful swelling, inflammation) the treatment with
[INN] should be discontinued and alternative treatment should be considered. The
affected limb(s) should be appropriately treated (e.g. immobilisation).
Corticosteroids should not be used if signs of tendinopathy occur.
Peripheral neuropathy
Cases of sensory or sensorimotor polyneuropathy resulting in paraesthesia,
hypaesthesia, dysesthesia, or weakness have been reported in patients receiving
quinolones and fluoroquinolones. Patients under treatment with [INN] should be
advised to inform their doctor and pharmacist prior to continuing treatment if
symptoms of neuropathy such as pain, burning, tingling, numbness, or weakness
develop in order to prevent the development of potentially irreversible condition
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*Very rare cases of prolonged (up to months or years), disabling and potentially
irreversible serious drug reactions affecting several, sometimes multiple, system
organ classes and senses (including reactions such as tendinitis, tendon rupture,
arthralgia, pain in extremities, gait disturbance, neuropathies associated with
paraesthesia, depression, fatigue, memory impairment, sleep disorders, and
impairment of hearing, vision, taste and smell) have been reported in association
with the use of fluoroquinolones in some cases irrespective of pre-existing risk
factors (see section Warnings and Precautions).
- Tell your healthcare providers if you have a family history of aortic aneurysm or
aortic dissection or other risk factors or predisposing conditions (e.g.
connective tissue disorders such as Marfan syndrome, or vascular Ehlers-Danlos
syndrome, or vascular disorders such as Takayasu arteritis, giant cell arteritis,
Behcet´s disease, high blood pressure, or known atherosclerosis).
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If you feel sudden, severe pain in your abdomen, chest or back, go immediately to
the emergency department.
Stop taking your fluoroquinolone antibiotic and contact your healthcare providers
immediately if you have the following signs of a side effect:
• Tendon pain or swelling, often beginning in the ankle or calf. If this happens,
rest the painful area until you can see your healthcare providers.
• Pain in your joints or swelling in your shoulder, arms, or legs.
• Abnormal pain or sensations (such as persistent pins and needles, tingling,
tickling, numbness, or burning), weakness in your body, especially in the legs
or arms, or difficulty walking.
• Severe tiredness, depressed mood, anxiety, problems with your memory, or
severe problems sleeping.
• Changes in your vision, taste, smell, or hearing.
Tell your healthcare providers if you have had one of the above effects during or
shortly after taking a fluoroquinolone – this means you should avoid them in the
future. You and your healthcare providers will decide on continuing the treatment
considering also an antibiotic from another class.
Tendinitis and tendon rupture
Pain and swelling in the joints and inflammation or rupture of tendons may occur
rarely. Your risk is increased if you are elderly (above 60 years of age), have
received an organ transplant, have kidney problems or if you are being treated with
corticosteroids. Inflammation and ruptures of tendons may occur within the first 48
hours of treatment and even up to several months after stopping of [product name]
therapy. At the first sign of pain or inflammation of a tendon (for example in your
ankle, wrist, elbow, shoulder or knee), stop taking [product name], contact your
healthcare providers and rest the painful area. Avoid any unnecessary exercise as
this might increase the risk of a tendon rupture.
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You may rarely experience symptoms of nerve damage (neuropathy) such as pain,
burning, tingling, numbness and/or weakness especially in the feet and legs or
hands and arms. If this happens, stop taking [product name] and inform your
healthcare providers immediately in order to prevent the development of
potentially irreversible condition.
c) Side Effects:
References:
Circular Bil (20) dlm BPFK/PPP/01/03 Jld 1. Direktif untuk Memperkukuhkan Amaran Berkaitan
dengan Exacerbation of Myasthenia Gravis dalam Sisip Bungkusan Semua Produk Antibiotik dalam
Kumpulan Fluoroquinolones
Directive No.9 Year 2019. BPFK/PPP/07/25 (9). Direktif Untuk Semua Produk Yang Mengandungi
Antibiotik Kumpulan Fluoroquinolone (Sediaan Oral Dan Injeksi Sahaja): Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan
Berkaitan Risiko Aortic Aneurysm Dan Aortic Dissection
Directive No.12 Year 2019. BPFK/PPP/07/25 (12). Direktif Untuk Semua Produk Yang Mengandungi
Fluoroquinolone (Sediaan Oral Dan Injeksi): Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berikut: a) Membatalkan dan
Menghadkan Indikasi Antibiotik Kumpulan Fluoroquinolone b) Amaran Berkaitan Disabling and
Potentially Permanent Side Effects (tendinitis, tendon rupture, peripheral neuropathy & central nervous
system/ neuropsychiatric effects)
80. GABAPENTIN
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Gabapentin;
Package Insert
Respiratory depression
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Tell your doctor or pharmacist if you are taking or have been recently taking
any medicines for convulsions, sleeping disorders, depression, anxiety, or any
other neurological or psychiatric problems.
b) Side Effects:
References:
Directive No. 9 Year 2018. BPFK/PPP/07/25 ( 9 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Gabapentin: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Respiratory Depression
Directive No. 5 Year 2020. BPFK/PPP/07/25 ( 5 ) Jld 4. Direktif Untuk Semua Produk Yang
Mengandungi Gabapentin: Pengemaskinian Sisip Bungkusan dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Penambahan Maklumat Keselamatan Berkaitan Risiko Dysphagia
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b) Other indications including use in MRI of the brain and spine, as contrast-
enhanced MR- angiography & MRI of the breast shall be removed.
The following boxed warning and warning shall be included in the package inserts of
products containing Gadolinium Based Contrast Medium for Magnetic Resonance
Imaging:
BOXED WARNING
- NSF is a debilitating and sometimes fatal disease affecting the skin, muscle,
and internal organs
- Avoid use of GBCAs unless the diagnotic information is essential and not
available with non-contrast enhanced magnetic resonance imaging (MRI).
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• The risk, if any, for developing NSF among patients with mild to moderate
renal insufficiency or normal renal function is unknown.
The following boxed statement shall be included in the package inserts of topical
Gentamicin preparations:
The following statements shall be included on the labels and in the package inserts of
products containing Gingko biloba/ Gingko extract:
As the use of Ginkgo may increase the tendency of bleeding, please consult your
physician/ pharmacist if you are on or intend to start using any other medicines and
before you undergo any surgical/dental procedure.
Reference: Circular Bil (47) dlm BPFK/02/5/1.3: Pernyataan Amaran Pada Label Dan Sisip
Bungkusan Produk Yang Mengandungi Ginkgo Biloba / Ginkgo Ekstrak
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86. GINSENG
The following statements shall be included on the labels and in the package inserts of
products containing Ginseng (including all Panax genus):
87. GLUCOSAMINE
The following statement shall be included on the labels and package inserts of
products containing Glucosamine (derived from seafood);
• Cardiovascular
Peripheral oedema, tachycardia were reported in a few patients following
larger clinical trials investigating oral administration in osteoarthritis.
Causal relationship has not been established.
• Central nervous system
Drowsiness, headache, insomnia have been observed rarely during therapy
(less than 1%).
• Gastrointestinal
Nausea, vomiting, diarrhoea, dyspepsia or epigastric pain, constipation,
heartburn and anorexia have been described rarely during oral therapy
with glucosamine.
• Skin
Skin reactions such as erythema and pruritus have been reported with
therapeutic administration of glucosamine.
References:
Circular Bil (52) dlm BPFK/02/5/1.3: Muatkan Kenyataan 'Derived From Seafood' Pada Label Produk
Jika Bahan AKtif Adalah Daripada Sumber Laut'
Circular Bil (72) dlm BPFK/02/5/1.3: Mengemaskini dan menyelaraskan maklumat mengenai kesan
sampingan pada label & sisip bungkusan produk yang mengandungi glucosamine
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89. HYDROCHLOROTHIAZIDE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing hydrochlorothiazide;
Package Insert
Patients taking HCTZ should be informed of the risk of NMSC and advised to
regularly check their skin for any new lesions and promptly report any suspicious
skin lesions. Possible preventive measures such as limited exposure to sunlight
and UV rays and, in case of exposure, adequate protection should be advised to the
patients in order to minimize the risk of skin cancer. Suspicious skin lesions
should be promptly examined potentially including histological examinations of
biopsies. The use of HCTZ may also need to be reconsidered in patients who have
experienced previous NMSC.
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c) Pharmacodynamic:
Inform your healthcare providers before taking [product name] if you have had
skin cancer or if you develop an unexpected skin lesion during the treatment.
Treatment with hydrochlorothiazide, particularly long term use with high doses,
may increase the risk of some types of skin and lip cancer (non-melanoma skin
cancer). Protect your skin from sun exposure and UV rays while taking [product
name].
b) Side Effects:
Frequency ‘not known’: Skin and lip cancer (Non-melanoma skin cancer)
Reference: Directive No.11 Year 2019. BPFK/PPP/07/25 (11). Direktif Untuk Semua Produk Yang
Mengandungi Hydrochlorothiazide Termasuk Kombinasi: Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Penambahan Maklumat Keselamatan Berkaitan
Non-Melanoma Skin Cancer
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90. HYDROQUINONE
The following warning shall be included on the outer labels of products containing
Hydroquinone:
WARNING:
Some users of this product may experience skin irritations. Should this occur, stop
using and consult a medical doctor.
For hydroquinone products that do not contain any sun screening agent, a statement
should be included in the package insert to advise users to either use a sun screening
agent or protect themselves from sunlight or to use the products only at night.
Reference: Circular(26)dlm.BPFK/02/5/1.2 : Amaran bagi Produk Mengandungi Hydroquinone
a) Contraindications:
Cardiac disorders
Common: tachycardia
Reference: Directive No. 17 Year 2017. BPFK/PPP/07/25 ( 22 ) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Hyoscine (Bentuk Dos Injeksi Sahaja) : Pengemaskinian Sisip Bungkusan Dengan
Maklumat Keselamatan Berkaitan Risiko Kesan Advers Serius Pada Pesakit Jantung Dan Kardiovaskular
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92. IMMUNOSUPPRESANTS
Reference: Circular Bil (44) dlm. BPFK/PPP/01/03: Kenyataan Amaran Berkaitan Dengan
“Increased Risk for Opportunistic Infections Such As Activation of Latent Viral Infections Including BK
Virus – Associated Nephropathy” Yang Perlu Dimuatkan Pada Sisip Bungkusan Produk
Immunosuppressant
93. INSULIN
The label of the product shall state clearly the source of insulin.
The following statement shall be included on the labels and package inserts of
products containing ingredients derived from seafood.
Reference: Circular Bil (52) dlm BPFK/02/5/1.3: Muatkan Kenyataan 'Derived From Seafood' Pada
Label Produk Jika Bahan AKtif Adalah Daripada Sumber Laut'
The following statements shall be included in the package insert and RiMUP of
products containing Interferon Alpha:
Package Insert
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a) Side Effects
Reference: Directive No. 1 Year 2017. BPFK/PPP/07/25 ( 6 ) Jld 1. Direktif Bagi Semua Produk Yang
Mengandungi Interferon Alfa Dan Interferon Beta : Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna Dengan Maklumat Keselamatan Berkaitan Risiko Kesan Advers
Pulmonary Arterial Hypertension (PAH)
The following statements shall be included in the package insert and RiMUP of
products containing Interferon Beta:
Package Insert
a) Side Effects
Reference: Directive No. 1 Year 2017. BPFK/PPP/07/25 ( 6 ) Jld 1. Direktif Bagi Semua Produk Yang
Mengandungi Interferon Alfa Dan Interferon Beta: Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna Dengan Maklumat Keselamatan Berkaitan Risiko Kesan Advers
Pulmonary Arterial Hypertension (PAH)
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The following statements shall be included in the package insert for products
containing Iodinated Contrast Media;
Package Insert
Reference: Directive No. 24 Year 2018. Circular Bil (24) dlm. BPFK/PPP/07/25 ( 24 ) Jld 2. Direktif
Untuk Semua Produk Yang Mengandungi Iodinated Contrast Media : Pengemaskinian Sisip Bungkusan
Dengan Maklumat Keselamatan Berkaitan Severe Cutaneous Adverse Reactions (SCARs)
98. ISONIAZID
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Isoniazid:
Package Insert
a) Side Effects:
Inflammation of the pancreas, which causes severe pain in the abdomen and back
(pancreatitis)
Reference : Directive No. 27 Year 2018. BPFK/PPP/07/25 ( 27 ) Jld 2.Direktif Untuk Semua Produk
Yang Mengandungi Isoniazid: Pengemaskinian Sisip Bungkusan dan Risalah Maklumat Ubat Untuk
Pengguna (RIMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Pancreatitis
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WARNING
Severe constipation, which may lead to faecal impaction, may rarely occur in children
and the elderly patients taking kaolin and pectin. Kaolin and pectin may interfere
with the absorption of other drugs, including antibiotics, administered concurrently.
PRECAUTION
Appropriate fluid and electrolyte therapy should be given to protect against
dehydration. Oral rehydration therapy with the use of appropriate fluids including
oral rehydration salts - remains the most effective treatment for dehydration due to
diarrhoea. The intake of as much of these fluids as possible is therefore imperative.
100. KETOCONAZOLE
[BRAND NAME] (ketoconazole) Tablets should be used only when other effective
antifungal therapy is not available or tolerated and the potential benefits are
considered to outweigh the potential risks.
[BRAND NAME] (ketoconazole) Tablets are indicated for the treatment of the
following systemic fungal infections in patients who have failed or who are
intolerant to other therapies: blastomycosis, coccidioidomycosis, histoplasmosis,
chromomycosis, and paracoccidioidomycosis.
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CONTRAINDICATIONS
In patients with acute or chronic liver disease.
Because of the risk for serious hepatotoxicity, [BRAND NAME] should be used
only when the potential benefits are considered to outweigh the potential risks,
taking into consideration the availability of other effective antifungal therapy.
Assess liver function, prior to treatment to rule out acute or chronic liver
disease, and monitor at frequent and regular intervals during treatment, and at
the first signs or symptoms of possible hepatotoxicity.
Hepatotoxicity
Very rare cases of serious hepatotoxicity, including cases with a fatal outcome or
requiring liver transplantation have occurred with the use of oral ketoconazole.
Some patients had no obvious risk factors for liver disease. Cases have been reported
that occurred within the first month of treatment, including some within the first
week.
The cumulative dose of the treatment is a risk factor for serious hepatotoxicity.
Factors which may increase the risk of hepatitis are prolonged treatment with
ketoconazole tablets, females over 50 years of age, previous treatment with
griseofulvin, a history of liver disease, known drug intolerance and concurrent use of
medication which compromises liver function. A period of one month should be
allowed between cessation of griseofulvin treatment and commencement treatment
with ketoconazole tablets because of an apparent association between recent
griseofulvin therapy and hepatic reactions to ketoconazole tablets.
Monitor liver function in all patients receiving treatment with ketoconazole tablets
(see Monitoring of hepatic function).
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Hepato-biliary Disorders
Reference: Directive Bil (22) dlm BPFK/PPP/01/03 Jld 1: Direktif memperkukuhkan amaran
berkaitan dengan risiko hepatoksisiti yang teruk dalam sisip bungkusan semua produk oral ketoconazole
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CONTRAINDICATIONS
• A history of peptic ulceration or gastrointestinal bleeding
• A history of haemorrhagic diathesis
• A history of confirmed or suspected cerebrovascular bleeding
• Operations associated with a high risk of haemorrhage
• A history of asthma
• Moderate or severe renal impairment (serum creatinine > 160mol/L)
• Hypovolaemia or dehydration from any cause
• Hypersensitivity to NSAIDs or aspirin
• During pregnancy, labour, delivery or lactation
• Concomitant administration with other NSAIDs, anticoagulant including low
dose heparin
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102. LAMOTRIGINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing lamotrigine;
Package Insert
Brugada-type ECG
A very rare association with Brugada-type ECG has been observed, although a
causal relationship has not been established. Therefore, careful consideration
should be given before using [product name] in patients with Brugada syndrome.
Post-marketing
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There have been reports of a rare but very serious immune system reaction, in
patients taking lamotrigine.
References:
Directive No. 3 Year 2019. BPFK/PPP/07/25 ( 3 ) Jld 3. Direktif Untuk Semua Produk Yang
Mengandungi Lamotrigine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Hemophagocytic
Lymphohistiocytosis (HLH)
Directive No. 14 Year 2019. BPFK/PPP/07/25 ( 14 ) Jld 3. Direktif Untuk Semua Produk Yang
Mengandungi Lamotrigine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Penambahan Maklumat Keselamatan Berkaitan Risiko Brugada-Type
ECG
103. LENOGRASTIM
Aortitis has been reported after G-CSF administration in healthy subjects and in
cancer patients. The symptoms experienced included fever, abdominal pain,
malaise, back pain and increased inflammatory markers (e.g. C-reactive protein
and white blood cell count). In most cases aortitis was diagnosed by CT scan and
generally resolved after withdrawal of G-CSF.
Vascular disorders
Frequency “rare”: Aortitis
Reference: Directive No. 30 Year 2018. Bil (30) dlm. BPFK/PPP/07/25. Direktif Untuk Semua
Produk Yang Mengandungi Filgrastim, Pegfilgrastim Dan Lenograstim: Pengemaskinian Sisip
Bungkusan Dengan Maklumat Keselamatan Berkaitan Aortitis
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104. LEVETIRACETAM
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Levetiracetam;
Package Insert
a) Side Effects:
105. LEVONORGESTREL
The following statements shall be included in the package insert, label and RiMUP of
emergency contraceptives containing Levonorgesteral:
Package Insert
a) Recommended Dose:
Women who have used enzyme-inducing drugs during the last 4 weeks and need
emergency contraception are recommended to use a non-hormonal emergency
contraceptive, i.e. Cu-IUD or take a double dose of levonorgestrel (i.e. <number of>
tablets taken together) for those women unable or unwilling to use Cu-IUD.
b) Interactions:
For women who have used enzyme-inducing drugs in the past 4 weeks and need
emergency contraception, the use of non-hormonal emergency contraception (i.e.
a Cu-IUD) should be considered. Taking a double dose of levonorgestrel (i.e. 3 mg
within 72 hours after the unprotected intercourse) is an option for women who
are unable or unwilling to use a Cu-IUD, although this specific combination (a
double dose of levonorgestrel during concomitant use of an enzyme inducer) has
not been studied.
Label
If you have used certain other medicines in the last 4 weeks, in particular treatment
for epilepsy, tuberculosis, for HIV infection or herbal medicines containing St. John´s
wort (see leaflet), [product name] may work less effectively. If you use these medicines
take <number of> tablets of [product name]. If you are unsure or to ask for an
alternative treatment speak to your doctor or pharmacist before using [product name].
If you have used any of the medicines below during the last 4 weeks, [product
name] may work less effectively.Your doctor may prescribe another type of
(non-hormonal) emergency contraceptive, i.e. a copper intrauterine device (Cu-
IUD). If this is not an option for you or if you are unable to see your doctor
promptly, you can take a double dose (i.e. <number of> tablets) of [product
name]:
• medicines used to treat epilepsy (e.g. phenobarbitone, phenytoin,
carbamazepine)
• medicines used to treat tuberculosis (e.g. rifampicin)
• medicines used to treat HIV (e.g. ritonavir, efavirenz)
• medicines used to treat fungal infections (e.g. griseofulvin)
• herbal remedies containing St. John’s wort (Hypericum perforatum)
Speak to your doctor or pharmacist if you need further advice on the correct
dose for you.
Consult your doctor as soon as possible after taking the tablets for further advice
on a reliable form of regular contraception and to exclude a pregnancy.
Reference: Directive No. 11 Year 2017. BPFK/PPP/07/25 ( 16 ) Jld 1. Direktif Untuk Semua Produk
Kontraseptif Kecemasan Yang Mengandungi Levonorgestrel Dengan Maklumat Berkaitan Interaksi
Antara Ubat-Ubatan Yang Dikelaskan Sebagai Hepatic Enzyme Inducer Dan Keberkesanan Kontrasepsi
106. LINCOMYCIN
The following statement shall be included on the labels of products containing Liquid
paraffin as laxative:
108. LOPERAMIDE
a) WARNING
Not recommended for children under 6 years of age. Its use has been
associated with fatal episodes of paralytic ileus in infants and young children.
b) PRECAUTION
The use of higher than the recommended doses for control of the diarrhea
may cause abnormal heart rhythms and serious cardiac events leading to
Post-marketing Experience
e) Overdose
109. LOVASTATIN
1. Contraindications:
Concomitant Therapy
The combined use of lovastatin with gemfibrozil should be avoided.
4. Interactions:
Contraindicated Drugs
Strong inhibitors of CYP3A4: Concomitant use with strong CYP3A4 inhibitors
(e.g. itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease
inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin
Other Drugs
• Gemfibrozil, other fibrates, niacin ≥1g/day:
These drugs increase the risk of myopathy when given concomitantly with
lovastatin, probably because they can produce myopathy when given alone.
There is no evidence to suggest that these agents affect the pharmacokinetics
of lovastatin. Myopathy, including rhabdomyolysis, has occurred in patients
who were receiving coadministration of lovastatin with fibric acid derivatives
or niacin.
110. MEFLOQUINE
Eye disorders, including but not limited to optic neuropathy and retinal disorders,
have been reported during treatment with mefloquine. Any patient presenting
with a visual disorder should be referred to the treating physician, as certain
conditions may require stopping treatment with [Brand name] (mefloquine).
Eye disorders, including but not limited to optic neuropathy and retinal disorders,
have been reported during treatment with mefloquine. Any patient presenting
with a visual disorder should be referred to the treating physician, as certain
conditions may require stopping treatment with [Brand name]
(mefloquine/artesunate).
a) Malay language:
AMARAN
Produk ini tidak boleh disapu pada muka, khususnya di kawasan hidung
bayi dan kanak-kanak. Ia mungkin boleh menyebabkan masalah
pernafasan/ kesukaran bernafas.
b) English language:
WARNING
This product should not be applied to the facial area, in particular around
the nose of infants and small children. It might cause breathing problem /
shortness of breath.
Reference: Directive No. 13, Year 2016. (44)dlm.BPFK/PPP/07/25 Direktif Bagi Semua Produk Yang
Mengandungi Bahan Aktif Minyak Cajeput (Melaleuca Leucadendra) Dalam Bentuk Dos Topikal Dengan
Menambah Kenyataan Amaran Berkaitan Risiko Masalah Pernafasan/ Kesukaran Bernafas
112. MESALAZINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing mesalazine;
Package Insert
• Photosensitivity
More severe reactions are reported in patients with pre-existing skin
conditions such as atopic dermatitis and atopic eczema.
b) Side Effects:
References:
Directive No. 12 Year 2018. BPFK/PPP/07/25 ( 12 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Mesalazine : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Amaran Kesan Advers Photosensitivity
Directive No. 1 Year 2021. NPRA.600-1/9/13 (11). Direktif Untuk Semua Produk Yang Mengandungi
Mesalazine Dan Sulfasalazine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Nephrolithiasis
113. METFORMIN
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing Metformin:
Package Insert
1. Recommended Dosage:
Renal impairment
* The text “to be divided into 2-3 daily doses” should be omitted for extended release products containing metformin as single
agent.
Renal impairment
The maximum daily dose of metformin should preferably be divided into 2-3 daily
doses. Factors that may increase the risk of lactic acidosis should be reviewed
before considering initiation of metformin in patients with GFR <60 ml/min.
2. Contraindications:
Lactic acidosis
Lactic acidosis, a very rare but serious metabolic complication, most often occurs
at acute worsening of renal function or cardiorespiratory illness or sepsis.
Metformin accumulation occurs at acute worsening of renal function and
increases the risk of lactic acidosis.
Renal function
GFR should be assessed before treatment initiation and regularly there after
[See Section Recommended Dosage]. Metformin is contraindicated in patients
with GFR <30 mL/min and should be temporarily discontinued in the
presence of conditions that alter renal function [See Section
Contraindications].
[Product name] may cause a very rare, but very serious side effect called lactic
acidosis, particularly if your kidneys are not working properly. The risk of
developing lactic acidosis is also increased with uncontrolled diabetes, serious
infections, prolonged fasting or alcohol intake, dehydration, liver problems and
any medical conditions in which a part of the body has a reduced supply of
oxygen (such as acute severe heart disease). If any of the above apply to you,
talk to your doctor for further instructions.
Stop taking [roduct name] for a short time if you have a condition that may be
associated with dehydration (significant loss of body fluids) such as severe
vomiting, diarrhoea, fever, exposure to heat or if you drink less fluid than
normal. Talk to your doctor for further instructions.
Stop taking [product name] and contact a doctor or the nearest hospital
immediately if you experience some of the symptoms of lactic acidosis, as this
condition may lead to coma.
During treatment with [product name], your doctor will check your kidney
function at least once a year or more frequently if you are elderly and/or if
you have worsening kidney function.
The following statements shall be included in the package inserts and product
literature of topical preparations containing methyl salicylate ≥5%:
The following warning shall be included in the package inserts of products containing
Methylcarbocysteine (Mecysteine):
CONTRAINDICATIONS
116. METHYLPHENIDATE
The following boxed statement shall be included on the labels and in the package
insert of products containing Methylphenidate HCl:
Priapism
Prolonged and painful erections, sometimes requiring surgical intervention, have
been reported with methylphenidate products in both pediatric and adult patients.
Priapism was not reported with drug initiation but developed after some time on the
Reference: Directive No. 12 Year 2014. Circular (19) dlm.BPFK/PPP/07/25 Direktif Untuk Semua
Produk Yang Mengandungi Methylphenidate: Amaran Berkaitan Risiko Priapism (Kesan Ereksi Yang
Berpanjangan) Di Kalangan Lelaki
117. METOCLOPRAMIDE
DOSAGE
Total daily dose of metoclopramide, especially for children and young adults, should
not normally exceed 0.5mg/kg body weight.
The following route of products containing Metoclopramide shall update its package
inserts according to the directive (24)dlm.BPFK/PPP/07/25. As below:
1) PARENTERAL ROUTE
• Indication
• Dose and Administration
• Contraindication
• Warnings and Precautions
Reference: Directive No. 17 Year 2014. (24)dlm.BPFK/PPP/07/25. Direktif Untuk Semua Produk
Metoclopramide: Memperketatkan Indikasi Dan Mengehadkan Dos Penggunaan Berikutan Risiko Kesan
Advers Neurologik
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products (except for external use)
containing Metronidazole:
Package Insert
Cases of severe hepatotoxicity/ acute hepatic failure, including cases with a fatal
outcome with very rapid onset after treatment initiation in patients with Cockayne
syndrome have been reported with products containing metronidazole for
systemic use. In this population, metronidazole should therefore be used after
careful benefit-risk assessment and only if no alternative treatment is available.
Liver function tests must be performed just prior to the start of therapy,
throughout and after end of treatment until liver function is within normal ranges,
or until the baseline values are reached. If the liver function tests become
markedly elevated during treatment, the drug should be discontinued.
Cases of severe liver toxicity/ acute liver failure in patients with Cockayne
syndrome have been reported with products containing metronidazole.
Stop taking [product name] and tell your doctor immediately if you develop:
stomach pain, decreased appetite, nausea, vomiting, fever, unusual tiredness,
yellowing of the skin and the whites of the eyes, dark-coloured urine, light or clay-
coloured stools or itching.
Reference: Directive No. 18 Year 2017. BPFK/PPP/07/25 (23) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Metronidazole (Kecuali Produk Untuk Kegunaan Luar) : Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Amaran Berkaitan Risiko
Hepatotoxicity Dalam Kalangan Pesakit Cockyne Syndrome
119. MICONAZOLE
1. Intravaginal preparations
The following boxed warning shall be included on the label and in the package
insert of intravaginal preparations containing Miconazole:
Reference: Circular (bil 45) dlm bpfkweb.bpkp.2.2001: Keputusan Mesyuarat Pihak berkuasa
Kawalan Dadah (PBKD) ke 122 Berhubung Amaran Berkaitan Interaksi Ubat Bagi Semua Keluaran
Antifungal Intravaginal Yang Mengandungi Miconazole
The following statements shall be included in the package insert and RiMUP of
oral gel preparations containing Miconazole:
Package Insert
a) Contraindications
Use of miconazole oral gel in combination with the following drug that is
subjected to metabolism by CYP2C9 (see Interactions):
• Warfarin
b) Interactions
The following statements shall be included in the package insert and RiMUP of
preparations (other than oral gel) containing Miconazole:
Package Insert
b) Interactions
Reference: Directive No. 10 Year 2017. BPFK/PPP/07/25 (15) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Miconazole: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
120. MIDAZOLAM
121. MINOCYCLINE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Minocycline:
Package Insert
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) including fatal
cases have been reported with minocycline use. DRESS, which often occurs
several weeks after initiation of treatment, consists of a combination of three or
more of the following: cutaneous reaction (such as rash or exfoliative dermatitis),
eosinophilia, fever, lymphadenopathy, and one or more systemic complications
such as hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis.
Discontinue minocycline if DRESS is suspected.
a) Side Effects:
Stop taking [product name] and contact your doctor immediately if you
experience any of the following:
Reference: Directive No. 6 Year 2018. BPFK/PPP/07/25 (6) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Minocycline: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Drug Reaction With Eosinophilia And
Systemic Symptoms (DRESS)
122. MINOXIDIL
The label and the package insert shall include the following statement:
To be supplied only on the prescription of a registered medical practitioner.
Note: The statement is exempted for external use preparation containing not more
than 5% of Minoxidil; its salts; its derivatives
(Please refer latest Poison List: Preparations for external use containing not more than 5%
of Minoxidil; its salts; its derivatives, which is under Group C)
124. MONTELUKAST
The following statement shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products that contains Montelukast:
Package Insert
Postmarketing Experience
Blood and lymphatic system disorders: thrombocytopenia
Psychiatric disorders:
obsessive-compulsive symptoms
a) Side Effects:
Tell your healthcare provider right away if you notice any of the following behavior
and mood-related changes:
• Obsessive-compulsive symptoms
References:
Directive (31)dlm.bpfk/ppp/07/25 Arahan Pengarah Kanan Perkhidmatan Farmasi Bilangan 6 Year
2015 : Direktif Untuk Semua Produk Yang Mengandungi Montelukast : Pengemaskinian Sisip Bungkusan
Dengan Maklumat Kesan Advers Berkaitan Thrombocytopenia
Directive No. 8 Year 2019. BPFK/PPP/07/25 (8). Direktif Untuk Semua Produk Yang Mengandungi
Montelukast: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP)
Dengan Penambahan Maklumat Keselamatan Berkaitan Risiko Obsessive-Compulsive Symptoms
CONTRAINDICATIONS
• [Product name] is contraindicated during pregnancy due to its mutagenic and
teratogenic potential (see Use in Special Populations: Pregnancy).
• [Product name] is contraindicated in women of childbearing potential not
using highly effective contraceptive methods (see Use in Special Populations:
Pregnancy).
• [Product name] is contraindicated in women who are breastfeeding (see Use
in Special Populations: Breastfeeding).
Pregnancy
[Product name] is contraindicated during pregnancy and in women of childbearing
potential not using highly effective contraceptive methods. (see Contraindications).
Before the start of treatment, female and male patients of reproductive potential
must be made aware of the increased risk of pregnancy loss and congenital
malformations and must be counseled regarding pregnancy prevention, and
planning.
Sexually active men are recommended to use condoms during treatment and for at
least 90 days after cessation of treatment. Condom use applies for both
reproductively competent and vasectomised men, because the risks associated with
the transfer of seminal fluid also apply to men who have had a vasectomy. In
addition, female partners of male patients are recommended to use highly
effective during treatment and for total of 90 days after the last dose of [product
name].
Breastfeeding
[Product name] is contraindicated during breastfeeding due to the potential for
serious adverse reactions in nursing infants (see Contraindications).
Post-marketing experience:
Congenital Disorders
Congenital malformations have been reported post-marketing in children of patients
exposed to mycophenolate in combination with other immunosuppressants during
pregnancy (see Use in Pregnancy).
Reference: Directive No. 6 Year 2016 BPFK/PPP/07/25 (37). Direktif Untuk Semua Produk Yang
Mengandungi Mycophenolate (Mycophenolate Mofetil Dan Mycophenolic Acid): Pengemaskinian Sisip
Bungkusan Dengan Maklumat Keselamatan Berkaitan Risiko Kesan Teratogenik
126. NEVIRAPINE
Reference: Circular Bil (43) dlm BPFK/02/5/1.3: Pendaftaran Produk Yang Mengandungi Nevirapine
127. NIFEDIPINE
The following statement shall be included in the package inserts of “short acting”
Nifedipine products:
DOSAGE
• Lower doses may be required in elderly patients as a result of reduced drug
clearance.
• For hypertension, the dose used should not exceed 60mg daily.
128. NITRATES
The following statements shall be included in the package inserts of all “NITRATES
FOR STABLE ANGINA PECTORIS”:
• An appropriate statement concerning the development of tolerance (under
precaution section). A suggested statement would be as follows:
‘Development of tolerance may occur with all forms of nitrate therapy
particularly with the long acting preparations that maintain continuously high
plasma nitrate concentration’.
• An appropriate recommendation on dosage regimens. The recommended
dosage regimens should be one that is able to provide a low-nitrate period or
a nitrate-free period of 8-12 hours every 24 hours to prevent the development
of tolerance and thus maintain the antianginal effects.
129. NORADRENALINE
Package Insert
Cardiac disorders
Frequency ‘not known’: stress cardiomyopathy
Reference: Directive No. 5 Year 2019. BPFK/PPP/07/25 (5) Jld 3 Direktif Untuk Semua Produk
Yang Mengandungi Noradrenaline: Pengemaskinian Sisip Bungkusan Dengan Maklumat Keselamatan
Berkaitan Stress Cardiomyopathy
130. NORFLOXACIN
PRECAUTION
i. Should not be used in children or pregnant women
ii. Phototoxicity may occur
INTRAMUSCULAR (IM)
The following statement shall be included in the package inserts of Normal globulin
IM preparations:
132. NOSCAPINE
PRECAUTION
Studies to date have not identified any subset of patients not at risk of developing
peptic ulceration and bleeding. Patients with prior history of serious GI events and
other risk factors associated with peptic ulcer disease (e.g. alcoholism, smoking, and
corticosteroid therapy) are at increased risk. Elderly or debilitated patients seem to
tolerate ulceration or bleeding less than other individuals and account for most
spontaneous reports for fatal GI events.
134. OLANZAPINE
The following statements shall be included in the package insert and RiMUP of
products containing Olanzapine:
Package Insert
a) Side Effects:
Very rare: Serious allergic reactions such as Drug Reaction with Eosinophilia and
Systemic Symptoms (DRESS). DRESS appears initially as flu-like symptoms with a
rash on the face and then with an extended rash, high temperature, enlarged lymph
nodes, increased levels of liver enzymes seen in blood tests and an increase in a type
of white blood cell (eosinophilia).
Reference: Directive No. 19 Year 2016. BPFK/PPP/07/25 ( 5 ) Jld 1. Direktif Bagi Semua Produk
Yang Mengandungi Olanzapine Dengan Maklumat Keselamatan Berkaitan Kesan Advers Drug Reaction
With Eosinophilia And Systemic Symptoms (DRESS)
135. ONDANSETRON
The following statements shall be included in the package inserts and Consumer
Medication Information Leaflet (RiMUP) for products containing Ondansetron;
Package Insert
….
….
In patients 65 years of age or older, all IV doses should be diluted and infused over 15
minutes and, if repeated, given no less than 4 hours apart.
In patients 75 years of age or older, the initial IV dose of ondansetron should not
exceed 8 mg infused over 15 minutes. The initial dose of 8 mg may be followed by 2
doses of 8 mg, infused over 15 minutes and given no less than 4 hours apart.
Pregnancy
The use of ondansetron in pregnancy is not recommended.
Reproductive studies in rats and rabbits did not show evidence of harm to the
fetus.
If you are a woman of childbearing age, your doctor will check if you are pregnant
and perform a pregnancy test if necessary before starting treatment with [product
name]. If you may become pregnant, you should use effective birth control during
treatment and for at least 2 days after stopping [product name]. Ask your doctor
about options of effective birth control.
Reference: Directive No. 5 Year 2021. NPRA.600-1/9/13 (15). Direktif Untuk Semua Produk Yang
Mengandungi Ondansetron: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Kecacatan Kelahiran (Birth
Defects) Susulan Penggunaan Ketika Hamil
136. OPIOID
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing opioid:
Package Insert
Profound sedation, respiratory depression, coma, and death may result from
the concomitant use of [product name] with benzodiazepines. Observational
studies have demonstrated that concomitant use of opioids and
benzodiazepines increases the risk of drug-related mortality compared to use
of opioids alone. Because of these risks, reserve concomitant prescribing of
these drugs for use in patients for whom alternative treatment options are
inadequate.
Follow patients closely for signs and symptoms of respiratory depression and
sedation. Advise both patients and caregivers about the risks of respiratory
depression and sedation when [product name] is used with benzodiazepines.
Advise patients not to drive or operate heavy machinery until the effects of
concomitant use of the benzodiazepine have been determined. Screen patients
for risk of substance use disorders, including opioid abuse and misuse, and
warn them of the risk for overdose and death associated with the use of
benzodiazepines (See Drug Interactions).
3. Adrenal Insufficiency
Cases of adrenal insufficiency have been reported with opioid use, more often
following greater than one month of use. Presentation of adrenal insufficiency
may include non-specific symptoms and signs including nausea, vomiting,
decreased appetite, fatigue, weakness, dizziness, and low blood pressure. If
adrenal insufficiency is suspected, confirm the diagnosis with diagnostic
testing as soon as possible. If adrenal insufficiency is diagnosed, treat with
physiologic replacement dosing of corticosteroids. Wean the patient off of the
opioid to allow adrenal function to recover and continue corticosteroid
treatment until adrenal function recovers. Other opioids may be tried as some
cases reported use of a different opioid without recurrence of adrenal
insufficiency. The information available does not identify any particular
opioids as being more likely to be associated with adrenal insufficiency.
4. Sexual Function/Reproduction
Long term use of opioids may be associated with decreased sex hormone
levels and symptoms such as low libido, erectile dysfunction, or infertility (See
Postmarketing Experience)
Postmarketing Experience:
c) Interactions:
1. Benzodiazepines
Due to additive pharmacologic effect, the concomitant use of opioids with
benzodiazepines increases the risk of respiratory depression, profound
sedation, coma and death.
Reserve concomitant prescribing of these drugs for use in patients for whom
alternative treatment options are inadequate (see Warnings and Precautions).
2. Serotonergic Drugs
The concomitant use of opioids with other drugs that affect the serotonergic
neurotransmitter system has resulted in serotonin syndrome. If concomitant
use is warranted, carefully observe the patient, particularly during treatment
initiation and dose adjustment. Discontinue [product name] if serotonin
syndrome is suspected. Examples of serotonergic drugs are selective
serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake
inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor
antagonists, drugs that affect the serotonin neurotransmitter system (e.g.
mirtazapine, trazodone, tramadol), monoamine oxidase (MAO) inhibitors
(those intended to treat psychiatric disorders and also others, such as
linezolid and intravenous methylene blue) (See Warnings and Precautions).
References:
Directive No. 23 Year 2017. BPFK/PPP/07/25 (28) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Opioid Dan Benzodiazepin : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat
Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
Directive No. 27 Year 2017. BPFK/PPP/07/25 (32) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Opioid : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna
(RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Kesan Advers Serotonin Syndrome Kesan
Daripada Interaksi Dengan Serotonergic Drugs Dan Risiko Kesan Advers Adrenal Insufficiency Dan
Androgen Deficiency Akibat Penggunaan Jangka Panjang
137. OSELTAMIVIR
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) for products containing Oseltamivir;
Package Insert
a) Side effects:
Rare side effects:
- thrombocytopenia (low platelet count)
Reference: Directive No.6 Year 2021. NPRA.600-1/9/13 (16). Direktif Untuk Semua Produk Yang
Mengandungi Oseltamivir: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Thrombocytopenia
138. PALIPERIDONE
The following statement shall be included in the package inserts of products
containing Paliperidone:
Intraoperative floppy iris syndrome (IFIS) has been observed during cataract
surgery in patients treated with medicines with alpha1a-adrenergic antagonist
effect, including risperidone. IFIS may increase the risk of eye complications
during and after the operation. Current or past use of medicines with alpha1a-
adrenergic antagonist effect should be made known to the ophthalmic surgeon in
advance of surgery. The potential benefit of stopping alpha1 blocking therapy
prior to cataract surgery has not been established and must be weighed against
the risk of stopping the antipsychotic therapy.
Postmarketing Data
Eye Disorders
Frequency: Not known – Floppy iris syndrome (intraoperative)
139. PARACETAMOL
The following statement shall be included on the labels, package inserts and RiMUP
of ALL products containing Paracetamol:
WARNING
• Allergy alert: Paracetamol may cause severe skin reactions. Symptoms may
include skin reddening, blisters or rash.
These could be signs of a serious condition. If these reactions occur, stop use
and seek medical assistance right away.
Package Insert
Reference: Directive No.5 Year 2015. (29)dlm.bpfk/ppp/07/25 : Direktif Untuk Produk Yang
Mengandungi Paracetamol, Termasuk Produk Kombinasi : Pengemaskinian Label, Sisip Bungkusan, Dan
Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Amaran Berkaitan Kesan Advers Serius Pada
Kulit
The following statement shall be included on the labels and in the package inserts
and RiMUP of products containing Paracetamol with Caffeine in combination:
WARNING
• Avoid other caffeine containing products. Too much caffeine may cause rapid
heart rate, nervousness or sleeplessness.
• Ask a doctor or pharmacist before use if you have high blood pressure,
glaucoma, or overactive bladder syndrome.
• DO NOT exceed 8 tablets in 24 hours.
• DO NOT take more than the recommended dose unless advised by your doctor.
Use the smallest effective dose. Taking more than the maximum daily dose may
cause severe or possibly fatal liver damage.
• DO NOT use with other drugs containing paracetamol.
• NOT recommended for children under 12 years
Package Insert
Reference: Directive No. 5 Year 2015. (29)dlm.bpfk/ppp/07/25: Direktif Untuk Produk Yang
Mengandungi Paracetamol, Termasuk Produk Kombinasi : Pengemaskinian Label, Sisip Bungkusan, Dan
Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Amaran Berkaitan Kesan Advers Serius Pada
Kulit
Package Insert
Reference : Directive No.15 Year 2020. NPRA.600-1/9/13 (6) Direktif Untuk Semua Produk
Parenteral Nutrition Yang Mengandungi Asid Amino Dan/Atau Lipid (Yang Indikasinya Termasuk Untuk
Kegunaan Dalam Kalangan Golongan Pediatrik Di Bawah Usia Dua Tahun): Pengemaskinian Sisip
Bungkusan Dengan Kesan Advers (Adverse Outcomes) Akibat Pendedahan Produk Kepada Cahaya
Semasa Administrasi
142. PEGFILGRASTIM
The following statement shall be included in the package inserts of ALL biosimilar
products containing PEGFILGRASTIM
Aortitis has been reported after G-CSF administration in healthy subjects and in
cancer patients. The symptoms experienced included fever, abdominal pain, malaise,
back pain and increased inflammatory markers (e.g. C-reactive protein and white
blood cell count). In most cases aortitis was diagnosed by CT scan and generally
resolved after withdrawal of G-CSF.
Post Marketing
Vascular disorders
Cases of capillary leak syndrome have been reported in the post marketing setting
with granulocyte colony stimulating factor use. These have generally occurred in
patients with advanced malignant diseases, sepsis, taking multiple chemotherapy
medications or undergoing apheresis.
Frequency “rare”: Aortitis
References:
Directive No. 13 Year 2014. Bil (20) dlm. BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Filgrastim Dan Pegfilgrastim: Amaran Berkaitan Risiko Capillary Leak Syndrome (CLS)
Bagi Pesakit Kanser Dan Healthy Donor (Filgrastim) Dan Bagi Pesakit Kanser (Pegfilgrastim)
Directive No. 30 Year 2018. Bil (30) dlm. BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Filgrastim, Pegfilgrastim Dan Lenograstim: Pengemaskinian Sisip Bungkusan Dengan
Maklumat Keselamatan Berkaitan Aortitis
The following warning shall be included on the labels and in the package inserts of
products containing Pelargonium Sidoides:
WARNING
In very rare cases, pelargonium sidoides may cause hypersensitivity reactions.
144. PEMETREXED
The following statements shall be included in the package insert for products conta
pemetrexed:
Nephrogenic diabetes insipidus and renal tubular necrosis were also reported in
marketing setting with pemetrexed alone or with other chemotherapeutic agents.
of these events resolved after pemetrexed withdrawal. Patients should be regu
monitored for acute tubular necrosis, decreased renal function and signs and symp
of nephrogenic diabetes insipidus (e.g. hypernatraemia).
Nephrogenic diabetes insipidus and renal tubular necrosis have been reported in
marketing setting with an unknown frequency.
Reference: Directive No. 29 Year 2018. BPFK/PPP/07/25 (29) Jld.2. Direktif Untuk Semua Produk
Mengandungi Pemetrexed: Pengemaskinian Sisip Bungkusan Dengan Maklumat Keselamatan Ber
Nephrogenic Diabetes Insipidus Dan Renal Tubular Necrosis
145. PENICILLIN
146. PHENIRAMINE
The following statement shall be included on the label and in the package inserts of
liquid oral products containing Pheniramine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2
to 6 years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
147. PHENYLEPHRINE
The following statement shall be included on the labels and in the package insert of
liquid oral products containing Phenylephrine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2
to 6 years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
CONTRAINDICATIONS
• Piroxicam should not be prescribed to patient who is more likely to
develop side effects, such as those with a history of gastro-intestinal
disorders associated with bleeding, or those who have had skin reactions
to other medicines.
• Piroxicam should not be prescribed in association with any other NSAID or
an anticoagulant.
Reference: Circular Bil (80) dlm BPFK/02/5/1.3: Menghadkan Indikasi bagi Produk untuk Kegunaan
Systemic yang Mengandungi Piroxicam kepada 'For the symptomatic relief of pain and inflammation in
patients with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis' dan Tambahan Amaran
dan Kontraindikasi terkini pada sisip bungkusan
149. PRAVASTATIN
INTERACTIONS
Gemfibrozil and nicotinic acid: Gemfibrozil and nicotinic acid do not statistically
significantly affect the bioavailability of pravastatin. However, in a limited size
clinical trial, a trend toward CK elevations and musculoskeletal symptoms was seen
in patients treated concurrently with pravastatin and gemfibrozil. Myopathy,
including rhabdomyolysis, has occurred in patients who were receiving
coadministration of HMG-CoA reductase inhibitors with fibric acid derivatives and
niacin, particularly in subjects with pre-existing renal insufficiency.
Fusidic acid: The risk of myopathy including rhabdomyolysis may be increased by the
concomitant administration of pravastatin with systemic fusidic acid. Co-
administration of this combination may cause increased plasma concentrations of
both agents. The mechanism of this interaction (whether it is pharmacodynamics or
pharmacokinetic, or both) is yet unknown. There have been reports of
rhabdomyolysis (including some fatalities) in patients receiving this combination. If
Reference: Directive No. 8 Year 2014 Circular Bil (15) dlm. BPFK/PPP/07/25. Direktif Untuk Semua
Produk Pravastatin: Mengehadkan Dos Penggunaan Pravastatin Untuk Mengurangkan Risiko
Kecederaan Otot
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Prednisone dan
Prednisolone (except topical preparations);
Package Insert
Reference: Directive No. 17 Year 2018. BPFK/PPP/07/25 ( 17 ) Jld 2. Direktif Untuk Semua
Produk Yang Mengandungi Prednisone Dan Prednisolone (Kecuali Persediaan Topikal) :
Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan
Maklumat Keselamatan Berkaitan Schleroderma Renal Crisis
The following additional information shall be included on the label and in the
package insert of liquid oral products containing Promethazine HCl:
WARNING
When used for treatment of cough and cold
(a) “It (brand or generic names) should not be used in pediatric patients less than
2 years of age because of the potential for fatal respiratory depression”.
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to 6
years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
152. PROPAFENONE
The following warning shall be included in the package insert of products containing
propafenone:
153. PROPOFOL
There have been very rare reports of epileptiform movement in epileptics and
non-epileptics occurring during induction orbemergence from anaesthesia
induced by propofol.
b) INTERACTIONS:
A need for lower propofol doses has been observed in patients taking valproate.
When used concomitantly, a dose reduction of propofol may be considered.
References:
Directive No. 7 Year 2018. BPFK/PPP/07/25(7)Jld.2. Direktif Untuk Semua Produk Yang
Mengandungi Propofol Dan Sodium Valproate : Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
Directive No. 16 Year 2020. NPRA.600-1/9/13(7) Direktif Untuk Semua Produk Yang Mengandungi
Propofol: Pengemaskinian Sisip Bungkusan Dengan Penambahan Maklumat Keselamatan Berkaitan
Risiko Priapism
The following information shall be included on the labels and/ or package inserts of
products containing Propolis (for topical use):
WARNINGS
Propolis may cause allergic skin reaction.
References:
Circular Bil (48) dlm BPFK/02/5/1.3: Pernyataan Amaran Pada Label Dan Sisip Bungkusan Produk
Yang Mengandungi Propolis (Topikal) dan Royal Jelly (Semua Bentuk)
Bil (56) dlm BPFK/02/5/1.3: Pernyataan Amaran pada Label dan Sisip Bungkusan Produk yang
Mengandungi Propolis (topikal) dan Royal Jelly (Semua Bentuk)
156. PROPYLTHIOURACIL
BOXED WARNING
Severe liver injury and acute liver failure, in some cases fatal, have been
reported in patients treated with propylthiouracil. These reports of
hepatic reactions include cases requiring liver transplantation in adult
and pediatric patients.
Propylthiouracil should be reserved to patients who cannot tolerate
carbimazole/ methimazole and in whom radioactive iodine therapy or
surgery are not appropriate treatments for management of
hyperthyroidism.
Because of the risk of fetal abnormalities associated with carbimazole/
methimazole, propylthiouracil may be the treatment of choice when an
antithyroid drug is indicated during or just prior to the first trimester of
pregnancy (See Warnings and Precautions).
References:
Circular 1Bil (41) dlm. BPFK/PPP/01/03: Kenyataan Amaran Berkaitan Dengan “Potential for an
Increase in Risk of Hepatotoxicity” yang Perlu Dimuatkan Pada Sisip Bungkusan Produk Propylthiouracil
Circular 2Bil (55) dlm. BPFK/PPP/01/03: Kenyataan Amaran Berbentuk “Boxed Warning” Yang Wajib
Dimuatkan Pada Sisip Bungkusan Produk Propylthiouracil Dengan “Severe Liver Injury”
The following statements shall be included in the package insert and RiMUP of
pharmaceutical products containing Proton Pump Inhitors (PPI):
Package Insert
Regular Surveillance
Patients on proton pump inhibitor treatment (particularly those treated for
long term) should be kept under regular surveillance.
Hypomagnesaemia
Severe hypomagnesaemia has been reported in patients treated with PPI like
{product name} for at least three months, and in most cases for a year. Serious
manifestations of hypomagnesaemia such as fatigue, tetany, delirium,
convulsions, dizziness and ventricular arrhythmia can occur but they may
begin insidiously and be overlooked. In most affected patients,
hypomagnesaemia improved after magnesium replacement and
discontinuation of the PPI.
Fracture
Proton pump inhibitors, especially if used in high doses and over long
durations (>1 year), may modestly increase the risk of hip, wrist and spine
fracture, predominantly in the elderly or in presence of other recognised
risk factors. Observational studies suggest that proton pump inhibitors may
increase the overall risk of fracture by 10–40%. Some of this increase may be
due to other risk factors. Patients at risk of osteoporosis should receive care
according to current clinical guidelines and they should have an adequate
intake of vitamin D and calcium.
Gastrointestinal disorders
Microscopic colitis: Frequency ‘not known’
Interstitial Nephritis
Renal and urinary disorders: Interstitial nephritis
Hypomagnesaemia
Metabolism and nutritional disorders
Frequency “not known”: hypomagnesaemia.
Fracture
Musculoskeletal disorders
Frequency “uncommon”: Fracture of the hip, wrist or spine.
4. Pharmacodynamic
i. Side Effects:
When you are taking this medicine, your doctor will want to monitor you
(especially if you are taking it for long term). Hence, you should report any new
and exceptional symptoms and circumstances whenever you see your doctor.
Please tell your doctor promptly if you get any of the symptoms below:
• Rash (especially in areas exposed to the sun), possibly with pain in the
joints (Subacute Cutaneous Lupus Erythematosus, SCLE)
• Fever, extreme tiredness, pus/blood in urine.
• Involuntary muscle contractions, disorientation, convulsions, dizziness,
increased heart rate
• Fracture in the hip, wrist or spine.
• Watery stool, stomach pain and fever that do not go away
• Anemic (pale skin, weakness, tiredness or lightheadedness), shortness
of breath, a smooth tongue, nerver problems (numbness or tingling,
muscle weakness and problems walking), vision loss and mental
problems (depression, memory loss or behavioral changes).
b) Interstitial Nephritis
Kidney problems (interstitial nephritis)
c) Hypomagnesaemia
Frequency “not known”: Low levels of magnesium can also lead to a
reduction in potassium or calcium levels in the blood.
d) Fracture
Frequency “uncommon”: Tell your doctor if you have osteoporosis or if you
are taking corticosteroids (which can ncrease the risk of osteoporosis).
Tell your doctor before taking this medicine, if you are due to have a specific
blood test (Chromogranin A).
References:
Directive No. 16 Year 2017. BPFK/PPP/07/25 (21) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Proton Pump Inhibitors (PPI) : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Berkaitan Risiko Kesan Advers Akibat Penggunaan
Jangka Panjang (no. 1, 2, i)
Directive No. 15 Year 2017. BPFK/PPP/07/25 (20) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Proton Pump Inhibitors (PPI) : Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Berkaitan Elevated Circulating Levels of
Chromogranin A (CgA) (no. 3, 4, ii)
Directive No. 7 Year 2020. BPFK/PPP/07/25 (7) Jld 4. Direktif Untuk Semua Produk Yang
Mengandungi Proton Pump Inhibitors (PPI) Termasuk Produk Kombinasi: Pengemaskinian Sisip
Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan
Berkaitan Microscopic Colitis
158. PSEUDOEPHEDRINE
The following statement shall be included on the labels and in the package inserts of
liquid oral products containing Pseudoephedrine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to
6 years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
CAUTION:
This preparation may be habit forming on prolonged use.
“Please consume a large amount of fluid/ water when taking this product.”
“Do not take this product if you are already on statin products (lovastatin,
atorvastatin, fluvastatin, prasvastatin, simvastatin, rosuvastatin, etc).
“If you experience any allergic reactions or side effects such as lethargy, body
and muscle aches, please stop using this product”
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing retinoid (oral);
Package Insert
Psychiatric symptoms
*An additional statement should also be included in the package insert of oral
isotretinoin: Suicidal ideation, suicide attempts and suicide have been reported
in patients treated with isotretinoin.
Talk to your doctor before taking [product name] If you have ever had any kind
of mental health problems. This includes depression, aggressive tendencies or
mood changes.
*An additional statement should also be included in the RiMUP of oral
isotretinoin: It also includes suicidal thoughts.
Mental health problems
Your mood may be affected while taking [product name]. You may not notice
some changes in your mood and behaviour and so it is very important that you
tell your friends and family that you are taking this medicine. They may notice
these changes and help you quickly identify any problems that you need to talk
to your doctor about.
Reference: Directive No. 6 Year 2019. BPFK/PPP/07/25 (6) Jld 3 Direktif Untuk Semua Produk
Yang Mengandungi Retinoid (Oral): Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat
Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Neuropsychiatric Disorders
The following statements shall be included in the label, package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing oral retinoids
indicated for treatment of skin diseases:
Label
WARNING
Do not use if you are pregnant or you think you may be pregnant
Package Insert
a) Contraindications:
• Pregnant women
• Women of childbearing potential unless all of the conditions of the Pregnancy
Prevention Programme are met (See Section Warnings and Precautions)
Teratogenic effects
[Product name] is a powerful human teratogen inducing a high frequency of
severe and life threatening birth defects.
These conditions also concern women who are not currently sexually active unless
the prescriber considers that there are compelling reasons to indicate that there is no
risk of pregnancy.
• The patient complies with the conditions for pregnancy prevention as listed
above, including confirmation that she has an adequate level of understanding.
• The patient has acknowledged the aforementioned conditions.
• The patient understands that she must consistently and correctly use one
highly effective method of contraception (i.e. a user-independent form) or two
complementary user-dependent forms of contraception, for at least 1 month
prior to starting treatment and is continuing to use effective contraception
throughout the treatment period and for at least 1 month* [*3 years for
acitretin] after cessation of treatment.
• Negative pregnancy test results have been obtained before, during and 1 month
after the end of treatment. The dates and results of pregnancy tests should be
documented.
for acitretin this last bullet point should be]
• Negative pregnancy test results have been obtained before, during and
periodically with 1-3 monthly intervals for a period of 3 years after stopping
treatment. The dates and results of pregnancy tests should be documented.
If pregnancy occurs after stopping treatment there remains a risk of severe and
serious malformation of the fetus. This risk persists until the product has been
completely eliminated, which is within one month* following the end of treatment
[*3 years for acitretin].
Contraception
Pregnancy testing
At least one month after the patient has started using contraception, and shortly
(preferably a few days) prior to the first prescription, the patient should undergo a
medically supervised pregnancy test. This test should ensure the patient is not
pregnant when she starts treatment with [product name].
Follow-up visits
End of treatment
1 month after stopping treatment, women should undergo a final pregnancy test.
[for acitretin this last paragraph should be]
Women should undergo pregnancy test periodically with 1-3 monthly intervals for a
period of 3 years after stopping treatment.
This monthly follow-up will allow ensuring that regular pregnancy testing and
monitoring is performed and that the patient is not pregnant before receiving the
next cycle of medication.
Male patients
The available data suggest that the level of maternal exposure from the semen of the
patients receiving [product name] is not of a sufficient magnitude to be associated
with the teratogenic effects of [product name]. Male patients should be reminded
that they must not share their medication with anyone, particularly not females.
Additional precautions
Patients should be instructed never to give this medicinal product to another person
and to return any unused capsules to their pharmacist at the end of treatment.
Patients should not donate blood during therapy and for 1 month* [*3 years for
Educational material
Full patient information about the teratogenic risk and the strict pregnancy
prevention measures as specified in the Pregnancy Prevention Programme should be
given by the physician to all patients, both male and female.
WARNING
Do not use if you are pregnant or you think you may be pregnant
Women must use effective contraception before, during and after taking
[product name]:
• You must agree to use at least one very reliable method of contraception (for
example an intra uterine device or contraceptive implant) or, two effective
methods that work in different ways (for example a hormonal contraceptive pill
and a condom). Discuss with your doctor which methods would be suitable for
you.
• You must use contraception for a month before taking [product name], during
treatment and for a month* afterwards [*for acitretin should be 3 years].
• You must use contraception even if you do not have periods or you are not
sexually active (unless your doctor decides this is not necessary).
Women must agree to pregnancy testing before, during and after taking
[product name]:
If you get pregnant while taking [product name], stop taking the medicine straight
away, and contact your doctor.
Also, if you become pregnant within one month* [3* years for acitretin] after you
stop taking [product name], you should contact your doctor.
The levels of oral retinoid in the semen of men taking [product name] are too low to
harm their partners’ unborn baby. However, you must never share your medication
with anyone, especially females.
Additional precautions
You should never give this medicinal product to another person. Please take any
unused capsules to your pharmacist at the end of treatment.
You should not donate blood during treatment with this medicine and for 1 month*
[*3 years for acitretin] after stopping [product name] because an unborn baby could
be harmed if a pregnant patient receives your blood.
Reference: Directive No.16 Year 2019. BPFK/PPP/07/25 (16)Jld.3. Direktif Untuk Semua Yang
Mengandungi Retinoid Yang Diindikasikan Untuk Rawatan Penyakit Kulit (Termasuk Topikal):
Pengemaskinian Label, Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Bagi
Memperkukuhkan Maklumat Keselamatan Berkaitan Kesan Teratogenik
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of topical products containing retinoids:
Package Insert
a) Contraindications:
Reference: Directive No.16 Year 2019. BPFK/PPP/07/25 (16)Jld.3. Direktif Untuk Semua Yang
Mengandungi Retinoid Yang Diindikasikan Untuk Rawatan Penyakit Kulit (Termasuk Topikal):
Pengemaskinian Label, Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Bagi
Memperkukuhkan Maklumat Keselamatan Berkaitan Kesan Teratogenik
165. RISPERIDONE
Intraoperative floppy iris syndrome (IFIS) has been observed during cataract surgery
in patients treated with medicines with alpha1a-adrenergic antagonist effect,
including risperidone. IFIS may increase the risk of eye complications during and
after the operation. Current or past use of medicines with alpha1a-adrenergic
antagonist effect should be made known to the ophthalmic surgeon in advance of
surgery. The potential benefit of stopping alpha1 blocking therapy prior to cataract
surgery has not been established and must be weighed against the risk of stopping
the antipsychotic therapy.
Postmarketing Data
Eye Disorders
Frequency: Not known – Floppy iris syndrome (intraoperative)
166. ROSIGLITAZONE
1. The following black box warning shall be included in the first part of package
inserts of products containing Rosiglitazone as single ingredient or in
combination with other active ingredients:
CONTRAINDICATIONS
Rosiglitazone is contraindicated in patients with NYHA Class I to IV heart failure or
history of cardiac failure, patients with known ischaemic heart disease and patients
with Acute Coronary Syndrome (unstable angina, non-ST segment elevation
myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction.
Reference: Circular Bil (6) dlm BPFK/PPP/01/03 Jld 1: Direktif Memperketatkan Penggunaan
Rosiglitazone dan Memperkukuhkan Amaran Berkaitan Dengan Risiko Kesan Advers Kardiovaskular
Pada Sisip Bungkusan Semua Produk Rosiglitazone Termasuk Produk Kombinasi
167. ROSUVASTATIN
The following information shall be included on the labels and/or package inserts of
products containing Rosuvastatin:
Concomitant Therapy
Rosuvastatin is a substrate of various transporter proteins (e.g. OATP1B1 and BCRP).
The risk of myopathy (including rhabdomyolysis) is increased when rosuvastatin is
administered concomitantly with certain medicinal products that may increase the
plasma concentration of rosuvastatin due to interactions with these transporter
proteins (e.g. certain protease inhibitors including combinations of ritonavir with
atazanavir, lopinavir, and/or tipranavir). Whenever possible, alternative medications
should be considered, and if necessary, consider temporarily discontinuing [Product
Name] therapy. In situations where co-administration of these medicinal products
with rosuvastatin is unavoidable, the benefit and the risk of concurrent treatment
and rosuvastatin dosing adjustments should be carefully considered.
All generic products containing Rosuvastatin should update their package inserts
respectively according to the innovator’s information such as parts for Interactions,
Pharmacokinetics and other parts deemed relevant.
Reference: Circular (16)dlm. BPFK/PPP/07/25 Directive No. 9 Year 2014. Direktif Untuk Semua
Produk Rosuvastatin: Mengehadkan Dos Penggunaan Rosuvastatin Untuk Mengurangkan Risiko
Kecederaan Otot
168. ROXITHROMYCIN
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Roxithromycin;
Package Insert
a) Side Effects:
[Product name] may cause severe allergy and serious skin reactions.
Stop using [Product name] and seek medical assistance immediately if you
experience any of the following symptoms:
Reference: Directive Bil 22 Year 2018. Circular Bil (22) dlm BPFK/PPP/07/25 Jld.2. Direktif Untuk
Semua Produk Yang Mengandungi Azithromycin, Clarithromycin, Erythromycin Dan Roxithromycin :
Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan
Maklumat Keselamatan Berkaitan Severe Cutaneous Adverse Reactions (SCARs)
The following information shall be included on the labels and/or package inserts of
products containing Royal jelly:
WARNINGS
This product contains royal jelly and may cause severe allergic reactions including
fatal anaphylactic reactions in susceptible individuals. Asthma and allergy sufferers
may be at the greater risk.
References:
Circular Bil (48) dlm BPFK/02/5/1.3: Pernyatan Amaran Pada Label Dan Sisip Bungkusan Produk
Yang Mengandungi Propolis (Topikal) dan Royal Jelly (Semua Bentuk)
Circular Bil (56) dlm BPFK/02/5/1.3: Pernyataan Amaran pada Label dan Sisip Bungkusan Produk
yang Mengandungi Propolis (topikal) dan Royal Jelly (Semua Bentuk)
Circular Bil (12) dlm. BPFK/PPP/01/03: Pernyataan amaran pada label dan sisip bungkusan produk
yang mengandungi royal jelly (produk kosmetik)
Package Insert
a) Contraindications:
b) Side Effects:
Very rare side effects: Penetration of yeast into blood (fungaemia)
Label
Please consult your doctor/pharmacist before using this product. Do not take this
product if you are immunocompromised (altered/ weakened immune system) or
have central venous catheter.
Reference: Directive No. 23 Year 2018. Circular Bil (23) BPFK/PPP/07/25 Jld.2. Direktif Untuk
Semua Produk Yang Mengandungi Saccharomyces Boulardii : Pengemaskinian Label, Sisip Bungkusan
Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko
Fungaemia
171. SALBUTAMOL
• Due to the risk of pulmonary oedema and myocardial ischaemia that has been
observed during the use of beta2-agonists in the treatment of premature labour,
before these products are given to any patient with known heart disease, an
adequate assessment of the patients’s cardiovascular status should be made by
a physician experienced in cardiology.
2. The following information shall be included in the package inserts and product
literature of products containing Salbutamol in oral tablet/ capsule dosage form:
• Due to the risk of pulmonary oedema and myocardial ischaemia that has been
observed during the use of beta2-agonists in the treatment of premature
labour, before these products are given to any patient with known heart
disease, an adequate assessment of the patients’s cardiovascular status should
be made by a physician experienced in cardiology.
References:
Circular Bil (6) dlm. BPFK/PPP/01/03: Kenyataan Amaran Mengenai Insiden Myocardial Ischaemia
pada Wanita Mengandung yang Menerima Rawatan Beta Agonist bagi Rawatan Melambatkan
Kelahiran Pramatang pada Sisip Bungkusan Kumpulan Produk Ini
Circular Bil (18) dlm BPFK/PPP/01/03 Jld 1: Direktif untuk Memperkukuhkan Amaran Berkaitan
dengan Risiko Kesan Advers Serius pada Jantung Termasuk Kematian dengan Penggunaan Produk
Suntikan dan Oral Beta Agonis dalam Rawatan Kelahiran Pra-Matang
172. SALICYLIC ACID (NATURALLY OCCURING IN PLANTS E.G. WILLOW SALIX SPP)
Please state: “Individual allergic to aspirin/ other NSAID should avoid this product.”
Reference: Circular Bil (75) dlm BPFK/02/5/1.3: Pernyataan Amaran Pada Sisip Bungkusan Semua
Produk Sedatif-Hipnotik Oral Berkaitan dengan Risiko Complex Sleep - Related Behaviors Which May
Include Sleep Driving, Making Phone Calls, Preparing and Eating Food (While Asleep)
WARNING
Do not use on broken skin or inflamed. Avoid contact with eyes.
(AMARAN: Selenium sulphide tidak boleh digunakan pada kulit yang pecah dan
radang. Elakkan daripada terkena mata.)
175. SENNA (CASSIA SPP.) – fruit/ pod/ semen and leaf and Rhubarb/ Radix et
Rhizoma Rhei/ Rheum Palmatum/ Rheum Officinalis – root part
The following statement shall be included on the labels of products containing senna
(cassia spp.) – fruit/ pod/ semen and leaf and Rhubarb/ Radix et Rhizoma Rhei/ Rheum
Palmatum/ Rheum Officinalis – root part:
• Do not use when abdominal pain, nausea or vomiting is present.
• Frequent or prolonged use of this preparation may result in dependence
towards the product and ‘imbalanced electrolytes’.
• Please consult a health care practitioner for use beyond 7 days.
176. SIMVASTATIN
The 80mg dose is only recommended in patients at high risk for cardiovascular
complications who have not achieved treatment goals on lower doses and when
the benefits are expected to outweigh the potential risks.
Concomitant Therapy
In patients taking fibrates (other than gemfibrozil and fenofibrate) concomitantly
with [Product Name], the dose of [Product Name] should not exceed 10mg/day.
2. Contraindications
Contraindicated Drugs
Potent inhibitors of CYP3A4: Concomitant use with medicines labeled as having a
potent inhibitory effect on CYP3A4 at therapeutic doses (e.g.: itraconazole,
ketoconazole, posaconazole, voriconazole, erythromycin, clarithromycin,
telithromycin, HIV protease inhibitors, boceprevir, telaprevir or nefazodone) is
contraindicated. If treatment with potent CYP3A4 inhibitors is unavoidable, therapy
with simvastatin should be suspended during the course of treatment.
Other Drugs
• Other fibrates: The dose of simvastatin should not exceed 10 mg daily in
patients receiving concomitant medication with fibrates other than
gemfibrozil or fenofibrate. When simvastatin and fenofibrate are given
concomitantly, there is no evidence that the risk of myopathy exceeds the sum
of the individual risks of each agent. Caution should be used when prescribing
fenofibrate with simvastatin, as either agent can cause myopathy when given
alone. Addition of fibrates to simvastatin typically provides little additional
reduction in LDL-C, but further reductions of TG and further increases in HDL-
C may be obtained. Combinations of fibrates with simvastatin have been used
without myopathy in small short-term clinical studies with careful
monitoring.
• Amiodarone: In a clinical trial, myopathy was reported in 6% of patients
receiving simvastatin 80 mg and amiodarone. The dose of simvastatin should
not exceed 20 mg daily in patients receiving concomitant medication with
amiodarone.
• Calcium channel blockers:
- Verapamil or diltiazem: In a clinical trial, patients on diltiazem treated
concomitantly with simvastatin 80 mg had an increased risk of myopathy.
The dose of simvastatin should not exceed 20 mg daily in patients
receiving concomitant medication with verapamil or diltiazem.
- Amlodipine: In a clinical trial, patients on amlodipine treated
concomitantly with simvastatin 80 mg had a slightly increased risk of
myopathy. The dose of simvastatin should not exceed 40 mg daily in
patients receiving concomitant medication with amlodipine.
- Niacin (≥1g/day): The dose of simvastatin should not exceed 40mg daily in
patients receiving concomitant medication with niacin (nicotinic acid) ≥
1g/day. Cases of myopathy/rhabdomyolysis have been observed with
simvastatin co-administered with lipid-modifying doses (≥ 1 g/day) of
niacin.
The following statements shall be included in the label, package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing sodium valproate:
Label
If you are thinking about becoming pregnant, or if you are pregnant, contact your
doctor urgently.
You must CONTINUE taking sodium valproate unless your doctor tells you to stop
Package Insert
PANCREATITIS:
CASES OF LIFE-THREATENING PANCREATITIS HAVE BEEN REPORTED IN
BOTH CHILDREN AND ADULTS RECEIVING VALPROATE. SOME OF THE
CASES HAVE BEEN DESCRIBED AS HEMORRHAGIC WITH A RAPID
PROGRESSION FROM INITIAL SYMPTOMS TO DEATH. CASES HAVE BEEN
REPORTED SHORTLY AFTER INITIAL USE AS WELL AS AFTER SEVERAL
YEARS OF USE. PATIENTS AND GUARDIANS SHOULD BE WARNED THAT
ABDOMINAL PAIN, NAUSEA, VOMITING, AND/OR ANOREXIA CAN BE
SYMPTOMS OF PANCREATITIS THAT REQUIRE PROMPT MEDICAL
EVALUATION. IF PANCREATITIS IS DIAGNOSED, VALPROATE SHOULD BE
DISCONTINUED.
b) Contraindications:
• In bipolar disorder
- sodium valproate is contraindicated in pregnancy
- sodium valproate is contraindicated in women of childbearing potential, unless
the conditions of Pregnancy Prevention Programme are fulfilled (see Female
children, Women of childbearing potential, pregnant women section)
These conditions also concern women who are not currently sexually active
unless the prescriber considers that there are compelling reasons to indicate
that there is no risk of pregnancy.
Female children
The prescriber must ensure that:
• The parents/caregivers of female children understand the need to
contact the doctor once the female child using sodium valproate
experiences menarche.
• The parents/caregivers of female children who have experienced
menarche are provided with comprehensive information about the risks
of congenital malformations and neurodevelopmental disorders
including the magnitude of these risks for children exposed to sodium
valproate in utero.
Pregnancy test
Pregnancy must be excluded before start of treatment with sodium valproate.
Treatment with sodium valproate must not be initiated in women of
childbearing potential without a negative pregnancy test (plasma pregnancy
test) result, confirmed by a healthcare provider, to rule out unintended use in
pregnancy.
Contraception
Women of childbearing potential who are prescribed sodium valproate must
use effective contraception without interruption during the entire duration of
treatment with sodium valproate. These patients must be provided with
comprehensive information on pregnancy prevention and should be referred
Pregnancy planning
If a woman is planning to become pregnant, a prescriber experienced in the
management of epilepsy must reassess sodium valproate therapy and consider
alternative treatment options. Every effort should be made to switch to
appropriate alternative treatment prior to conception and before contraception
is discontinued. If switching is not possible, the woman should receive further
counselling regarding the risks of sodium valproate for the unborn child to
support her informed decision-making regarding family planning.
In case of pregnancy
If a woman using sodium valproate becomes pregnant, she must be
immediately referred to a doctor to re-evaluate treatment with sodium
valproate and consider alternative treatment options. The patients with sodium
valproate-exposed pregnancy and their partners should be referred to a doctor
experienced in prenatal medicine for evaluation and counselling regarding the
exposed pregnancy.
Educational materials
In order to assist healthcare professionals and patients in avoiding exposure to
sodium valproate during pregnancy, the Marketing Authorisation Holder has
provided educational materials to reinforce the warnings, provide guidance
regarding use of sodium valproate in women of childbearing potential and
provide details of the Pregnancy Prevention Programme. A Patient Guide and
Patient Card should be provided to all women of childbearing potential using
Congenital malformations
Data derived from a meta-analysis (including registries and cohort studies) has
shown that 10.73% of children of epileptic women exposed to sodium valproate
monotherapy during pregnancy suffer from congenital malformations (95% CI:
8.16 -13.29). This is a greater risk of major malformations than for the general
population, for whom the risk is about 2-3%. The risk is dose dependent but a
threshold dose below which no risk exists cannot be established.
Available data show an increased incidence of minor and major malformations.
The most common types of malformations include neural tube defects, facial
dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital
defects, limb defects (including bilateral aplasia of the radius), and multiple
anomalies involving various body systems.
Available data show that children exposed to sodium valproate in utero are at
increased risk of autistic spectrum disorder (approximately three-fold) and
childhood autism (approximately five-fold) compared with the general study
population.
Limited data suggests that children exposed to sodium valproate in utero may be
more likely to develop symptoms of attention deficit/hyperactivity disorder
(ADHD).
Pregnant women
Sodium valproate as treatment for epilepsy is contraindicated in pregnancy unless
there is no suitable alternative treatment. If a woman using sodium valproate
becomes pregnant, she must be immediately referred to a doctor to consider
alternative treatment options.
It is recommended to:
- Use the lowest effective dose and divide the daily dose sodium valproate into
several small doses to be taken throughout the day.
- The use of a prolonged release formulation may be preferable to other treatment
formulations to avoid high peak plasma concentrations.
All patients with sodium valproate-exposed pregnancy and their partners should
be referred to a doctor experienced in prenatal medicine for evaluation and
counselling regarding the exposed pregnancy. Specialised prenatal monitoring
should take place to detect the possible occurrence of neural tube defects or other
malformations. Folate supplementation before the pregnancy may decrease the
risk of neural tube defects which may occur in all pregnancies. However the
available evidence does not suggest it prevents the birth defects or malformations
due to sodium valproate exposure.
If you are thinking about becoming pregnant, or if you are pregnant, contact your
doctor urgently.
You must CONTINUE taking sodium valproate unless your doctor tells you to stop
- Sodium valproate can seriously harm an unborn baby when taken during
pregnancy.
- The higher the dose, the higher the risks but all doses carry a risk.
- It can cause serious birth defects and can affect the way in which the child
develops as it grows. Birth defects which have been reported include spina
bifida (where the bones of the spine are not properly developed); facial and
skull malformations; heart, kidney, urinary tract and sexual organ
malformations; limb defects.
- If you take sodium valproate during pregnancy you have a higher risk than
other women of having a child with birth defects that require medical
treatment. Because sodium valproate has been used for many years it is known
that in women who take sodium valproate around 10 babies in every 100 will
have birth defects. This compares to 2-3 babies in every 100 born to women
who don’t have epilepsy.
- It is estimated that up to 30-40% of preschool children whose mothers took
sodium valproate during pregnancy may have problems with early childhood
development. Children affected can be slow to walk and talk, intellectually less
able than other children, and have difficulty with language and memory.
- Autistic spectrum disorders are more often diagnosed in children exposed to
sodium valproate and there is some evidence children may be more likely to
develop symptoms of Attention Deficit Hyperactivity Disorder (ADHD).
Some medicines and sodium valproate may interfere with each other, these
include propofol (a medicine used before and during general anaesthesia). Tell
your doctor that you are taking [product name] if you are going for an operation.
References:
Directive No. 17 Year 2016. BPFK/PPP/07/25 ( 3 ) Jld 1. Direktif Bagi Semua Produk Yang
Mengandungi Sodium Valproate Bagi Memperkukuhkan Amaran Berkaitan Risiko Abnormal Pregnancy
Outcomes
Directive No. 7 Year 2018. BPFK/PPP/07/25 ( 7 ) Jld 2. Direktif Untuk Semua Produk Yang
Mengandungi Propofol Dan Sodium Valproate : Pengemaskinian Sisip Bungkusan Dan Risalah
Maklumat Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
Directive No. 21 Year 2019. BPFK/PPP/07/25 (21) Jld. 3 Direktif Untuk Semua Produk Yang
Mengandungi Sodium Valproate: Pengukuhan Maklumat Keselamatan Pada Label, Sisip Bungkusan Dan
Risalah Maklumat Ubat Untuk Pengguna (RiMUP) Berkaitan Risiko Kecacatan Kongenital Dan Masalah
Perkembangan Dalam Kalangan Bayi Dan Kanak-Kanak Yang Terdedah Kepada Penggunaan Sodium
Valproate Semasa Dalam Kandungan
The following boxed statement shall be included on the labels of products containing
St. John’s Wort:
Please consult your physician/ pharmacist before using this product if you
are on any prescription medicines as there is possibility that interactions may
occur with certain drugs.
(Sila dapatkan nasihat doktor/ ahli farmasi sebelum menggunakan produk ini,
kerana kemungkinan berlakunya interaksi dengan penggunaan ubat
preskripsi).
181. STATINS
The following statement shall be included in the package inserts and RiMUP of ALL
products containing statins (single active or in combination):
Package Insert
a) INTERACTION:
Increases in HbA1c and fasting blood glucose have been reported with statins.
The risk of hyperglycemia, however, is outweighed by the reduction in
vascular risk with statins.
Musculoskeletal disorders:
Frequency not known: Immune-mediated necrotizing myopathy
Side Effects
If you have muscle problems that do not go away even after your doctor has told
you to stop taking {product name}, please refer to your doctor. Your doctor may
do further tests to diagnose the cause of your muscle problems.
References:
Directive No. 7 Year 2014. Circular (14) dlm.BPFK/PPP/07/25. Direktif Untuk Semua Produk Statin:
Memperkukuhkan Amaran Berkaitan Risiko Kesan Advers Kognitif Dan Peningkatan HBA1C Serta
Fasting Blood Glucose (FBG)
Directive No. 29 Year 2017. BPFK/PPP/07/25 ( 34 ) Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Statin: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna
(RiMUP) Dengan Maklumat Berkaitan Immune-Mediated Necrotizing Myopathy (IMNM)
1. The following black boxed warning shall be included in the first part of package
inserts of products containing Strontium Ranelate:
[Brand Name] should only be used for whom treatment with other
medicinal products approved for the treatment of osteoporosis is not
possible due to, for example, contraindications or intolerance.
[Brand Name] is contraindicated in patients with:
established, current or past history of ischaemic heart disease;
peripheral arterial disease and/or cerebrovascular disease;
uncontrolled hypertension;
current or previous venous thromboembolic events (VTE);
temporary or permanent immobilisation.
Indications
• Treatment of severe/established osteoporosis in postmenopausal women
at high risk of fracture to reduce the risk of vertebral and hip fractures
• Treatment of severe/established osteoporosis in men at increased risk of
fracture
[Brand Name] should only be used for whom treatment with other
medicinal products approved for the treatment of osteoporosis is not
possible due to, for example, contraindications or intolerance.
Contraindications
• Established, current or past history of ischaemic heart disease, peripheral
arterial disease and/or cerebrovascular disease
• Uncontrolled hypertension
Myocardial infarction
In pooled randomised placebo-controlled studies of post-menopausal
osteoporotic patients, a significant increase of myocardial infarction has been
observed in strontium ranelate treated patients as compared to placebo (1.7%
versus 1.1%), with a relative risk of 1.6 (95% CI = [1.07; 2.38]).
Reference : Directive No. 28 Year 2018. BPFK/PPP/07/25 ( 28 ) Jld 2.Direktif Untuk Semua Produk
Yang Mengandungi Succinylated Gelatin (Modified Fluid Gelatin): Pengemaskinian Sisip Bungkusan
Dengan Maklumat Keselamatan Berkaitan Risiko Cross-Reaction Yang Melibatkan Alergen Galactose-
Alpha-1,3-Galactose (Alpha-Gal)
184. SULFASALAZINE
The following statements shall be included in the Package Insert and Consumer
Medication Information Leaflet (RiMUP) of products containing sulfasalazine:
Package Insert
b) Interactions:
Tell your doctor if you are taking or have recently taken [product name], or any
other sulfasalazine containing products, because they may affect results of blood
and urine tests.
References:
Directive No.20 Year 2019. BPFK/PPP/07/25 (20) Jld. 3 Direktif Untuk Semua Produk Yang
Mengandungi Sulfasalazine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Gangguan Terhadap Ujian
Makmal Yang Menggunakan Reaksi Dihydronicotinamide-Adenine Dinucleotide/
Dihydronicotinamide-Adenine Dinucleotide Phosphate (NADH/NADPH)
Directive No. 1 Year 2021. NPRA.600-1/9/13 (11). Direktif Untuk Semua Produk Yang
Mengandungi Mesalazine Dan Sulfasalazine: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat
Ubat Untuk Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Risiko Nephrolithiasis
Discontinue treatment with this drug immediately if skin rash or any sign of
adverse reaction occurs.
1. Indication and duration of use for products containing synthetic salmon calcitonin
(according to the stated dosage forms) are restricted as follows, and the package
insert of the product shall be amended accordingly:
188. TEMOZOLOMIDE
Hepatic injury, including fatal hepatic failure has been reported in patients receiving
temozolomide. Baseline liver function tests should be performed prior to treatment
initiation. If abnormal, physicians should assess the benefit/ risks prior to initiating
temozolomide including the potential for fatal hepatic failure.
For patients on a 42 days treatment cycle, liver function test should be repeated
midway during this cycle. For all patients, liver function test should be checked after
treatment cycle. For patient with significant liver function abnormalities, physicians
should assess the benefit/ risks of continuing treatment. Liver toxicity may occur
several weeks or more after the last reatment of temozolomide.
Reference: Directive No. 11 Year 2014. Circular Bil (18) dlm BPFK/PPP/07/25. Direktif Untuk
Semua Produk Yang Mengandungi Temozolomide: Maklumat Keselamatan Baru Berkaitan Dengan
Risiko Kecederaan Hati
189. TERBUTALINE
• Due to the risk of pulmonary oedema and myocardial ischaemia that has
been observed during the use of beta2-agonists in the treatment of
premature labour, before these products are given to any patient with
known heart disease, an adequate assessment of the patients’s
cardiovascular status should be made by a physician experienced in
cardiology.
2. The following information shall be included in the package insert and product
literature of products containing Terbutaline in oral tablet/ capsule dosage
form:
• Due to the risk of pulmonary oedema and myocardial ischaemia that has
been observed during the use of beta2-agonists in the treatment of
premature labour, before these products are given to any patient with
known heart disease, an adequate assessment of the patients’s
cardiovascular status should be made by a physician experienced in
cardiology.
190. TESTOSTERONE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing Testosterone;
Package Insert
b) Overdose:
The following adverse reactions have also been reported in men: transient
ischemic attacks, convulsions, hypomania, irritability, dyslipidaemias, testicular
atrophy, subfertility, and infertility.
The following adverse reactions have been reported in male and female
adolescents: premature closure of bony epiphyses with termination of growth,
and precocious puberty.
Taking more than the recommended dose of [product name] for a long period of
time can cause serious health problems including effects on the heart, liver, and
reproductive functions, as well as serious psychiatric problems.
Reference: Directive No. 19 Year 2017. BPFK/PPP/07/25 (24) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Testosteron: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Maklumat Keselamatan Berkaitan Kesan Advers Susulan Penyalahgunaan
Dan Kebergantungan Ubat
The following boxed warning shall be included on the label and in the package inserts
of products containing Tetracycline (syrup)
192. THIOMERSAL
The following statement shall be included on the label and package inserts of
products containing thiomersal for preparations other than ophthalmic preparation:
WARNING
‘RISK OF SENSITIZATION IN RELATION TO THIOMERSAL AND OTHER
PRESERVATIVES’
Reference: Circular Bil (34)dlm BPFK/02/5/1.3: Penggunaan Thiomersal Dalam Persediaan Vaksin
To prevent bleeding at the site of centesis or other regions, caution must be exercised
concerning procedures and management of arterial/ venus puncture.
The use of heparin in conjunction with the thrombolytic agent for the purpose of
prevention of reocclusion may increase the risk of intracranial haemorrhage. Close
monitoring of patients is strongly recommended.
195. TOPIRAMATE
The following statements shall be included in the package insert and Consumer
Medication Information Leaflet (RiMUP) of products containing topiramate:
Package Insert
Postmarketing data:
Eye disorders
Frequency “not known”: Uveitis
a) Side Effects:
- There is a potential significant risk for metabolic acidosis that may have no
symptoms and if left untreated may be associated with adverse effects on
kidneys (e.g. kidney stone/ nephrocalcinosis).
- Sudden changes in your eyesight (e.g. blurred vision)
- Eye pain
- Red eye
References:
Directive No.15 Year 2014. (22) BPFK/PPP/07/25. Direktif Untuk Semua Produk Yang
Mengandungi Topiramate: Amaran Berkaitan Risiko Gangguan Penglihatan
Directive No.13 Year 2019. BPFK/PPP/07/25 (13). Direktif Untuk Semua Produk Yang
Mengandungi Topiramate: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk
Pengguna (RiMUP) Dengan Penambahan Maklumat Keselamatan Berkaitan Nephrocalcinosis
Directive No.14 Year 2020. NPRA.600-1/9/13(5). Direktif Untuk Semua Produk Yang Mengandungi
Topiramate: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP)
Dengan Maklumat Keselamatan Berkaitan Risiko Uveitis
196. TRAMADOL
The following statements shall be included in the package insert and RiMUP of
products containing Tramadol:
Package Insert
a) Recommended Dosage:
Paediatric population
The safety and efficacy of [product name] has not been studied in the paediatric
population. Therefore, use of [product name] is not recommended in patients
under 12 years of age.
b) Contraindications:
- Children younger than 18 years to treat pain after surgery to remove the
tonsils and/or adenoids.
- Adolescents between 12 and 18 years who are obese or have conditions such
as obstructive sleep apnea or severe lung disease, which may increase the risk
of serious breathing problems.
Paediatric population
The safety and efficacy of [product name] has not been studied in the paediatric
population. Therefore, use of [product name] is not recommended in patients
under 12 years of age.
Respiratory depression
Administer [product name] cautiously in patients at risk for respiratory
depression, including patients with substantially decreased respiratory reserve,
hypoxia, hypercapnia, or pre-existing respiratory depression, as in these patients,
even therapeutic doses of [product name] may decrease respiratory drive to the
point of apnea. In these patients, alternative non-opioid analgesics should be
considered. When large doses of tramadol are administered with anaesthetic
medications or alcohol, respiratory depression may result. Respiratory
depression should be treated as an overdose. If naloxone is to be administered,
use cautiously because it may precipitate seizures.
Pregnancy
Tramadol has been shown to cross the placenta. There are no adequate and well-
controlled studies in pregnant women. Safe use in pregnancy has not been
established. [Product name] is not recommended for pregnant women.
Lactation
Approximately 0.1% of the maternal dose of tramadol is excreted in breast milk.
In the immediate post-partum period, for maternal oral daily dosage up to 400
mg, this corresponds to a mean amount of tramadol ingested by breast-fed infants
of 3% of the maternal weight-adjusted dosage. For this reason tramadol should
not be used during lactation or alternatively, breast-feeding should be
discontinued during treatment with tramadol. Discontinuation of breast-feeding
is generally not necessary following a single dose of tramadol.
Reference: Directive No. 20 Year 2017. BPFK/PPP/07/25 (25) Jld 1. Direktif Untuk Semua Produk
Yang Mengandungi Tramadol Dengan Maklumat Bagi Mengehadkan Penggunaan Tramadol Dalam
Kalangan Kanak-Kanak Dan Amaran Berkaitan Penggunaan Dalam Kalangan Ibu Mengandung Dan Ibu
Menyusu
197. TRIMETAZIDINE
Special populations
Patients with renal impairment:
In patients with moderate renal impairment (creatinine clearance [30-60]
ml/min), the recommended dose is 1 tablet of 20mg twice daily, i.e., one in
the morning and one in the evening during meals.
Elderly patients:
Elderly patients may have increased trimetazidine exposure due to age-
related decrease in renal function. In patients with moderate renal
impairment (creatinine clearance [30-60] ml/min), the recommended dose is
1 tablet of 20mg twice daily, i.e., one in the morning and one in the evening
during meals. Dose titration in elderly patients should be exercised with
caution.
Special populations
Patients with renal impairment:
In patients with moderate renal impairment (creatinine clearance [30-60]
ml/min), the recommended dose is 1 tablet of 35mg in the morning during
breakfast.
Elderly patients:
Elderly patients may have increased trimetazidine exposure due to age-
related decrease in renal function. In patients with moderate renal
impairment (creatinine clearance [30-60] ml/min), the recommended dose is
1 tablet of 35mg in the morning during breakfast. Dose titration in elderly
patients should be exercised with caution.
b) Contraindications:
- Parkinson disease, parkinsonian symptoms, tremors, restless leg
syndrome, and other related movement disorders
- Severe renal impairment (creatinine clearance < 30ml/min).
These cases have a low incidence and are usually reversible after treatment
discontinuation. The majority of the patients recovered within 4 months after
trimetazidine withdrawal. If parkinsonian symptoms persist more than 4
months after drug discontinuation, a neurologist opinion should be sought.
198. TRIPROLIDINE
The following statement shall be included on the label and in the package inserts of
liquid oral products containing Triprolidine:
WARNING
When used for treatment of cough and cold:
(a) Not to be used in children less than 2 years of age
(b) To be used with caution and doctor’s/ pharmacist’s advice in children 2 to
6 years of age.
Reference: Circular Bil (34) dlm. BPFK/PPP/01/03: Kenyataan Amaran Pada Label dan Sisip
Bungkusan Produk Persediaan Cecair Oral Untuk Rawatan Batuk dan Selsema (Cough and Cold) yang
Mengandungi Antihistamin, Antitusif dan Dekongestan (Sebagai Bahan Aktif Tunggal atau Kombinasi)
199. VARENICLINE
Reference: Circular Bil (83) dlm. BPFK/17/FV/28: Maklumat daripada European Medicines Agency
(EMEA) berkaitan penggunaan produk Champix (Varenicline) untuk rawatan berhenti merokok
(smoking cessation).
200. VITAMIN K
1. The following statement shall be included in the label and package insert of
health supplement products containing Vitamin K as combined ingredients
with other vitamins and minerals in oral preparation:
ADMINISTRATION:
In severe bleeding, or situations where other routes are not feasible, Vitamin
K1 may be given by very slow intravenous injection, at a rate not exceeding
1mg per minute.
201. WARFARIN
The following statements shall be included in the package insert and RiMUP of
products containing Warfarin:
Package Insert
Caution
Contraindications
Interactions
The following drugs have been reported to potentiate the warfarin effect (increase
INR):
• Miconazole
Side Effects:
Tell your doctor straight away if you have any of the following side effects :
[...]
A painful skin rash. On rare occasions warfarin can cause serious skin conditions,
including one called calciphylaxis that can start with a painful skin rash but can lead
to other serious complications. This adverse reaction occurs more frequently in
patients with chronic kidney disease.
Some commonly used medicines and products that may interfere with [product
name] include:
• Miconazole
References:
Directive No. 15 Year 2016. BPFK/PPP/07/25 ( 1 ) Jld 1. Direktif Bagi Semua Produk Yang
Mengandungi Warfarin Dengan Risiko Kesan Advers Calciphylaxis
Directive No. 12 Year 2017. Ref. BPFK/PPP/07/25(17)Jld 1. Direktif Untuk Semua Produk Yang
Mengandungi Warfarin: Pengemaskinian Sisip Bungkusan Dan Risalah Maklumat Ubat Untuk Pengguna
(RiMUP) Dengan Maklumat Keselamatan Berkaitan Interaksi Ubat
APPENDIX 21
NO. PRODUCTS
1. BLOOD PRODUCTS
3. KETOCONAZOLE
4. MIDAZOLAM
8. VACCINES
Appendix 21: Special Conditions for Registration of a Particular Product or Group of Products
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
1. BLOOD PRODUCTS
a) Each batch of product must comply with WHO requirements for the product.
b) The following documents must be enclosed with each bath of the product imported
into Malaysia:
i. Batch Release Certificate from the relevant authority in the country of
manufacture
ii. Certificate confirming that the blood or plasma used in the production of the
lot is tested and found to be negative for HIV antibody, HbsAg, and HCV, and
that high-risk donors were excluded.
iii. Certificate of analysis.
Oral products containing ketoconazole are restricted for hospital use only.
MIDAZOLAM
4.
Products containing midazolam are restricted for use in government and private hospitals
and specialist clinics only.
5. PARACETAMOL IN COMBINATION WITH CAFFEINE
a) For products containing a combination of paracetamol and caffeine:
Dose unit of caffeine for adults is 65mg and maximum dose of caffeine is 520mg per day
Dose unit for paracetamol is 500mg with the maximum dose of 4,000mg per day or 8
tablets daily.
b) Products containing caffeine for pediatric patients are not allowed.
c) Allowable packing size should not exceed 20 tablets/ capsules.
Appendix 21: Special Conditions for Registration of a Particular Product or Group of Products
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a) The product registration holder shall ensure that the product shall only be sold or
supplied to, and prescribed by:
i. Dermatologists registered in the National Specialist Register; or
ii. Dermatologists serving in any government health facilities.
b) The product registration holder shall submit a proper record containing the following
information to the Authority upon request.
i. Name of product;
ii. Product registration number;
iii. Date & quantity of product manufactured/ imported and supplied; and
iv. Name, address & contact number of purchaser (prescriber).
c) The prescriber shall keep and maintain proper patient records for audit purpose, if
any.
Reference: Directive No. 17, 2020. NPRA.600-1/9/13 (8). Direktif Berkenaan Pindaan Syarat
Pendaftaran Khas Bagi Produk Yang Mengandungi Oral Retinoid Yang Diindikasikan Untuk
Rawatan Penyakit Kulit
8. VACCINES
a) Each batch of the product must comply with WHO requirements for the product.
b) A batch release certificate must be enclosed with each batch of the product imported
into Malaysia.
Appendix 21: Special Conditions for Registration of a Particular Product or Group of Products
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Drug Registration Guidance Document (DRGD) Third Edition, January 2021
APPENDIX 22
EDUCATIONAL MATERIALS
NO. PRODUCTS
References:
• Directive No. 21 Year 2019. (21)dlm.BPFK/PPP/07/25 Jld.3: Direktif untuk semua
produk yang mengandungi sodium valproate: pengukuhan maklumat keselamatan
pada label, sisip bungkusan dan Risalah Maklumat Ubat Untuk Pengguna (RiMUP)
berkaitan risiko kecacatan kongenital dan masalah perkembangan dalam kalangan
bayi dan kanak-kanak yang terdedah kepada penggunaan sodium valproate semasa
dalam kandungan dan penyediaan bahan-bahan pengajaran
• NPRA website.
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The potential for pregnancy must be assessed for all female patients prescribed [product name].
Before initiating [product name] in a female patient, the following checklist is to be completed
by the prescriber and kept with the patient notes to document compliance with the [product
name] Pregnancy Prevention Programme. After completion, a copy of this document should be
given to the patient.
[Product name] belongs to the retinoid class of drugs that cause severe birth defects. Foetal
exposure to [product name], even for short periods, presents a high risk of congenital
malformations. [Product name] is therefore strictly contraindicated in women of childbearing
potential, unless all conditions in the [product name] Pregnancy Prevention Programme are
fulfilled.
As the prescriber, you must make sure that the risk of serious harm from drug exposed
pregnancy is fully understood by all female patients before treating them with [product name].
This checklist should also be used in all follow-up visits with women of childbearing potential.
Please use the patient reminder card to support your discussion with the patient.
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Women of childbearing potential: Review the below statements, explain them to the patient
and record confirmation of this and acknowledgment from the patient in this form. If the
answer to any of these questions is NO, [product name] must not be prescribed.
Prescriber Patient
confirm: I have confirm: I
explained this have
to my patient understood
this
1. Teratogenicity
2. Contraception
The patient understands that the risk persists even Yes No Yes No
after the medication is stopped and that she must not
get pregnant within 1 month* [*for acitretin: 3 years]
after stopping treatment.
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Prescriber Patient
confirm: I have confirm: I
explained this have
to my patient understood
this
The first prescription for [product name] can only be Yes No Yes No
given after the patient has had one negative
medically supervised pregnancy test. This is to make
sure she is not already pregnant before starting
treatment.
The patient knows to contact their doctor if they have Yes No Yes No
unprotected sex, miss their period, become pregnant,
or suspect that they have become pregnant during
the risk period.
The patient has received a reminder card and copy of Yes No Yes No
this form.
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Prescriber Patient
confirm: I have confirm: I
explained this have
to my patient understood
this
4. Other Precautions
Patient understands that she must not donate blood Yes No Yes No
during treatment with [product name] and for one
month* [*for acitretin: 3 years] after discontinuation
due to the potential risk to the foetus of a pregnant
transfusion recipient.
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[Product name] belongs to the retinoid class of drugs that cause severe birth defects. Foetal
exposure to [product name], even for short periods of time, presents a high risk of congenital
malformations and miscarriage.
Female patient must use effective contraception before, during and for 1 month* [*for acitretin:
3 years] after stopping treatment with [product name].
If you are aware that a female patient has become pregnant within 1 month* [*for acitretin: 3
years] of stopping [product name], she should be referred to her prescribing doctor.
As the pharmacist, you should only dispense [product name] after checking the following
information:
Not to donate blood during [product name] therapy and for 1 month* [*for
acitretin: 3 years] after discontinuation due to the potential risk to the foetus of a
pregnant transfusion recipient.
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2. SODIUM VALPROATE
2.1 Patient Card
PATIENT CARD
Note:
- This also applies to all girls and women taking sodium valproate who could become
pregnant
- Keep this card safe so you always know what to do
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that this patient is already stable on ……… dose and she is reluctant to change to other medication.
Other reason (to specify) ……………………………………………………………………………..
I have discussed the following information with the above-named patient or care-giver:
The overall risk to fetus and children whose mothers are exposed to sodium valproate during pregnancy are:
• an approximately 10% chance of birth defects and
• up to 30 to 40% chance of a wide range of early developmental problems that can lead to learning
difficulties.
Sodium valproate should not be used during pregnancy (except in rare situations for epileptic patients that
are resistant or intolerant to other treatments)
The need for regular (at least annually) review and the need to continue sodium valproate treatment by the
prescriber.
The need for negative pregnancy test at treatment initiation and as required thereafter (if child bearing age).
The need for an effective contraception without interruption during the entire duration of treatment with
sodium valproate (if childbearing age).
The need to arrange an appointment with her doctor as soon as she is planning pregnancy to ensure timely
discussion and switching to alternative treatment options prior to conception and before contraception is
discontinued.
The need to contact her doctor immediately for an urgent review of the treatment in case of suspected or
inadvertent pregnancy.
In case of pregnancy, I confirm that this pregnant patient:
• received the lowest possible effective dose of sodium valproate to minimise the possible harmful effect
on the unborn
• is informed about the possibilities of pregnancy support or counselling and appropriate monitoring of
her baby if she is pregnant.
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Why I need a negative pregnancy test at treatment initiation and if needed thereafter (if child bearing age)
That I must use an effective contraception without interruption during the entire duration of my treatment
with sodium valproate (if childbearing age).
We discussed the possibilities of effective contraception or we planned a consultation with a professional
who is experienced in advising on effective contraception.
The need for regular (at least annually) review and the need to continue sodium valproate treatment by the
prescriber.
The need to consult my doctor as soon as I am planning to become pregnant to ensure timely discussion
and switching to alternative treatment options prior to conception, and before contraception is
discontinued.
That I should request an urgent appointment if I think I am pregnant
In case of a pregnancy, I have discussed the following with my doctor and understand:
• The possibilities of pregnancy support or counselling
• The need to appropriate monitoring of my baby if I am pregnant
Part B shall be completed: all boxes shall be ticked, and the form signed by prescriber and the patient. This is to make
sure all the risks and information related to the use of sodium valproate during pregnancy have been understood.
Part B - to be given to patient
- a copy to be kept by the prescriber
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Note: This guide is to inform you of important information and strengthened warnings related
to this risk
1. Congenital Malformations
Data derived from two meta-analysis (including registries and cohort studies) have shown that
10.73% (95% Confidence Interval: 8.16-13.29%)1 to 10.93% (95% Confidence Interval: 8.91-
13.13%) of children of epileptic women exposed to sodium valproate monotherapy during
pregnancy suffer from congenital malformations)2. This represents a greater risk of major
malformations than for the general population, for whom the risk is equal to about 2-3%1.
Available data show that the risk is dose dependent.The risk is greatest at higher doses (above
1g daily). A threshold dose below which no risk exists cannot be established based on available
data.
The most common types of malformations include neural tube defects, facial dysmorphism, cleft
lip and palate, craniostenosis, cardiac, renal and urogenital defects, limb defects (including
bilateral aplasia of the radius), and multiple anomalies involving various body system.
2. Developmental Disorders
Exposure to sodium valproate in utero can have adverse effects on mental and physical
development of the exposed children. The risk seems to be dose-dependent but a threshold dose
below which no risk exists cannot be established based on available data. The exact gestational
period of risk for these effects is uncertain and the possibility of a risk regardless of when
during the pregnancy exposure occurs cannot be excluded.
Studies3-6 in preschool children show that up to 30-40% of children with a history of sodium
valproate exposure in utero experience delays in their early development such as talking and
walking later, lower intellectual abilities, poor language skills (speaking and understanding) and
memory problems.
Available data show that children with a history of sodium valproate exposure in utero are at
increased risk of autistic spectrum disorder (an approximately three-fold) and childhood autism
(an approximately fivefold) compared with the general study population6.
Limited data suggests that children with a history of sodium valproate exposure in utero may be
more likely to develop symptoms of attention deficit/hyperactivity disorder (ADHD)7.
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RECOMMENDATIONS
1. The use of sodium valproate had been restricted in pregnancy as such:
• In epilepsy
- sodium valproate is contraindicated unless there is no suitable alternative treatment.
• In bipolar disorder
- sodium valproate is contraindicated in pregnancy.
2. The use of sodium valproate in women of childbearing potential is contraindicated unless
patient had been assessed and counselled appropriately on the risks associated with
sodium valproate.
3. Treatment should only be initiated if other treatments ineffective or not tolerated.
4. Treatment should only be initiated after pregnancy has been excluded (negative pregnancy
test).
5. The benefit and risk should be carefully reconsidered at regular treatment reviews.
Preferably, sodium valproate should be prescribed as monotherapy and at the lowest
effective dose. A prolonged release formulation is preferred to avoid high peak plasma
concentrations. The daily dose should be divided into at least two single doses
6. Carry out annual review and ad-hoc treatment review when required. The benefit and risk
should be carefully reconsidered during every treatment review.
7. In the case where sodium valproate must be used during pregnancy, prenatal monitoring is
recommended to detect any malformations.
COUNSELLING POINT
advise patient/ caretaker on the risk of congenital malformations and
neurodevelopmental disorders associated with sodium valproate. Inform patient also
about the risks of untreated seizure or bipolar disorder.
advise patient to use effective contraception without interruption throughout the entire
duration of sodium valproate treatment
advise patient not to stop treatment abruptly and to urgently contact the doctor when
planning for pregnancy or in the case of suspected pregnancy.
ensure that patient has received educational materials such as patient card and patient
guide that has been provided by the supplier of sodium valproate.
References
1. Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: a systematic
review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008; 81(1):1-13.
2. Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, Hounsome J, McKay AJ, Tudur Smith C,
Marson AG. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child.
Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010224
3. Bromley RL, Mawer G, Love J, Kelly J, Purdy L, McEwan L et al. Early cognitive development in children born to
women with epilepsy: a prospective report. Epilepsia 2010 October; 51(10):2058-65.
4. Cummings et al. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and
carbamazepine. Arch Dis Child 2011;96: 643-647
5. Meador K et al. Cognitive Function at 3 years of age after fetal exposure to antiepileptic drugs. NEJM 2009; 360
(16): 1597- 1605
6. Thomas S.V et al. Motor and mental development of infants exposed to antiepileptic drugs in utero. Epilepsy and
Behaviour 2008 (13):229-236
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7. Christensen J et al. Prenatal Sodium valproate Exposure and Risk of Autism Spectrum Disorders and Childhood
Autism. JAMA 2013; 309(16):1696-1703
8. Cohen M.J et al. Fetal Antiepileptic Drug Exposure: Motor, Adaptive and Emotional/Behavioural Functioning at
age 3 years.Epilepsy Behav. 2011; 22(2):240-246
KEY POINTS:
• Sodium valproate is an effective medicine used to treat seizure (epilepsy) and bipolar
disorder.
• Sodium valproate can seriously harm an unborn child when taken during pregnancy and
should not be taken by women and girls unless no other medicine works.
• Never stop taking sodium valproate unless your doctor tells you to stop.
• Always use contraception and do not stop using as long as you are taking sodium
valproate.
• See your doctor at once if you are planning pregnancy or if you suspect that you are
pregnant. Do not stop taking sodium valproate.
• Please make sure that you receive the patient educational materials such as patient card
and patient guide from your healthcare provider.
• For women who are able to get pregnant (of child-bearing age):
o When taking sodium valproate, always use reliable contraception and never
stop using it so you do not have unplanned pregnancy as long as you are taking
sodium valproate
o Tell your doctor at once if you think you may be pregnant or know you are
pregnant.
o Never stop taking sodium valproate unless your doctor tells you to as your
condition may become worse
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You can help by reporting any side effects that you may get directly to the National
Pharmaceutical Regulatory Agency (NPRA) through the website http://npra.gov.my
(Consumer→Consumer Reporting of Side effects To Medicines Or Vaccines→ConSERF).
Sodium valproate can be harmful to unborn children when taken by a woman during
pregnancy.
Sodium valproate can cause serious birth defects and can affect the way in which the
child develops as it grows. Birth defects include spina bifida (where the bones of the
spine are not properly developed); facial and skull malformations; heart, kidney, urinary
tract and sexual organ malformations; and limb defects.
Because sodium valproate has been used for many years, we know that in women who
take sodium valproate, around 10 babies in every 100 will have birth defects. This
compares to 2-3 babies in every 100 born in the general population.
It is estimated that up to 30-40% of preschool children whose mothers took sodium
valproate during pregnancy may have problems with early childhood development.
Children affected can be slow to walk and talk, intellectually less able than other
children, and have difficulty with language and memory. In addition, disorders which
affect the way a child communicates and interacts with others, for example autism, are
more often diagnosed in children exposed to sodium valproate.
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APPENDIX 23
Contents:
1. Purpose
2. Objectives
3. Definition
4. Benefits
5. Criteria for Implementation of Patient Dispensing Pack
6. Exempted Products
7. Other Considerations for Implementation
8. Implementation Timeline
9. Conclusions
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1. PURPOSE
2. OBJECTIVES
3. DEFINITION
4. BENEFITS
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• The patient dispensing pack size should be based on the medication, intended use,
recommended dosage and dosage form sufficient for one month supply or per
treatment for one patient’s use.
• This requirement does not apply for blister or strip pack.
• The maximum permitted supply is one month but may be less depending on the
intended use of the medication.
• The Product Registration Holder (PRH) is responsible for justifying the proposed
patient dispensing pack size based on these criteria as the dosing regimen for
certain medications may equate to large amounts of tablets/ capsules. The
justification provided should also define one month supply, whether for 28, 30 or
31 days.
• Blisters or strip packs are strongly recommended for solid oral dosage forms (e.g.
tablets and capsules). Bulk loose pack for supply of more than one month is not
permitted unless properly justified by the PRH.
• Oral chemotherapeutics in tablet or capsule must be packed in blisters to reduce
personnel exposure and presumable risk to minimise the toxic effect of the
chemotherapeutics.
6. EXEMPTED PRODUCTS
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VARIATION APPLICATIONS
• Change in patient pack size (regardless of whether a new pack type is involved)
shall be submitted to the Variation Unit, Centre of Product & Cosmetic Evaluation
(PPPK).
• Lists of products with recommended maximum pack sizes for oral liquid
preparations and dermatological preparations are presented in Table 1 and Table
2 respectively.
• For tablets and capsules in loose pack, the maximum pack size will depend on the
highest dosage and frequency per patient’s treatment or one month supply.
8. IMPLEMENTATION TIMELINE
9. CONCLUSIONS
Patient Dispensing Pack is convenient, safe and improves the quality of dispensed
medicines. It increases efficiency in dispensing and improves patient safety by reducing
the risk and possibility of error. It also reduces drug waste and promotes better use of
resources.
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TABLE 1:
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N05A Antipsychotics
P01B Antihelmintics 60ml
N05C Tranquillizers/ Anxiolytics 250ml
A05B Hepatic protector – lipotropics 150ml
J05 Antivirals for systemic use 250ml
J05B Antivirals excluding Anti-HIV
J05C HIV antivirals
J01 Antibiotics systemic 120ml
J01A Tetracyclines & combination
J01B Chloramphenicols combinations
J01C1 Oral broad spectrum Penicillins
J01D1 Oral Cephalosporins
J01E Trimethoprim combinations
J01F Macrolides & similar type
J01H Medium & narrow spectrum
penicillins
J01X Other antibiotics
J02A Systemic Antifungals Agents
N06D Nootropics 125 ml
N06E Neurotonics & Miscellaneous
G01A1 Trichomonacides 120ml
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TABLE 2:
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** Note:
Pack size of 500g is for hospitals and skin
specialist clinics use.
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References: Circulars
i. (Bil 16) dlm bpfk02/5/1.3.pdf
Kawalan Saiz Pek Persediaan Ubat Batuk Mengandungi Pholcodine (13 October 2003)
ii. Bil (22) dlm BPFK/02/5/1.3.pdf
Lanjutan Tempoh Untuk Menarik Balik Saiz Pek Persediaan Ubat Batuk Mengandungi
Pholcodeine Yang Melebihi 90mL Dari Pasaran (7 November 2003)
iii. Bil (21) dlm.BPFK/02/5/1.3.pdf
Kawalan Penetapan Saiz Pek Maksima Bagi Semua Persediaan Ubat Batuk
(7 November 2003)
iv. Bil (24) dlm BPFK/02/5/1.3.pdf
Pindaan Kepada Kawalan Penetapan Saiz Maksima Bagi Semua Persediaan Ubat Batuk (8
March 2004)
v. dlm. BPFK/02/5/1.4
Perlaksanaan Konsep Pek Saiz Pesakit (Patient Pack Size) bagi Produk Farmaseutikal (20
February 2008)
vi. Bil (4) dlm BPFK/PPP/01/03 Jld 1
Direktif Justifikasi Untuk Perubahan Pek Saiz Pesakit Untuk Penyakit Kulit Tertentu Bagi
Produk-produk Dermatologi (14 December 2010)
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APPENDIX 24
APPEAL
As stipulated under Regulation 18, CDCR 1984, any person aggrieved by the decision of the
Authority or the Director of Pharmaceutical Services, may make a written appeal to the Minister
of Health Malaysia.
All notice of appeals shall be made within fourteen (14) days from the date of notification by
the Authority;
• A period of 60 days from the date of appeal confirmation is given for submission of any
additional information/ supplementary data/ documents for all product categories.
• The appeal shall not be considered if all the required information is not submitted within
the specified time frame given. Any request for extension of this period shall not be
considered.
The appeal for rejected applications of product registration shall be submitted via the online
QUEST system ONLY. Other types of appeal shall may be submitted manually.
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***Note:
***Evaluation by the Authority a) 120 days for evaluation of NCE, Biologic,
prescription and non-prescription (full
evaluation) products.
b) 90 days for evaluation of non-prescription
Memorandum of appeal prepared
by the Authority and sent to the (abridged evaluation), health supplement and
Minister of Health natural products.
Rejected
Regulatory outcome Appeal rejected
Approved
Appeal approved
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Tarikh:
Y. B.,
NAMA PRODUK : Sila nyatakan nama produk (Please state the product name)
NO. RUJUKAN : Sila nyatakan nombor pendaftaran produk
(Please state the product reference number)
Dengan segala hormatnya, pihak kami ingin membuat rayuan terhadap penolakan
permohonan produk seperti di atas.
2. Alasan – alasan rayuan serta data tambahan/ maklumat akan dihantar kepada pihak
Y.B. dalam tempoh 60 hari dari tarikh pengesahan penerimaan rayuan oleh pihak Y.B.
Yang benar,
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APPENDIX 25
This guideline consists of general and specific requirements for the POA submission. The
general requirements are referred for POA content whilst details of specific requirements are
illustrated according to the test category.
1. GENERAL REQUIREMENTS
i) Name of product;
ii) Name and address of manufacturer;
iii) Name, signature and designation of authorized person;
iv) Effective date and Review date.
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f) All relevant data collected during chemical and microbiological testing such as
chromatograms HPLC/ GC, test reports and formulae used for calculating should also
be submitted.
2. SPECIFIC REQUIREMENTS
The specific requirements for test methods are based on type of tests and dosage forms of
product as stated below:
Dissolution test
a. Dissolution parameters should
include:
i) type of apparatus
Physical & ii) type and volume of dissolution
Performance medium
Tests iii) rotation rate
iv) temperature of solution
v) sampling time
b. Complete formula for calculation
especially for extended and
delayed release products.
c. Method of analysis for example
HPLC, UV, etc.
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Sterility Test
a. List of media and reagent
i) Culture media
ii) List of rinsing solution, buffer
solution and diluent
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Note:
1. Finished product testing shall be conducted on every batch produced as per approved
finished product specifications.
2. Manufacturer shall ensure that products manufactured locally or overseas are free from
any contamination of Burkholderia cepacia. Please refer to these circulars for details:
Ref. (90) dlm.BPFK/PPP/01/03/ Jld. 2
Ujian Kontaminasi Burkholderia cepacia (19 December 2012).
3. Products are not allowed to send for gamma radiation treatment for the control of
microbial contamination. Please refer to this circular for details:
Ref. (54) dlm.BPFK/02/5/1.3.
Aktiviti Pendedahan Produk Berdaftar kepada Sinar Gamma (18 April 2006)
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APPENDIX 26
a) Identification tests
b) Quantitative tests for impurities' content
c) Limit tests for control of impurities
d) Quantitative tests of the active ingredient in the sample (assay and dissolution)
e) Bacterial endotoxin test
f) Sterility test
g) Microbial Contamination Test
h) Biological Assay of Antibiotics
*For detailed information on requirements for analytical method validation, please refer
to:
• Checklist For AMV Identification, Assay, Dissolution & Related Substances
• Checklist For Microbial Contamination Test
• Checklist For Sterility
• Checklist For Bacterial Endotoxin Test
Appendix 26: Guideline for the Submission of Analytical Method Validation (AMV) Documents
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TABLE I:
Accuracy √ √
Precision
Repeatability √ √
Interm. Precision √ (1) √ (1)
Specificity (2) √ √ √ √
Quantitation Limit √
√
Linearity √
√
√
Range
Appendix 26: Guideline for the Submission of Analytical Method Validation (AMV) Documents
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TABLE II:
Precision
Intermediate
√ (1) √ (1)
Precision
Specificity (2) √ √ √ √
Quantitation Limit √
Note:
(1) In cases where reproducibility has been performed, intermediate precision is not
needed.
Appendix 26: Guideline for the Submission of Analytical Method Validation (AMV) Documents
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TABLE III:
Note:
1. All the analytical validation done by the industry should be in accordance to ASEAN
Guidelines for Analytical Procedures, ICH Technical Requirements for Registration of
Pharmaceuticals for Human Use under Validation of Analytical Procedures: Text and
Methodology Q2 (R1), British Pharmacopoeia (BP), United States Pharmacopoeia (USP), or
Japanese Pharmacopoeia (JP).
2. The applicants should ensure all documents available in the online Quest system are of the
latest versions. All correspondence on the protocol of analysis and analytical method
validation should comply with any relevant circulars regarding the registration process.
Failure to do so may cause cancellation or rejection of product registration.
3. Raw data is required for new product application that is not registered with DCA reference
countries.
Appendix 26: Guideline for the Submission of Analytical Method Validation (AMV) Documents
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APPENDIX 27
INSPECTION
Refer to NPRA website for the latest directives and circulars pertaining to GMP and GDP.
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The PRH must provide acceptable evidence to prove that the manufacturer of the product
follows an internationally accepted standard of GMP and recognized by the Authority in
Malaysia.
The CDCR 1984 requires that the standard of manufacturing and quality control of medicinal
products manufactured outside Malaysia be taken into consideration before the products are
registered with the Authority. NPRA, as the secretariat to the DCA, is responsible for ensuring
that all manufacturers of registered products in Malaysia provide acceptable evidence that the
manufacturing premises conform to current GMP requirements. Hence, foreign manufacturers
are also subjected to GMP conformity assessments through acceptable GMP evidence or GMP
inspection.
For further details and forms, refer to the Guidance Document Foreign GMP Inspection.
This section only focuses on changes related to manufacturing premises including quality
control laboratories and storage/ warehouse facilities. For changes to product particulars, refer
to Section E of Post Registration Process, which discusses Amendments to Particulars of a
Registered Product.
Changes at the manufacturers’ facility can potentially have a quality and safety impact. It is the
responsibility of the site to assess information on the changes via a formal change control
system and risk management, where applicable. Manufacturers, Importers and Wholesalers are
recommended to have a system for categorizing types of changes. All changes to the facility
shall be notified to the Centre of Compliance & Quality Control (PKKK) and/ or Centre of
Regulatory Coordination & Strategic Planning (PKPSR).
Notification of changes will be reviewed to assess its significance and may be verified during the
scheduled GMP inspection. The PKKK will communicate further and arrange for an
investigative/ for-cause inspection focusing on these changes, if deemed necessary.
Additional Information:
1. This section is applicable to local manufacturers only. For changes of importer or
wholesaler particulars, refer to Section E: Post-Registration Process
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OR
b) Official letter, which may include information (at the very least) such as;
• Description of changes to the facility
• Plan of changes (E.g. Gantt Chart, Validation Master Plan, etc.)
• Details of the products affected, where applicable.
Examples of changes that require Periodical Notification are as per Table B. Example of
Periodical Notification
Note: Both Table A. Example of Immediate Notification and Table B. Example of Periodical
Notification are examples for both regulator and the industry. Requirement for further action is
still subject to the evaluation by PKKK based on the risk of the changes proposed/ implemented by
the manufacturer.
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Type of
Requirement Documentation
Items Example Description Application under Remarks (If any)
of BPFK-503 Required
BPFK-503
Verification of
New premises
information via GMP
Change of Manufacturing Require submission of new layout
As per BPFK-503 inspection, if necessary.
1. site (including drug layout plan YES
requirement
substance if any) E.g. New lot (Processing Fee=
Please refer further to
RM1000.00)
Section E.
Verification of
Revision of existing
information via GMP
a. Addition of new premises layout
Introduction of new line/ As per BPFK-503 inspection, if necessary.
2. manufacturing/ YES
upgrading clean room requirement
packaging line (Processing fee: RM
Please refer further to
500.00)
Section E.
Type of
Requirement Documentation
Items Example Description Application under Remarks (If any)
of BPFK-503 Required
BPFK-503
Revision of existing
premises layout
Verification of
(no changes of
As per BPFK-503 information via GMP
c. New Production Block YES premises address)
requirement inspection, if necessary.
(Processing fee: RM
Please refer further to
500.00)
Section E.
Type of
Requirement Documentation
Items Example Description Application under Remarks (If any)
of BPFK-503 Required
BPFK-503
Revision of existing
premises layout
a. Relocate or add As per BPFK-503
YES
manufacturing rooms, requirement
(Processing fee: RM
which affect the
500.00)
process flow
Type of
Requirement Documentation
Items Example Description Application under Remarks (If any)
of BPFK-503 Required
BPFK-503
Verification of
information via GMP
Changes/ addition of inspection, if necessary.
critical steps in Notification to
NO Not applicable
manufacturing (including PKKK, NPRA May involve product
packaging) process variation (Refer to CPCE,
NPRA)
Type of
Application
Requirement under BPFK- Documentation
Items Example Description Remarks (If any)
of BPFK-503 503 Required
Type of
Application
Requirement under BPFK- Documentation
Items Example Description Remarks (If any)
of BPFK-503 503 Required
Applicable to QA/QC
Notification to
Manager, Head of May involved change of holder
4. Change of key personnel NO Not applicable PKKK & PKPSR,
production, Production of Manufacturer’s License.
NPRA
Pharmacist
a. Replacement of old
equipment with
new equipment in
Addition or replacement existing designated
of manufacturing room Verification of information via
Notification to
5. equipment, without NO Not applicable GMP inspection, if necessary.
PKKK, NPRA
affecting existing E.g. Replace the old
manufacturing layout tableting machine with
new tableting machine
in existing tableting
room.
Type of
Application
Requirement under BPFK- Documentation
Items Example Description Remarks (If any)
of BPFK-503 503 Required
b. Installation of new
equipment in
existing room
Notification to
E.g. New encapsulation NO Not applicable Verification of information via
PKKK, NPRA
or tableting machine in GMP inspection, if necessary.
the existing room.
Type of
Application
Requirement under BPFK- Documentation
Items Example Description Remarks (If any)
of BPFK-503 503 Required
Type of
Application
Requirement under BPFK- Documentation
Items Example Description Remarks (If any)
of BPFK-503 503 Required
Notification to
Example:
PKKK, NPRA
• Relocation to new Verification of information by
9. Cessation of Manufacturer’s
site. NO Not Applicable PKKK if necessary.
manufacturing operation License to be
returned to NPRA
• Cessation of
business activity
APPENDIX 28
LICENSING
1. TYPES OF LICENSES
The license application for registered products (Manufacturer’s License, Import License and
Wholesaler’s License) shall be submitted via the QUEST system.
An application shall only be processed if it is complete and payment has been approved.
The processing fee shall not be refundable. The processing fee of an application for a
Manufacturer’s License is RM 1,000.00 and RM 500.00 for an Import License or a Wholesaler’s
License.
Each license is valid for one (1) year or until 31st December, whichever earlier.
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When submitting the application for Additional Product List of License for Registered Products,
a copy of the current Manufacturer’s License/ Import License and a copy of approval letter from
the Authority (The Authority’s meeting result) shall be provided as supporting documents.
The application of additional list shall be submitted via the QUEST system.
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APPENDIX 29
CERTIFICATE
A CPP in the format recommended by WHO for a registered product can be applied by the PRH
where such certificate is required by any country importing such product.
To apply a CPP, the PRH shall fill up completely and submit the online application form via the
QUEST system.
Upon receipt of complete application, the certificate shall be issued within fifteen (15) working
days.
ii) CFS and GMP from the relevant competent authorities is deemed acceptable by the
Authority for health supplements and natural products only.
CPP shall be in the format of the WHO Certification Scheme on the Quality of Pharmaceutical
Products Moving in International Commerce & be issued by the Health Authorities listed in the
WHO Certification Scheme (list is available from WHO website: http://www.who.int).
CPP which is issued by EMA for products registered through the centralized procedure in EU
will be accepted.
If more than one manufacturer is involved in the manufacture of a product, GMP certification
shall be available for all the manufacturers.
The Authority reserves the right to conduct an inspection on any manufacturing site.
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Unless otherwise supported by justifications acceptable to the Authority, the following products
are unlikely to be registered:
i) products not licensed/ certified for sale in the country of manufacture/ product
owner;
ii) products manufactured for export only (imported products).
GMP is a standard which shall be followed by the manufacturers to ensure that the products
manufactured are safe, efficacious and of quality.
A GMP Certificate is issued for the purpose of exporting locally manufactured registered
products. It endorses that the local manufacturer complies with the current GMP requirements.
These certificates are required by overseas regulatory agencies for the purpose of product
registration in their respective countries. Thus, when filling in the GMP Certificate application
form, it is crucial for the company to provide the correct address of the overseas regulatory
agency.
Upon complete application, a GMP certificate will be issued. A fee of RM50.00 is payable for the
issuance of such certification.
The application of GMP Certificate by local manufacturers shall be submitted via the online
QUEST system, while applications from foreign manufacturers that have been inspected by
NPRA shall be submitted manually via Borang BPFK-420 Permohonan Sijil Amalan Perkilangan
Baik (APB).
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APPENDIX 30
AFFECTED FIELDS
VARIATION TYPE I SUPPORTING DOCUMENTS REQUIRED AND CONDITIONS
NO.
(MINOR VARIATION) ABRIDGED APPLIED
FULL EVALUATION
EVALUATION
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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NO.
(MINOR VARIATION) ABRIDGED APPLIED
FULL EVALUATION
EVALUATION
2. For foreign manufacturers/ other manufacturers:
A valid Good Manufacturing Practice (GMP) certificate.
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
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NO.
(MINOR VARIATION) ABRIDGED APPLIED
FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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NO.
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FULL EVALUATION
EVALUATION
or units (e.g. tablets,
ampoules) in a pack. *The sentence ‘Sample not for sale’ can be added in the
• Change in volume of product label without going through variation approval.
non sterile
preparations
SUPPORTING DOCUMENTS
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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NO.
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FULL EVALUATION
EVALUATION
For (c):
1. Updated information of the manufacturer of the drug
substance.
2. Official document/ evidence when required.
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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FULL EVALUATION
EVALUATION
3. For generic product please provide supporting documents
e.g. Martindale or equivalent document to support the
change.
SUPPORTING DOCUMENT
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
between the currently approved and proposed solid
dosage forms formulation (where applicable).
8. Stability data of drug product (please refer to ASEAN
Guideline On Stability Study of Drug Product)
9. Revised drafts of the package insert and labeling
incorporating the proposed variation (where applicable).
10. Batch analysis data.
11. Product interchangeability/ equivalent evidence (if any).
12. Justification for the change supported by appropriate
development of pharmaceutics.
13. New unit formula for coating agent (where applicable).
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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FULL EVALUATION
EVALUATION
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FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
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EVALUATION
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EVALUATION
CONDITION
13. Change in storage • A15 • A12
conditions • P8 • B5 The studies must show conformance to the current shelf life
• D1 • D1 specification.
• D2 • D2
• D3 • D3 SUPPORTING DOCUMENTS
SUPPORTING DOCUMENTS
14. Appointment, deletion or • D1 • E3
change of other • D2 • F12
1. GMP certificates of the proposed other manufacturers.
manufacturers • D3 • D1 2. Description of the manufacturing activity of all other
• E14 • D2 manufacturers involved (including assembling process).
• E12 • D3 3. Letter of appointment and acceptance for contract of other
manufacturers.
4. Revised drafts of the labeling incorporating the proposed
variation (where applicable).
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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AFFECTED FIELDS
VARIATION TYPE II SUPPORTING DOCUMENTS REQUIRED AND CONDITIONS
NO.
(MAJOR VARIATION) ABRIDGED APPLIED
FULL EVALUATION
EVALUATION
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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AFFECTED FIELDS
VARIATION TYPE II SUPPORTING DOCUMENTS REQUIRED AND CONDITIONS
NO.
(MAJOR VARIATION) ABRIDGED APPLIED
FULL EVALUATION
EVALUATION
SUPPORTING DOCUMENTS
CONDITIONS
17. Change or addition of fill • P3.4 Not applicable
volume and/or change of • P8 1. Release and end-of-shelf life specifications of the drug
shape or dimension of • E12 product are not affected.
container or closure for a • C 2. The packaging material remains the same.
sterile solid and liquid • D1
drug product • D2 SUPPORTING DOCUMENTS
• D3
(if applicable) 1. Justification that the proposed pack size is consistent with
the dosage regimen and duration of use as approved in the
package insert.
2. Validation data of the manufacturing process, sterilization
and container closure system (if applicable).
3. Stability data of drug product (please refer to ASEAN
Guideline on Stability Study of Drug Product) where
applicable.
4. Revised drafts of the package insert and labeling
incorporating the proposed variation, where applicable.
Appendix 30: Conditions and Supporting Documents Required for An Application of Variation
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APPENDIX 31
Change of Manufacturing Site (COS) refers to change of manufacturing site for certain or all of
the manufacturing process of a product. This does not cover changes related to a new site,
where only:
a) batch release takes place OR
b) to a new packager (secondary packaging or labelling), as these changes are covered
under applications for amendments to the particulars of a registered product
However, a change of manufacturing site for biologics shall require a new product registration if
the change is extensive and will have an impact on the quality, safety and efficacy profile of the
final product.
Once NPRA deems the application is complete, the outcome of the COS application shall be
decided by the Drug Control Authority (DCA) within sixty (60) working days.
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A change of manufacturing site under a crisis situation may be considered for the following:
a) A change between contract manufacturers for local natural and health supplement
products;
b) A change to a contract manufacturer outside of Malaysia for pharmaceutical
products.
Validity of registration for a product approved for change of manufacturing site remains
unchanged.
2. TYPES OF COS
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3. MODE OF SUBMISSION
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For the list of documents to be submitted for each type of COS applications, kindly refer to the
table below:
Type
I
Type Type Type Type
No Document to Be Submitted (Except
II III IV V
Natural
Product)
1. Letter of authorization/ appointment from
the product owner to authorise Product
Registration Holder to submit the change
of site application.
√ √ √ √ √
In case of a contract manufacturer, a letter
of acceptance from the proposed contract
manufacturer to manufacture the product.
2. Letter from the manufacturer/ product
owner to clarify/ explain the need to √ √ √ √ √
change site of manufacture.
3. Written declaration from the manufacturer
to certify that the manufacturing process,
and the release and expiry (check)
specifications of the product as the same as
already approved.
√ √ √ √ √
OR
OR √ √ √ √ √
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Type
I
Type Type Type Type
No Document to Be Submitted (Except
II III IV V
Natural
Product)
6. Specification of the drug substance
√ √ √ √ √
7. Product formula/ Batch Manufacturing
Formula √ √ √ √ √
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Type
I
Type Type Type Type
No Document to Be Submitted (Except
II III IV V
Natural
Product)
15. A written plan for assessing the effect of
the change of site on the quality of the
product with the objective of √ √ √
demonstrating that the pre- and post-
change products are equivalent.
OR
OR
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Type
I
Type Type Type Type
No Document to Be Submitted (Except
II III IV V
Natural
Product)
OR
OR
Note:
No. 6, 9, 12, 13, 16 and 17 in the table above are not applicable for Natural products and
Health supplements.
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2. Letter of declaration stating the reason(s) for change of manufacturing site and clearly
state the proposed and current name and address of manufacturer
3. Written declaration from the manufacturer to certify that the manufacturing process, and
the release and expiry specifications of the product as the same as already approved.
OR
If there are minor changes, to declare the ‘minor changes’ & justify the need for such
changes.
5. Letter of confirmation on GMP status or valid manufacturer’s license for the new
manufacturing site.
7. Amended immediate label, outer label and package insert for the product from the
proposed site.
8. Declaration and commitment that the manufacturer will carry out continuous quality
monitoring on the post change products
9. Letter of commitment to submit stability data and certificate of analysis after approval of
site change.
10. A written plan for assessing the effect of the change of site on the quality of the product
with the objective of demonstrating that the pre- and post-change products are
equivalent.
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5. OTHER INFORMATION
a) Application for COS will be rejected if the applicant failed to submit required data
within six (6) months from the first correspondence date;
c) If deemed necessary, NPRA reserves the right to request for additional supporting
documents.
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APPENDIX 32
1. INTRODUCTION
Change of PRH (COH) refers to a transfer procedure for the purpose of changing the existing
product registration holder (PRH) that is authorized to market a registered product in Malaysia
to another holder. This procedure allows the registered product to maintain the same
registration number.
Once NPRA deems the application is complete, the outcome of the change of PRH application
shall be decided by the Drug Control Authority within forty-five (45) working days.
2. CONDITIONS
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7) However, the existing PRH is still allowed to deplete remaining stocks and will still
be held liable for any pharmacovigilance issues or quality defects associated with
the product during the interim of the transfer.
8) The existing PRH or newly approved PRH shall submit a written request to deplete
the existing stocks after DCA approval has been obtained for the transfer. The PRH
that submits the request shall be held responsible for the batches and quantity
requested in the event of any pharmacovigilance issues or quality defects associated
with those product batches.
9) Application may be rejected if the applicant fails to provide satisfactory required
documents within thirty (30) working days starting from the first date of
correspondence by the evaluator.
3. SUBMISSION
The existing PRH shall submit the application via the QUEST system and hard copy of
original documents to NPRA.
4. PROCESSING FEES
1. NON-REFUNDABLE processing fees:
- For a Traditional Product : RM 500.00
- For a Pharmaceutical Product (including : RM 1,000.00
Health Supplement)
2. The processing fee shall be paid via the QUEST system immediately after the
change of PRH application has been submitted.
5. SUPPORTING DOCUMENTS
i) Letter of Authorization (LOA) issued by the Product Owner. If the Product Owner
is an entity registered outside of Malaysia, the LOA must be certified by the
Notary Public from the country of origin of said Product Owner. However, if
the Product Owner is a Malaysian registered entity, the LOA must be certified
by a local Commissioner for Oaths.
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*Note: LOA format example (Please refer 7.2 Example format for the Letter of
Authorization)
ii) Resolution by the Company Board of Directors of local Product Owner verifying
that ALL the Board of Directors/ Partners have given their consent to the Change of
PRH. This resolution must be signed by ALL the Board of Directors/ Partners. This
requirement can be omitted if the Product Owner is not a local entity.
iii) Latest document indicating details of director/s and shareholder/s of local Product
Owner (e.g. Corporate Information, Summary of Share Capital, Directors/ Officers,
Shareholders/ Members from the MyData SSM website). These documents must be
certified by the Commissioner for Oaths (i.e. Statutory Declaration). This
requirement can be omitted if the Product Owner is not a local entity.
iv) Resolution by the Company Board of Directors of existing PRH verifying that ALL
the Board of Directors/ Partners have given their consent to the Change of PRH.
This resolution must be signed by ALL the Board of Directors/ Partners.
v) Latest document indicating details of director/s and shareholder/s of existing PRH
(e.g. Corporate Information, Summary of Share Capital, Directors/ Officers,
Shareholders/ Members from the MyData SSM website). These documents must be
certified by the Commissioner for Oaths (i.e. Statutory Declaration).
vi) The Company/ Business Registration Certificate of the proposed new PRH certified
true copy by a MAICSA accredited company secretary or by the Companies
Commission of Malaysia (e.g. Form 9 and/ or Form 13).
vii) Statement of Acceptance as Product Registration Holder, NPRA-430.5(3) to be filled
by the proposed new PRH.
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5.2 The ORIGINAL documents listed above shall be submitted to the Centre of Product &
Cosmetic Evaluation, NPRA once payment for the application is made. Photocopies of
documents will not be accepted.
5.3 Date of the documents including date of stamps/signatures of certifying bodies must be
recent, i.e. not exceeding six (6) months from the date of application.
5.4 Each page of attachment (if any), i.e. product list, must be endorsed by the signatory.
5.5 The Secretariat, if necessary, has the right to request further supplementary information
or documentation. Failure to provide these additional information or documentation(s)
will result in the rejection of the transfer application.
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Secretariat
Receive and evaluate application and original
documents.
Secretariat
Processing of evaluated application;
Non-satisfactory 1. Satisfactory:
a) Table to DCA meeting for approval
2. Non-satisfactory:
b) Table to DCA meeting for rejection
Satisfactory (processing fee is NON-REFUNDABLE if
application is rejected)
DCA Meeting
Secretariat
Processing of DCA meeting outcome;
1. For approved application: Notification of transfer
approval to new proposed PRH and termination
notification to existing PRH;
2. For rejected application: Notification of transfer rejection
to existing PRH
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7. OTHER INFORMATION
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(Please state) Date of LOA (the existing PRH shall submit an application within 6 months from this date)
2. We, Name of registered Product Owner, the undersigned as the product owner for the said product(s) listed
below:
Name of Product(s) Registration Number
(If number of product > 10, endorsed attachment is allowed.)
hereby authorize
Company name with business registration number and full address of the proposed new PRH
to be the Product Registration Holder and to act on our behalf/ responsible for all matters pertaining to the
registration of the listed product(s) including obtaining approval for any subsequent product variation and
maintenance of the product(s) registration.
3. Therefore, we hereby terminate marketing authorization of the existing Product Registration Holder
Company name with business registration number and full address of the existing PRH
for the listed product(s) effectively on date of authorization / termination.
4. We shall confirm that the entire dossier of the listed product(s) includes all the data in support of the
original application, together with all correspondence with the Drug Control Authority (DCA)/ National
Pharmaceutical Regulatory Division concerning the listed product(s), to be transferred from Company name of the
existing PRH to Company name of the proposed new PRH upon the approval from DCA.
Thank you.
**Certified by
Sincerely, Notary Public/
Commissioner
*Company officer’s signature(s) for Oath
*Full name & Title/ Positition
Company stamp
IMPORTANT NOTICE:
1. *LOA shall be signed by Managing Director/ Director/ President/ Chief Executive Officer/ General Manager who
has overall responsibility for the company or organization.
2. **LOA shall be certified by Notary Public of the country of origin for overseas company or Malaysia Commissioner
for Oath for local company.
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APPENDIX 33
1. INTRODUCTION
2. OBJECTIVES
3. DEFINITIONS
Terms Definitions
Manufacture, in relation to any product includes –
a) The making or assembling of the product;
b) The enclosing or packing of the product in any container in a form
suitable for administration or application, and the labelling of the
Manufacture
container and;
c) The carrying out of any process in the course of any of the foregoing
activities.
All operations, including filling & labelling, that a bulk product has to
undergo in order to become a finished product. Filling of a sterile product
Packaging
under aseptic conditions or a product intended to be terminally sterilized,
would not normally be regarded as part of packaging.
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Terms Definitions
Printed
Packaging material which is imprinted with text or numbers or a
packaging
combination of both.
material
The term ‘labeling’ designates all labels and other written, printed, or
graphic matter upon, or in, any package or wrapper in which it is enclosed,
Labelling except any outer shipping container. A shipping container, unless such
container or the outside of the consumer package, is exempted from labelling
requirements.
A company that affixes the original label to a finished product (i.e labeller) or
Labeller/
changes in any way the labelling on a product without affecting the product
relabeller
or its container (i.e. relabeller).
Composed of a container system with its closure. This system may include
Packaging
several layers of protection for the Pharmacopeia preparation along with
system
any sealing devices, delivery devices, labelling and package inserts.
A company who removes a finished product from its final packaging and
places the finished products into a different container which is labelled or to
Repacker
be labelled before the product is for sale and/or distribution for human use.
Repacker may consist of primary and secondary repacker.
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Product to be
Require
included in
No. Description of Repacking Activity GMP/GDP Responsibility Remarks (If any)
Manufacturing
Control
License List
Packing/ blistering of imported product
1. √ √ Primary repacker
(tablet/capsule/liquid/etc.) into a different container
To form a secondary packaging material (unit box) to e.g. 5 strips in a unit box to
3. pack blister strips, bottles, etc. into this packaging √ √ Secondary repacker be repack to 1 strip in a
material unit box
To affix an immediate label to a container of product
that contains information such as Product Name, Refer Appendix 19:
Dosage Form, Name of Active Substance(s), Strength of Primary repacker/ General Labelling
4. √ √
Active Substance(s), Batch Number, Manufacturing Secondary repacker Requirements for
Date, Expiry Date, Route of Administration, Storage Immediate Labels
Condition, etc.
Product to be
Require
included in
No. Description of Repacking Activity GMP/GDP Responsibility Remarks (If any)
Manufacturing
Control
License List
Product to be
Require
included in
No. Description of Repacking Activity GMP/GDP Responsibility Remarks (If any)
Manufacturing
Control
License List
Refer Appendix 20:
Primary/ Secondary
11. To affix specific labelling requirement of a product √ √ Specific Labelling
repacker
Requirements
5. ADDITIONAL NOTES
5.1 √* denotes that the repacking activity has to be done in a Good Distribution
Practice (GDP) controlled or licensed facility.
5.2 The repacking activities as listed in Para 4 is non-exhaustive. Product and
license holders shall be responsible to ensure that the registered products are
repacked in an appropriate manner and all relevant documents is maintained
(batch packaging records/logbooks/inventory records/ procedures).
5.3 The conditions of the product must meet the storage requirements as stated in
the Good Distribution Practice Guideline by National Pharmaceutical
Regulatory Division (NPRA).
5.4 In deciding whether a particular bulk product is suitable for repacking, the
repacker should take into consideration any available information from the
manufacturer, published literature and any reference pharmacopoeia.
6. REFERENCES
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APPENDIX 34
Contents:
1. Introduction
2. Objectives
3. Safety Data
4. Overview
5. Glossary
6. References
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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1. Introduction
Consumer interest in health and self-care has expanded the market for a wide range of health
supplements and traditional products. These categories of products have been used since the
earliest history of humanity and have formed one of the foundations for healthcare in cultures
throughout the world. With the increased use of such products and the broad spectrum of
products classified under this category, it is important to ensure that the products consumed
are safe for consumers.
Most ingredients might be considered as safe, considering the experience or history of long use.
When an ingredient is well known for a specific use, the assessment will be limited to published
data (including traditional references). However, under certain conditions, additional data will
be required to prove the safety of the product, e.g. for a new active ingredient or a new
combination of ingredients. Even if a product has been in use over a long period of time, chronic
toxicology risks may have occurred but not recognized.
2. Objectives
This Guideline aims to provide guidance in submitting safety data requirements for assessment
to facilitate registration of complementary medicine.
3. Safety Data
Proof that a product is of quality, safe and as efficacious as claimed is a pre-condition for
marketing of a complementary medicine product. Safety is dependent upon the overall product
formulation, its intended use, dosage, route of administration, duration of use and targeted
group where applicable.
Each active ingredient shall make a relevant and reasonable contribution to the overall therapy
and the quantity of each active ingredient shall be safe for the recommended use and range of
dosage.
3.1 Safety data shall be required to substantiate the safety profile for the following
complementary medicine product to be marketed but not limited to:
a. New ingredients
b. Existing active ingredients/products with new combination, new dosage, new
delivery system, new methods of manufacturing or for use in a special target
population (e.g. pregnant, lactating women, children, etc.).
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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3.2 Safety substantiation might not be required for complementary medicine products that
do not fall under items a. - c. as mentioned above. Traditional medicines with
documented data; health supplements which have been consumed as food or is a food
constituent within the normal usage limit or for those containing ingredients with well
documented and established safety profile may also not require further safety
substantiation.
a) Single ingredient
For well-known ingredients such as vitamins or minerals and herbal ingredients, documented
data will be accepted to demonstrate safety of use.
If an ingredient has been used traditionally and documented that it had no safety concerns, the
submission of toxicology studies will not be required. However, if history of use is used to
support safety, then the details of use must be consistent with its traditional use.
If toxic effects have been reported or there is insufficient documented safety evidence and there
are doubts concerning the product/active ingredient, submission of toxicological reports will be
required.
In a case when the anticipated intake of this ingredient is significantly higher than the estimated
historical intake, or for which the historical intake cannot be assessed, additional safety
data/studies will be required.
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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b) Combination products
There are no special requirements for combinations of well-known ingredients such as vitamins
or minerals. Each active ingredient and dosage will be assessed independently and according to
documented data.
The intended use/function of each ingredient must support a logical use of the combination in
question and if for traditional use must prescribe to the philosophy of that culture. Like acting
herbal ingredients are considered to have an additive effect.
Therefore, the dosage of each active substance may be reduced as compared to its single use.
The counteracting by one active ingredient to the adverse reaction produced by another must
be explained. Illogical combination of herbs or ingredients having widely different therapeutic
uses will require justification.
However, for a combination consisting of new active ingredients, toxicological and clinical data
for finished product may be requested. This will also apply to new combinations of well-known
ingredients. Safety data will have to be on the product with information on individual
ingredients as supportive references.
c) Target population
It cannot be assumed that an ingredient is suitable for pregnant or lactating women unless
evidence is provided to the contrary. If required, the product should carry the following
statement:
“Pregnancy and breastfeeding: Insufficient reliable data”
or
“If you are pregnant /breastfeeding, please consult your doctor/pharmacist before taking this
product.”
A product will also be generally assumed not safe for children unless proven otherwise. If the
product has children dosage instructions, there must be evidence to fully demonstrate safety in
children of that age.
4. Overview
Information that will be required to substantiate the safe use of a product may include but is not
limited to:
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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If evidence is to be based on traditional use, it must be clearly stated that the ingredient
under review is equivalent to that used traditionally. Knowledge of chemical
components of an ingredient will aid in safety evaluation by identifying potentially toxic
constituents or constituents known to mimic or modulate endogenous intermediates.
Modern extraction methods used may in some instances produce a substance that is
compositionally different from those produced using traditional methodology.
The industry should be able to capture the safety data of any abnormalities and or
untoward adverse reaction that might be occurred or derived from animal and or
human study. Efficacy data will also often include information on adverse events that
will be useful in safety evaluation.
Evidence of the regulatory status of the product in other countries may also be provided
as supportive evidence to justify safe use of the product.
Toxicity data could be derived from sources such as authoritative reference test or from
animal and/or human study. The Organisation for Economic Co-operation and
Development (OECD) Guidelines shall be used as a guide to conduct toxicity study on
animals.
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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Interaction with other medications/ supplementation or even food has significant safety
implications because of their effects on bioavailability or induction/inhibition of
metabolizing enzymes. Such interaction may lead to synergism or antagonism of
intended effects.
Safety concerns from existing products may come from the reporting of the adverse
reaction monitoring mechanism in the market or through post market control.
The industry and regulator may collect those data from post-market reporting and
should assess the causality between the emerging safety concern and the product.
5. Glossary
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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6. References
Appendix 34: Guideline on Safety Data Requirements For Complementary Medicine Products
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