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< INN/WHO Ref. No.

> WHO Prequalification Team: medicines ― WHOPAR part 4 <Date>

SUMMARY OF PRODUCT CHARACTERISTICS (SmPC) TEMPLATE

[Should the product to which a completed summary of product characteristics (SmPC) be


prequalified, it will form Part 4 of the WHO Public Assessment Report that will be posted on the
website of the WHO Prequalification Team: medicines (PQTm).

Please also consult the prequalification guidance documents: Section Guidance for Part 4 —
Summary of Product Characteristics (SmPC) — of a WHO Public Assessment Report
(WHOPAR) and Annotated Summary of Product Characteristics (SmPC) Template and Ensuring
Consistency Between Product Information Documents.

<text> signifies text to be selected or deleted as appropriate.

{text} refers to information to be added.]

1. NAME OF THE MEDICINAL PRODUCT DO

{(Invented) name strength pharmaceutical form}1

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

<Excipient(s):>
For a full list of excipients, see Section 6.1.

3. PHARMACEUTICAL form DO

<The scoreline is only to facilitate breaking for ease of swallowing and not to divide into equal doses.>

<The tablet can be divided into equal halves.>

<The tablet should not be divided.>

4. Clinical particulars

4.1 Therapeutic indications DO

<{X} is indicated in <adults> <neonates> <infants> <children> <adolescents> <aged {x to y}> <years>
<months>>.>

4.2 Posology and method of administration DO only population stuff

Posology

Paediatric population

<The <safety> <and> <efficacy> of {X} in children aged {x to y} <months> <years> {or any other
relevant subsets e.g. weight, pubertal age, gender} <has> <have> not <yet> been established.>

<No data are available.> <Currently available data are described in Section <4.8> <5.1> <5.2> but no
recommendation on a posology can be made.>

<{X} should not be used in children aged {x to y} <years> <months> {or any other relevant subsets
e.g. weight, pubertal age, gender} because of <safety> <efficacy> concern(s).>

<There is no relevant use of {X} <in the paediatric population> <in children aged {x to y} <years>,
<months> {or any other relevant subsets e.g. weight, pubertal age, gender} <in the indication...>

1
Trade names are not prequalified by WHO. This is the national medicines regulatory authority’s responsibility.
Throughout a WHOPAR the proprietary name is given as an example only.

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< INN/WHO Ref. No.> WHO Prequalification Team: medicines ― WHOPAR part 4 <Date>

<{X} is contraindicated in children aged {x to y} <years> <months> {or any other relevant subsets e.g.
weight, pubertal age, gender} <in the indication...> (see Section 4.3).>

Method of administration

4.3 Contraindications DO

<Hypersensitivity to the active substance(s) or to any of the excipients <or {name of the residue(s)}>.>

4.4 Special warnings and precautions for use DO

4.5 Interaction with other medicinal products and other forms of interaction DO

<No interaction studies have been performed.>

<Interaction studies have only been performed in adults.>

4.6 Pregnancy and lactation DO summarize a lot

[See prequalification guidance: Section Guidance for Part 4 — Summary of Product Characteristics
(SmPC) — of a WHO Public Assessment Report (WHOPAR).]

<Women of childbearing potential>

<Contraception in males and females>

<Pregnancy>

<Breastfeeding>

<Fertility>

4.7 Effects on ability to drive and use machines DO

<{Invented name} has <no <or negligible> influence> <minor influence>, <moderate influence> <major
influence> on the ability to drive and use machines.>

<No studies on the effects on the ability to drive and use machines have been performed.>

<Not relevant.>

4.8 Undesirable effects ONLY DO summarized tables

[See prequalification guidance: Section Guidance for Part 4 — Summary of Product Characteristics
(SmPC) — of a WHO Public Assessment Report (WHOPAR).]

<Paediatric population>

4.9 Overdose DO

<No case of overdose has been reported.>

5. PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties DO partly

Pharmacotherapeutic group: {group}, ATC code: {code}

<Mechanism of action> DO

<Pharmacodynamic effects> DO

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< INN/WHO Ref. No.> WHO Prequalification Team: medicines ― WHOPAR part 4 <Date>

<Clinical efficacy and safety>

<Paediatric population>

5.2 Pharmacokinetic properties DO

<Paediatric population>

5.3 Preclinical safety data

<Non-clinical data reveal no special hazard for humans based on conventional studies of safety
pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction and
development.>

<Effects in non-clinical studies were observed only at exposures considered sufficiently in excess of
the maximum human exposure indicating little relevance to clinical use.>

<Adverse reactions not observed in clinical studies, but seen in animals at exposure levels similar to
clinical exposure levels and with possible relevance to clinical use were as follows:>

6. PHARMACEUTICAL PARTICULARS

6.1 List of excipients

6.2 Incompatibilities DO

<Not applicable.>

<In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal
products.>

<This medicinal product must not be mixed with other medicinal products except those mentioned in
Section 6.6.>

6.3 Shelf life

<...> <6 months> <...> <1 year> <18 months> <2 years> <30 months> <3 years> <...>

6.4 Special precautions for storage

[For storage condition statements see prequalification guidance Section Guidance for Part 4 —
Summary of Product Characteristics (SmPC) — of a WHO Public Assessment Report (WHOPAR).]

<For storage conditions of the <reconstituted> <diluted> medicinal product, see Section 6.3.>

6.5 Nature and contents of container <and special equipment for use, administration or
implantation>

6.6

<Not all pack sizes may be marketed.>

6.6 Special precautions for disposal <and other handling>

<No special requirements.>

<Any unused product or waste material should be disposed of in accordance with local requirements.>

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< INN/WHO Ref. No.> WHO Prequalification Team: medicines ― WHOPAR part 4 <Date>

7. <APPLICANT/SUPPLIER>

{Name and address}


<{tel}>
<{fax}>
<{email}>

8. WHO PREQUALIFICATION REFERENCE NUMBER

9. DATE OF <PREQUALIFICATION> / <RENEWAL OF PREQUALIFICATION>

<{DD/MM/YYYY}> <{DD month YYYY}>

10. DATE OF REVISION OF THE TEXT

{MM/YYYY}

Reference list

[This list provides references to relevant WHO guidelines and to relevant literature and
databases, in addition to the SmPC(s) of the innovator product(s). The list is compiled by WHO.]

Detailed information on this medicinal product is available on PQTm’s website (see:


http://www.who.int/prequal).

24 October 2016 4

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