Inconsistencies in the quality of the information on package inserts of medicines for veterinary use commercialized in Brazil

Authors

  • Vanessa Cola Thomazini Graduate Program in Veterinary Sciences, Center for Agricultural Sciences and Engineering, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Vitória Ribeiro Mantovanelli Pharmaceutical Product Development Laboratory, Center of Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Marcela Saager Dias Pharmaceutical Product Development Laboratory, Center of Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Letycia Fernandes Franklin Ávila Pharmaceutical Product Development Laboratory, Center of Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Vinycius Fernandes da Rocha Pharmaceutical Product Development Laboratory, Center of Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Nayhara Madeira Guimarães Graduate Program in Veterinary Sciences, Center for Agricultural Sciences and Engineering, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
  • Gabriel Mendes da Cunha Graduate Program in Pharmaceutical Sciences, Center of Health Sciences, Federal University of Espírito Santo, Alegre, ES, Brazil
  • Cristiane dos Santos Giuberti Graduate Program in Pharmaceutical Sciences, Center of Health Sciences, Federal University of Espírito Santo, Alegre, ES, Brazil
  • Janaína Cecília Oliveira Villanova Graduate Program in Veterinary Sciences, Center for Agricultural Sciences and Engineering, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil; Pharmaceutical Product Development Laboratory, Center of Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil; Graduate Program in Pharmaceutical Sciences, Center of Health Sciences, Federal University of Espírito Santo, Alegre, ES, Brazil https://orcid.org/0000-0001-6166-1724

DOI:

https://doi.org/10.1590/

Keywords:

Package insert, Legibility, Health communication, Veterinary pharmacy

Abstract

This study examines the adequacy, readability, and quality of the information provided on package inserts for veterinary medicines in Brazil. It aims to identify the essential information required in these documents and assess non-compliance with regulatory standards. Initially, a documentary analysis was conducted to identify mandatory information as per Federal Decree No. 5,053/2004 and Normative Instruction No. 26/2009 of the Ministry of Agriculture, Livestock and Supply. Subsequently, 256 package inserts were analyzed to evaluate their suitability using descriptive quantitative analysis. This analysis showed a lack of essential technical and scientific information, necessary for the rational use of veterinary medicines. Mandatory elements supporting the correct use of veterinary medicines and essential information, such as a qualitative description of excipients, equivalence factors, the mass of active pharmaceutical ingredient per volume (when applicable), and information about the customer service center, were absent from these documents. This study found at least one non-conformity in the 252 evaluated package inserts. These findings underscore the significant lack of adherence to established rules and the low quality of technical-scientific information, reducing the comprehension of both prescribers and owners. The authors highlight the need for regulatory agencies to review and improve the guidelines that govern the format and content of package inserts.

Downloads

Download data is not yet available.

References

Abrantes CG, Duarte D, Reis CP. An overview of pharmaceutical excipients: safe or not safe? J Pharm Sci. 2016;105(7):2019-26.

Ahmed I, Kasraian K. Pharmaceutical challenges in veterinary product development. Adv Drug Del Rev. 2002;54(6):871-882.

Al Jeraisy M, Alshammari H, Albassam M, Al Aamer K, Abolfotouh MA. Utility of patient information leaflet and perceived impact of its use on medication adherence. BMC Public Health. 2023;23(488):1-10.

Allen LV, McPherson TB. Ansel’s pharmaceutical dosage forms and drug delivery systems. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2021.

Agência Nacional de Vigilância Sanitária (Brasil). Resolução da Diretoria Colegiada nº. 768, de 12 de dezembro de 2022. Estabelece as regras para a rotulagem de medicamentos, definindo os critérios, aprimorando a forma e o conteúdo dos dizeres de rotulagem de todos os medicamentos regularizados no Brasil. Diário Oficial da União 14 dez 2022; Seção 1. 2022a.

Agência Nacional de Vigilância Sanitária (Brasil). Resolução da Diretoria Colegiada nº. 770, de 12 de dezembro de 2022. Estabelece frases de alerta em bulas e em embalagens de medicamentos de acordo com as substâncias, classes terapêuticas e listas de controle dos medicamentos. Diário Oficial da União 14 dez 2022; Seção 1. 2022b.

Aronson JK, Ferner RE. Joining the DoTS: new approach to classifying adverse drug reactions. BMJ. 2003;327(7425):1222-25.

Attebäck M, Hedin B, Mattsson S. Formulation optimization of extemporaneous oral liquids containing naloxone and propranolol for pediatric use. Sci Pharm. 2022;90(15):1-18.

Brasil. Decreto-Lei nº. 467, de 13 de fevereiro de 1969. Dispõe sobre a fiscalização de produtos de uso veterinário, dos estabelecimentos que os fabriquem e dá outras providências. Diário Oficial da União 13 fev 1969; Seção 1.

Brasil. Decreto nº. 5.053, de 23 de abril de 2004. Aprova o regulamento de fiscalização de produtos de uso veterinário e dos estabelecimentos que os fabriquem ou comerciem, e dá outras providências. Diário Oficial da União 23 abr 2004; Seção 1.

Conselho Federal de Farmácia (CFF). Resolução nº. 625, de 14 de julho de 2016. Determina a aplicação dos cálculos de correções em insumos utilizados nas preparações farmacêuticas dentro da competência e âmbito do farmacêutico e dá outras providências. Diário Oficial da União 18 jul 2016; Seção 1.

Costa AX, Cristovam PC, Covre JL, Zorat YMC, LaMonica LC, Gomes JAP et al. Mass variability in drops of multidose eyedrops: a quality and reliability study. Arq Bras Oftalm. 2021;84(6):582-586.

Davidson G. Veterinary compounding: regulation, challenges, and resources. Pharmaceutics 2017;9(1):1-11.

European Comission. EC. Directive nº. 83, of 6 november 2001. On the community code relating to medicinal products for human use. 2001. [cited 2023 Dec 29]. Available from: https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:2001L0083:20121116:EN:PDF

» https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:2001L0083:20121116:EN:PDF

European Commission. EC. Guideline on the readability of the labelling and package leaflet of medicinal products for human use. 2009. [cited 2023 Dec 29]. Available from: https://health.ec.europa.eu/system/files/2016-11/2009_01_12_readability_guideline_final_en_0.pdf

» https://health.ec.europa.eu/system/files/2016-11/2009_01_12_readability_guideline_final_en_0.pdf

European Medicines Agency. EMA. Committee for medicinal products for veterinary use (CVMP): Summary of veterinary product characteristics. 2012. [cited 2023 Dec 29]. Available from: https://www.hma.eu/uploads/media/Quality_Review_of_Documents_veterinary_product-information_annotated_template__English__version_8_-_clean.pdf

» https://www.hma.eu/uploads/media/Quality_Review_of_Documents_veterinary_product-information_annotated_template__English__version_8_-_clean.pdf

Food and Drug Administration. FDA. Veterinary medication errors. 2020. [cited 2023 Dec 30]. Available from: https://www.fda.gov/animal-veterinary/product-safety-information/veterinary-medication-errors

» https://www.fda.gov/animal-veterinary/product-safety-information/veterinary-medication-errors

Food and Agriculture Organization. FAO. Labelling regulations of veterinary medicinal products. Issued pursuant to Section 5, Clauses 3 and 12 of the Pharmaceutical Law. 2016. [cited 2023 Dec 29]. Available from: https://faolex.fao.org/docs/pdf/lat178460.pdf

» https://faolex.fao.org/docs/pdf/lat178460.pdf

Golightly LK, Smolinske SS, Bennett ML, Sutherland EW, Rumack BH. Pharmaceutical excipients. Adverse effects associated with 'inactive' ingredients in drug products (Part II). Med Toxicol Adverse Drug Exp. 1988;3(3):209-40.

Guimarães, FR. Avaliação das informações técnicas contidas nas bulas de antibacterianos indicados para mastite bovina no Brasil em 2019. [dissertação]. Juiz de Fora: Universidade Federal de Juiz de Fora, Faculdade de Farmácia e Bioquímica; 2019.

Gulwako MS, Mokoele JM, Ngoshe YB, Naidoo V. Evaluation of the proper use of medication available over the counter by subsistence and emerging farmers in Mbombela Municipality, South Africa. BMC Vet Res. 2023;19(83):1-12.

Hoeve CE, Francisca RDC, Zomerdijk I, Sturkenboom MCJM, Straus SMJM. Description of the risk management of medication errors for centrally authorised products in the European Union. Drug Saf. 2020;43(1):45-55.

Machado TS, Abreu MN, Martins MR, Cunha LC. Adequabilidade das bulas veterinárias segundo a legislação, quanto instrumento técnico de caráter informativo adequação de inserções veterinárias à legislação, como instrumento técnico de caráter informativo. RB&C. 2017;6(2):8-37.

Ministério da Agricultura, Pecuária e Abastecimento (Brasil). Instrução Normativa nº. 26, de 9 de julho de 2009. Aprovar o regulamento técnico para a fabricação, o controle de qualidade, a comercialização e o emprego de produtos antimicrobianos de uso veterinário. Diário Oficial da União 10 jul 2009; Seção 1.

Ministério da Agricultura, Pecuária e Abastecimento. Nota Técnica Conjunta DFIP/DAS/MAPA – GGIMP/ANVISA/MS, de 23 de abril de 2012. Necessidade de instalações segregadas para fabricação de medicamentos para uso veterinário e para uso humano. 2012. [cited 2023 Oct 10]. Available from: https://www.gov.br/agricultura/pt-br/assuntos/insumos-agropecuarios/insumos-pecuarios/produtos-veterinarios/legislacao-1/notas-tecnicas/nota-tecnica-conjunta-dfip-dsa-mapa-ggimp-anvisa-ms-de-23-04-2012.pdf

» https://www.gov.br/agricultura/pt-br/assuntos/insumos-agropecuarios/insumos-pecuarios/produtos-veterinarios/legislacao-1/notas-tecnicas/nota-tecnica-conjunta-dfip-dsa-mapa-ggimp-anvisa-ms-de-23-04-2012.pdf

Ministério da Agricultura, Pecuária e Abastecimento (Brasil). Instrução Normativa nº. 23, de 22 de dezembro de 2016. Estabelecer os critérios e procedimentos necessários para as alterações de registro de produto de uso veterinário de natureza farmacêutica e biológica. Diário Oficial da União 24 dez 2016; Seção 1.

Ministério da Agricultura, Pecuária e Abastecimento. Portaria da Secretaria de Defesa Agropecuária nº. 624, de 21 de julho de 2022. Aprova o regulamento de registro, emprego e fiscalização de produtos de uso veterinário, dos estabelecimentos relacionados e dá outras providências. Diário Oficial da União 22 jul 2022; Seção 1.

Mengesha A. A review on veterinary drug management, handling, utilization, and its resistance side effects. Austin J Vet Sci Anim Husb. 2021;8(2):1-21.

Paula RAO, Souza SVC. Antimicrobial package inserts for veterinary use and public health: a critical analysis and impacts from the residue’s perspectives. Res Soc Devel. 2020;9(11):e53291110216.

Peacock G, Parnapy S, Raynor S, Wetmore S. Accuracy, and precision of manufacturer-supplied liquid medication administration devices before and after patient education. J Am Pharm Assoc. 2010;50(1):84-6.

Pires C, Vigário M, Cavaco A. Graphical content of medicinal package inserts: an exploratory study to evaluate potential legibility issues. Health Info Libr J. 2016;33(2):121-39.

Poole M, Quimby JM, Hu T, Labelle D, Buhles W. A double-blind, placebo-controlled, randomized study to evaluate the weight gain drug, mirtazapine transdermal ointment, in cats with unintended weight loss. J Vet Pharm Ther. 2019;42(2):179-88.

Riet V. Evaluation of the level of compliance of veterinary medicine package inserts with Regulatory authority guidelines. [Master’s dissertation]. Cape: University of Western Cape, Biodiversity and Conservation Biology; 2021.

Silva RA, Arenas NE, Luiza VL, Bermudez JAZ, Clarke SE. Regulations on the use of antibiotics in livestock production in South America: A comparative literature analysis. Antibiotics. 2023;12(8):1303:1-27.

Souza GN, Silva MR, Brandão HM, Gern JC, Guimaraes AS, Barbosa LA, et al. Avaliação de informações técnicas contidas nas bulas dos antimicrobianos indicados para mastite bovina como método auxiliar na definição de protocolos de tratamento. Juiz de Fora: Embrapa Gado de Leite, 2015. 8p. (Circular Técnica 108).

The Business Research Company. Veterinary Healthcare Market Reports 2024. 2024. [cited 2024 Jan 10]. Available from: https://www.thebusinessresearchcompany.com/reports/veterinary-healthcare-market-research

» https://www.thebusinessresearchcompany.com/reports/veterinary-healthcare-market-research

Thomazini VC, Cunha GM, Guimarães NM, Saleme SD, Melo RCG, Paula GA, et al. Impact of concerning excipients on animal safety: insights for veterinary pharmacotherapy and regulatory considerations. Daru J Pharm Sci. 2023 (in press).

Tufa TB, Gurmu F, Beyi AF, Hogeveen H, Beyene TJ, Ayana D, et al. Veterinary medicinal product usage among food animal producers and its health implications in Central Ethiopia. BMC Vet Res. 2018;14(1):409:1-7.

United States Pharmacopoeia. USP. United States Pharmacopoeia 45 - National Formulary 40 (USP 45-NF 40). Rockville: United States Pharmacopeial Convention; 2022.

Zini EM, Lanzola G, Quaglini S, Cornet R. Standardization of immunotherapy adverse events in patient information leaflets and development of an interface terminology for outpatients’ monitoring. J Biomed Inform. 2018;77:133-44.

Downloads

Published

2024-11-05

Issue

Section

Article

How to Cite

Inconsistencies in the quality of the information on package inserts of medicines for veterinary use commercialized in Brazil. (2024). Brazilian Journal of Pharmaceutical Sciences, 60. https://doi.org/10.1590/